The Safe Environment for Every Kid (SEEK) Approach: Two Training Modalities and Child Maltreatment Prevention

A Maintenance of Certification-4 activity (MOC) will help primary care practices implement the Safe Environment for Every Kid (SEEK) approach to prevent child maltreatment more effectively than simpler independent online learning (IND). A secondary aim compared costs and effort.

This longitudinal, multisite study randomized 25 practices to MOC or IND training groups. Of 19 practices that continued in the study, 14 provided electronic health record (EHR) data for 2-year periods prior to and after implementing SEEK. Pediatric primary care practices across the US, included solo practices and large university training clinics. The outcome measure included possible child abuse and unmet child needs, using ICD-10 codes. We estimated costs and primary care professional (PCP) time.

There was a trend with rates for possible abuse declining in the overall sample from pre- to post-SEEK (Post/Pre OR=0.81, CI=0.63,1.04, P=0.09). MOC and IND practices did not differ significantly (P=0.31). Rates regarding unmet needs held steady in the overall sample (OR=1.12, CI=0.87,1.44, P=0.36) and did not differ between groups (P=0.68). Pre-implementation costs were $896 and $1955 for IND and MOC practices. PCPs averaged 3.8 min addressing social drivers of health during well visits prior to SEEK vs. 3.4 min afterwards.

The study offers an example of evaluating common training strategies. The few differences between MOC and IND training supports the simpler IND modality. The findings add limited support to prior studies of SEEK's effectiveness in preventing child abuse. The costs were minor and PCP time for routine visits decreased slightly, demonstrating SEEK's practicability.