The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol).

Background: Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. Aim: To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Method: Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. Outcome: The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Impact: Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. Clinical Trial Registration: ClinicalTrial.gov, identifier NCT05023447.

Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system.

LAY ABSTRACT: Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention-based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.

A handbook for Rhythmic Relating in autism: supporting social timing in play, learning and therapy.

We present a handbook for Rhythmic Relating, an approach developed to support play, learning and therapy with young autistic children, unconventional communicators, and autistic people who have additional learning needs. Rhythmic Relating is based on the Movement Sensing perspective, a growing body of research that recognizes that autistic social difficulties stem from more basic sensory and motor differences. These sensorimotor differences directly affect embodied experience and social timing in communication. The Rhythmic Relating approach acknowledges that autistic/non-autistic interactive mismatch goes both ways and offers bidirectional support for social timing and expressive action in play. This handbook is presented in an accessible fashion, allowing the reader to develop at their own pace through three skill-levels and encouraging time out to practice. We begin with the basics of building rapport (seeing, copying, and celebrating interactional behaviors), introduce the basic foundations of sensory stability, and then move on to developing reciprocal play (using mirroring, matching, looping, and "Yes…and" techniques), and further to understanding sensory impetus (using sensory contours, accents and flows) and its potential in support of social timing. Rhythmic Relating is offered in support of each practitioner's creative practice and personal sense of fun and humor in play. The model is offered as a foundation for interaction and learning, as a base practice in schools, for Occupational Therapists, Speech Therapists and Physiotherapists, and can also provide a basis for tailoring creative arts therapies when working with autistic clients.

Early pirfenidone treatment enhances lung function in idiopathic pulmonary fibrosis patients.

This editorial comments on the study by Lei et al investigating the efficacy of early treatment with pirfenidone on the lung function of patients with idiopathic pulmonary fibrosis (IPF) published. This study evaluates the efficacy of early treatment with pirfenidone on lung function in patients with IPF. The early and advanced stages of IPF are defined, highlighting the drug's benefits. While prior research indicates pirfenidone's effectiveness in advanced IPF, this study focuses on its advantages in early stages. The study emphasizes the importance of computed tomography imaging alongside biochemical data and lung function tests for a comprehensive analysis of symptom relief. Results show that early intervention with pirfenidone significantly reduces disease progression and preserves lung function, underscoring its potential as a critical treatment strategy in early IPF.

The Role of Early Intervention Therapy in Neurodevelopmental Outcomes of Premature Infants.

Neurodevelopmental impairments are known to be more common in premature infants. Premature and low birth weight babies are now more likely to survive because of modern technologies and advancements in perinatal and postnatal care. However, long stays and exposure to harsh stimuli in neonatal intensive care units are known to have a negative impact on the developing neonatal brain. Therefore, the goal of early intervention (EI) is to assist an infant and their family in achieving the greatest potential outcome. This encompasses a broad spectrum of strategies and structured programs that might differ in many aspects, such as who should implement them, where they should take place, and when they should begin. They aid in minimizing brain damage and optimizing growth via varied sensory and motor stimuli. Current evidence supports the initiation of EI therapy soon after birth, starting from neonatal intensive care units and continuing post-discharge. This research is important, especially in developing countries like ours, owing to the increasing number of premature deliveries due to multiple reasons. The focus of this article is to analyze the various protocols and applications available to us for the implementation of EI therapies and their benefits.

Non-invasive TMS attenuates neuropathic pain after spinal cord injury associated with enhancing brain functional connectivity and HPA axis activity.

Patients with spinal cord injury (SCI) often suffer from varying degrees of neuropathic pain. Non-invasive repetitive transcranial magnetic stimulation (TMS) has been shown to improve neuropathic pain, while the appropriate intervention strategies of TMS treatment and how TMS affects brain function after SCI were not entirely clear. To investigate the effects and mechanisms of TMS on neuropathic pain after SCI, high-frequency TMS on primary motor cortex (M1) of mice was performed after SCI and pain response was evaluated through an electronic Von-Frey device and cold/hot plates. Functional magnetic resonance imaging (fMRI), bulk RNA sequencing, immunofluorescence and molecular experiments were used to evaluate brain and spinal cord function changes and mechanisms. TMS significantly improved SCI induced mechanical allodynia, cold and thermal hyperalgesia with a durative effect, and TMS intervention at 1 week after SCI had pain relief advantages than at 2 weeks. TMS intervention not only affected the functional connections between the primary motor cortex and the thalamus, but also increased the close connection of multiple brain regions. Importantly, TMS treatment activated the hypothalamic pituitary adrenal (HPA) axis and increased the transcript levels of genes encode hormone proteins, accompanied with the attenuation of inflammatory microenvironment in spinal cord associated with pain relief. Totally, these results elucidate that early intervention with TMS could improve neuropathic pain after SCI associated with enhancing brain functional connectivity and HPA axis activity which should be harnessed to modulate neuropathic pain after SCI.

The same but different too: Depression profiles in young adults without a history of psychiatric treatment identified using Bayesian and partial correlation networks.

Depression is a heterogenous diagnostic construct; however, dynamic interactions between specific depressive symptoms across their qualitatively different profiles remain largely unknown. The study aimed to recognize the most prevalent profiles of depressive symptoms and assess their dynamics in young adults without a history of psychiatric treatment. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). The data were assessed for all theoretical and empirical combinations of depressive symptoms in participants with a positive screening for depression. The profiles identified in the majority of participants were analyzed using partial correlation and Bayesian networks. Data from 3583 individuals with a positive screening for depression were analyzed. Out of 382 theoretical profiles, 150 profiles (39.3%) were present in this dataset. The majority of participants (56.8%) showed 4 profiles of depressive symptoms including the profile with all depressive symptoms present, the profile without suicidal ideation, the profile without psychomotor impairment, and the profile without both psychomotor impairment and suicidal ideation. The profiles differed largely in terms of their dynamics and symptoms that are necessary to activate the whole network. The network characteristics within specific profiles did not differ significantly across the level of difficulties attributable to depressive symptoms. Our findings indicate that depression emerging in young adults shows a limited number of symptom profiles. However, dynamics of depressive symptoms differs largely between specific profiles regardless of functional impairment indicating the need to personalize therapeutic approaches. Future studies should further disentangle the heterogeneity of depressive symptoms, e.g., by dissecting the symptoms that are combined together by single PHQ-9 items (i.e., hypersomnia and insomnia; psychomotor agitation and retardation).

Implementing early intervention in psychosis in Indonesia: A scoping review.

In order to prevent the immense burden and costs associated with psychotic disorders, (preventive) interventions in the early phase are considered a most promising strategy. Yet, their implementation faces particular challenges in low- and middle-income countries, where treatment gaps are greatest and resources are extremely limited. To exemplify these challenges, we conducted a scoping review of the relevant literature from Indonesia, a lower-middle-income Southeast-Asian country. We searched PubMed, CINAHL, Web of Science, PsycInfo, Garuda, and Repository UNAIR in titles and abstracts, using the following English search term and its equivalent in Bahasa Indonesia: (early OR risk OR prodromal) AND (psychosis OR schizophrenia OR psychotic) AND Indonesia. We included full papers on service delivery to first-episode psychosis (FEP) or clinical high-risk of psychosis (CHR), and on assessment of CHR in Indonesia. Seven papers, including one newspaper article, met our inclusion criteria. They showed a focus on economic, widely applicable risk assessments, mainly questionnaires or artificial intelligence-based algorithms, and brief interventions, particularly psychoeducation. Furthermore, our review exposed several areas that require further examination. In particular, Western diagnostic definitions of psychotic disorders and their early course need to be re-examined in the light of local health concepts and the role of the spiritual world. This re-examination is crucial for developing and prospectively validating culturally adapted definitions of CHR states and early intervention strategies for both CHR and FEP, with particular attention to the role of the (extended) family and spiritual, traditional healers, who are often the first point of contact.

Pediatrician Knowledge of Early Intervention Process as Contributor to Disparities in Management of Development Delay.

INTRODUCTION: Lack of knowledge of Early Intervention (EI) is a barrier to developmental delay (DD) management. We aimed to examine the feasibility of measuring pediatricians' knowledge of EI, determine the distribution of EI knowledge, and determine factors associated with increased EI knowledge. METHODS: We conducted an exploratory cross-sectional study with a convenience sample from a local American Academy of Pediatrics chapter to administer a survey with 10 multiple-choice questions regarding the EI referral process, evaluation process, eligibility criteria and fee structure. Our outcome variable was a composite score of these 10 multiple-choice questions, Total Knowledge Score (TKS). Our predictor variables included physician characteristics (i.e., years of experience, percentage of patients seen with private insurance, receipt of EI training in the last 5 years) and practice characteristics (i.e., medical home status). RESULTS: Our sample consisted of a total of 194 pediatric residents/attendings. Multivariable regression demonstrated seeing ≥ 50% patients who were privately insured, increased experience, and receiving training in the last 5 years were associated with higher TKS. DISCUSSION: We were able to quantitatively evaluate physician's knowledge of EI and demonstrated that seeing a majority of privately insured patients, having more experience, and having received formal EI training in the last 5 years were associated with higher EI knowledge. This disproportionate distribution of EI knowledge has the potential to contribute to disparities in the management of DD. This may indicate that medical institutions, where physicians see a small percent of privately insured patients, need to hire more experienced physicians, and provide routine EI training.

Diagnostic accuracy of Ages and Stages Questionnaire, Third Edition to identify abnormal or delayed gross motor development in high-risk infants.

AIM: To investigate the diagnostic accuracy of parent-completed Ages and Stages Questionnaire, Third Edition (ASQ-3) to identify abnormal or delayed gross motor development in infants born less than 1000 g or less than 28 weeks gestation. METHODS: Prospective cohort study of high-risk infants comparing ASQ-3 as the index test with concurrent score on Alberta Infant Motor Scale (AIMS) as the reference standard, at 4-, 8- and 12-month corrected (post-term) age. Reference standard positivity cut-offs were 'Abnormal motor development' (AIMS Clinical Range) and 'Motor delay' (AIMS score >1 SD below mean, not captured in Clinical Range). RESULTS: Participating infants (n = 191) had mean gestational age (95% confidence interval (CI)) 26.8 weeks (26.6-27.1) and mean birthweight (95% CI) 870 g (844-896). AIMS rated 51%, 31% and 23% of infants as having 'Abnormal motor development' and 12%, 28% and 13% with 'Motor delay', at 4, 8 and 12 months, respectively. Diagnostic accuracy of ASQ-3 to identify abnormal motor development was acceptable for older infants only if 'Monitor' cut-off was used: sensitivity (95% CI) 33% (23-44), 86% (73-95) and 80% (63-92) and specificity (95% CI) 84% (74-92), 76% (66-84), and 76% (67-83) at 4, 8 and 12 months, respectively. ASQ-3 sensitivity to identify motor delay was low. CONCLUSIONS: ASQ-3 has poor sensitivity to identify abnormal or delayed motor development at 4 months. Using the 'Monitor' cut-off improves the diagnostic accuracy of ASQ-3 for identification of older infants with abnormal motor development who are at high risk of motor disability. However, ASQ-3 has poor sensitivity to identify motor delay. Clinical motor assessment of high-risk infants is recommended, particularly in early infancy.

Introducing a self-managed early communication resource for parents - A mixed methods feasibility study of the Swedish "ComAlong online".

BACKGROUND: Web-based programmes offer parents of children with communication difficulties promising access to parent-mediated, early interventions. However, empirical evaluations of such programmes are limited. This study focused on parents and used mixed methods to examine the feasibility of ComAlong online. METHODS: ComAlong online is a Swedish, self-managed web-resource teaching parents supportive strategies to promote child communication. Data of different types were collected from a total of 71 parents: ten individual parent interviews, 21 pre-questionnaires and 10 post-questionnaires, and finally 50 anonymous digital evaluation surveys. Descriptive statistics and deductive qualitative content analysis were used. RESULTS: Findings indicate that parents perceived improved child communication and own competence after using the ComAlong online. The most valued parts included podcasts with experts and videos of parent-child interaction. Parents reported that the resource was easy to use, but they wanted to have gained access to the resource when the child was younger. Suggestions for changes included adding a chat function with experts, a parent net forum, and the possibility of creating personalised playlists of videos and podcasts. Evaluation of the research process revealed difficulties in recruiting parents from local child healthcare services and parents of children not yet with a diagnosis. CONCLUSIONS: This study supports the potential for self-managed, web-based resources to disseminate evidence-based parent training for supporting early communication development. Importantly, parents lack individual guidance from experts and contact with other parents. Also, measures need to be made to disseminate the resources within local child healthcare services.

Web-based service delivery programmes and digital technology offer promising access to parent-mediated interventions to support children with communication difficulties, but the empirical evaluations of such programmes are limited.Parents perceive web-based, self-managed resources teaching supportive strategies to promote child communication, in this case ComAlong online, easy to use, and such resources may improve child communication and increase competence in parents.Parents want to have access to web-based communication resources, such as ComAlong Online, early in the child's life, and a chat function with experts, a parent forum, and the possibility of creating personalised playlists of videos and podcasts are desired functionality.

Evaluating the effect of cochlear implantation age on pragmatic abilities before and after age of 3.

INTRODUCTION: The cochlear implant (CI) is crucial in developing hearing, speech, language, and communication skills in children with profound hearing loss (HL). The study aimed to assess how the age at which children receive a CI affects the development of pragmatic abilities between the ages of 5 and 8 for those who received a CI before or after the age of 3. METHODS: Forty children with CI were evaluated. The children between the ages of 5 and 8 were divided into two groups who received CIs before or after age 3. The Persian version of the Children's Communication Checklist (CCC) was used to assess pragmatic abilities with a parent rating scale. RESULTS: Children implanted under 3 got higher scores in social relationships, using context, conversational rapport, syntax, and speech. Also, their performance in inappropriate and stereotyped conversations was better than those over 3 years. They have a significant difference in the pragmatic composite than those who received CI over 3 except for coherence and interest (p < 0.05). CONCLUSION: According to the results, children with CI under 3 performed better in pragmatic composites, which means they have better pragmatic abilities. These findings suggest that early CI is important. Of course, other individual and environmental factors must also be considered.

Effects of 4 weeks of play in standing and walking on gross motor ability and segmental trunk control in preterm infants using a playpen: A randomized control trial.

OBJECTIVE: To investigate the effect of computer-based early intervention with a playpen to enhance standing and walking, and to examine the relationship between changes in gross motor percentile and segmental trunk control in preterm infants nine months corrected age. METHODS: Forty infants born before 37 weeks of gestation were randomly assigned to either the experimental or control group. The Alberta Infant Motor Scale (AIMS) and the Segmental Assessment of Trunk Control (SATCo) were administered before and after the intervention. The experimental group, consisting of twenty preterm infants, participated in a computer-based early intervention involving 45 min of play in standing and walking positions, five times a week for 4 weeks. RESULTS: There were significant between-group differences in the gross motor percentiles of the AIMS (p-value <0.001). In addition, there was a significant difference in all conditions of the SATCo scores (p-value <0.05) compared with baseline score. The change in percentiles of gross motor development was significantly correlated (rs = 0.643; p-value <0.001) with reactive SATCo during walking in infants in the experimental group. CONCLUSION: Early intervention with a playpen in a standing and walking position can be applied to improve changes in gross motor percentiles and segmental trunk control in preterm infants.

The Small Step Early Intervention Program for Infants at High Risk of Cerebral Palsy: A Single-Subject Research Design Study.

Background/Objectives: Early interventions for infants at high risk of cerebral palsy (CP) are recommended, but limited evidence exists. Our objective was, therefore, to evaluate the effects of the family-centered and interprofessional Small Step early intervention program on motor development in infants at high risk of CP (ClinicalTrials.gov: NCT03264339). Methods: A single-subject research design was employed to investigate participant characteristics (motor dysfunction severity measured using the Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) at three months of corrected age (3mCA) related to intervention response. The repeated measures Peabody Developmental Motor Scales-2 fine and gross motor composite (PDMS2-FMC and -GMC) and Hand Assessment for Infants (HAI) were analyzed visually by cumulative line graphs, while the Gross Motor Function Measure-66 (GMFM-66) was plotted against reference percentiles for various Gross Motor Function Classification System (GMFCS) levels. Results: All infants (n = 12) received the Small Step program, and eight completed all five training steps. At two years of corrected age (2yCA), nine children were diagnosed with CP. The children with the lowest HINE < 25 and/or AIMS ≤ 6 at 3mCA (n = 4) showed minor improvements during the program and were classified at GMFCS V 2yCA. Children with HINE = 25-40 (n = 5) improved their fine motor skills during the program, and four children had larger GMFM-66 improvements than expected according to the reference curves but that did not always happen during the mobility training steps. Three children with HINE = 41-50 and AIMS > 7 showed the largest improvements and were not diagnosed with CP 2yCA. Conclusions: Our results indicate that the Small Step program contributed to the children's motor development, with better results for those with an initial higher HINE (>25). The specificity of training could not be confirmed.

Navigating childhood hearing loss: the experiences of parents, grandparents and siblings.

PURPOSE: This study aimed to explore the impact of childhood hearing loss on the family unit and their resulting intervention needs. MATERIALS & METHODS: Qualitative descriptive methodology was used, with in-depth interviews analysed using reflexive thematic analysis. Four family units of children with hearing loss participated in the study, including parents (n = 5), grandparents (n = 7), and siblings (n = 5). RESULTS: Five themes were developed from interview data: (1) the daily grind; (2) we're all in this together; (3) family dynamics; (4) the early intervention experience and (5) personal growth and adaptations. Family members were impacted in multi-faceted ways and identified informational and emotional intervention needs, with an integrative theme highlighting the emotional toll of childhood hearing loss on families. CONCLUSIONS: Early intervention services have a crucial role in addressing third-party disability through a multi-disciplinary service delivery model that addresses the needs of all family members, beyond the child with hearing loss.

The diagnosis and management of childhood hearing loss takes an emotional toll on the entire family unit including parents, grandparents, and siblings.Parents, grandparents, and siblings experience a broad ranging and pervasive impact to daily functioning and family dynamics because of hearing loss.It is essential to move beyond a child-centred approach and adopt a truly family-centred approach which both assesses and targets the unique needs of all family members.

Effect of a Nurses' Training Program on Early Detection of Egyptian Children With Developmental Disabilities in Assiut Governorate.

This study aimed to determine the effectiveness of a designed training program for nurses toward early detection of developmental disabilities among children aged 0-3 years. A group of 21 licensed nurses with professional experience ranging from 5-11 years participated in the study. The participants completed the measurements to evaluate their current knowledge, practice, and perception pre- and post-training program, as well as during a follow-up, in relation to early detection of disabilities. The results showed highly statistically significant difference between the studied nurses' total knowledge, perception, and practice in pre- and post-program application (p = 0.01). However, there was no statistically significant difference between the post-program and follow-up application (p = 0.180).

Development of a family-centred intervention for families and children with hearing loss transitioning into early intervention: application of the Behaviour Change Wheel.

OBJECTIVE: To describe the application of the Behaviour Change Wheel (BCW) to the development of a family-centred intervention for families of children with hearing loss transitioning into early intervention. DESIGN: The BCW was used in a mixed methods design to understand the gaps in family-centred service provision and to identify appropriate intervention functions and implementation options to address these gaps. STUDY SAMPLE: Families and health professionals participated in different steps of the BCW. RESULTS: The qualitative interviews revealed that families required individualised information and support. The quantitative and interview data suggested inconsistencies in the provision of information and support to some families. It was determined that administration of a needs assessment by the support professionals was the most appropriate target behaviour to address this issue. In the analysis of the professionals' capabilities, opportunities, and motivations for administration of a needs assessment, a resource limitation was identified, and therefore, a Minimum Data Set for a Needs Assessment Tool was developed to facilitate the assessment of families' needs during the transition period. CONCLUSIONS: This study provided an example of how the BCW could be successfully applied to the design of a family-centred intervention for families of children with hearing loss.

Motor development trajectories of children with cerebral palsy in a community-based early intervention program in rural South India.

BACKGROUND: Developmental trajectories are crucial for evidence-based prognostication, planning interventions, and monitoring progress in children with cerebral palsy (CP). AIMS: To describe gross motor development patterns of children with CP in rural South India for the five Gross Motor Function Classification System (GMFCS) levels. METHODS: Longitudinal cohort study of 302 children (176 males, 126 females) with CP aged 0 to 10 years, followed by a community-based early intervention program. GMFCS levels were 5.4 % level 1, 16.5 % level II, 22.8 % level III, 26.8 % level IV, and 28.5 % level V. Assessments were undertaken using the Gross Motor Function Measure (GMFM-66) at 6-month intervals between April 2017 and August 2020. Longitudinal analyses were performed using mixed-effects linear regression models. OUTCOMES AND RESULTS: Five distinct motor development curves were created for ages 0 to 10 years by GMFCS levels as a function of age and GMFM-66 with a stable limit model, variation in estimated limits and rates of development. CONCLUSIONS AND IMPLICATIONS: Motor development trajectories for CP in an LMIC differ from those reported in HICs. Consideration of how social determinants of health, environmental and personal factors impact motor development in low-resource contexts is crucial. Further work is needed to describe developmental trajectories of children for CP in LMICs.

Effects of early intervention on the mental wellbeing and caregiving practices of preterm infant caregivers.

BACKGROUND: The rising incidence of preterm births worldwide presents a pressing public health challenge, affecting both infants and their preterm caregivers. Early Intervention (EI) programs aim to mitigate the negative impacts associated with preterm births on the physical, cognitive, and psychological health of both infants and their caregivers by providing personalized parental support and developmental monitoring. This study addressed the gap in research evaluating the long-term effects of community-based EI programs on the holistic coping mechanisms of families, encompassing mental wellbeing, caregiving competencies, and the transition process from hospital to home care. METHODS: This study evaluated the long-term effects of a community-based EI program (in-home only) and the added benefits of earlier Hospital-to-Home (H2H) support, focusing on preterm caregivers' mental wellbeing and caregiving practices. RESULTS: The findings highlight the extended benefits of EI, demonstrating that program duration and intensity significantly benefit families dealing with neonatal intensive care unit stays. For infants requiring extensive medical intervention, EI support markedly enhances caregiver mental wellbeing. Additionally, interventions initiated earlier yield a more substantial positive effect on preterm caregivers' mental wellbeing after discharge compared to those that commence later. CONCLUSION: These findings suggest the potential role of community-based EI programs and the benefits of supporting preterm caregivers before transitioning home. The study calls for future research to explore the effects of various EI program components to identify which interventions are most effective for addressing preterm infants' specific developmental challenges.