96 Chapter 5 environment, (2) becoming interested in social contact, (3) increasing social contact and communication, (4) improving social communication and (5) increasing flexible behavior. At its core, BEAR is about following the child’s interests, matching the child’s developmental level and pace, and ensuring fun in the interaction as the basis for all further learning. A paper version of BEAR is available for parents who prefer it. An outline of the BEAR intervention’s content and planning is provided in Table 1. Table 1. Outline of the content of the BEAR intervention Home visit Content Attendees Duration 1 A twelve minute play interaction between parent and child will be videotaped, enabling professionals to generally estimate the social and communicative competencies of the child. Together with parents, three specific modules are chosen. Child, parent, BEAR professional a 90 minutes 2-6 Parents complete e-learning modules accompanied by weekly home visits by the BEAR professional. The e-learning provides a theoretical introduction to the themes that will be discussed, are tailor made to the needs of parent and child and are implemented into practice during the home-visits. Child, parent and BEAR professional E-learning modules take about 45 minutes each Home visits take about 60 minutes. 7 The last session is a summary and evaluation of the learning process of child and parents. If serious concerns continue to exist, clinical assessment, diagnostic referral and/or further treatment can be advised. Specialized knowledge from the BEAR supervisor will enable to come up with an appropriate advise. Child, parent, BEAR professional 90 minutes a The ASD expert supervises remotely throughout the entire process. Cluster randomized controlled trial Study design and randomization The effectiveness of the BEAR intervention will be studied in a two-armed cluster RCT (ratio 44:44). Well-baby clinic locations in the Nijmegen area in the Netherlands will be randomly assigned to either the BEAR or Care-as-usual (CAU) condition. Before randomization, the wellbaby clinics will first be matched based on two characteristics (amount of children visiting that well-baby clinic and ethnicity/social-economic background of the specific area) to ensure an equal distribution in the two groups. By coin flipping, the well-baby clinics are at random assigned to either the BEAR condition or CAU. Consequently, the study is open-labeled; both
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