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
Evaluation Plan:
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 According to an unpublished analysis of the SEEK model, program-related costs averaged $244 per averted case of child maltreatment, whereas the medical and mental health services required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.
Publications:
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
E-mail: hdubowitz@peds.umaryland.edu
Multimedia: Pending
Where to learn more: http://brighfutures.org/