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Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model
Howard Dubowitz1, Susan Feigelman, Wendy Lane
1Department of Pediatrics, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201, USA. hdubowitz@peds.umaryland.edu
Insights
The Safe Environment for Every Kid (SEEK) model effectively reduced child maltreatment by integrating trained residents, screening tools, and social workers into pediatric primary care. This innovative approach showed significant decreases in protective services reports and harsh punishment.
Area of Science:
- Pediatric Primary Care
- Child Maltreatment Prevention
- Public Health Interventions
Background:
- Child maltreatment prevention strategies are critically needed.
- Primary care-based programs are scarce and often lack rigorous evaluation.
Purpose of the Study:
- To evaluate the efficacy of the Safe Environment for Every Kid (SEEK) model in pediatric primary care.
- To determine if the SEEK model reduces child maltreatment rates.
Main Methods:
- A randomized trial involving 558 parents of children aged 0-5 years in a pediatric clinic.
- Intervention group received the SEEK model (trained residents, screening questionnaire, social worker).
- Control group received standard pediatric care; child maltreatment measured via CPS reports, medical records, and parental surveys.
Main Results:
- The SEEK model significantly reduced child protective services reports.
- Fewer instances of medical neglect and delayed immunizations were observed in the intervention group.
- Parents in the SEEK model group reported significantly less harsh punishment.
Conclusions:
- The Safe Environment for Every Kid (SEEK) model shows promise as a practical strategy for child maltreatment prevention in pediatric primary care.
- Further replication and evaluation of the SEEK model are recommended.
Context:
Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated.
Objective:
Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.
Methods:
A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.
Results:
Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.
Conclusions:
The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.
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