The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals
ABSTRACT To examine whether the Safe Environment for Every Kid (SEEK) model of enhanced primary care would improve the attitudes, knowledge, comfort, competence, and behavior of child health care professionals (HPs) regarding addressing major risk factors for child maltreatment (CM).
In a cluster randomized controlled trial, 18 private practices were assigned to intervention (SEEK) or control groups. SEEK HPs received training on CM risk factors (eg, maternal depression). The SEEK model included the parent screening questionnaire and the participation of a social worker. SEEK's impact was evaluated in 3 ways: (1) the health professional questionnaire (HPQ), which assessed HPs' attitudes and practice regarding the targeted problems; (2) observations of HPs conducting checkups; and (3) review of children's medical records.
The 102 HPs averaged 45 years of age; 68% were female, and 74% were in suburban practices. Comparing baseline scores with 6-, 18-, and 36-month follow-up data, the HPQ revealed significant (P < .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence (6 and 18 months), and stress (6, 18, and 36 months), and in their comfort level and perceived competence (both at 6, 18, and 36 months). SEEK HPs screened for targeted problems more often than did controls based on observations 24 months after the initial training and the medical records (P < .001).
The SEEK model led to significant and sustained improvement in several areas. This is a crucial first step in helping HPs address major psychosocial problems that confront many families. SEEK offers a modest yet promising enhancement of primary care.
SourceAvailable from: Jenny Woodman[Show abstract] [Hide abstract]
ABSTRACT: Calls for a public health approach to child maltreatment - a strategy that aims primarily to reduce risk factors for maltreatment - have been based on four main arguments. (O'Donnell et al. 2008; Reading et al. 2009; Barlow and Calam, 2011) The right of children to be protected from harm in the first place. The frequency of child maltreatment, which, if all occurrences were notified, would overwhelm child protection systems. The inaccuracy of identification systems, which miss the large majority of maltreated children. And fourth, the effectiveness and cost effectiveness of intervening to prevent child maltreatment comparing with intervention once child maltreatment has occurred. We review the evidence to support these arguments and trace the development of UK policy and health services towards a public health approach.
Child Abuse & Neglect 11/2014; 38(11):1725-33. DOI:10.1016/j.chiabu.2014.07.011 · 2.47 Impact Factor