Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Apr;127(4):e962-70.
doi: 10.1542/peds.2010-1845. Epub 2011 Mar 28.

The safe environment for every kid model: impact on pediatric primary care professionals

Howard Dubowitz  1 , Wendy G Lane, Joshua N Semiatin, Laurence S Magder, Mamata Venepally, Merel Jans
Affiliations
Randomized Controlled Trial

The safe environment for every kid model: impact on pediatric primary care professionals

Howard Dubowitz et al. Pediatrics. 2011 Apr.

Abstract

Objective: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Overview of the study design to evaluate the SEEK model.
FIGURE 2
FIGURE 2
CONSORT diagram for SEEK and control practices according to wave. a To balance the number of HPs between groups, 2 control practices were added.
FIGURE 3
FIGURE 3
Mediation according to change in comfort-level scale scores of SEEK's impact on documented IPV screening. Control variables: percentage of patients on Medical Assistance, number of years that HP had been in practice, and the random effect of practice. a P < .01; b interpreted as average increase in comfort level (SD units) as a result of SEEK; c interpreted as screening percentage-points increase per 1 SD unit change in comfort level, controlling for intervention; d P < .001; e interpreted as screening percentage-point increase for SEEK compared with control practices.
FIGURE 4
FIGURE 4
Mediation according to change in IPV scale scores of SEEK's impact on documented IPV screening. Control variables: percentage of patients on Medical Assistance, number of years that HP had been in practice, and the random effect of practice. a P < .01; b interpreted as average increase in IPV scale scores (SD units) as a result of SEEK; c interpreted as screening percentage-point increase per 1 SD unit change in IPV scale scores, controlling for intervention; d P < .001; e interpreted as screening percentage-point increase for SEEK compared with control practices.
See this image and copyright information in PMC

References

    1. US Department of Health and Human Services, Administration for Children, Youth, and Families Child Maltreatment, 2009: Reports from the National Child Abuse and Neglect Data Systems. Washington, DC: US Government Printing Office, 2010
    1. Hussey JM, Chang JJ, Kotch JB. Child maltreatment in the United States: prevalence, risk factors, and adolescent health consequences. Pediatrics. 2006;118(3):933–942 - PubMed
    1. American Academy of Pediatrics, Committee on Child Abuse and Neglect and Section on Adoption and Foster Care; Stirling J, Jr; American Academy of Child and Adolescent Psychiatry; Amaya-Jackson L; National Center for Child Traumatic Stress Understanding the behavioral and emotional consequences of child abuse [published correction appears in Pediatrics. 2009;123(1):197]. Pediatrics. 2008;122(3):667–673 - PubMed
    1. Dubowitz H. Preventing child neglect and physical abuse: a role for pediatricians. Pediatr Rev. 2002;23(6):191–196 - PubMed
    1. Dubowitz H, Feigelman S, Lane W, Kim J. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009;123(3):858–64 - PubMed

Publication types

MeSH terms