76 Chapter 4 The innovative value of BEAR lies in the combination of an early start of intervention (prediagnosis), easy accessibility (no waiting list and at home), and strong collaboration between first line (executer) and specialized mental healthcare (supervisor). Without the need of an ASD diagnosis, BEAR is presumably more acceptable and better-received by parents who have relatively minor concerns, or who are somewhat ambivalent about getting help or those who dread diagnostic assessment. Additionally, it is seen as a suitable healthcare option for children who exhibit unclear clinical signals/ “red flags”. For more information regarding the development, theoretic framework, and content of the BEAR intervention we refer to our published protocol paper (Snijder et al., 2022). The effects of the intervention are currently being studied through a two-armed cluster randomized controlled trial (RCT). Before starting the cluster RCT, a pilot study was conducted in a small sample. Based on insights gained from the pilot sample, potential research problems for the cluster RCT were identified and solved to maximize the potential of a successful study design. Therefore, the aim of the current study is to 1) test the feasibility of the proposed research design, identify and solve potential research difficulties, and 2) to present the results of pilot testing the new BEAR intervention in a small sample (N=6). Methods Study design and procedures A pilot study was conducted in collaboration with two well-baby clinic locations in Nijmegen, the Netherlands. The study was approved by the medical ethics Committee on Research involving Human Subjects (CCMO, Arnhem-Nijmegen) and the local institutional research committee of Karakter, child-and adolescent psychiatry center. Both well-baby clinic locations were allocated to the BEAR condition, there was no control group. Preventive care physicians who worked at the two participating well-baby clinics received additional training in screening for early ASD symptoms and administering the CoSoS questionnaire (Communication and Social development Signals, Dietz et al., 2006). Training consisted of preventive care physicians completing an e-learning and live-online learning to improve their knowledge and self-confidence in recognizing possible early clinical risk behaviors. Children and their parents were eligible to participate if the following criteria were met: a) a screen positive result (≥3) on the CoSoS OR with a screen negative result (<3) but despite serious concerns regarding social-communicative development; b) aged between 12-30 months; and c) at least one of the parents was able to understand and speak Dutch. Exclusion criteria were family issues that limited the likelihood to engage in a home-based
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