Social support and vulnerability: state of the art in relation to families and children.

The purpose of this presentation is to review the concepts of social support and vulnerable families and children, propose a theoretical model on coping and adaptation, and ascertain any significant implications for the delivery of health care services and future research. The review of the literature indicates that major problems persist in the classification, conceptualization, empirical investigation, and clinical application of social support due to a lack of clarity regarding the definition of social support and how it works. Related perspectives such as bonding, child development, and child rearing also reaffirm the need for and the utilization of social support. High-risk factors, such as low maternal age, poverty, single parenthood, and long-term health problems, increase the vulnerability of families and children. This literature strongly suggests that the interactions of adults and children with supportive members of their social networks are important in the development of essential cognitive and social skills, as well as for the promotion of security and comfort. Supports from individuals, families, and groups also are associated with more successful adaptation and favorable outcomes. Despite numerous articles and research projects, however, questions concerning how social support works to assist vulnerable children and families remain. Seven factors are proposed as a theoretical model to identify threatening situations and coping difficulties so that appropriate support can be provided. These factors are surprise, experience, confusion, perceived effectiveness, perceived allies, perceived uniqueness of threat, and overload. Additional testing is required for this model so that a more meaningful investigation and utilization of social support can be established. Additional research also is indicated to determine the specific types of support needed in the presence of certain factors, network style preferences, the supply and demand for support over the life span, and cultural aspects of coping and support processes. The position that appropriate social support will promote mastery and self-determination has significant implications for health professionals.