Rethinking early intervention

Analysis and Intervention in Developmental Disabilities, Vol. 5, pp. 165-201, 1985

0270-4684/85 $3.00 + .00 Copyright O 1985 Pergamon Press Ltd.

Printed in the USA. All rights reserved.

Rethinking Early Intervention Carl J. Dunst Western Carolina Center

A model o f early intervention that focuses on Proactive Empowerment through Partnerships (PEP) is described. The PEP model is embedded within a social systems perspective o f child, parent, and family development and functioning. Social systems theory is used as a basis for an expanded definition o f early intervention, a broader-based viewpoint o f the effects o f early intervention, and a set o f decision rules regarding what types o f intervention can strengthen families" abilities to meet family needs. Early intervention is defined as the provision o f support to families o f infants and young children from members o f informal and formal social support networks. The manner in which the PEP principles and social systems notions are operationalized at the programmatic level is also described. Data are presented from a series o f studies designed to validate the social systems perspective o f early intervention as well as discern the impact o f provision o f support.

T i l e t e r m " e a r l y i n t e r v e n t i o n " has b e e n u s e d to d e s c r i b e p r o g r a m s f o r i n f a n t s and p r e s c h o o l - a g e d children at-risk for d e v e l o p m e n t a l p r o b l e m s ( F r i e d l a n d e r , S t e r r i t t , & K i r k , 1975; T j o s s e m , 1976). M o r e s p e c i f i c a l l y , t h e t e r m r e f e r s to e x p e r i m e n t a l , e d u c a t i o n a l , o r t h e r a p e u t i c t r e a t m e n t s d e s i g n e d e i t h e r to p r e -

Reprints may be obtained from the author at the Family, Infant and Preschool Program, Western Carolina Center, Morganton, NC 28655. Work reported in this paper was supported, in part, by grants from the National Institute of Mental Health (#MH38862), US Department of Education, Office of Special Education Programs (#G008302292 and #029PH30061), NC Department of Human Resources, Division of Mental Health, Mental Retardation and Substance Abuse, Research Section (#83527), and the NC Council on Developmental Disabilities. Portions of this paper were presented at the Early Childhood Development Association Conference, Seattle, WA, May, 1984, and the North Carolina Association for Infants and Families Conference, Charlotte, NC, October, 1984. Appreciation is extended to Pat Condrey for help in preparation of the manuscript, Jean Young and Johnna Clontz for assistance in data analysis, and Carol Trivette for her contributions to the research reported in the paper. Special thanks and recognition is extended to lverson Riddle, M.D., Director, Western Carolina Center, for his continued support and encouragement in the development of the early intervention model described in this paper. 165

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vent or ameliorate an anticipated or existing deficiency among a target population of children (Bricker, Bailey, & Bruder, 1984; Sigel, 1972). Early intervention programs can be broadly divided into two categories: those for children at-risk for developmental problems due to environmental factors (Bronfenbrenner, 1975; Horowitz & Paden, 1973) and those at-risk due to biological factors (Bricker et al., 1984; Dunst, 1985; Dunst & Rheingrover, 1981; Simeonsson, Cooper, & Scheiner, 1982). Both types of programs began to appear in the early 1960s and have since expanded rapidly. There have been a number of attempts to categorize programs according to different intervention models (Dunst, 1981, 1982; Filler, 1983; Garwood, 1983; Lambie, Bond, & Weikert, 1975), but for the most part the large majority of early intervention programs have been conceptualized and implemented in a fundamentally similar manner. Based on one or more risk factors, a target population of children is identified. The children (and sometimes the families) are evaluated or assessed to determine the probability or presence of deficits or weaknesses. Interventions are then devised to prevent or ameliorate the deficiencies and are implemented by either professionals, paraprofessionals, or the parents of the children. Almost always, the efficacy of intervention efforts are gauged using child progress or other indices of child change as the principal measure of program success (see Bricker et al., 1984; Bronfenbrenner, 1975; Dunst & Rheingrover, 1981; Simeonsson et al., 1983). Programs which espouse the above approach to intervention are generally well entrenched in a deficit perspective of the child and his or her family (Foster, Berger, McLean, 1981; Lambie et al., 1975; Zigler & Berman, 1983). (Moreover, these same programs are often based on a number of assumptions that are not entirely t e n a b l e - s e e Dunst, 1985, for a discussion.) An alternative model for conceptualizing and implementing early intervention is described in this paper. The model uses social systems theory as a framework for both expanding the definition of early intervention and a set of decision rules regarding what types of interventions are likely to affect child, parent, and family functioning. According to H o b b s (1975), a social systems approach to: intervention focuses on the exchanges between the child, the settings in which (s)he participates, and the significant individuals who interact with (the child). The objective is not merely to change or improve the child but to make the system work . . . . The goal (of intervention) is to strengthen normal socializing agencies (the family, the school, the church, the neighborhood), not to replace them. (p. 114, italics added) PEP M O D E L The social systems approach to early intervention described in this paper is being implemented and evaluated at the Western Carolina Center Family,

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Infant and Preschool Program (FIPP) located in Morganton, North Carolina. Before describing the conceptual bases of the program and the operationalization of social systems notions, several comparisons are made between traditional and social systems approaches to early intervention to place the FIPP model in proper perspective. The F I P P approach to early intervention is based on three simple but far reaching principles. These can be reduced to the acronym PEP: Proactive Empowerment through Partnerships. Table l contrasts the P E P model with the more traditional approach to early intervention.

Deficit Versus Proactive M o d e l s

Lambie et al. (1975) review the different deficit models of development and intervention and note that "all deficit models evaluate behavioral differe n c e s . . , based upon assumptions about what is normal or desirable" (p. 266). These approaches to early intervention view deviations in child performance as resulting from deficits inherent in the child, in his or her parents, or both. Differences are either implicitly or explicitly equated with deficits because of the relativistic stance assumed by advocates of this approach. The focus of intervention is the remediation of these deficits through means that reduce the variance between actual and expected patterns of behavior. To the extent that child performance a n d / o r parent behavior is made consonant with some standard (average test performance, "normal" patterns of behavior, middle class values, etc.), the interventions are presumed to have had a positive impact. The deficit model has its roots in the now well-documented observations (e.g., Deutsch, 1973; Hess, 1970; Tyler, 1965) that lower SES children and their families differ from middle SES families in a number of ways (school performance, parenting behavior, aspirations, etc.). These differences are presumed to be the result of deficits in the lower SES children, their parents, and their culture (hence the cultural deficit hypothesis), and intervention programs are designed primarily to correct these deficiencies. The assumptions implicit in the deficit model have been challenged on a number of fronts (Foster et al., 1981; Zigler & Berman, 1983), but perhaps most unfortunate has been the adoption of the model for use with particular children and families for whom the assumptions are blatantly incorrect and potentially damaging. Foster et al. (1981) offer some insightful observations that bear directly on this contention: Many of the (handicapped) children now served by early intervention programs come from middle- or upper-income families . . . . Models of parent involvement predicated on a cultural deficit hypothesis are not easily applied to these families, whose interaction patterns were the very standard against which low-income family styles were compared and f o u n d wanting. (p. 57, italics added)

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As this quote so well points out, inferring deficits in the very population who constituted the standard use to establish valued performance, and in turn inferring that the standard is a deficit, is illogical and cannot help but lead to the application of inappropriate interventions. An alternative to the deficit approach is a proactive model. A proactive approach focuses on a child's family's strengths and not weaknesses (Hobbs, 1975; Zigler & Berman, 1983). Primary emphasis is placed on strengthening and supporting families (Hobbs et al., 1984). Emphasis on individual strengths as well as strengthening families cannot but have more positive influences. As Stoneman (1985) points out, "Every family has strengths and, if the emphasis is on supporting strengths rather than rectifying weaknesses, chances for making a difference in the lives of children and families are vastly increased" (p. 462). The particular proactive model used by FIPP is embedded within a social systems framework. In a social systems approach to early intervention, differences are not viewed as deficits residing in the child or his or her parents, but variations in behavior resulting from ecological forces that affect parent, child, and family behavior. Support for this contention come from a number of studies conducted in our program (e.g., Dunst & Trivette, 1984; Dunst, Trivette, & Cross, 1984; Leet & Dunst, in preparation). The primary purpose of these studies was to determine the extent to which physical, emotional, instrumental, and other forms of support differentially affected child, parent, and family functioning. The findings showed that behavior differences were indeed significantly related to different types of support available to the families. Moreover, our data cast doubt on the assumption that lower SES children and their families have inherent deficits. The extent to which lower SES families were likely to manifest different behavioral attributes (enhanced well-being, family integrity, nurturing styles of parent-child interaction, etc.) was influenced as much by adequacy of support as social class per se. That is, lower SES families were just as likely to demonstrate socially valued behavior if they had resources (physical, emotional, instrumental, etc.) that were supportive in nature. Taken together, these data indicate that behavior differences are not deficits but variations resulting from ecological forces both within and outside the family.

Usurpation Versus Empowerment The usurpation of control over decision-making for families is often a common occurrence in early intervention programs. Parents are told what is wrong with their child and family, what needs to be done to correct (inferred?) deficits, when and how interventions ought to be done, how often and how long they should work with their child, and so on. Control over the child's life and sometimes the life of the fa.mily cannot but foster a sense of helplessness and powerlessness in the child's caregivers.

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Evidence from both the learned helplessness (e.g., Abramson, Seligman, & Teasdale, 1978) and locus of control (e.g., Lefcourt, 1976, 1981; P hares, 1976) literature suggests the potentially negative effects of the control exercised by many early intervention programs. To the extent that others make decisions for a family which the family feels obligated to follow, a personal sense of helplessness (lack of personal efficacy) is likely to be fostered. Likewise, controlability by others is likely to depress any sense of interpersonal efficacy. Where one makes all the decisions for another person, that individual is likely to develop external locus of control. Empowerment rather than usurpation is fundamental to a proactive approach to intervention. Proactive intervention empowers individuals to make informed decisions and take control over their lives by imparting information, skills, knowledge, and so on to the families. Empowerment involves both the generation and allocation of power (decision-making) in the form of access and control of physical, emotional, and instrumental resources (Rappaport, 1981). According to Katz (1984), fostering a sense of "control over (one's) life becomes a renewable, expansively accessible resource, as does the process of empowerment itself" (p. 202). That is, provision of support that empowers families to control their lives not only fosters a sense of intrapersonal and interpersonal efficacy but also enhances an understanding of one's own empowerment as a resource, coping, and adaptational mechanism. FIPP places primary emphasis on empowerment as a focus of intervention efforts. To the extent that a family can meet needs as a result of increased intrapersonal and interpersonal efficacy, strengthening of the family is likely to occur, which in turn is likely to decrease (and hopefully ultimately alleviate) any unnecessary dependence on social agencies. Paternalism Versus Partnerships

Traditional approaches to early intervention are often paternalistic in their treatment of children and families. This paternalism is well entrenched in the paradigm known as the client-professional relationship. In this model the client (child a n d / o r family) is seen as having some sickness or pathology. The client seeks the expert advice of the professional who prescribes a treatment designed to alleviate the illness. Both the deficit model and the usurpation paradigm are embodied in the paternalism displayed by many early intervention programs. In a proactive approach to intervention, empowerment occurs within the context of partnerships between families and professionals that avoids the paternalism of the client-professional paradigm. Partnerships involve individuals working together, on an equal footing, devising and implementing plans designed to attain specified objectives and goals. Fundamental to partnerships is not only the utilization of one another's strengths in achievement of

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goals, but also mutual empowerment through exchange of skills, knowledge, and competencies. Proactive intervention that utilizes partnerships avoids viewing differences as deficits that have some pathological origins that must be "treated" as an illness. Rather, differences arising from intra- and extrafamily influences are seen as conditions which generate needs that can best be met by mobilizing resources that allow these needs to be met and thus strengthen families. Proactive Empowerment through Partnerships provides an alternative framework for conceptualizing early intervention practices. The principles central to the PEP approach are ones that have been increasingly recognized as crucial if positive benefits from early intervention are to be realized (Foster et al., 1981; Hobbs, 1975; Hobbs, Dokecki, Hoover-Dempsey, Moroney, Shayne, & Weeks, 1984; Stoneman, 1985; Zigler & Berman, 1983). SOCIAL SYSTEMS THEORY The approach to intervention used by FIPP integrates and synthesizes theoretical formulations and empirical evidence from a number of social systems models, including social network theory (Bott, 1971; Mitchell & Trickett, 1980; Mueller, 1980; Unger & Powell, 1980), ecological psychology (Bronfenbrenner, 1979; Cochran & Brassard, 1979), help-seeking theory (Gourash, 1978), and adaptational theory (Crnic, Friedrich, & Greenberg, 1983). A fundamental tenet of social systems theory is that social units do not operate in isolation but affect one another both directly and indirectly so that changes in one unit or subunit reverberate and impact upon other units. Thus, the behavior of a child, his/her sibling, parents, and other family members may be affected by events in settings in which the persons may not even be present (see especially Bronfenbrenner, 1979). Social Network Theory

Social network theory attempts to describe the properties of social units, the linkages among units, and how provision of support from members of different units contribute to the promotion of individual, family, and community well-being. Mitchell (1969) defined social networks as a "specific set of linkages among a defined set of persons" (p. 12). Linkages are generally described in terms of different social network characteristics, including size, density, intensity of ties, satisfaction, reciprocity, and so on (see Mitchell & Trickett, 1980). Social networks have long been viewed as powerful mediators of social support (Mitchell & Trickett, 1980). Broadly defined, social support includes emotional, physical, informational, instrumental, and material assistance provided to others to maintain well-being, promote adaptations to different life

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events, and foster development in an adaptive manner. There is general consensus among social network theorists that social support networks function to nurture and sustain linkages among persons that are supportive of one another on both a day-to-day basis and in times of need and crises (e.g., Brim, 1974; Caplan, 1974; Cobb, 1976; Walker, MacBride & Vachon, 1977; Weiss, 1974). A sizable body of literature indicates that various forms of social support have powerful mediational influences on personal and familial well-being (Bott, 1971; Dean & Lin, 1977; McCubbin, Joy, Cauble, Comeau, Patterson, & Needle, 1980; Mitchell & Trickett, 1980). For example, parenthood has been found to be a crisis situation for some (Hobbs, 1965; LeMasters, 1957), yet the simple reintegration of extended family members into the nuclear family has been found successful in buffering new parents from stressful reactions associated with the birth of their first born child (Litwak, 1960). Ecological Psychology

Human ecology (Bronfenbrenner, 1979; Cochran & Brassard, 1979) provides the type of framework that both explicates the relationships between different social units and helps explain the broad-based impacts of social support. According to Bronfenbrenner (1979), ecological units, or social networks, may be conceived topologically as a nested arrangement of concentric structures each embedded within one another. At the innermost level is the developing child and his/her family (mother, father, siblings). The family unit is embedded in broader ecological systems consisting of blood and marriage relatives, friends, neighbors, and other acquaintances. These formal and informal kinship units are further embedded in larger social units, including neighborhoods, churches, social organizations, the parents' place of work, school, etc. Still further, these formal and informal social units are embedded within larger social systems consisting of governments and other decision making groups (school boards, county governments, etc.). A fundamental tenet of ecological psychology is that social units and their members do not act in isolation, but rather interact both within and between levels so that events occurring in different units or subunits reverberate and impact upon the behavior of members in other units. According to an ecological perspective of development, the behavior of individuals is affected by a host of factors emanating from different ecological systems and units, indicating that a child's development is influenced both directly and indirectly. "Network influences come directly to the child through the range and variety of persons with whom the child has contact on a recurring basis, either together with other family members or independently" (Cochran & Brassard, 1979, p. 602). Less obvious but no less powerful are indirect influences that bear upon a child's development. According to Bron-

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fenbrenner (1979), "A person's development is affected profoundly by events in settings in which a person is not even present" (p. 3). Besides contemporaneous influences, sources of information and/or experiences from one's past can profoundly affect the development of a child. Luscher and Fisch (1977) found, for example, that traditional knowledge passed on from one generation to the next influenced the socialization processes used by parents with their young preschool aged children. Fundamental to human ecology is the description of growth and development with "concern for the progressive accommodations between a growing human organism and its immediate environment, and the way in which this relation is mediated by forces emanating from remote regions in the larger physical and social milieu" (Bronfenbrenner, 1979, p. 3, italics added). Recent work has shown that the effects of provision of support go beyond moderation of intrapersonal and intrafamily physical and psychological wellbeing. Evidence indicates that social support influences attitudes toward parenting (Crnic, Greenberg, Ragozin, Robinson, & Basham, 1983), parental styles of interaction with their children (Crnic, Friedrich, & Greenberg, 1983; Crockenberg, 1981; Embry, 1980; Giovanoni & Billingsley, 1970; Hetherington, Cox, & Cox, 1976, 1978; Philliber & Graham, 198 I; Weinraub & Wolf, 1983), parental expectations and aspirations for their children (Lazar & Darlington, 1982), and child behavior and development (Crnic, Friedrich, & Greenberg, 1983; Crockenberg, 1981). These direct and indirect influences of social support are examples of first-, second-, and higher-order effects resulting from the provision of support (Bronfenbrenner, 1979). Besides influences mediated by social support, other influences, including parent (education level, age, values, etc.), child (age, sex, birth order, diagnosis, etc.), and family (SES, income, work status, etc.) characteristics are also likely to affect behavior and development (Bronfenbrenner, 1979; Cochran & Brassard, 1979). Furthermore, the characteristics of settings (Bronfenbrenner, 1979) are likely to affect a person's behavior. The study of the ecology of human development recognizes the multitude of factors that are likely to impinge upon development, and strives to discern how and in what manner they contribute to behavior change. As we shall see, explicit recognition of the myriad of ecological factors that are likely to influence parent, family, and child functioning has major implications for redefining early intervention as well as for conducting research designed to assess the efficacy of early intervention efforts.

Help-Seeking Theory Help-seeking theory predicts an inverse relationship between the need for help from members of formal support networks (e.g., professionals) and the extent to which members of infoi~mal support networks (e.g., friends, neigh-

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bors, kin) can provide or mediate resources necessary for family adaptations and functioning (Gourash, 1978). Evidence from the mental health field (see Mitchell & Trickett, 1980) indicates that provision of support from persons and groups closest to the family is often sufficient in alleviating the need for professional services in dealing with most day-to-day crises and stresses, and professional interventions are needed only when support cannot be provided by one's personal social network (Granovetter, 1973). On the one hand, this indicates that the extent to which help from informal social network members has proactive influences will reduce the need for assistance from more formal support sources; and on the other hand, it suggests that interventions which focus on strengthening informal support networks should reduce the probability of undue reliance on professionals and agencies. Another factor implicit within the help-seeking model will dictate whether or not help is sought. This is the relationship (dissonance) between expected and actual behavior. If no discrepancy exists between perceptions and expectations, then cognitive dissonance (Festinger, 1957) will be minimal and the person unlikely to see the need for help. Thus, parents of a Down syndrome infant, for example, who see no discrepancy between their child's actual behavior and their expectations for the child at a given point in time, may not see the need for help (intervention). In such an instance the failure to perceive the necessity for intervention may have less to do with any lack of concern on the part of the parents (a deficit viewpoint), and more to do with the parents' ability to have adequately provided a nurturing environment for their child (a proactive viewpoint). The ability to recognize the difference between these two sets of conditions has generally been overlooked in early intervention practices. Adaptational Theory

Crnic, Greenberg, Ragozin, Robinson, and Bosham (1983) recently proposed an adaptational model that attempts to explain how ecological influences affect the reactions associated with the birth and rearing of a mentally retarded or handicapped child. The model views the family as a social system; considers those variables that affect adaptations to a retarded or handicapped person; and proposes how ecological influences, including social support, mediate stress and coping associated with the presence of a retarded or handicapped child. According to Crnic et al., adaptations to the birth and rearing of a handicapped child vary tremendously, which suggests that ecological influences within and beyond the family unit account, in part, for the variance associated with differing reactions. These factors include, but are not limited to, social support (Dunst & Trivette, 1984), locus of control (Sarason, Johnson, & Siegel, 1978), individual coping and problem-solving mechanisms (Folkman, Schaefer, & Lazarus, 1979), SES and income (Nihira, Meyers, &

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Mink, 1980), and self-concepts and personal beliefs in self-efficacy (Gregory, 1981). (Blacher, 1984, has recently compiled an extensive review of the different factors that affect family functioning in families with a mentally retarded or handicapped child.) The model proposed by Crnic, Greenberg, Ragozin, Robinson, and Basham (1983) offers a way to integrate the three preceding areas (social network theory, human ecology, & help seeking), and apply the notions to the study of parent, family, and child functioning in families with a child who differs in one or more ways from what a family considers to be "normal." AN ECOLOGICAL MAPPING Figure 1 shows an ecological map for unifying the various themes and notions described in the preceding section. Seven topologically nested settings and structures are specified, each embedded within the next highest level: (a) child, (b) family, (c) formal kinship network, (d) informal kinship network, (e) social organizations, (f) human service agencies and professionals, and (g) policy makers (exosystem). These particular groupings are derived from

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research (Dunst, Jenkins, & Trivette, 1984) which found that these different groups constitute discrete support sources (see Table 2 below). The bottom portion of the figure shows the particular child, parent, and family characteristics; forms of support (intrafamily, informal, & formal); and exosystem influences that are likely to have first-, second-, and higherorder effects on family development and functioning. By no means are the individual characteristics or sources of support/influence exhaustive. Rather, those provided are meant to be suggestive of the myriad of ecological factors that impinge upon a child and family. The inverse relationship between help-seeking from informal and formal sources of support is also shown in Figure 1. Region A shows the largest area consisting primarily of informal social support units, and represents conditions where the adequacy of informal support is the greatest and most helpful. In such instances, the need for help from formal social support systems would be minimal. Region B shows the largest area consisting primarily of formal social support units, and represents conditions where the adequacy of informal support is minimal. In this case, the need for help from formal social support systems would be greatest. The ecological map shown in Figure 1 is designed as a mnemonic for representing the multidimensional nature of factors influencing child, parent, and family behavior. The map is also used at a programmatic level for deciding at which level mediation and provision of support ought to occur.

SOCIAL SYSTEMS T H E O R Y AND EARLY I N T E R V E N T I O N Social systems theory suggests a need for a broader-based definition, an expansion of the goals and objectives, and an alternative model for discerning the impact of different forms of early intervention. The remainder of this paper proposes a number of changes in the manner in which early intervention can be conceptualized, implemented, and evaluated based on the preceding discussions o f the P E P principles and social systems theory.

A Social Support Definition o f Early Intervention Early intervention has generally been defined either at the level of program involvement (i.e., involved vs. not involved) or in terms of the provision of a certain therapeutic or educational treatment. The presumption is typically made that effects observed on an outcome measure are attributable to the intervention, without which the observed effects would not have been manifested. In statistical terms, the variance associated with the intervention is considered a main effect due to the treatment, and the remaining variance not accounted for is considered error variance. This relationship is depicted graph-

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ically in Figure 2 where I is the amount of variance accounted for in the dependent measure by the intervention and the remaining variance is treated as an error (E) component. Figure 2 also shows graphically a social systems conceptualization of early intervention. The variance not accounted for by a particular treatment or program is not considered all error variance but rather variance that is, in part, associated with other forms of "early intervention" (social support) as well as variance associated with other intrafamily and extrafamily influences. In a social systems conceptualization of development, the variance accounted for in the dependent measure can be partitioned into that attributable to ~/n intervention (I), other types of support (S), other explainer variables (O), and an error (E) component. (The statistically minded reader will note that the social systems model produces a smaller error term which increases the power of tests used to establish statistical significance. In contrast, the traditional

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F I G U R E 2. A graphic representation of the sources of variance accounted for by a traditional and social systems perspective of early intervention.

(NOTE. I= Variance associated with a particularly early intervention program, S= Variance associated with other types of support, O = Variance associated with nonintervention related variables, and E= Error compbnent.)

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model o f early intervention produces a larger error term which is likely to decrease the power o f tests o f significance.) The validity o f a social systems perspective o f intervention can be illustrated with data gathered in a study examining the mediating influences o f social support (Dunst, Trivette, & Cross, 1984). As part o f this study, the Family S u p p o r t Scale (Dunst, Jenkins, & Trivette, 1984) was completed by 137 parents o f preschool mentally retarded, physically impaired, and developmentally at-risk children. The FSS includes 18 potential sources o f support (friends, spouse, church, parent groups, professional helpers, etc.) which respondents rate on a five-point scale in terms o f how helpful each source has been in terms o f the care o f their preschool age child(ren). A factor analysis o f the responses on this scale yielded a six factor solution shown in Table 2. It happens that the Specialized Professional Services factor includes three items that are traditionally considered early intervention services: early intervention p r o g r a m , specialized preschool/developmental day care services, and professional helpers (social workers, therapists, teachers, etc.). TABLE 2. Varimax-Rolated Factor Solutions for the Family Support Scale*

Items Informal kinship: Spouse's friends Friends Other parents Own children Church Social organizations: Social groups/clubs Parent groups Co-workers Formal kinship: Relatives/kin Parents Spouse's relatives/kin Nuclear family: Husband/wife Spouse's parents Specialized professional services: Specialized early intervention program Professional helpers School/day care Generic professional services: Professional agencies Family/child's physician

Factor Loadings Factor I (15)~ .753 .742 .722 .598 .523 Factor II (10) .763 .747 .575 Factor III (10) .757 .698 .473 Factor IV (10) .824 .751 Factor V (09) .735 .709 .553 Factor VI (08) .661 .637

*Reprinted from Dunst, C. J., Jenkins, V., & Trivette, C. M. Family Support Scale: Reliabilityand validity. Journal oflndividual, Family, and Community Wellness, 1984, 1, 45-52, by permission of the authors. aPercentage of variance accounted for by the factor.

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A traditional view of early intervention presumes that the services/treatments provided by a program are the principal if not the only variable(s) that affects changes on an outcome measure. To test this assumption, factor scores were computed for each subject in our study, and these scores correlated with a number of outcome variables (personal well-being, family integrity, parental attitudes, child expectations, the nature of parent-child interactions, child progress) that would be expected to be influenced by early intervention services. To discern the unique effects of the six different sources of support, hierarchical multiple regression analysis (MRA) was performed. MRA provides a method for determining the unique contributions of each different source of support to the total amount of variance on the dependent measure. The different sources of support are entered cumulatively, and the increments (I) in R 2 determined to assess the relative importance of each variable. For purposes of testing the assumption implicit in the traditional conceptualization of early intervention, the specialized professional services factor scores were entered first into the analyses, followed by the nuclear family, formal kinship, informal kinship, social organizations, and generic professional services factors. This particular order derives from the embedded relationships among ecological units described above (see Figure l). Table 3 presents the results of the analyses. Early intervention accounted for a significant proportion of variance in only one dependent measure (family opportunities). However, significant amounts of variance beyond that attributable to the early intervention factor were accounted for in all but one dependent measure (Developmental Gain) by informal kinship support and nuclear family support. The informal kinship factor accounted for significant proportions of variance in eight dependent measures and the nuclear family factor in four dependent measures. These findings question the assumptions implicit in the traditional perspective of early intervention, and suggest the need for a broader-based conceptualization of early intervention. Considering all of the above, early intervention can be defined as the provision of support to families of infants and young children from members of informal and formal social support networks that impact both directly and indirectly upon parental, family, and child functioning. Stated differently, early intervention can be conceptualized as an aggregation of the many different types of help, assistance, and services that are provided to families by individuals and groups. Involvement in a home-based or center-based special education program is one type of early intervention, but so is compassion from a friend, advice from a physician, baby sitting by a neighbor, participation in a parent-to-parent support program, and role-sharing between a husband and wife. The types and forms of support that a family is afforded can be expected to be quite varied. The extent to which we can quantitatively capture the nature of support provides a basis for determining the impact of the different interventions either taken together (aggregated) or individually.

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Early Intervention

181

Broad-Based Effects o f Early Intervention The efficacy of early intervention has been primarily gauged using child progress as the principal measure of program effectiveness (see Dunst & Rheingrover, 1981; Simeonsson et al., 1982; Zigler & Balla, 1982). Bronfenbrenner (1979) noted that the focus on child outcomes as the principle index of program efficacy has resulted in an ecologically restricted view of early intervention. Social systems theory suggests both broader-based measures of program effectiveness as well as more ecologically relevant outcome measures (see especially Bronfenbrenner, 1979, Chapter 8). The particular dependent measures that support has been found to influence directly and indirectly tentatively suggest categories of behavior that might be examined as outcomes resulting from the provision of help. A number of investigators have either proposed or employed such expansive measures (Bronfenbrenner, 1979; Lazar & Darlington, 1982; Zigler, & Balla, 1982) (see Dunst, 1985, for a detailed summary). These include personal (parent) well-being and coping; family integrity; parental attitudes, aspirations, expectations for self and child; parent self-concepts and locus-of-control; different dimensions of parent-child interactions (parenting styles and balance-of-power, Bronfenbrenner, 1979); child behavior and development (social and adaptive competence, physical health, emotional and motivational development, and engagement levels, Bailey, Harms, & Clifford, 1983; McWilliam, Trivette, & Dunst, 1985); schoolaged characteristics of the children (retention in grade, special education vs. regular class placement); institutional avoidance; child attitudes, values, and aspirations; and community acceptance. By no means would any one evaluation effort employ outcome measures in all of the above categories of dependent variables. Moreover, social support would not be expected to influence all the outcomes directly. Rather, it would be expected that some of the dependent variables (e.g., parental locus of control) might be intervening variables in affecting other outcomes. Nonetheless, what the proposed categories suggest is that when early intervention is conceptualized in broader-based, social systems terms, one would expect both direct and indirect influences (first-, second-, and higher-order effects) on a host of child, parental, and family outcomes, and inclusion of these measures in the study of the efficacy of early intervention is strongly indicated in order to discern broad-based effectiveness. FAMILY, INFANT AND PRESCHOOL PROGRAM

Program Goal The major programmatic goal of FIPP is proactive empowerment of families through partnerships. This is accomplished through provision and mediation of support that strengthens families as well as other normal socializ-

182

Carl J. Dunst

ing agents (relatives, friends, neighbors, the church, etc.) but which neither replaces or supplants them. The process of strengthening families consists of imparting information, knowledge, skills, and competencies through provision or mediation of support that proactively influences child, parent, and family functioning. Operationally, sources of support are thought of as varying on the continuum oulined in Figure 1 above. The focus of all intervention efforts is the mobilization of informal support networks (Attneave, 1976; Hobbs, 1975) at the level closest to the family to the extent that individuals or groups have or can generate the resources necessary to meet individual family needs. That is, once needs are identified, efforts are made to design and implement interventions that use persons that are members of the family's informal support network rather than relying on members of more remote networks to always provide supportive services. This strategy insures that FIPP does not replace or supplant normal socializing agents but rather strengthens them through establishment of linkages that permit needs to be met. Consequently, FIPP strives to provide only those supportive services that cannot be provided by normal socializing agents. Organizational Structure

FIPP is organized in two broad program components (Comprehensive Services and Special Projects) and numerous subcomponents to accomplish proactive empowerment through partnerships. Figure 3 shows this organization graphically. (A document entitled "Directory of Projects and Services of the Family, Infant and Preschool Program" describes the major components and subcomponents of the program in more detail. It may be obtained by writing Community Resource Services, Family, Infant and Preschool Program, Western Carolina Center, Morganton, NC 28655.) Comprehensive services. Comprehensive Services includes four subcompo-

nents: Child and Family Services, Specialized Intervention Services, Community Resource Services, and Research and Evaluation Services. The Child and Family Services component includes two teams of professionals from psychology, special education, nursing, social work, pediatrics, communications, occupational therapy, and physical therapy. The transdisciplinary services of these teams fall into four broad categories: intervention planning, home-based family services, parent-child support groups (clusters), and mediation of support. The Specialized Intervention Services team focuses on the development and implementation of interventions with children and families for whom more conventional approaches to early intervention are inappropriate, ineffective, and often discriminatory. Child-, family-, and community-level interventions are being developed, implemented, and field-tested by this team.

Early Intervention

183

PROGRAMI[ [ F~'IILY, [~/VIT AI~ PI~SCHOOL I

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PROJECTPROACT(RESPITEPROGR~) PROJECTSTEP-UP (SYSTEMATICTRAINING EXPERIENCES

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Organizational structure of the Family, Infant and Preschool Program.

Community Resource Services focuses on the establishment of supportive linkages between families of handicapped youngsters, FIPP, other service providers, and the general public. Component activities fall into four categories: public awareness, dissemination, technical assistance, and follow-along and bridging of services for families. The major function of Research and Evaluation Services is to evaluate the extent to which the activities of the above three program components have been implemented as planned (process evaluation) and have the effects intended (outcome evaluation). Research designed to isolate factors that contributed to the observed outcomes is also a focus of activities within the component.

Special projects. The FIPP Special Projects component includes 10 direct service programs as well as two research laboratories. Each of the direct service projects is designed to provide or mediate supportive linkages to affect one or more aspects of parent, family, a n d / o r child functioning. The special projects include: (a) Community Connection, a toy, book (child, sibling, &

184

Carl J. Dunst

adult), and equipment lending library, a toy exchange program and a repository of clothing and other resources that can be given to families; (b) FAMIL YPLACE, a drop-in parents' day out program for parents of handicapped and nonhandicapped children, and a parents' learning center for pregnant teenagers and teenage mothers; (c) Let's Grow Together Project, workshops for the older siblings of the handicapped children enrolled in FIPP, and an elementary school resource program for teaching children about handicaps; (d) Parent Advisory Board, a consumer group consisting of families that evaluates existing FIPP services, advises on the need for new services, and suggests ways to improve the FIPP service-delivery system; (e) Project HOPE (Helping Other Parents through Empathy), a parent-to-parent support program designed to establish linkages among families who share common concerns about rearing a handicapped child; (f) Project PAVE (Parents Are Volunteers who Excel), a training program that builds upon parents' natural parenting skills by empowering them to serve as support personnel in preschool classes; (g) Project PROACT, an in-home respite program designed to reduce the demands of rearing a handicapped youngster through provision of specialized child-care support; (h) Project STEP-UP (Systematic Training Experiences Provided to Underserved Preschoolers), a model-demonstration preschool program designed to optimize the learning opportunities of severely handicapped children; (i) Special Edition, the FIPP parent newsletter which emphasizes the empowerment of parents through exchange of information; and (j) Project SUNRISE (Support Network of Rural Intervention Services), parent-operated preschool programs (co-ops) that empower parents with teaching skills necessary to provide preschool services to handicapped youngsters.

RESEARCH FINDINGS

The extent to which ecological influences, including social support, impact upon child, parent, and family functioning in a manner predicted by social systems theory has been examined in a series of studies conducted in our Child Development Laboratory. A detailed description in the methodology employed in these investigations (Dunst, McWilliam, Trivette, & Galant, in press) as well as detailed accounts of the individual studies (Dunst & Trivette, 1984; Dunst, Trivette, & Cross, 1984; Dunst, Trivette, & Cross, in press-a, in press-b; Trivette, 1982; Trivette & Dunst, 1984) can be found elsewhere. The major goals of our research are to describe inter- and intra-individual changes in child, parent, and family functioning; identify factors associated with these changes; study changes within and across ecological settings; and translate findings into interventions that can optimize family functioning and development (Baltes, Reese, & Nesselroade, 1977). To date, six studies have been completed.

Early Intervention

185

The subjects were families who participated in FIPP. In each study the parents completed a number of questionnaires about themselves, their families, and children. In most studies, the parents were interviewed about their social support networks, and videotaped interacting with their children from which parental styles of interactions are coded. The independent variables included parental characteristics (age, education level, and locus of control, Norwicki & Duke, 1974; Paulhus & Christie, 1981), family characteristics (SES, Hollingshead, 1975, and income), child characteristics (age and sex), child diagnosis (level of retardation and diagnostic group), and social support. The scales used to measure support included Family Support Scale (Dunst, Jenkins, & Trivette, 1984), Maternal Social Support Index (Pascoe, Loda, Jeffries, & Earp, 1981), Parent Role Scale (Gallagher, Cross, & Scharfman, 1981), and Psychosocial Kinship Inventory (Pattison, DeFrancisco, Wood, Frazier, & Crowder, 1975). The FSS is an 18-item scale that yields indices of degree of helpfulness of support (FSS Satisfaction) and number of sources of support (FSS Number). The MSI is a 7-item scale that yields an overall index of qualitative and quantitative aspects of support (MSI Total) and intrafamily support as manifested in role sharing (MSI Number). The PRS is a 20-item scale that yields indices of intrafamily role satisfaction (PRS Satisfaction) and intrafamily support as manifested in role sharing (PRS Number). The PKI yields indices of the number of persons in the respondent's social network (PKI Number), qualitative ratings of provision of support (PKI Satisfaction), the extent to which network members know one another (PKI Density), and the frequency of contacts that the respondent has with network members (PKI Contacts). Not all the independent variables were used in every study; rather, the particular independent variables employed were dictated by the specific aims of the individual studies. The dependent variables included measures of parent, family, child, parentchild, and child functioning. The scales employed included Questionnaire on Resources and Stress (Holroyd, 1974), Psychological Well-Being Index (Bradburn & Caplovitz, 1965), Parent Expectation Scale (Dunst, 1983; Schaefer & Edgerton, 1977), Parent-Child Interaction Rating Scale (Dunst, 1984), ParentChild Interaction Scale (Farran, Kasari, & Jay, 1983), Styles of Parental Interaction Scale (Dunst, in preparation), Bayley (1969) scales, Griffiths (1954, 1970) scales, and Stanford-Binet (Terman & Merrill, 1960) scales. The QRS includes 15 scales that measure the personal well-being of the respondent in relationship to the care of a child, parent attitudes toward their child, family integrity, and parent perceptions of child functioning. The PWI measures the emotional well-being of the respondent in relationship to general life events. The PES measures the extent to which parents expect their children to achieve different levels of independence in the school-age and adult years. The Parent-Child Interaction Rating Scale (Dunst, 1984) is a parent-completed scale that measures how many and how often parents play different games with their children. The Parent-Child Interaction Scale (Farran et al., 1983)

186

Carl J. Dunst T A B L E 4, Correlations Well-Being,

Between the Independent Time Demands,

Variables and

and Family Integrity

Dependent Measures QRS Time Demands

Q R S E m o t i o n a l a n d Physical P r o b l e m s I n d e p e n d e n t Variables Personal characteristics: Mother's age Father's age Mother's education level Father's education level Family characteristics: SES Income Child characteristics: Chronological age Sex (l =Male, O = Female) Child diagnosis: Developmental quotient Group: Mentally retarded Group: Physically impaired Social support: FSS satisfaction FSS number PRS role satisfaction PRS numbera MSI total score MSI number a PKI network size PKI satisfaction PKI network density PKI contacts

l

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NOTES. Decimal points have been omitted. The numbers under each dependent variable indicate the study in which the dependent measure was used. The sample sizes for the six studies were: Study I (N = 137), Study 2 (N = 40), Study 3 (N = 59), Study 4 (N = 62), Study 5 (N = 62), and Study 6 (N = 103). Studies 3 and 4 were, respectively, a follow-up study of a subsample of subjects included in Study I and a replication of the study. The correlations for the personal characteristics variables are therefore identical for the studies 3 and 4 and are reported only once. Missing correlation coefficients indicates that the independent variable was not used in that study. alncreases in PRS Number and MSI Number are indicative of lack of intrafamily support. *p < .05 **p<.01 ***p<.O05

was completed by a person familiar with the parent and child (i.e., FIPP staff) who rated the amount, quality, and appropriateness of interactions. The Styles of Parental Interaction Scale includes 12 mutually exclusive categories of interactive styles that are ordered on a bipolar continuum ranging from (a) caregiver passivity to (b) joint-action between the parent and child to (c) caregiver control and coercion. Ratings of individual styles were coded from videotapes of play episodes. The developmental test data were used to determine child progress.

Early Intervention TABLE

Correlations

4

QRS 1

3

01 15 09 23*

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(continued)

Measures

Family Integration

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Variables and Well-Being,

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4.

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187

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Correlational A nalyses

To discern the relationships between the independent and dependent variables, bivariate correlational analyses were first performed. Table 4 shows the results for several personal well-being scales and a family integration scale used in a number of the studies. The directions of the relationships were almost entirely as predicted. Mothers' and fathers' education levels as well as SES and income tended to be significantly correlated with the four dependent measures. Sex was the only child characteristic measure generally correlated with the dependent measures. The child diagnosis variables were not generally related to either QRS emotional and physical problems or PWI well-being, but were consistently correlated with both time demands and family integration. Nearly two-thirds (62%) of the social support measures were significantly correlated with the four dependent measures. Increased provision of support was related to decreasecl emotional and physical problems and time demands, and increased well-being and family integration.

188

Carl J. Dunst

Table 5 shows the correlations between the independent variables and the remaining QRS scales. (These particular scales were used only in Study 1.) For the four parent attitude scales, the child diagnosis variables and, to a lesser degree, the social support variables were significantly correlated with the dependent measures. Attitudes were more likely to be positive among respondents with children with higher DQs and among respondents with increased provision of support. Personal characteristics, family characteristics, child diagnosis, and intrafamily support (PRS) were consistently correlated with the two family outcome measures. The direction of the relationships were all as expected. As parents' ages, educational levels, family income, child's DQ, and intrafamily support increased, family opportunities increased and financial problems decreased. The respondents' perceptions of their children's behavior were predominately correlated with child diagnosis and, to a lesser degree, social support. Increased social integration (use of community resources and social acceptance) was reported by respondents with children with higher DQs and respondents with increased provision of support. Perceptions of child physical limitations and behavior difficulties were more likely to be reported by respondents with children with lower DQs, a diagnosis of mental retardation, and minimal provision of support. The extent to which the independent variables were correlated with the different measures of parent-child interaction is shown in Table 6. Both the number of games and frequency at which the parents played the games with their children were significantly correlated with father's education level, child DQ, and FSS satisfaction. Individual styles of interaction were differentially correlated with the various independent variables. For example, as parents' education levels and SES increased, the use of both passive and directive styles of interaction decreased. Likewise, as child age increased, contingent-responsiveness (e.g., lap games) decreased, and directive styles increased. Social support was correlated with only three interactive styles, although the nature of relationships were as expected. As support increased, both passive and directive styles decreased and facilitative styles increased. With regard to ratings of the amount, quality, and appropriateness of parent-child interactions, there were significant sets of correlations with the personal and family characteristics variables, child age, physical impairment, and MSI satisfaction. The differences in the patterns of correlations for the three parent-child interaction measures are due, in part, to differing measurement procedures. Parent-child games were assessed using a self-report measure that the parents completed on themselves. Individual styles of interaction were rated by independent observers from videotapes of parent-child play episodes. And amount, quality, and appropriateness of parent-child interactions were rated by a staff member (case coordinator) from the intervention program who was familiar

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with the family. Moreover, the findings from the Parent-Child Interaction Scale (Farran et al., 1983) must be interpreted with caution since the scale appears to be as much a measure of parents' education level and SES as it does of parental patterns of interaction resulting from intervention (see Figure 4). Table 7 shows the correlations between the independent variables and two child progress measures. Not surprisingly, the child diagnosis variables were most related to child progress. The family characteristics set produced the P<.05..

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(Notes. See the text for a description of the variables that entered into aggregated sets. Negative correlations are shown by an * (asterisk) above the independent variable.)

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second largest rlumber of significant correlations, followed by parents' age. Only a few support measures were significantly correlated with child progress, although the direction of the relationships were as expected. As support increased, so did child progress. Taken together, the patterns of covariation obtained through the correlational analyses indicate that support has positive influences on child, parent, and family functioning. In addition, the data clearly illustrate the myriad of factors that are related to parent, family, parent-child, and child behavior. Perhaps most noteworthy were the conditional relationships between the various independent and dependent variables. Rather than being global in influence, the different sets of independent measures, and variables within sets, were differentially related to the different outcome measures. To make further sense out of the literally hundreds of correlation coefficients presented in Tables 4-7, a data aggregation process was employed that averaged intergroup and intragroup correlation coefficients to obtain eStimates of the population coefficients for different subsamples of subjects as well as for different measures of similar behavioral constructs. (There are both advantages and disadvantages to this procedure. The advantages include the reduction in spurious findings due to the large number of analyses that were performed; and the fact that replication of significant findings across studies produces consistently high mean correlations, and thus the findings may be taken as particularly robust. The major disadvantage is that specificity in detecting relationships between particular independent measures and particular dependent measures is reduced, and thus differential effects may be masked.) The independent variables for this analysis were parents' age (both mother's and father's), parents' education level (both mother's and father's), SES (SES and income), child's age, child DQ (developmental quotients), FSS support (satisfaction and number), PRS support (satisfaction and number), and MSI support (total and number). The dependerit variables were personal well-being (QRS emotional and physical health, QRS time demands, and PWI wellbeing), family integrity (QRS family integration, QRS family opportunities, and QRS financial problems), parental permissiveness (QRS overprotection and QRS overcommitment), parental attitudes toward child (QRS negative attitudes and QRS pessimism), parent perceptions of child functioning (QRS physical limitations, QRS social acceptance, and QRS behavior difficulties), parent-child play (number and frequency of parent-child games), parent-child interactive patterns (amount, quality, and duration), interactive styles (phasing, facilitative, and elaboration), and child progress (DQ difference scores and developmental gain scores). The nine dependent variables are roughly ordered with regard to degree of influence of social support on the dependent measures, with support having the most direct effect on personal well-being and the least direct (indirect) effect on child progress. Correlation coefficients were transformed to Fischer's z coefficients; the arithmetic mean of the zs computed for the variables that entered into the

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aggregated set; and the mean zs converted back to the corresponding mean r. The direction of all correlation coefficients were adjusted so that increases in the independent variables were related to positive influences in the dependent variables. The degrees of freedom for the mean rs based on independent samples were the sum of the separate sample sizes. The degrees of freedom for mean rs based on the same sample of subjects were the sample size for the group. The pattern of results for the aggregated analyses is shown in Figure 4. Social support was related to 5 of the 9 dependent measures. The social support measures were (a) all significantly related to personal well-being and family integrity; (b) differentially related to parental permissiveness and parent perceptions of child functioning; (c) related to only one aspect of parent-child interactions (parent-child play); and (d) not at all related to parent attitudes toward the child or child progress. The direction of significant relationships were all as expected. As provision of support increased so did positive influences on parent, family, parent-child, and child functioning. With regard to first-, second-, and higher-order effects, the findings for the social support analyses indicate that support becomes progressively less related to the different outcomes as the degree of influence becomes more removed from the recipient of support. Of the nonsupport independent variables, child DQ was significantly related to seven dependent measures. Parents' education level, SES, and child's age were each significantly related to three of the outcome measures. Therefore, level of child functioning and support were the independent variables consistently related to the majority of dependent variables, indicating that child's DQ and social support had the greatest influence on child, parent, and family behavior.

Multiple Regression Analyses Since it would be expected that a number of the independent variables used in our studies would themselves be correlated and therefore have shared variance, hierarchical multiple regression analyses (Cohen & Cohen, 1983) have been performed in order to discern the unique contributions of the independent variables to the dependent variables, particularly the social support measures. In the analyses performed thus far, the unique amount of variance accounted for by social support has been determined after the family characteristics (SES and income), child characteristics (age and sex), and child diagnosis (DQ and diagnostic group) variables have been partialled from the total amount of variance accounted for in the dependent variables. (Detailed accounts of the findings from the studies that have used this analytical method can be found elsewhere, Dunst & Trivette, 1984; Dunst, Trivette, & Cross, 1984; Dunst et al., in press-b). A number of consistent findings have emerged from the regression analy-

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ses. First, social support is generally related to parent, family, parent-child, and child outcomes even after the effects of the covariate sets have been partialled. Inasmuch as support accounts for significant amounts of nonshared variance, its importance as a mediating and intervening variable is strongly indicated. Second, qualitative rather than quantitative dimensions of support are the most important mediators of family functioning. Satisfaction with provision of support consistently emerges as being more important than number of sources of support. Third, personal well-being is generally related to intra- and extra-family informal support and formal support. (Intrafamily support refers to support from one's spouse or mate, one's own children, and other members of the nuclear family; extrafamily support refers to support from friends, relatives, and other acquaintances; and formal support refers to support from professionals and professional agencies.) Our findings indicate that both emotional and physical well-being can be influenced by different members of a person's support network, suggesting that help from any level of ecological influence (see Figure 1) can have positive effects on healthrelated outcomes. Fourth, family integrity is most related to intra-family and informal provision of support. Family functioning is almost always influenced by support within the household and from friends, neighbors, and kin, and rarely influenced by formal provision of support. Fifth, parental attitudes toward their child are most related to extrafamily support whereas parental overcommitment and overprotection are most related to intrafamily support. That is, the extent to which a parent is likely to have positive attitudes toward his or her child is influenced primarily by support from friends, neighbors, and kin, whereas the extent to which a parent overprotects or invests undue time to their child is influenced primarily by support from one's spouse or mate, one's other children, and other members of the nuclear family. Sixth, parental perceptions of child functioning are most related to extrafamily support. Parents' perceptions of both child competencies and the degree of the childrens' impairments are most influenced by support outside the home provided by friends, neighbors, and kin. Seventh, different dimensions of parentchild interactions are differentially related to different forms of support (see Table 6). Eighth, actual developmental progress by the children is generally unrelated to any type of support. Taken together, these results show that social support has first-, second-, and higher-order effects on parent, family, and parent-child functioning, and indicates that support constitutes a form of intervention when conceptualized in social systems terms. Social systems theory and multiple regression analysis provide, respectively, the conceptual and analytical framework for the experimental evaluation of early intervention efforts (Dunst, 1985; Dunst, McWilliam, Trivette & Galant, in press). To the extent that an aggregated set of measures of social support accounts for a significant proportion of variance beyond that attributable to competing independent variables, we have evidence documenting the unique

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effects of early intervention. To the extent that different types and forms of support account for significant proportions of variance, the differential effects o f early intervention are discerned. Thus, as well as providing a basis for rethinking early intervention practices, social systems theory offers an alternative framework for conducting program evaluations designed to isolate the effects of provision of support. Our research program has produced the type of evidence which indicates that early intervention, when conceptualized in social systems terms, has broad-based impacts upon child, parent, and family behavior (first-, second-, and higher-order effects). Our current research efforts are designed to isolate the components of support, and the manner in which these different components affect parent, child, and family functioning. SUMMARY The purpose of this paper was to propose an alternative way for conceptualizing, implementing, and evaluating early intervention programs. Social systems theory was used as a framework for proposing a broader-based definition of early intervention as well as a set of decision rules regarding the types of interventions that are likely to affect child, parent, and family functioning. Early intervention was defined as the provision of support to families of infants and young children from members of informal and formal social support networks. Social systems notions were operationalized in terms of Proactive Empowerment through Partnerships (PEP). Proactive intervention focuses on strengthening and supporting families. Empowerment emphasizes the generation and allocation of power (decision-making) in the form of access and control of physical, emotional, and instrumental resources through provision of support. Partnerships between families and professionals were proposed as the mechanism for proactive empowerment. The PEP principles are designed to provide a framework that will optimize the benefits of early intervention efforts. Data from a number of studies were presented to support the social systems approach to conceptualizing early intervention practices. The findings indicated that early intervention is but one form of social support, and that social support as well as other explainer variables were significantly related to a number of child, parent, and family outcomes. Taken together, the data provide converging evidence to indicate that different forms and types of support have powerful influences on behavior, and that support has first-, second-, and higher-order effects on child, parent, and family functioning. It is argued that a broader-based conceptualization of early intervention can lead to better designed studies needed to isolate the benefits derived from provision of different types and forms o f support.

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