Author: admin

Gatekeeping for Faith Leaders, Part 3: Let’s Talk about Safety

Posted on | by admin

NOTE: The following article is in no way meant to be a replacement for formal, in-person training on mental health first aid.

Welcome back to our Gatekeeping for Faith Leaders series! If for some reason you missed our first two installments, I highly encourage you to begin by reading Part 1, How do I know When to Refer Someone to Counseling, and Part 2, What is my Role after I Refer Someone to Counseling?

Do not be fooled by the order of these installments. Safety in crisis situations, despite it being the metaphorical caboose of this discussion, is probably the most important of the three topics. I intentionally left it for last to make sure that we had fully discussed the roles and relationships between the mental health and faith leader communities prior to discussing crisis situations. Why? Well, the last thing I want to happen to someone reading this article is for them to assume that we in the mental health field expect you to take on tasks for which you have not been trained or prepared.

So please, hear my plea and read installments 1 and 2 before delving into this topic of Safety.

____________________________________________

The Importance of Gatekeeping in a Crisis

A year or two into my counseling training, I was out of town visiting a small church, and a teenager came forward at the end of service for prayers. It was a Sunday night with sparse attendance. The usual prayer was said on his behalf before dismissal, and everyone went their separate ways. Within minutes, my father found me and asked me if I was comfortable talking to this young adult who had expressed some suicidal ideation, as there was no one else available trained on the topic.

First, I was floored. I was green to the counseling world and did not even have a degree in it yet, much less a license. Thankfully I had just recently completed my crisis counseling class and had role-played this scenario what felt like hundreds of times. I did have some experience working with teenagers with suicidal ideation in the inpatient hospital where I was currently employed, but all of these scenarios were under strict and appropriate supervision.

Surely I am not the only one here, I thought. This cannot be happening.

But my second train of thinking was, if not me, who?

It absolutely frightens me to think of how often this scenario could be happening in our churches. I praise God that this teen chose to share his thoughts in a safe space—that act of courage still brings tears to my eyes– but how safe was the space, really, if no one was trained in helping him seek further professional care?

Research on this topic concludes that gatekeeping training in religious settings is a very strong protective factor for suicidality, especially since many individuals speak with close friends and family prior to dying

by suicide. For many people, the church is an important line of defense. But faith leaders must know what to do [3,4,8].

Some things to consider:

When I spoke with this individual that evening, I did not pretend to be his therapist—that was not my role. I didn’t pretend to be his parent or guardian, either, but after chatting with him I made sure they were fully in the loop. I used skills that I had learned to assess the situation in the moment, decide how to address his current state, and ensure that follow-up care was obtained.

In a very serious case, follow-up care could have looked like calling a hotline with him, calling 911, or driving him to the emergency room. Thankfully the most appropriate steps for him were to be closely observed by a family member who would assist him with speaking to a professional immediately the next day.

____________________________________________

I was no hero that evening. I just happened to be someone who knew how to ask a few questions and take action according to the answers. Gatekeeping is just that: a way of leading someone to the next, most appropriate step. These scenarios can feel nerve-wracking, and in our fear and great care for someone we can often get caught up in details that keep us from being immediate in making sure the next connections to professional care are made.

Think of this role like being trained in CPR: you are on the scene until a professional arrives or the person can get to a professional with your help.

Whether you have been trained to respond or not, these scenarios will absolutely arise. And honestly, I hope that they do—because it is a fact that people are struggling with mental health concerns in droves–and I would rather the people in our church communities reach out to you than suffer in silence. When they reach out and you are trained in gatekeeping, then we can work together in our revolving-door fashion to help them.

When a person seeks crisis support from faith leaders, we know that they have a built-in system of support already, and a community willing to walk with them through it.

As mentioned above, this article is not a replacement for training, but instead a call to action for you to obtain crisis training in a manner that allows you the opportunity to ask pertinent questions and hopefully role-play scenarios you may encounter. If you or your congregation would be interested in receiving specific training on this topic from ChristianWorks, we encourage you to reach out to us.

____________________________________________

Here are some various resources for Mental Health First Aid training and/or Suicide Prevention Training:

Question. Persuade. Refer

www.QPRinstitute.com

Mental Health First Aid from the National Council for Wellbeing

https://www.mentalhealthfirstaid.org/

Mental Health First Aid from Texas Health and Human Services

https://www.hhs.texas.gov/about/process-improvement/improving-services-texans/behavioral-health-services/mental-health-first-aid

Some of the things that you will learn in a Mental Health First Aid Training or Suicide Prevention Training are:

– Risk factors of suicidality

– Warning signs that a person may be thinking about suicide

– How to actively engage in conversation with a person you believe could be in danger to themself.

– What questions to ask and how to respond to the answers given

– How to “triage” the situation to guide the person toward immediate, most effective care for the situation

– How to enlist help from the individual’s support system

– What crisis resources exist in your area

Some quick tips that have helped me (I cannot stress enough that this is not a replacement for training): – If you are unsure of what to do or the situation feels out of control, call a 24/7 hotline or 911. I have used this rule of thumb both in the counseling room and as a layperson. Often an individual will not want to call on their own, but you can offer to do it for them and talk on speakerphone. This keeps you from operating in isolation to keep the person safe.

– Remember that you are the first line of defense, but not the last. You are not expected to do this singlehandedly. Just as if you were performing CPR compressions while waiting on medics, you are a critical part of care but are not expected to serve as the professional.

– Be proactive. Do not receive “I’ll call the hotline/my mom/my friend when I leave” as an acceptable answer. You will be staying with the person until they take the next step toward support or safety, whatever that step may be (full training will make sure you know what these steps are and how to assess the situation).

DFW Resources and Hotlines

National Suicide Hotline: 998

North Texas Hotline: 214-828-1000

DFPS Youth hotline: 1-800-989-6884 (call or text)

ADAPT 24/7 Mobile Crisis hotline: 866-260-8000

North Texas Behavioral Health Authority: 1-877-653-6363 or 1-214-366-9407

References:

1. American Psychiatric Association Foundation. (2018). Mental health: A guide for faith leaders.

2. American Psychiatric Association Foundation. (2018). Quick reference on Mental Health for faith leaders. Retrieved April 26, 2023, from https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental_Health_Guide_Quick_Reference_Guide_2018.pdf

3. Bazley, R., Pakenham, K., & Watson, B. (2019). Perspectives on Suicide Prevention amongst members of Christian faith-based organizations. Community Mental Health Journal, 55(5), 831–839. https://doi.org/10.1007/s10597-018-0355-4

4. Bazley, R., Pakenham, K., & Watson, B. (2019, January 2). Perspectives on Suicide Prevention amongst members of Christian faith-based organizations – community mental health journal. SpringerLink. Retrieved April 25, 2023, from https://link.springer.com/article/10.1007/s10597-018-0355-4

5. 5. Mental health first aid. Mental Health First Aid. (2023, March 28). Retrieved April 20, 2023, from https://www.mentalhealthfirstaid.org/

6. Mental health first aid. Texas Health and Human Services. (n.d.). Retrieved April 25, 2023, from https://www.hhs.texas.gov/about/process-improvement/improving-services-texans/behavioral-health-services/mental-health-first-aid

7. QPR Institute . (n.d.). QPR Institute: Practical and proven suicide prevention training. QPR Institute Practical and Proven Suicide Prevention Training QPR Institute (en-US). Retrieved April 20, 2023, from http://www.QPRinstitute.com/

8. 8. Wood, D. S., Ohri, F., Hudnall, G., & Cahoon, L. (2022). Suicide gatekeeper training outcomes in educational and religious settings. Journal of Human Behavior in the Social Environment, 33(2), 225–231. https://doi.org/10.1080/10911359.2022.2049414

A Time to Weep

Posted on | by admin

 

“Rejoice with those who rejoice; weep with those who weep.” Romans 12:15 NIV

When I was a little girl, I would go to slumber parties. These parties were filled with laughter, silliness, and watching a movie. However, there was one movie, The Neverending Story, that always made me cry. It had a scene with the death of an animal, and I really cared about animals. Every time I would watch that scene, even though I knew the end of the movie, streaks of tears would fall down my face. One night, as we watched it, I could feel myself on the verge of tears; but that night I made the decision that I was done with crying and feeling sad. As the movie played, I held it together and forced myself to watch that scene with a dry face. Even with all my friends crying in the room, I remained stoically dry-eyed. Afterward, I felt a powerful feeling that I liked. I didn’t know it at the time, but, now, I would call that feeling pride.

Back then, I felt like I had stumbled upon a genius new strategy, and, so, my journey into avoidance began. I wouldn’t let things affect me like I had allowed them to affect me before. It seemed to work—too well. I didn’t realize it at the time, but I slowly began to go numb. As I numbed myself to sadness, I also numbed myself to delight. It was many years later when I realized I had made a mistake, and I had to learn to let my heart be moved again. Over time, I did, and I am blessed to say that when my father died in 2017, I was able to weep and weep with others.

Now as I reflect back on his death, I can remember the sadness and deep pain, but I also remember the love and support of those who empathized with me. Even in the exquisite pain of my grief, I wasn’t alone. Because I could weep with those who were safe, I was comforted.

At GriefWorks, we hope to provide a safe place for families to share and be comforted during their time of grief.

What is Grief?

Grief is our response to loss. This response may be physical, emotional, cognitive, behavioral, and/or spiritual. Grieving is usually a unique combination of these responses for each person.

Physical reactions to grief may include:

  • Sleep disturbances
  • Headaches/Stomachaches
  • Dizziness
  • Exhaustion
  • Digestive difficulties
  • Muscular aches
  • Changes in appetite

 

Emotional reactions to grief may include:

  • Yearning
  • Guilt and self-blame
  • Anger
  • Helplessness
  • Fear
  • Anxiety
  • Sadness
  • Withdrawn/Apathy
  • Appreciation/Relief

 

Cognitive reactions to grief can include:

  • Forgetfulness
  • Disbelief/Denial
  • Easily overwhelmed
  • Obsession w/deceased
  • Confusion
  • Loss of focus
  • Magical thinking (I made it happen)

 

Behavioral reactions to grief can include:

  • Aggressive behaviors/irritability/tension
  • Crying
  • Withdrawal
  • Hyperactivity
  • Avoiding reminders
  • Seeking reminders
  • Diminished/Increased performance at work/school

 

Spiritual reactions to grief can include:

  • Anger at God
  • Strengthening of faith
  • Search for meaning
  • Questioning faith/values

 

Source: Grief Counseling Resource Guide: A field manual.

 

Children and Grief

Grief is universal, and children grieve. If a child can respond to separation, then he/she has the capacity to grieve. While there can be some similarities between how adults and children grieve, there are also some distinctions. For example, the age and development of the child can affect how they understand death.

Pre-schoolers/young children: Children between the ages of 2-4 typically understand death to be temporary and reversible. You may hear questions like, “When will mom come back?” even after you’ve explained death to the child. It is also very common for grieving children this age to demonstrate major regression to an earlier developmental stage (toilet-training, language, and/or clinging behavior).

School-age: A child between the ages of 5-8 is more prone to guilt and magical thinking. You may hear comments like “It’s my fault this happened.” Children this age may also think of death as a person (the boogeyman), and their dreams and fears may reflect this. A child between the ages of 9-12 is beginning to understand the permanency of death like an adult, but he/she may want more details of what happened. You may hear questions like, “What happened to Grandpa? And then what?” Children this age are also prone to somaticizing grief, which means grief may be expressed in their body; for example, they may complain of more headaches and stomachaches. They may also revert to more clinging behavior and/or experience anger outbursts.

 

Adolescents: Teens between the ages of 13-18 tend to understand death to be permanent and universal. They understand that death can happen to you and me.  After a death, teens may feel a desire to connect with family and a desire to continue exploring independence, which can lead to friction within families. Teens may also develop their own opinions and views about morality, the world, and their role that may or may not differ from those of their family and the person who died.

Source: (https://hospicefoundation.org/Professionals/Experts-Talk-EOL-Care/Interview-with-Dr-J-William-Worden)

When to Ask for Help?

Here are some signs to watch out for:

  • If a child cannot speak about the person who died ever, or he/she leaves the room when the person’s name is mentioned;
  • A child whose aggression becomes destructive, especially if this is new or unusual behavior;
  • A child who develops persisting anxiety
  • Any expression of suicidal ideation
  • Substance abuse

 

Source: https://hospicefoundation.org/Professionals/Experts-Talk-EOL-Care/Interview-with-Dr-J-William-Worden

 

How to Help Grieving Children:

 

 “With support and understanding, bereaved children usually learn early in life that human beings cannot have complete control over themselves and their world. They learn that faith and hope are central to finding meaning in whatever one does in this short life. They learn a true appreciation for life and what it has to offer…”

“… They learn to look for the goodness in others. They learn an empathetic appreciation for the suffering of others. And perhaps most of all, they learn to meet not only their own needs, but to help others meet theirs.” –  Alan D. Wolfelt, Ph.D, Companioning the Grieving Child: A Soulful Guide for Caregivers, 2012.   Dr. Wolfelt is the director of Center for Loss and Life Transition, Fort Collins, Colorado  (www.centerforloss.com)

 

Some tips for parents and caregivers:

  • One of the strongest predictors of how well a child will function is how well his/her parent is functioning after a death (https://hospicefoundation.org/Professionals/Experts-Talk-EOL-Care/Interview-with-Dr-J-William-Worden). If you need additional support, please ask for help. This also models for children that it’s okay to ask for help, which is one of the most important coping tools we can teach.
  • Use clear explanations of death and dying, without euphemisms, such as “lost,” “passed away,” or “sleeping,” etc. Use the words dead, died, death, and dying.
  • Let the child choose if they would like to participate in the funeral and burial rituals. If they do, prepare the child by explaining what to expect, including what they will see at the funeral. For example, they may see photos, the coffin, adults who are crying, etc.
  • Allow and encourage the child to retain his/her rightful place in the family as a child.
  • Accept a child’s expression of feelings and continue with appropriate boundaries for behaviors.
  • Keep routines and structure in the child’s life as near to normal as possible. The rules for conduct should stay the same.
  • Children need outlets to release their energy. It’s important to recognize that children share equally through their play. Pay attention to their behaviors and play.
  • Understand that grief may vary, even within a family. Remember, grief is unique for each person. One child may express a lot of emotions. Another child may want to do things in memory of the person who died.
  • Become a listener.
  • Know that you will not have all the answers, and “I don’t know. What do you think?” is an honest and powerful response. Listening to their answer will help you know how to respond and what information they may need.
  • Communicate with the people in the child’s life (teachers, coaches, etc.) because they can be part of the support system.
  • Allow for remembering and memorializing the person who died. Memories are important and powerful. Please don’t avoid them.
  • Remind the child that they show courage when they grieve.

 

GriefWorks

“I think when you care for someone who is going through this terrible process of losing someone, it really is more about listening to them and seeing where they’re at in their learning than it is about trying to make them feel better. The point is not to cheer them up. The point is to be with them and let them know that you will be with them and that you can imagine a future for them where they’re not constantly being knocked over by the waves of grief.”  Mary-Frances O’Connor

https://www.npr.org/sections/health-shots/2021/12/20/1056741090/grief-loss-holiday-brain-healing

 

Sometimes we need more than what our friends and family can provide. The purpose of GriefWorks is to provide a safe and supportive environment for children ages 5-17 and their adult family members who are grieving the death of a family member or friend.

Our groups can provide a sense of community to counter the sense of isolation so many people experience while grieving.  Being with others can also help normalize the grief experience by allowing family members to observe a wide range of grief expressions and coping styles. Our groups also address issues for children and teens at their developmental phase of life, while also providing support and education for parents and caregivers.

These groups offer a setting where coping skills can be observed and learned for present and future application. Group members often find that coping skills that are taught or modeled in our support groups apply to other situations in their lives at home, school, or in the community.

ChristianWorks

We hope that along the grief journey, individuals and families see a diminishing in the intensity of their grief, that they begin to function as well as they did prior to the loss using healthy coping skills, and that they understand their grief will continue and evolve as they go throughout their lives.

 

Final Note: In response to the mass shooting at the Allen Outlet Mall ChristianWorks, in partnership with KLTY 94.9 and a few donors, has created a fund to provide FREE counseling to families and first responders from this tragic event. Please contact our offices to speak to our counseling coordinator today at (800) 375-2229

 

 

The Sandwich Generation: Caretaking Times Two

Posted on | by admin

The Sandwich Generation: Caretaking Times Two

The day Hurricane Katrina swept herself 150 miles inland into my hometown, my parents were in a pretty difficult stage of their Sandwich Generation era.

Papaw, my paternal grandfather, sat with us at the kitchen table while we watched the forest surrounding my parents’ house begin to fall trees, one by one. My Mamaw, his wife, was in a temporary medical facility half an hour away.

Our house was miraculously unscathed, but both cellular towers and landlines were down for days, power was down for over a week, and my dad spent the night in his car at the gas station with half of the rest of our town waiting for the gas truck to arrive.

Only then were we able to drive the distance to where my Mamaw was located to know for sure that she was safe.

We drug mattresses across town and all lived at my dad’s workplace for a few days until power was restored, because the August heat and humidity was simply too dangerous for my grandparents.

My memories of Hurricane Katrina are incredibly mild compared to others, and I also recognize that it also stands out as an extreme circumstance of caretaking. But for some reason that experience stands out as one of the first moments I was brutally aware of the burdens placed on my parents in simultaneously raising three children and managing the care of their aging parents.

______________________________________

What is the Sandwich Generation?

The Sandwich Generation is a term used to describe caretakers who are caring for both younger and older family members. Typically you may see this in the form of parents who have children still at home but who also are active in the caretaking of their own aging parents.

Why is this phenomenon happening?

Simply put, baby boomers are getting older and living longer, but “there’s been no significant change in the level of mild to moderate disability for older people.” While people may be living longer lives, those lives are not necessarily healthier ones [8].

Also, census data tells us that the mean age of women having children is increasing [5]. Families are having children later than generations before us. There was a time in which seasons of empty nesting and middle age seemed to be concurrent life events, but now middle age finds many families still in the active child-rearing stage of life.

How many people are part of this sandwich generation?

12% of parents (as defined as someone who has a child under the age of 18 in their home) in the United States also serve as unpaid caregivers for one or more adults [4].

This number is estimated to be about 11 million people, or 28% of all caregivers [1].

What are the impacts/ challenges for sandwich generation caregivers?

Adults in this sandwich generation may be constantly attending to medical events, balancing personal careers, and often struggling to find time for partners or the management of their own homes [3]. Even if a loved one has full-time residential or in-home medical care, sandwich generation caretakers are probably still actively present for emergency room visits and doctor’s visits, and help with managing insurance concerns, finances, and general tasks.

Most sandwich generation families are also impacted financially, by directly helping cover medical and living expenses for loved ones, or indirectly by needing to decrease work hours to manage family the member’s care [8].

It is estimated that “a third of sandwich generation caregivers report a high level of emotional stress and a fifth report high levels of financial and physical strain” [1].

One can see how the emotional toll of this role is warranted.

And, the management of emotions can be quite complicated for someone in the Sandwich Generation.

Maybe a person feels…

Guilt for being less present with their spouse or children

Frustration if the parent they are caretaking was not always kind or supportive to them

Anticipatory grief while making end-of-life decisions for a loved one whose health is declining

Stress over finances or time management

Confused about how to manage the changing mental state of the person they are caring for

…and none of these feelings are wrong! They are normal and often expected, but they may require some extra support at times.

How caring for yourself heals the whole sandwich

Caring for a parent can, as we say in the counseling world, “bring up a lot” for a person. Imagine for a moment that your brain has a cardboard box of every experience and resulting emotion you’ve had regarding your parent: it’s a hodgepodge of good, bad, and ugly memories. Maybe this box is shoved in a forgotten closet under some vintage Christmas decorations and the Pythagorean theorem and your first boyfriend’s home phone number. You stashed it there to keep yourself from swinging too heavily into hurt or even rage. Maybe your relationship with your parents is best at balance when you’ve decided to avoid certain topics. But all of those topics are right here in this box.

The relationship balance is skewed when you begin more actively managing your parent’s day-to-day life tasks. The role of caregiver shifts from parent to child, and each of you responds accordingly. Chances are, this box gets pulled out into the daylight and dumped in the front yard of your brain.

These are tough emotions to manage. Family work is tough and complicated, even if your childhood was seemingly ideal.

A therapist can help you sort through this box, reorganize it, and heal—even in the midst of a sandwich generation time of life.

And you know what is best about healing your own childhood wounds? You become a better parent to your children. This is where you can stop the generational hurt for good while actively repairing relationships in the whole sandwich.

The Sandwich Generation will not fade from reality.

The US Census Bureau projects that by 2034, people over the age of 65 will outnumber children for the first time in United States history [6].

This is a phenomenon that has countless impacts on society as a whole.

I think often about the time that I will most likely be an active-duty member of the Sandwich Generation, myself. Is anyone ever really ready for the caregiving roles to turn on end?

There are ways we can prepare ourselves for the caretaking roles in our future, and support those who are in these roles now.

What you can do now.

-Begin having conversations with your parents now about their wishes and plans for this upcoming time of life prior to any major medical events or decline of mental capacities. While you may need to reassess some of these points later, this allows you to at least know what their current thoughts are on particular topics. Assisting your aging parents in maintaining as much dignity as possible as you slowly (or quickly, in some cases) begin to manage areas of their lives is of great importance.

– Understand how they manage finances. Have a trusted place for passwords. A New York Times article on this topic identified that it “may take years” for an aging parent to accept help, especially in the area of finances [3]. Who do they trust most to be the go-to for handling money management?

– Ask your parents about their medications. Are their medications being well-organized? If something happens, do you know what they take and when? Often, aging individuals begin to struggle with keeping track of medications and basic doctor’s appointments. Even if it seems like a while before your own parents could need this help, it is important to know where the information exists.

-Have contact information for your parents’ trusted professionals. Who are their doctors, lawyers, and faith leaders? Who mows the lawn or cleans the house? These are people you may be in direct contact with in the future. Know who they are.

– Know who your support system will be in this endeavor. Do you have siblings who can share the load? Do you have trusted friends willing to help with driving your parents or your kids to different places? Talk to your circle about how you can support one another when and if you become a sandwich generation caretaker. Maybe your brother-in-law is great at understanding investment accounts, while your sister has no problem talking assertively to insurance companies and managing medication schedules. Your next-door neighbor loves dog-sitting, a lady at church does in-home hair appointments for the elderly,

and your best friend is great at cracking jokes just exactly when you need them. Lean on these individuals.

Believe me, you will need them.

_______________________________________

While my parents have not had children to raise for quite some time now, their active-duty roles as caretakers to aging parents is currently creeping toward the 20-year mark. Watching my parents serve family members humbly and patiently (and sometimes not so patiently, to be honest) all this time has offered me a long-term case study in generational family systems.

I could easily paint a rosy picture for you and say that it has been glorious for them to be so present and that not a night of sleep or moment taken from other areas of their lives has been lost. But honestly, it has been very challenging at times to witness my parents through this season of life. It reminds me that serving another person, however much we love them, is never without sacrifice or hardship.

And yet, difficulty should not sway us from serving the best we can, in the most reasonable and sustainable way that we can for everyone involved. Remember, the health of the whole sandwich is important.

Sweet side effects of these difficulties exist, though. The New York Times article, It’s Pretty Brutal: The Sandwich Generation found that 23 percent of sandwich generation caretakers identify that the experience has strengthened their relationship with their aging relative.

I can think of several memories with my grandparents, like those from the weeks following Hurricane Katrina, that I kind of wish I never had to know.

But however raw and heartbreaking some of those moments felt, I witnessed them for the reality that they were, and I am a better person for all of them.

The most honest approach any of us can have about the prospect of aging parents, caretaking, and decision-making for the years of someone’s final season of life is this:

We honor our relative’s dignity and autonomy as much as possible, make the best decisions with the options we have at our disposal at the time, lean into tenderness, patience, and forgiveness, and find that grief and bravery can co-exist.

Shoot, this may just be the definition of being human.

References:

1. Caregiving and the sandwich generation. Mental Health America. (n.d.). Retrieved April 20, 2023, from https://mhanational.org/caregiving-and-sandwich-generation

2. The economist/YouGov poll December 28 – 31, 2019 – 1500 US adult citizens. (2020, January). Retrieved April 21, 2023, from https://d25d2506sfb94s.cloudfront.net/cumulus_uploads/document/2r6hyqtv9p/econTabReport.pdf

3. Grose, J. (2020, February 18). ‘it’s pretty brutal’: The sandwich generation pays a price. The New York Times. Retrieved April 25, 2023, from https://www.nytimes.com/2020/02/11/parenting/sandwich-generation-costs.html

4. Livingston, G. (2018, November 29). More than one-in-ten U.S. parents are also caring for an adult. Pew Research Center. Retrieved April 21, 2023, from https://www.pewresearch.org/short-reads/2018/11/29/more-than-one-in-ten-u-s-parents-are-also-caring-for-an-adult/

5. Mathews, T. J., & Hamilton, B. E. (2016, January). Mean age of mothers is on the rise: United States, 2000–2014 – CDC. Retrieved April 21, 2023, from https://www.cdc.gov/nchs/data/databriefs/db232.pdf

6. United States Census Bureau. (2018, March 13). Older people projected to outnumber children for first time in U.S. history. Census.gov. Retrieved April 20, 2023, from https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

7. United States Census Bureau. (2020, June 25). 65 and older population grows rapidly as baby boomers age. Census.gov. Retrieved April 21, 2023, from https://www.census.gov/newsroom/press-releases/2020/65-older-population-grows.html

8. Waters, S. (2022, May 27). The sandwich generation, understanding who they are. The Sandwich Generation, Understanding Who They Are. Retrieved April 20, 2023, from https://www.betterup.com/blog/sandwich-generation