164 Chapter 7 Lastly, cost-effectiveness analyses should be conducted to determine whether investing in a pre-emptive intervention like BEAR is worth the benefit in the long-term. Information regarding cost-effectiveness and potential savings is particularly relevant for government and municipal preventive programs and therefore vital for broader implementation. To summarize, there are numerous opportunities for further research on the BEAR intervention. As a next step in advancing this research, it is important to first hold an expert meeting, bringing together BEAR professionals, scientists, clinicians, and experts by experience. General conclusion This thesis aimed to contribute to the knowledge about the early detection process of young children with a neurodevelopmental vulnerability and to facilitate timely access to early interventions for infants and toddlers (along with their families) for whom concerns exist regarding their social-communicative development. The different studies and the combination of both quantitative and qualitative methodologies provided a comprehensive understanding in parents and professionals perspectives regarding the challenges, benefits and improvement strategies of early detection and emphasizes the complexity of the early detection process. Findings from our studies advocate for adopting a family-centered approach that involves active collaboration between parents and healthcare providers. Screening tools (for example the CoSoS) and the availability of pre-emptive interventions (intervening at a very early age without the need for a diagnosis) are considered effective means to achieve the overarching goal of providing timely and appropriate care for every family who faces early developmental concerns. The exploration of the effects of the BEAR intervention, as a pre-emptive approach for children with social-communicative vulnerabilities, demonstrates the potential benefits of early, low-intensity interventions in improving parental skills and, through that, parent-child interactions. This thesis also underscores the need for culturally sensitive approaches and the importance of ensuring that interventions are accessible for diverse populations. Future research should focus on optimizing the BEAR intervention by determining the optimal intensity and duration, exploring its long-term effects, and by examining the possibilities and value of including other social environments (like preschool) as active partners within BEAR intervention trajectories. Additionally, cost-effectiveness analyses are necessary to evaluate the overall value of pre-emptive interventions like BEAR. Throughout the course of this PhD trajectory, both the developers and researchers of BEAR have extensively discussed a dilemma: whether to invest early and more intensive in stimulating the behavior of the child OR to focus on guiding and supporting their parents as a primary goal. The results of these studies advocate for the latter approach, which also aligns the current clinical and
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