69 Parental experiences with early identification and care 3 and raise awareness amongst professionals and parents. International examples of this are the “Learn the Signs: Act Early” initiative by the Centers for Disease Control and Prevention (www. firstsigns.org), and the Autism Navigator website (www.autismnavigator.com), an initiative by the Autism Institute at the Florida State University College of Medicine. All these strategies aim to increase awareness amongst both parents and professionals, acknowledging at the same time the importance of a shared decision making process in the early identification of children that would otherwise be stuck in the ‘B’ compartment, receiving adequate care later than preferred. An important note on increasing awareness of ASD symptoms in infancy and toddlerhood is that is has to go hand in hand with easily accessible and appropriate healthcare (Dietz et al., 2007; Oosterling et al., 2010; Snijder et al., 2021). Therefore, a strategy to tackle the difficulties mainly of the ‘A’ compartment, but also possibly in the ‘B’ group, is offering accessible early interventions in a high-risk group. Without the need of an ASD diagnosis, these interventions are presumably more acceptable for those parents who do not yet have concerns (then for example a referral to a specialized center for infant psychiatry), and is at the same time an appropriate form of healthcare for the children in the ‘yellow’ compartment for whom referral for a diagnostic trajectory might not be applicable yet (because of unclear risk signals). Previous studies show promising outcomes of early interventions in at-risk groups and can reduce the severity of autism symptoms, enhance parent-child communication and improve parents’ responsiveness (Green et al., 2017; Kasari et al., 2014). Another new example of this is the BEAR intervention, recently developed in the Netherlands and based on effective naturalistic developmental behavioral early interventions (Bruinsma, Minjarez, Schreibman & Stahmer, 2020). BEAR stands for Blended E-health for children at eArly Risk and is an intervention offered to parents of young children identified as at risk for ASD. It concerns a short, parent adopted and easily accessible intervention that can be applied in the pre-diagnostic phase. For some children, this intervention will be the influx to more intensive and specialized healthcare, whereas for other children BEAR will function as a preventive intervention. BEAR is delivered by a skilled professional working in primary healthcare, ideally under supervision of a specialized mental healthcare expert. To this end, it also improves the collaboration between different healthcare organizations (an improvement strategy suggested by both parents and professionals). As such the training can also be perceived as a way of triage, where the professional supports parents in navigating the healthcare system, while parents themselves are actively involved during the whole process. Through all of this, it is hypothesized that easily accessible interventions such as BEAR will identify children that otherwise would be stuck in the ‘A’ and possibly ‘B’ compartment, and also provide adequate care to the ‘yellow’ children (Oosterling et al., 2019). Also, as known from the family-centered care principles, it is likely that the strategies of BEAR will enhance shared-decision making and boost collaboration between parents and professionals. Currently, the effectiveness of BEAR is being studied in a separate study.
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