McCallion 2004.

Study characteristics
Methods	Partial crossover with wait‐list control
Participants	97 grandparents with primary care of at least one grandchild with a developmental delay or disability (49 intervention, 48 control at baseline; 49 intervention, 46 control after 3 months). These included intellectual or other developmental disabilities, learning problems or attention deficit and hyperactivity disorders. Children were an average age of 11. Five children in the study were 21 years old.
Interventions	Support groups with trained leaders (from local community agencies) and education (topics chosen by members). 8‐10 grandparent caregivers attended 6 fortnightly group meetings of 90 minutes duration. In addition to educational topics, sessions covered self‐care such as stress reduction, relaxation, nutrition, and own health needs. Participants also received active case management. Control was active case management by a single trained agency staffer.
Outcomes	Primary Depression; sense of empowerment; caregiving mastery. Center for Epidemological Studies Depression Scale (CES‐D): a 20 item self‐report measure, measuring symptoms of depression on a 4‐point Likert scale. Items are summed to reach the total, which ranges from 0‐60. A higher score indicates greater severity of depressive symptoms. Scores over 16 indicate a likely clinical depression. Family Empowerment Scale (FES): a 34 item self‐report measure, rated on a 5‐point Likert scale (1=not at all true, to 5=very true). Includes 3 sub‐scales of family, service system, and community/political empowerment. Sub‐scales are aggregates; sub‐scales can be added for total score, which can range from 34‐170. A higher score indicates greater family empowerment. Caregiving Mastery Scale (CMS): a 7 item self‐report measure, rated on a 5‐point Likert scale (1=strongly, to 5= strongly agree). Items are summed for the total score, which ranges from 7‐28. A higher score indicates greater mastery. Outcomes were measured at baseline and 3 months following baseline.
Notes	FES was given as three separate sub‐scales: Family, Services, and Community. Looking at the items (Family Empowerment Scale, Koren, DeChillo, & Friesen 1992) it makes most sense to include the Family and Services sub‐scales under Family Functioning.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Random assignment asserted but not described
Allocation concealment (selection bias)	Unclear risk	Allocation concealment not reported
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not described
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not described
Incomplete outcome data (attrition bias) All outcomes	Low risk	Minimal attrition, and data analysed as intention‐to‐treat
Selective reporting (reporting bias)	Low risk	No indication of possible selective reporting; program developers’ stated outcomes of interest were all reported in this study.
Other bias	High risk	Possible bias from recruitment. Agencies running the intervention were responsible for recruiting; not reported how many eligible participants declined to participate. All participants (eventually) received the intervention; without knowing whether or not this was disclosed during recruitment, and what proportion of potential participants declined, can’t know how many people self‐selected in to the study. Recruiters may have consciously or unconsciously selected for inclusion.