Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs]

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] has been rated by the CEBC in the area of: Prevention of Child Abuse and Neglect (Primary) Programs.

Target Population: Families with children aged 0-5 years

For children/adolescents ages: 0 – 5

For parents/caregivers of children ages: 0 – 5

Brief Description

SEEK utilizes pediatric primary care as an opportunity to help prevent child maltreatment in families who may have risk factors for child maltreatment. Most children receive this care and there are frequent visits in the first 5 years. Also, the generally good relationship between health professionals and parents offers an opportunity to identify and help address prevalent psychosocial problems.

SEEK begins with training professionals to play this role. Online videos and supplemental materials are available on the SEEK website. Continuing Medical Education (CME) credits are offered as well as Maintenance of Certification (MOC) Categories 2 and 4 credits (through the American Board of Pediatrics and the American Board of Family Medicine). The SEEK Parent Questionnaire (PQ) is a tool to screen for the targeted problems: parental depression, substance abuse, major stress, intimate partner violence, food insecurity, and harsh punishment. It is completed in advance and given to the professional at the start of a regular checkup.

The trained professional then briefly assesses and initially addresses identified risk factors and makes necessary referrals to community resources, ideally with the help of a mental health professional. Principles of Motivational Interviewing have been incorporated into SEEK, and parent handouts are available as adjuncts to advice offered in the visit.

Note: SEEK is rated a "1 - Well-Supported by Research Evidence" in the Prevention of Child Abuse and Neglect (Primary) Programs topic area and is rated a "2 - Supported by Research Evidence" in the Prevention of Child Abuse and Neglect (Secondary) Programs topic area due to the difference in program characteristics considered for inclusion each of the two topic areas. Please click on the topic areas above to see the complete definitions for each of them and a link to the corresponding SEEK entry in the program list listed below the definition. There is published, peer-reviewed research on SEEK that qualifies it to be rated in both topic areas, but the research for one of them is stronger than the other. Please see the CEBC Scientific Rating Scale to see the differences in rating classifications.

Program Goals:

The goals of Safe Environment for Every Kid (SEEK) are:

  • Improve pediatric primary care, in order to better address prevalent psychosocial problems
  • Prepare pediatric primary care professionals (e.g., pediatricians, family medicine physicians, nurse practitioners and physician assistants) to identify, briefly assess and help address major risk factors for child maltreatment
  • Identify families with major risk factors for child maltreatment and facilitate help when indicated
  • Strengthen families, support parents, and promote children’s health, development, and safety
  • Prevent child abuse and neglect

Essential Components

The essential components of Safe Environment for Every Kid (SEEK) include:

  • Health Professional Training: SEEK recognizes the importance of preparing child health professionals to assess and address problems such as parental depression. In addition to the initial training via online videos and other materials, ongoing training and support is offered. Continuing Medical Education (CME) credits are available, and Maintenance of Certification Categories 2 and 4 credits are available through the American Board of Pediatrics and the American Board of Family Medicine.
  • Motivational Interviewing (MI): SEEK incorporates principles of Motivational Interviewing to improve upon the traditional prescriptive approach to more effectively work with parents in planning and engaging in services.
  • The SEEK Parent Questionnaire (PQ): The PQ is a brief screening tool parents complete before seeing the health professional. It has 15 questions, takes 2-3 minutes to complete, and is currently available in English, Spanish, Chinese, and Vietnamese. It can be completed on paper or computer.
  • SEEK Parent Handouts: User-friendly, one-page handouts are available for all of the targeted problems, with space to list local resources and customized information about the practice. It is critical that professionals know what is available in the community to help address identified problems, such as substance abuse.
  • Mental Health Professional: It is recommended that medical professionals work with a mental health colleague, such as a social worker. SEEK, however, has been designed to be deliberately flexible regarding who does what in addressing problems. Some health professionals are interested in playing a substantial role, others less so. Some parents may prefer discussing sensitive matters with the professional they know and trust. Thus, many health professionals do address psychosocial problems, with office or clinic staff helping to facilitate referrals. Nevertheless, a mental health colleague is a valuable asset.

Child/Adolescent Services

Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] directly provides services to children/adolescents and addresses the following:

  • Food insecurity; harsh punishment; having a parent who is depressed, very stressed, and/or abusing substances; and being exposed to intimate partner violence (IPV)

Parent/Caregiver Services

Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] directly provides services to parents/caregivers and addresses the following:

  • Depression, substance abuse, intimate partner violence (IPV), major parental stress, food insecurity, and use of harsh punishment
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: SEEK encourages enlisting family members for support, or referring to community resources for services such as substance abuse treatment. The response is carefully tailored to the needs and interests of the individual parent and family.

Delivery Setting

This program is typically conducted in a(n):

  • Primary Care Settings Serving Children

Homework

This program does not include a homework component.

Languages

Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] has materials available in languages other than English:

Chinese, Spanish, Vietnamese

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • A “champion” to lead implementation of Safe Environment for Every Kid (SEEK)
  • Buy-in from the health professionals in the practice, preferably all
  • 1 hour to train office staff
  • Access to a mental health professional is ideal, but not essential

Minimum Provider Qualifications

Medical professionals should be licensed to practice as pediatricians, family medicine physicians, nurse practitioners, or physician assistants.

Mental health professionals need at least a Master’s degree in a relevant field and to be licensed to provide clinical services.

Education and Training Resources

There is not a manual that describes how to implement this program; but there is training available for this program.

Training Contact:
Training is obtained:

Online, electronically, webinars, phone

Number of days/hours:

Initial training: 2-3 hours Ongoing training: Variable, depending on needs and interest Maintenance of Certification (MOC) Category 4: 12 hours

Implementation Information

Since Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] as listed below:

The SEEK Health Professional Questionnaire assesses attitudes, knowledge, level of comfort, perceived competence, and practice behavior regarding addressing the problems targeted by SEEK.

Formal Support for Implementation

There is formal support available for implementation of Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] as listed below:

The SEEK project office based in the Department of Pediatrics at the University of Maryland School of Medicine offers technical assistance to interested parties. Contact one of the following two people for more information:

  • Howard Dubowitz, MD, MS, FAAP, at hdubowitz@peds.umaryland.edu or 410-706-6144
  • Emily Redding, BA, at eredding@peds.umaryland.edu or 410-706-1703

Fidelity Measures

There are fidelity measures for Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] as listed below:

  • The SEEK Health Professional Questionnaire (HPQ)
  • The SEEK Medical Record Review
  • The SEEK Health Professional Observation Checklist

All of the measures can be obtained from the Evaluation section of the SEEK website.

Implementation Guides or Manuals

There are implementation guides or manuals for Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs] as listed below:

The SEEK website (http://theinstitute.umaryland.edu/frames/seek.cfm) has a section on Implementation that offers detailed information to assist with the implementation of SEEK, such as the SEEK Parent Questionnaire (PQ) and the SEEK Parent Handouts, information on Continuing Medical Education (CME) and Maintenance of Certification (MOC) processes, and responses to Frequently Asked Questions (FAQs).

Research on How to Implement the Program

Research has not been conducted on how to implement Safe Environment for Every Kid (SEEK) [Prevention of Child Abuse and Neglect (Primary) Programs].

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcomes: Safety and Child/Family Well-Being

Show relevant research...

Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) model. Pediatrics, 123(3), 858-864.

Type of Study: Randomized controlled trial
Number of Participants: 558

Population:

  • Age — Children: 0-5 years; Parents: Mean=25 years
  • Race/Ethnicity — 92% Black
  • Gender — 48% Female
  • Status — Participants were clients of a pediatric primary care resident continuity clinic serving a low income urban community of families involved with Child Protective Services.

Location/Institution: Baltimore, Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this paper was to evaluate the efficacy of Safe Environment for Every Kid (SEEK) in reducing the occurrence of child maltreatment. Resident continuity clinics were cluster randomized by day of the week to the SEEK or standard care (control) groups. Measures utilized include the Parent Screening Questionnaire (now called the Parent Questionnaire) and the Parent-Child Conflict Tactics Scale (CTSPC). Child Protective Services data were also examined, along with the child’s medical record. SEEK 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. Limitations include relatively small sample size, concerns regarding generalizability to other populations, and the lack of true baseline data. In addition, families with prior child welfare involvement were not excluded from the study sample, blending results for primary, secondary, and tertiary prevention (intervention) samples.

Length of postintervention follow-up: Varied by individual.

Dubowitz, H., Lane, W. G., Semiatin, J. N., Magder, L. S., Venepally, M., & Jans, M. (2011). The Safe Environment for Every Kid model: Impact on pediatric primary care professionals. Pediatrics, 127(4), 962-970.

Type of Study: Randomized controlled trial
Number of Participants: 102

Population:

  • Age — Health care professionals: Mean=45 years
  • Race/Ethnicity — Not specified
  • Gender — Health care professionals: 68% Female
  • Status — Participants were child health care professionals that dealt with major risks factors addressing child maltreatment.

Location/Institution: 18 private practices loosely associated with the University of Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examines whether Safe Environment for Every Kid (SEEK) with 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). Private practices were randomly assigned to intervention (SEEK) or control groups. Measures utilized included the Parent Screening Questionnaire (PSQ, now called the Parent Questionnaire) and the Health Professional Questionnaire (HPQ). The child’s medical record was also examined and check-up visits were observed. Results showed the SEEK model led to significant and sustained improvement in several areas. Results revealed significant improvement in the SEEK group compared with controls in addressing depression, substance abuse, intimate partner violence, and major parental stress and in their comfort level and perceived competence. SEEK HPs screened for targeted problems more often than did controls - up to 24 months after the initial training. Limitations include relatively small sample size and possibility of socially desirable responses on self-report measures.

Length of postintervention follow-up: 6, 18, and 36 months.

Feigelman, S., Dubowitz, H., Lane, W., Grube, L., & Kim, J. (2011). Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment. Academic Pediatrics, 11(6), 474-480.

Type of Study: Randomized controlled trial
Number of Participants: 95

Population:

  • Age — Pediatric Residents: Mean=28 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were pediatric residents in a primary care resident continuity clinic serving a low income urban community.

Location/Institution: Baltimore, Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This sample was obtained from the practice sites examined in Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). The objectives of this study were to determine whether 1) Residents trained in Safe Environment for Every Kid (SEEK) would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (e.g., parental depression, parental substance abuse, intimate partner violence, stress, corporal punishment, and food insecurity); 2) Intervention residents would be more likely to screen for and assess those risk factors; and 3) Families seen by intervention residents would report improved satisfaction with their child’s doctor compared to families receiving standard care from control residents. Measures utilized include the Parent Screening Questionnaire (PSQ, now called the Parent Questionnaire), the Physician Questionnaire (PQ), and the Patient-Doctor Interaction Scale; children’s medical records were also reviewed. Results indicate that the SEEK model improved residents’ level of comfort, perceived competence, and practice behavior regarding prevalent psychosocial problems that are risk factors for child maltreatment. Limitations include generalizability of the findings may not apply to lower risk communities, private practice, or other settings and possible sharing of information between participants.

Length of postintervention follow-up: 6 and 18 months.

*Dubowitz, H., Lane, W. G., Semiatin, J. N., & Magder, L. S. (2012). The SEEK model of pediatric primary care: Can child maltreatment be prevented in a low-risk population?. Academic pediatrics, 12(4), 259-268.

Type of Study: Randomized controlled trial
Number of Participants: 1,119 Mothers

Population:

  • Age — SeekParents: Mean=33.4 years; Control Parents: Mean=34.5 years
  • Race/Ethnicity — SEEK Children: 86% White, 4% African American, 1% Latino, 2% Asian, and 8% Other; Control Children: 75% White, 7% African American, 1% Latino, 5% Asian, and 12% Other
  • Gender — 100% Female
  • Status — Participants were families at private pediatric practices loosely associated with the University of Maryland.

Location/Institution: University of Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: Sample was obtained from the practice sites examined in Dubowitz, Lane, Semiatin, et al. (2011). The objectives of this study were to examine the effectiveness of Safe Environment for Every Kid (SEEK) with enhanced pediatric primary care in helping reduce child maltreatment. A total of 18 pediatric practices were assigned to intervention or control groups, and 1,119 mothers of children ages 0 to 5 years were recruited to help evaluate SEEK. Measures utilized include the Parent Screening Questionnaire (PSQ, now called the Parent Questionnaire) and the Parent-Child Conflict Tactics Scales (CTSPC). Children’s medical records and Child Protective Services data were also reviewed. Maltreatment was assessed 3 ways: maternal self-report using the Parent Child Conflict Tactics Scales (CTSPC), children’s medical records, and Child Protective Services reports. Results indicate that in the initial and 12-month assessments, SEEK mothers reported less Psychological Aggression than controls and SEEK mothers reported fewer Minor Physical Assaults than controls. There were few instances of maltreatment documented in the medical records and few Child Protective Services reports. Limitations include inability to collect true baseline data and some issues with the randomization process.

Length of postintervention follow-up: 6 and 12 months.

References

Dubowitz, H. (2013, September). The Safe Environment for Every Kid (SEEK) model: Promoting children’s health, development and safety. Zero to Three Journal, 45-50.

Dubowitz, H. (2014). The Safe Environment for Every Kid (SEEK) model: Promoting children’s health, development and safety. Child Abuse and Neglect, 38, 1725-1733.

Selph, S., Bougatsos, C., Blazina, I., & Nelson, H. (2013). Behavioral interventions and counseling to prevent child abuse and neglect: A systematic review to update the U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine, 158(3), 179-190.

Contact Information

Name: Howard Dubowitz, MD, MS, FAAP
Agency/Affiliation: University of Maryland School of Medicine
Website: theinstitute.umaryland.edu/SEEK
Email:
Phone: (410) 706-6144

Date Research Evidence Last Reviewed by CEBC: May 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: April 2015