Nursing and HHS Extension partner: Impacting kinship families and the aftermath of childhood trauma

The number of kinship families — the term used when family and friends, often the biological grandparents, have been called upon to care for a child — is growing dramatically. In Indiana, foster care placement with a relative increased 24.5 percent in one year, from 4,985 in 2014 to 6,210 in 2015.

I believe this growth is collateral damage from the national opioid crisis. In our work with a group of kinship families, we found that 75 percent of the birth parents experienced some substance abuse issues. Unfortunately, children may witness events and experience maltreatment at the hands of those who should be nurturing and caring for them. Because of this, children who have been placed with a relative may exhibit behaviors related to trauma and traumatic stress, adding to the vulnerabilities of these kinship families.

I knew there was potential to help these vulnerable families and create evidence to support an intervention. So, when Stephanie Woodcox, assistant program leader for Purdue Extension in the College of Health and Human Sciences, first shared the chance to seek funding from the National Institute of Food and Agriculture for rural health and safety education projects, I saw it as an opportunity to create a meaningful partnership between Nursing and HHS Extension. Throughout the project, Stephanie and I worked together, from proposal reviews to a mutual understanding of our organizations and the roles each organization contained.

With the use of a curriculum developed by the National Child Traumatic Stress Network, we implemented trauma-informed parenting classes for kinship caregivers to be taught by an HHS Extension educator and Nursing faculty member. The classes were offered to the underserved population of rural-dwelling kinship parents in counties such as Owen, Clay, Montgomery and Tipton. Undergraduate nursing students provided child care during the classes.

Through a curriculum of case studies and approachable, practical science, kinship parents began to understand behaviors in the children under their care — things such as food hoarding, their need for control, externalizing behaviors and other potentially destructive behavior patterns borne from past trauma. Kinship parents also began to understand the unique needs of these children, as well as caring for themselves, and to comprehend the concept of secondary trauma.

We measured the impact of the classes through a pilot, mixed-methods study. Recruitment was challenging. While the sample was small (43 parents attended classes with 16 usable data sets), I believe the evidence supports the positive impact of the trauma-informed education, and the project results offer preliminary evidence of the intervention's impact. Kinship parents in our study reported an increased understanding of trauma's effects on their child's behaviors, improved empathy, positive changes in parenting behaviors — for example, "I think before I yell" — and a better understanding of their role as caregivers.

Instrumental to this project were team members Susan Kersey, a clinical assistant professor of nursing; Lingsong Zhang, an associate professor of statistics; Brooke Wilkinson, a former HHS Extension educator; and HHS Extension educators Monica Nagale and Terri Newcom. HHS Extension educators Esmeralda Cruz and Denise Schoeder also provided support for the project.

Through this project I gained insights about Extension services and how this valuable organization works. Without Stephanie, the study would not have happened. I know many of my colleagues are accomplishing significant scholarship with HHS Extension, and I'm convinced the partnerships between Nursing and HHS Extension will continue to grow.

Foli is also the author of Nursing Care of Adoption and Kinship Families: A Clinical Guide for Advanced Practice Nurses (Springer, 2017). In 2016, she was inducted as a fellow in the American Academy of Nursing (FAAN), and participates on the AAN's Child, Adolescent, and Family Expert Panel. Launched in 2017, Foli also directs the PhD in Nursing program at the School of Nursing.