Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 31, 2025
Date Accepted: Mar 4, 2026
Telehealth Delivery of the Homeostasis-Enrichment-Plasticity (HEP®) Approach for Premature Infants with Developmental Risks: An Exploratory Feasibility Study
ABSTRACT
Background:
Preterm delivery is an increasing worldwide health concern linked to increased neurodevelopmental risks. Early intervention (EI) is crucial for harnessing neuroplasticity to enhance outcomes; nonetheless, access to EI is frequently obstructed by logistical, financial, and labor challenges. The Homeostasis–Enrichment–Plasticity (HEP®) Approach is a family-centered early intervention model based on enriched environments, designed to improve infants' sensory-motor, cognitive, and socio-emotional development.
Objective:
This study aimed to assess the feasibility, safety, acceptability, and preliminary effects of implementing the HEP® Approach through telehealth for premature infants at developmental risk.
Methods:
A pre-post exploratory feasibility study was performed, including 16 preterm infants, of whom 14 completed the study and were aged 4–12 months corrected age. The 12-week intervention included weekly online sessions focused on environmental enrichment, active exploration, and parental guidance. The feasibility and acceptability were evaluated using a 24-item questionnaire. Developmental outcomes were assessed with the Young Children’s Participation and Environment Measure (YC-PEM), Ages and Stages Questionnaire (ASQ), Alberta Infant Motor Scale (AIMS), Infant Motor Profile (IMP), and Depression Anxiety Stress Scales (DASS-21).
Results:
High adherence (100%) and retention (87.5%) rates demonstrated robust feasibility. Parents indicated 86–100% agreement across all feasible criteria, affirming safety, satisfaction, and acceptability. No adverse incidents were reported. Improvements were identified in participation (YC-PEM), motor development (AIMS, IMP, ASQ), communication and social-emotional domains (ASQ), and caregiver well-being (DASS-21) (p < .05).
Conclusions:
The telehealth implementation of the HEP® Approach demonstrated feasibility, safety, and strong acceptance among families, resulting in quantifiable developmental and psychosocial advantages. These initial findings endorse the model's viability as an accessible, family-oriented telehealth framework for preterm infants. Future randomized controlled and longitudinal studies are necessary to validate long-term efficacy and scalability.
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