Integration of the Safe Environment for Every Kid (SEEK) Model Across Primary Care Settings

Abstract

This project sought to assess the generalizability, barriers, and facilitators of implementing the Safe Environment for Every Kid (SEEK) model for addressing psychosocial risk factors for maltreatment across multiple primary care settings, including a pediatric practice, federally qualified health center, and family medicine practice. The SEEK model includes screening caregivers for psychosocial risk factors at well-child visits age 0 to 5 years, brief intervention incorporating principles of motivational interviewing to engage caregivers, and referral to treatment. All practices successfully implemented SEEK, with screening completion rates from 75% to 93% and brief intervention rates from 61% to 81%. Major parental stress (14%) and food insecurity (11%) were the most common risk factors. Providers found SEEK worthwhile for improving their knowledge, skills, and ability to address psychosocial concerns and provide whole person care. Barriers included limited time and resources, incomplete resource knowledge, and lack of follow-up. Facilitators included on-site support staff to assist with communication and referrals.

Screening Children for Social Determinants of Health: A Systematic Review

“…Two screeners included additional information reported by a social worker 16 or physician. 20 Screeners were completed via a variety of methods, including paper and pencil, 11,[17][18][19][20][23][24][25][26]30 computer or tablet, [17][18][19]22,26,27 faceto-face interview, 12,16,21,[27][28][29] and phone interview. 12,27 All screeners were available in English, with 7 screeners also available in Spanish.…”

“…12,27 All screeners were available in English, with 7 screeners also available in Spanish. 11,12,[17][18][19][20][22][23][24][25][26][27]30 Three screeners had validity and/or reliability assessed in $1 study. 18,24,29 With respect to the time frame that respondents were asked to reflect on when answering questions about SDOHs, the majority of screeners (ie, 6 screeners) did not have a clearly defined referent period (eg, past 30 days, past year, or lifetime); the referent periods for other screeners varied by question, 18,22,28 and only 2 screeners had a single, clearly defined referent period for all included questions.…”

“…newly created family context domain because this SDOH occurs within the family unit. Common areas examined under the economic stability domain included food insufficiency, 11,12,[16][17][18][19][21][22][23][24][25][26][27][28][29][30] housing instability, 11,12,16,[22][23][24][25][27][28][29][30] and difficulty paying bills, making ends meet, or meeting basic needs. 11,12,[21][22][23][24][25]27,28,30 Seven screeners assessed the education domain, which included questions assessing parental education 11,20,[23][24][25]28,30 and access to child care.…”

“…22,29,30 Authors of only 3 studies reported that screening results were discussed with caregivers, referrals were offered and/or scheduled, and an intervention was delivered. 12,25,26 Interventions came in the form of providers using motivational interviewing to engage caregivers 26 and navigators being assigned to caregivers to help caregivers access and understand resources. 12,25…”

Do Patients Want Help Addressing Social Risks?

“…[15][16][17][18] A more complex finding from these programs, however, is that many patients who screen positive for social risks subsequently decline assistance to address those risks from health care team members. [5][6][7]14,[19][20][21][22][23][24][25][26] In a recent community health center study, for instance, over 90% of patients screened positive for at least one social risk factor, but only about 20% wanted assistance from health center staff. 7 In other studies, differences are less dramatic, but the theme has surfaced across multiple settings.…”