Meta-Analyses of the Relationships between Family Systems Practices, Parents' Psychological Health, and Parenting Quality

(1) Background: Family systems theories include assertations that both personal and environmental factors are determinants of parents' psychological health, well-being, and parenting quality. Applied family systems theories focus on determinants that can be operationalized as intervention practices. The analyses described in this paper focused on the direct and indirect effects of four family systems practices (family needs, resources, supports, and strengths), parents' psychological health (depression, well-being, etc.), and parenting quality (parenting beliefs, involvement, and practices) in families of children with identified disabilities, medical conditions, or at-risk conditions for poor outcomes; (2) Methods: Data from previously completed meta-analyses of the relationships between family systems practices and parents' psychological health outcomes and parenting quality outcomes were reanalyzed. Next, a meta-analysis of the relationships between parents' psychological health and parenting quality was completed to identify which predictors were related to which parenting quality outcomes. Both main effects and mediated effects were examined; (3) Results: The four family systems practices were each related to six different psychological health measures and three parenting quality measures. The six different parental psychological health measures were also related to the three parenting quality measures. The relationships between family systems practices and parenting quality were partially mediated by parents' psychological health; (4) Conclusions: The effects of family systems practices and parents' psychological health on parenting quality were primarily direct and independent. The relationships between family systems practices and parenting quality were partially mediated by parents' psychological health. Future research should focus on the identification of other mediator variables found to be important for explaining the indirect effects of family systems practices measures on parenting beliefs, behavior, and practices.

Parent Coaching in Early Intervention for Autism Spectrum Disorder: A Brief Report

Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers' use of parent coaching in an early intervention system. Twenty-five early intervention sessions were coded for fidelity to established caregiver coaching techniques. We found low use of coaching techniques overall, with significant variability in use of coaching across providers. When providers did coach caregivers, they used only a few coaching strategies (e.g., collaboration and in-vivo feedback). Results indicate that targeted training and implementation strategies focused on individual coaching components, instead of coaching more broadly, may be needed to improve the use of individual coaching strategies. A focus on strengthening the use of collaboration and in-vivo feedback may be key to improving coaching fidelity overall.

Impact of the COVID-19 Pandemic and Governmental Policies on Rehabilitation Services and Physical Medicine in Jordan: A Retrospective Study

Background: Although the COVID-19 pandemic led to a series of governmental policies and regulations around the world, the effect of these policies on access to and provision of rehabilitation services has not been examined, especially in low and middle- income countries. Aims: The aim of this study was to investigate the impact of governmental policies and procedures on the number of patients who accessed rehabilitation services in the public sector in Jordan during the pandemic and to examine the combined effect of sociodemographic factors (age and gender) and the governmental procedures on this number of patients. Methods: A retrospective cohort study was conducted based on records of 32,503 patients who visited the rehabilitation center between January 2020 and February 2021. Interrupted time-series analysis was conducted with three periods and by age and gender. Results: The number of patients who visited the rehabilitation clinics decreased significantly between January 2020 and May 2020 due to government-imposed policies, then increased significantly until peaking in September 2020 (p = 0.0002). Thereafter, the number of patients decreased between October 2020 and February 2021 as a result of the second wave of the COVID-19 pandemic (p = 0.02). The numbers of male and female patients did not differ (p > 0.05). There were more patients aged 20 years and older attending rehabilitation clinics than younger patients during the first strict lock down and the following reduction of restriction procedures periods (p < 0.05). Conclusions: The COVID-19 public measures in Jordan reduced access to rehabilitation services. New approaches to building resilience and access to rehabilitation during public health emergencies are needed. A further examination of strategies and new approaches to building resilience and increasing access to rehabilitation during public health emergencies is warranted.

Family Hardiness and Parent and Family Functioning in Households with Children Experiencing Adverse Life Conditions: a Meta-Analysis

Objective:

The purposes of the meta-analysis were to evaluate the relationship between family hardiness and different dimensions of parent and family functioning in households experiencing adverse child or family life events and circumstances and determine if family hardiness had either or both stress-buffering and healthenhancing effects on parent and family functioning.

Method:

Studies were included if the correlations between family hardiness and different dimensions of parental or family functioning were reported. The synthesis included 53 studies (N = 4418 participants) conducted in nine countries between 1992 and 2017.

Results:

showed that family hardiness was related to less parental stress, anxiety/depression, and parenting burden/demands and positively related to parental global health, well-being, and parenting practices. Results also showed that family hardiness was negatively related to family stress and positively related to family life satisfaction, adaptation, and cohesion. The effects sizes between family hardiness and positive parent and family functioning indicators were larger than those for stress-buffering indicators. Child and family life events and child age moderated the relationship between family hardiness and family but not parental functioning.

Conclusion:

The results are consistent with the hypothesis that family hardiness is an internal resource that simultaneously has stress-buffering and health-enhancing effects on parent and family functioning.

Development and Psychometric Properties of the Arabic Parent Nutritional Assessment Scale (A-PNAS) for Children with Developmental Disabilities

Aims: To describe the development of the Arabic-Parent Nutritional Assessment Scale (A-PNAS), and to examine construct and known-group discriminant validity, internal consistency, and test-retest reliability of the A-PNAS.Methods: A cross-sectional design was used. Participants were 130-children with CP (mean age = 4.26 ± 3.29 years) who were registered in the national CP registry of Jordan with a matching group of 130-children with typical development (mean age = 4.65 ± 3.54 years). Parents completed the developed A-PNAS through a structured phone interview. Parents of children with CP confirmed their child's level of gross motor function classification system.Results: Exploratory factor analysis identified three subscales in the A-PNAS: Food Intake Problems, Health Problems, and Behavioral Problems which explained 31.6% of the variance in nutritional problems of children with CP. Cronbach's alpha indicated acceptable internal consistency for Food Intake (α = 0.61) and Health Problems (α = 0.67)subscales. Parents of children with CP reported that their children had more food intake, health, and behavioral problems compared to children with typical development (p<.001). Test-retest reliability was excellent for the subscales of the A-PNAS (ICCs = 0.96, 0.98, 0.96).Conclusions: The findings provide support for the face validity, construct validity, internal consistency, Known-Groups discriminant validity, and test-retest reliability of the A-PNAS.

Parent empowerment and coaching in early intervention: study protocol for a feasibility study

Background

Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children’s cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-mediated early interventions for ASD is clinician use of parent coaching and occurs when a clinician actively teaches the parent techniques to improve their child’s functioning. Available evidence suggests that community-based EI clinicians rarely coach parents when working with families of these children, although specific barriers to coaching are unknown. This consistent finding points to the need to develop strategies to improve the use of parent coaching in community EI programs. The purpose of this community-partnered study is to iteratively develop and pilot test a toolkit of implementation strategies designed to increase EI clinicians’ use of parent coaching.

Methods

This study has four related phases. Phase 1: examine how EI clinicians trained in Project ImPACT, an evidence-based parent-mediated intervention, coach parents of children with ASD. Phase 2: identify barriers and facilitators to clinician implementation of parent coaching by administering validated questionnaires to, and conducting semi-structured interviews with, clinicians, parents, and agency leaders. Phase 3: partner with a community advisory board to iteratively develop a toolkit of implementation strategies that addresses identified barriers and capitalizes on facilitators to improve clinician implementation of evidence-based parent coaching. Phase 4: pilot test the feasibility and effectiveness of the implementation strategy toolkit in improving EI clinicians’ use of parent coaching with nine EI clinicians and parent-child dyads using a multiple-baseline-across-participants single-case design.

Discussion

Completion of these activities will lead to an in-depth understanding of EI clinicians’ implementation of parent coaching in usual practice following training in an evidence-based parent-mediated intervention, barriers to their implementation of parent coaching, a toolkit of implementation strategies developed through an iterative community-partnered process, and preliminary evidence regarding the potential for this toolkit to improve EI clinicians’ implementation of parent coaching. These pilot data will offer important direction for a larger evaluation of strategies to improve the use of parent coaching for young children with ASD.

Family-centered practices and the parental well-being of young children with disabilities and developmental delay

BACKGROUND

Research evidence from studies in North America on the relationships between family-centered practices, parents' self-efficacy beliefs, parenting confidence and competence beliefs, and parents' psychological well-being was used to confirm or disconfirm the same relationships in two studies in Spain.

AIMS

The aim of Study 1 was to determine if results from studies in North America could be replicated in Spain and the aim of Study 2 was to determine if results from Study 1 could be replicated with a second sample of families in Spain.

METHODS AND PROCEDURES

A survey including the study measures was used to obtain data needed to evaluate the relationships among the variables of interest. The participants were 105 family members in Study 1 and 310 family members in Study 2 recruited from nine early childhood intervention programs. Structural equation modeling was used to test the direct and indirect effects of the study variables on parents' well-being.

OUTCOMES AND RESULTS

Results showed that family-centered practices were directly related to both self-efficacy beliefs and parenting beliefs, and indirectly related to parents' psychological well-being mediated by belief appraisals.

CONCLUSION AND IMPLICATIONS

The pattern of results was similar to those reported in other studies of family-centered practices. Results indicated that the use of family-centered practices can have positive effects on parent well-being beyond that associated with different types of belief appraisals.

Effects of a Collaborative Intervention Process on Parent Empowerment and Child Performance: A Randomized Controlled Trial

AIMS

To examine the effects of a four-step collaborative intervention process on parent and child outcomes and describe parents' and therapists' experiences.

METHODS

Eighteen children with physical disabilities, their mothers, and 16 physical therapists participated. Therapists randomized to the experimental group were instructed in the collaborative intervention process. All family-therapist dyads participated in six weekly sessions. Outcomes included the adapted Family Empowerment Scale (FES) and Canadian Occupational Performance Measure (COPM). A questionnaire was completed by parents and therapists to rate and describe their experiences.

RESULTS

Mean scores on the FES (p <.05) and COPM (p <.001) increased after intervention but there were no group differences (p >.05). Effect size for change in child performance (.73) and parent satisfaction (1.08) on the COPM favored the experimental group. Parents in the experimental group were more confident in carrying out activities during daily routines (p =.01) and worked together with therapists to a greater extent (p =.01) than parents in the comparison group. Therapists in the experimental group perceived that they provided information/instruction (p <.01) and worked together with parents (p =.02) to a greater extent than therapists in the comparison group.

CONCLUSIONS

Findings support the importance of shared goal setting for children's activities. Further research is recommended.

Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial

Aim: To determine whether a collaborative intervention process facilitates parent-therapist interactions. Methods: Participants were 18 children with physical disabilities, their mothers, and 16 physical therapists. Therapists randomized to the experimental group were instructed in strategies for collaboration (working together) with parents in goal setting, planning, and implementing interventions. Family-therapist dyads participated in 6 weekly sessions. Four sessions were videotaped and combined (1st and 2nd for goal-setting/planning, 3rd and 5th for implementation) to code behaviors using Response Class Matrix. Multivariate analysis of variance was used to compare therapist and parent behaviors between groups. Results: Therapists in the experimental group demonstrated a higher frequency of "seeking information" (p < 0.01), "giving information" (p < 0.05), "positive behavior" (p < 0.01) and lower frequency of "child-related behavior" (p < 0.001) than therapists in the comparison group during goal-setting/planning and implementation. Parents in the experimental group demonstrated a higher frequency of "giving information" than parents in the comparison group (p < 0.01) during goal-setting/planning and implementation. Conclusion: Parents and therapists in the experimental group interacted more with each other, whereas those in the comparison group focused more on the child. The collaborative strategies appear to have increased parent participation in the intervention process, which has been a challenge for physical and occupational therapists.

Multilevel linear modelling of the response-contingent learning of young children with significant developmental delays

AIM

The purpose of the study was to isolate the sources of variations in the rates of response-contingent learning among young children with multiple disabilities and significant developmental delays randomly assigned to contrasting types of early childhood intervention.

METHOD

Multilevel, hierarchical linear growth curve modelling was used to analyze four different measures of child response-contingent learning where repeated child learning measures were nested within individual children (Level-1), children were nested within practitioners (Level-2), and practitioners were nested within the contrasting types of intervention (Level-3).

RESULTS

Findings showed that sources of variations in rates of child response-contingent learning were associated almost entirely with type of intervention after the variance associated with differences in practitioners nested within groups were accounted for. Rates of child learning were greater among children whose existing behaviour were used as the building blocks for promoting child competence (asset-based practices) compared to children for whom the focus of intervention was promoting child acquisition of missing skills (needs-based practices).

IMPLICATIONS

The methods of analysis illustrate a practical approach to clustered data analysis and the presentation of results in ways that highlight sources of variations in the rates of response-contingent learning among young children with multiple developmental disabilities and significant developmental delays.

Psychometric properties of the Spanish version of the family-centred practices scale for use with families of young children receiving early childhood intervention

BACKGROUND

Early childhood intervention (ECI) centres in Spain recently initiated a process of change towards the adoption of family-centred practices (FCPs). Knowledge about the extent to which practitioners' use FCPs is needed. The psychometric properties of the Spanish version of the FCPs scale were examined.

METHOD

A convenience sample of 105 families of children with developmental delays attending three different ECI centres in Spain completed the FCPs scale and provided information about the ECI centre characteristics and practices, caregiver self-efficacy beliefs, and family and child demographic information.

RESULTS

The Spanish version of the FCP scale was found to be both reliable and valid. FCPs were correlated with self-efficacy beliefs, parents' involvement in their child's ECI program and family decision making.

CONCLUSION

The FCP scale provides practitioners with useful information about their practices, but also has capacity-building consequences for families. The study is a first step for examining the use of FCPs in Spain.

Contrasting approaches to the response-contingent learning of young children with significant delays and their social-emotional consequences

AIMS

The purpose of the analyses described in this paper was to evaluate the direct and indirect effects of two different approaches to child response-contingent learning on rates of child learning and both concomitant and collateral child social-emotional behaviour.

METHOD

The participants were 71 children with significant developmental delays or multiple disabilities randomly assigned to either of the two contrasting approaches to interventions.

RESULTS

Findings showed that an intervention which employed practices that built on existing child behaviour (asset-based practices) was more effective than an intervention focusing on teaching children missing skills (needs-based practices) for influencing changes in the rates of child learning as well as rates of child social-emotional behaviour mediated by differences in rates of child learning.

IMPLICATIONS

Both the theoretical and practical importance of the results are described in terms of the extended social-emotional benefits of asset-based response-contingent learning games.

Efficacy Trial of Contrasting Approaches to the Response-Contingent Learning of Young Children with Significant Developmental Delays and Multiple Disabilities

Findings from a randomized control design efficacy trial of an asset-based vs. needs-based approach to the response-contingent learning of infants and toddlers with significant developmental delays and disabilities who did not use instrumental behavior to produce or elicit reinforcing consequences are reported. The investigation included 71 children randomly assigned to the two contrasting types of interventions. The asset-based intervention and needs-based intervention differed in terms of how child behavior were identified and used to elicit reinforcing consequences as part of response-contingent learning games implemented by the children’s parents or other primary caregivers. Children in the asset-based group were provided more learning opportunities, acquired more response-contingent behavior, and demonstrated more efficient learning compared to children in the needs-based group. Implications for improving practices for very young children with significant developmental delays and multiple disabilities are described.

Family Needs, Sources of Support, and Professional Roles: Critical Elements of Family Systems Assessment and Intervention

A family-level, needs-based model of assessment and intervention is described. The model includes three major components: specification of family needs, identification of sources of support and resources to meet needs, and staff roles in helping families access resources from their support networks. The importance of a broader-based, social systems approach to assessment and intervention is emphasized.

A Cognitive-Social Approach For Assessment Of Early Nonverbal Communicative Behavior

A prototypic model of nonverbal communication development derived from the philosophy of Austin (1962) and the psychology of Piaget (1952, 1954, 1962) is presented. The model is used as a structural framework for formulating a strategy for assessment of early nonverbal communicative behavior. A developmental-ethological perspective of assessment is advanced. The assessment model specifies: (a) the parameters of communication development, (b) the sequential patterns of the acquisition of nonverbal communicative acts, and (c) the conditions under which assessment might best occur.

Assessment of Preschool Classroom Environments

The Preschool Assessment of the Classroom Environment (PACE) scale is described. The results from a pilot study involving 20 preschool classrooms showed that different aspects of the management, organization, and operation of classroom environments were significantly related to both caregiver and child outcomes. The particular pattern of findings confirmed the hypothesized relationships among the independent and dependent variables. The results are discussed in terms of the use of the PACE for proactively affecting the changes in the classroom ecology in order to produce changes in child behavior.

Parents' and Practitioners' Perspectives of Young Children's Everyday Natural Learning Environments

Parents' views of natural learning environments were compared to those of practitioners having either considerable or little experience with the characteristics of everyday natural learning opportunities. 8 experienced practitioners' views were congruent with those of the parents, whereas the 8 inexperienced practitioners' views were incongruent with those of both parents and their experienced peers.

Young Children's Natural Learning Environments: Contrasting Approaches to Early Childhood Intervention Indicate Differential Learning Opportunities

1,000 parents of infants and toddlers enrolled in early childhood intervention programs were surveyed about the number of learning opportunities provided their preschool children using different approaches to early intervention. Findings showed that more learning opportunities were reported when participation in everyday activity settings was conceptualized as a type of intervention rather than as settings for professionals to conduct their interventions.

Guide for calculating and interpreting effect sizes and confidence intervals in intellectual and developmental disability research studies

This paper includes a nontechnical description of methods for calculating effect sizes in intellectual and developmental disability studies. Different hypothetical studies are used to illustrate how null hypothesis significance testing (NHST) and effect size findings can result in quite different outcomes and therefore conflicting results. Whereas NHST uses probability levels (e.g., p < .05) to evaluate the results of studies, effect size analyses focus on the magnitude of differences between groups or contrasting conditions and the strength of the relationship among variables of interest to report and interpret study results. Two families of effect sizes are described (mean difference, correlation coefficients) that are likely to be applicable to most intellectual and developmental disability studies. Sources of information on effect size calculators are included to provide researchers ready-available data analysis procedures for computing effect sizes and confidence intervals for different types of research designs and studies.

Exploratory investigation of the effects of interest-based learning on the development of young children with autism

The influences of child participation in interest-based learning activities on the development of 17 preschoolers with autism was the focus of this brief report. The children’s mothers identified their children’s interests and the everyday family and community activities that provided opportunities for interest-based learning. Parents then implemented intervention procedures for 14 to 16 weeks to increase child participation in the selected activities. Based on an investigator-administered interestingness scale, the children were divided into high and low interest-based learning groups. The children’s language, cognitive, social, and motor development quotients obtained at the beginning, the middle, and the end of the intervention were the dependent measures. Results showed that the high interest-based group made considerably more developmental progress compared to the low interest-based group. Implications for practice and future research are discussed.

Extended child and caregiver benefits of behavior-based child contingency learning games

Findings from 2 studies of the relationship between response-contingent child behavior and child, caregiver-child, and caregiver behavior not directly associated with child contingency learning are described. The participants were 19 children with significant developmental delays and their mothers in 1 study and 22 children with significant developmental delays and their teachers in the second study. Caregivers engaged the children in learning games characterized by behavior-based contingencies for 15 weeks. Research staff observed the children and their caregivers in everyday routines and activities and rated child and caregiver behavior while the children and caregivers were not playing the games. Results from both studies showed that the degree of response-contingent responding during the games was related to child and caregiver behavior, not the focus of the contingency learning opportunities afforded the children. Implications for practice are described.

Influence of the Interests of Children with Autism on Everyday Learning Opportunities

Findings from a pilot study investigating the influence of the interests of young children with autism on parents' provision of everyday informal child learning opportunities are described. 17 children (13 boys, 4 girls) were divided into two groups that received everyday learning opportunities of Low interest and High interest, based on parents' bi-weekly ratings of the interestingness of the opportunities to the children, using an investigator-developed measure. A brief intervention of 12 to 14 weeks showed that the children in the High interest-based group were provided more learning opportunities than were the Low interest-based group, and that the parents indicated that their children benefited more from the learning opportunities. Implications for future research are described.

Meta-analysis of family-centered helpgiving practices research

A meta-analysis of 47 studies investigating the relationship between family-centered helpgiving practices and parent, family, and child behavior and functioning is reported. The studies included more than 11,000 participants from seven different countries. Data analysis was guided by a practice-based theory of family-centered helpgiving that hypothesized direct effects of relational and participatory helpgiving practices on self-efficacy beliefs and parent, family, and child outcomes. Results showed that the largest majority of outcomes were related to helpgiving practices with the strongest influences on outcomes most proximal and contextual to help giver/help receiver exchanges. Findings are placed in the context of a broader-based social systems framework of early childhood intervention and family support.

University faculty preparation of students in using natural environment practices with young children

155 university faculty teaching students in physical therapy, occupational therapy, speech and language pathology, early childhood special education, or multidisciplinary studies programs were surveyed to assess how the students were taught how to use everyday family and community activities as natural learning opportunities for young children. Analysis showed that the faculty provided very little training in using community activity settings as contexts for children's learning and that physical therapy faculty provided less training in using natural environments as sources of children's learning opportunities than faculty in the other disciplines.

University faculty preparation of students in using natural environment practices with young children

155 university faculty teaching students in physical therapy, occupational therapy, speech and language pathology, early childhood special education, or multidisciplinary studies programs were surveyed to assess how the students were taught how to use everyday family and community activities as natural learning opportunities for young children. Analysis showed that the faculty provided very little training in using community activity settings as contexts for children's learning and that physical therapy faculty provided less training in using natural environments as sources of children's learning opportunities than faculty in the other disciplines.

Young children's participation in everyday family and community activity

Patterns of participation in everyday family and community activities are described for children from birth to 6 years of age. Parents or other primary caregivers completed a survey of either family life or community life as sources of children's learning opportunities and experiences. Rates of children's participation in 50 family activities and 50 community activities at different ages were identified and analyzed in terms of similarities and differences in participation patterns. Findings indicated considerable variability in involvement in 100 family and community activities by young children of different ages. Implications for using everyday family and community activities as sources of enriched learning opportunities that enhance children's development are discussed.

Empowerment, effective helpgiving practices and family-centered care

Improving practices with families of pediatric patients is most likely to occur when nurses and other health care professionals more fully understand the characteristics and consequences of different approaches to their work. A review of relevant literature in the empowerment, helpgiving, and family-centered care fields suggests the kinds of beliefs, attitudes, and behaviors that will optimize benefits to families in different domains of functioning. Family-centered care is a special case of effective helpgiving, and effective helpgiving is a special case of an empowerment approach to working with people seeking professional advice and expertise.

Characteristics and consequences of help-giving practices in contrasting human services programs

Relationships between human services program models and help-giving practices, and between both program models and help-giving practices and help-seeker control appraisals were examined in a study of 107 low socioeconomic background families. Three kinds of human services agencies were included in the study, each of which differed in terms of their implicit and explicit assumptions about the families they served and the roles professionals and families played as part of helping relationships. Results support the hypotheses that (a) a program philosophy that was family centered would be associated with more empowering help-giving practices compared to more professionally centered philosophies and (b) a family-centered program philosophy and empowering help-giving practices would be related to an enhanced sense of personal control over needed supports and resources from a target help-giver.

Family-centeredness of the Children's Health Care journal

The extent to which authors of Children's Health Care articles showed increased attention to the elements of family-centered care following the publication of Shelton, Jeppson, and Johnson's (1987) book Family-Centered Care for Children with Special Health Care Needs was examined. A total of 223 parent-oriented and family-oriented articles published during the 1980 to 1991 period were analyzed. The findings showed greater incorporation of family-centered notions into published articles after versus before publication of the Shelton et al. book, although the year in which changes occurred and the magnitude of the changes were quite variable for different elements of care. In cases where increased attention was paid to the elements of care, different subsets of elements were more likely to be attended to by different authors.

Measuring the adequacy of resources in households with young children

Both the reliability and validity of the Family Resource Scale (FRS) are described. The FRS is a 30-item rating scale for measuring the adequacy of resources in households with young children. The ordinality of the items, rank ordered from the most to least basic, was established in a study of 28 professionals. Both the reliability and validity of the scale was established in a second study of 45 mothers of preschool-aged children. The utility of the FRS for assessment and intervention purposes is discussed.

Mediating influences of social support: personal, family, and child outcomes

The mediating influences of social support were examined in a study of 137 parents of mentally retarded, physically impaired, and developmentally at-risk children. Social system theory was used as a conceptual framework for assessing the effects of social support on personal well-being, parental attitudes toward their child, family integrity, parental perceptions of child functioning, parent-child play opportunities, and child behavior and development. A series of hierarchical multiple regression analyses by sets, controlling for family SES and income, child sex and age, and child developmental quotient and diagnosis showed that both satisfaction with support and number of sources of support had main and/or interactive effects in all sets of outcome measures. More supportive social networks were associated with better personal well-being, more positive attitudes, and more positive influences on parent-child play opportunities and child behavior and development. Findings were discussed in terms of both methodological and conceptual contributions to understanding the broad-based influences of social support.