The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals

Abstract

WHAT'S KNOWN ON THIS SUBJECT:It is well established that risk factors such as maternal depression are prevalent and jeopardize children's health and development. Pediatric primary care offers an opportunity for helping address such psychosocial problems that are connected with child abuse and neglect. WHAT THIS STUDY ADDS:Results of this study indicate that the Safe Environment for Every Kid model helps pediatric health professionals address targeted psychosocial problems. The study is one of the first to examine change in pediatric private practices concerning the management of psychosocial problems. 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 Ͻ .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence(6and18months),andstress(6,18,and36months),andintheircomfort 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 Ͻ .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.

Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial

“…49 Safe Environment for Every Kid uses a screening instrument, originally administered by physicians, to refer selected families to social work support. 50,51 DULCE differs from these interventions in that a specially trained FS who has established 52,53 ; DULCE, by making the visits more valuable for families, may offer another avenue for improvement in delivery of preventive health care. As health care systems become accountable for the delivery of preventive services, the cost of this intervention may be partially offset by reduction in case management costs.…”

Health, Developmental and Support Needs of Vulnerable Children – Comparing Children in Foster Care and Children in Need

“…More than a decade ago, Felitti et al (1998) explored relationships between, and outcomes of, various categories of childhood adversity including child abuse, neglect, caregiver's substance use, caregiver's depressive symptoms, family violence, criminality and children's outcomes. Social and environmental risk factors outlined in the above studies are not difficult to elicit in a CP setting if appropriate training and psychosocial support are available, as Dubowitz et al (2011b) suggests. Wills et al (2008) reported on a substantial improvement in the quality of assessment and identification of child and partner abuse in New Zealand, resulting in increased referrals from health to child protective services, by training health workers in identifying both child and intimate partner abuse and improving partnerships between agencies.…”

Translating Developmental Science to Address Childhood Adversity

“…When coupled with referrals to community-based resources, some screening protocols have been shown to reduce childhood abuse and to decrease family distress. [46][47][48] Most importantly for the FCPMH, many of these screening protocols have been well received by families and are not time intensive (Table). 32,33 Although the 2-generation approach is promising, discussing family-level needs can be difficult for both the family and the provider.…”