The National Safe Environment for Every Kid (SEEK) Study

Child maltreatment (CM) is a major public health problem associated with negative developmental, health and economic outcomes across the lifespan costing individuals, families and society dearly. There is a need for the broad implementation of effective, evidence-based preventive interventions, such as the SEEK model, developed for pediatric primary care. The family – primary care professional (PCP) relationship that builds during the well-child visits, between  birth and 5, affords PCPs an excellent opportunity to help address prevalent social determinants of health (SDH), such as parental depression, substance use and food insecurity, that are risk factors for CM. By helping address such problems, SEEK can support parents, strengthen families, promote children’s health, development and safety, and help prevent CM.

The National SEEK Study, funded for 5 years by the NIH has the overarching goal of learning what facilitates or impedes the adoption, implementation, and sustainability of the evidence-based practice SEEK, as well as  SEEK’s effectiveness in preventing CM. Specific aims include to:

  • Improve primary care for children and their families by better addressing specific SDH.
  • Compare independent online training and structured training (MOC Part 4/PI for credit) – two key approaches increasingly common in medical education.
  • Examine how SEEK is implemented in both pediatric and family medicine primary care practices.
  • Examine SEEK’s effectiveness in preventing child abuse and neglect.
  • Contribute to implementation science and guide the implementation of innovations in primary care practices.

Core Components of the SEEK Model 

  • PCPs complete the SEEK training
  • Use the SEEK Parent Questionnaire-R with parents
  • Incorporate principles of motivational interviewing to briefly assess and initially help address problems
  • PCPs collaborate with behavioral health professionals – ideally, within a practice or network
  • Develop and maintain a current community resource list
  • Use customized SEEK Parent Handouts or similar educational materials

Key Findings from Two Randomized Controlled Trials

  • SEEK helped reduce the rate of child maltreatment and harsh parenting.
  • There was sustained PCP improvement re. addressing SDH – for up to 36 months.
  • SEEK did not add significant time to visits.
  • SEEK appears to be cost-saving. 

What Does the National SEEK Study Involve?

  • We’re recruiting pediatric and family medicine primary care practices throughout the US.
  • We will recruit from each practice: (i) a practice leader and co-champion, (ii) PCPs, (iii) behavioral health professionals, if available, (iv) 2 ancillary staff and (v) 8 parents.
  • Completing brief online annual surveys for 2 years. A few participants will also be interviewed by phone.
  • Practices will be randomly assigned to one of the two training approaches (Independent online or MOC 4/PI); PCPs will be eligible for CME/MOC 2 and/or MOC 4/PI credits).
  • Practices implement the SEEK model.
  • We will gather de-identified, aggregated ICD 10 data – at a practice level – at the end of the study.

Potential Benefits to Primary Care Practices from Participation in this Study

  • You’ll enhance your practice in accordance with recommendations for addressing common psychosocial problems by the AAP, the AAFP, and the US Preventive Services Task Force.
  • Addressing SDH supports parents, strengthens families, promotes children’s health, development and safety, and helps prevent CM. This improves the care you provide and families’ satisfaction with their care.
  • NEW: Access to the National SEEK Study social worker, who will:
    • Help identify local resources for possible referral to address targeted problems
    • Help customize the SEEK Parent Handouts with info on the local resources
    • Manage the SEEK Helpline, available to PCPs, staff and parents during regular work hours
  • NEW: $2000 per year per practice to offset administrative efforts related to the study.
  • PCPs benefit from the SEEK training and materials, becoming more comfortable and competent addressing SDH.
  • CME, MOC 2 and possibly MOC 4 or PI credits – free.
  • SEEK helps you qualify as a “Patient Centered Medical Home” – in accordance with the NCQA guidelines.
  • Your practice may be reimbursed for administering the SEEK PQ-R. This varies by state and insurer.
  • Waiving of the license fee for implementing SEEK.
  • An opportunity to advance knowledge and practice re: primary care.

The National SEEK Study Leadership Team

The study is led by Howard Dubowitz, MD, MS, FAAP, Professor of Pediatrics at the University of Maryland School of Medicine. He led the development of the SEEK model and the two studies evaluating it. Lisa Saldana, PhD (clinical psychology) and John Landsverk, PhD (sociology), are Senior Research Scientists at the Oregon Social Learning Center in Eugene, Oregon, with expertise in Implementation Science. Larry Magder, PhD is a senior statistician at the University of Maryland School of Medicine who has worked on SEEK. Larry Palinkas, PhD (anthropology), the Albert G. and Frances Lomas Feldman Professor of Social Policy and Health and Chair of the Department of Children, Youth and Families at the University of the Southern California School of Social Work, is expert in qualitative methodology and implementation science. The senior project co-coordinators are Rosemarie (Rose) Belanger, PhD and Ugonna (Ugo) Nwosu MBBS, MPH, MS.

For More Information

Contact: Howard Dubowitz, MD, MS, FAAP – hdubowitz@som.umaryland.edu, Rose Belanger, PhD rbelanger@som.umaryland.edu  or Ugo Nwosu MBBS, MPH, MS – UNwosu@som.umaryland.edu

Please visit www.SEEKwellbeing.org for more info about the SEEK model.