The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals

Department of Pediatrics, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201, USA.
PEDIATRICS (Impact Factor: 5.47). 03/2011; 127(4):e962-70. DOI: 10.1542/peds.2010-1845
Source: PubMed


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.

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    • "There is also evidence from low-, middle-, and high-income settings of the potential for parenting interventions to improve parent–child relationships, child conduct disorders, and reduce harsh parenting (Cooper et al., 2009; Gardner, Burton, & Klimes, 2006; Knerr, Gardner, & Cluver, 2013). Limited, though increasing evidence is also available on the potential for interventions that are designed to prevent child maltreatment to impact outcomes related to IPV (Dubowitz et al., 2011; Duggan et al., 1999; Sim et al., 2014) which may prove particularly valuable as interventions to prevent child maltreatment may be less effective in households where IPV occurs (Guedes & Mikton, 2013). To our knowledge there is currently no evidence from rigorously-evaluated community-level interventions on the impact of IPV prevention interventions on children's well-being and exposure to violence. "
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    • "Single or multiple training sessions involving multiple 'modes' of delivery (e.g., video, role-play, etc.), including exchange between recipients and facilitators Allert, 1997; Barber-Madden, 1983; Davila, 2006; Hazzard, 1984; Kleemeier, 1988; Lo Fo Wong, 2006; McCosker, 1999; Nicolaidis, 2005; Salmon, 2006; Schoening, 2004; Shefet, 2007; Wathen, 2011 Generally effective at improving knowledge/attitude and behavioural outcomes, evidence for knowledge/ attitude outcomes is stronger Complex/multifaceted 15(26%) Intensive, multi-component interventions, usually over extended period of time Berger, 2002; Bonds, 2006; Campbell, 2001; Cerezo, 2004; Cyr, 2009; Dresser, 2012; Dubowitz, 2011; Feder, 2011; Heyman, 2009; Janssen, 2002; Paluzzi, 2000; Rischke, 2011; Thompson, 2000; Whitaker, 2012; Zachary, 2002 Generally effective at improving knowledge/attitude and behaviour/ behavioural intention outcomes (but most behavioural evidence is for screening or identification rates) "
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    • "Robinson-Whelan 2010 was not conducted in a healthcare setting. Three studies (Dubowitz 2011; Feigelman 2011; Dubowitz 2012) were excluded as they were targeted at children and clinicians. Three studies (Bair-Merritt 2006; Houry 2011; Klevens 2012b) were excluded as the results were not passed on to the healthcare professional according to our criteria. "
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    Full-text · Article · Apr 2013 · Cochrane database of systematic reviews (Online)
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