Title: SEEK ( Safe Environment for Every Kid) Program
Organization: University of Maryland School of Medicine
Innovation Type: Evidence Based Clinical Practice Support
What They’re Doing: Training health care professionals in pediatric primary care settings to identify and help address problems facing many families (eg, depression, substance abuse).
Clinical Innovation: Pediatric practices receive training and support to enhance knowledge, skills, and competence related to screening for and addressing important risk factors for child maltreatment. Training consisted of small-group sessions lasting 4 or 8 hours, followed by periodic "booster" sessions. (Although the program is moving towards an online training program.) The Safe Environment for Every Kids ( SEEK ) model has included a brief screening questionnaire given to parents to complete while waiting to be seen, customized handouts for parents and "cheat sheets" for health professionals, and a social worker to support health professionals and parents.
Evaluation Type: Experimental
The first randomized trial which ran from June 2002 to November 2005 compared the rate of child maltreatment in high-risk families receiving SEEK model program services to similar families receiving usual pediatric primary care in the same inner-city clinic.
The second randomized trial which ran from June 2006 until January 2009 compared the rate of child maltreatment in 7 suburban private pediatric practices that implemented SEEK to 11 similar practices that did not
Patient Health and Cost Outcomes:
Reduces Child Maltreatment: The program significantly reduced rates of child maltreatment among high-risk, inner-city families and led to improvements in less severe parenting problems in lower-risk, suburban families.
Potential to Avert Health System Spending. According to an unpublished analysis of the SEEK model, program-related costs averaged $244 per averted case of child maltreatment, whereas the medical and mental health services required for each child who is the victim of maltreatment cost an estimated $14,520.
Other outcomes of interest:
Increases provider confidence: SEEK improved health professionals' self-reported competence and comfort in addressing major risk factors of child maltreatment, as well as their practice behavior. Importantly, these improvements were sustained over several years.
Dubowitz, H., Prescott, L., Feigelman, S., Lane, W., Kim, J. Screening for Intimate Partner Violence in an Urban Pediatric Primary Care Clinic. Pediatrics. 2008: 121 ( 1 ): e85-91.
Lane, W., Dubowitz, H., Feigelman, S., Kim, J. Prescott, L., Meyer, W., Tracy, J.K. Screening for Parental Substance Abuse in an Urban Pediatric Primary Care Clinic. Ambulatory Pediatrics, 2007;7:458–462.
Dubowitz H., Feigelman S, Lane W, Prescott L, Blackman K, Grube L, Meyer W, Tracy JK. Screening for depression in an urban pediatric primary care clinic. Pediatrics. 2007; 119 ( 3 ): 435-43 .
Kim J, Dubowitz H., Hudson-Martin E, Lane W. Comparison of 3 data collection methods for gathering sensitive and less sensitive information. Ambul Pediatr. 2008; 8 ( 4 ): 255-60 .
Dubowitz H, Feigelman S, Lane W, Kim JW. Pediatric Primary Care to Help Prevent Child Maltreatment: The S afe E nvironment for E very K id ( SEEK ) Model. Pediatrics . 2009;123:858-864.
Feigelman S, Dubowitz H, Lane W, Kim J. Screening for Harsh Punishment in a Pediatric Primary Care Clinic. Child Abuse Neglect. 2009;33(5):269-77.
Dubowitz H, Lane W, Semiatin J, Magder L, Venepally M, Jans M. The Safe Environment for Every Kid ( SEEK ) Model: Impact on Pediatric Primary Care Professionals. Pediatrics. 2011;127(4):e962-70.
Dubowitz H, Lane W, Semiatin J, Magder L. The SEEK model of pediatric primary care: Can child maltreatment be prevented in a low-risk population? Under review.
Feigelman S, Dubowitz H, Lane W, Grube L, Kim J. Training Pediatric Residents in a Primary Care Clinic to Help Address Psychosocial Problems and Prevent Child Maltreatment. Academic Pediatrics , 201;11(6):474-80.
Target Population: Outpatient pediatric patients and families
Date of Implementation: 2002
Contact: Howard Dubowitz, MD, MS
Department of Pediatrics, University of Maryland School of Medicine
Where to learn more: http://brighfutures.org/