117 Short-term outcomes and six-month follow-up of BEAR 6 The study was open-labelled meaning that both participants, preventive healthcare professionals at the well-baby clinics and therapists knew to which group a participant was assigned. However, to maintain objectivity assessors responsible for rating parentchild interactions for the primary and secondary outcome measures, were masked, and thus were unaware of the group allocation. Intervention Care-as-usual (CAU) Children in the control condition received CAU. This encompassed typical care pathways for infants and toddlers presenting with concerns related to social-communicative, behavioral and/or play development. These trajectories normally vary considerably and are influenced by several factors, e.g. the severity of symptoms, parental preferences, professional considerations, and the availability of healthcare services in the respective region. Examples of care trajectories under CAU included referrals to a speech- and language therapist, a physical therapist or a specialized mental healthcare organization. Additionally, it was not uncommon for a wait-and-see approach to be adopted by parents and/or professionals. In such cases, CAU could entail that no treatment was offered to children and parents in the control condition. Blended E-health for children At early Risk (BEAR) Children and parents allocated to the BEAR group received seven in-person home visits, and parents were encouraged to work through five additional e-learning modules. A paper version of the e-learning modules was provided for parents on preference. A detailed description of the theoretical background, development and content of the BEAR intervention can also be found in the published protocol paper (Snijder et al., 2022). The intervention was carried out by trained professionals who were closely related to the WBC (i.e. first line healthcare professionals). The aims of BEAR include: 1) enhancing parental awareness, 2) supporting child development and parent-child interaction and 3) guidance to follow-up care (if needed) and appropriate triage. Participants Recruitment took place from November 2019 to March 2023. Families were eligible to participate when the following inclusion criteria were met: a) a screen positive result (≥3) on the CoSoS or a screen negative result (<3) though serious professional and/or parental concerns regarding social-communicative development of the child; b) aged between 12-30 months; and c) at least one of the parents was able to understand and speak Dutch. Families were excluded if there were issues that limited the possibility to engage in an home based intervention, e.g., significant chronic illness of the child, severe parental psychopathology (such as depression, psychosis, substance use disorder), a severe intellectual disability of both the child and parents, severe vision and hearing impairments and/or severe motor impairments.
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