A Safe Environment for Every Kid (SEEK II)
Our broad goal is to help prevent child maltreatment (CM) by modifying pediatric practice to be more responsive to important biopsychosocial needs of many children and families. Training pediatricians to address key risk factors for CM, thereby enhancing parenting and family functioning, reducing the risk for CM while helping ensure children's health and safety, are accomplishing this. We are building upon the existing pediatric primary care system and strengthen the training of pediatricians. The project also builds on our extensive research and clinical expertise in CM and in prevention (Black & Dubowitz, 1999, Dubowitz et al., 1998, 1999, in press; Dubowitz & Guterman, 2005, Gaudin & Dubowitz, 1997).
We have developed and implemented an enhanced model of pediatric primary care, taking advantage of the enormous opportunities of the existing pediatric primary care system, with its regular contact with young children and parents (Dubowitz & Newberger, 1989; Dubowitz, 1989, 1990; Green, 1994). Pediatricians typically devote over half their time to checkups, focusing on prevention. There is increasing recognition that pediatric care must incorporate aspects of parental and family functioning and collaborate with community resources (Academy of Pediatrics, 1998; Green, 1994b). The broad goal of this project is to implement concepts that have been embraced by the field of pediatrics, but have not been applied and tested.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Prevention
|Official Title:||Preventing Child Maltreatment: A Role for Community Pediatricians|
- Parent to Child Conflict Tactics Scale [ Time Frame: Initial contact, 6 months & 12 months after start of study participation ] [ Designated as safety issue: Yes ]
- Department of Human Services, Department of Child Protection records. [ Time Frame: Child's birth through March 2009 ] [ Designated as safety issue: Yes ]
|Study Start Date:||May 2006|
|Study Completion Date:||May 2010|
|Primary Completion Date:||March 2009 (Final data collection date for primary outcome measure)|
Experimental: Model Care
The Model Care approach was implemented in 7 practices, where healthcare providers (HPs) were trained to address major risk factors for CM, including maternal depression, alcohol/substance abuse, intimate partner violence, and stress. We taught the relevance of these problems for children's health and safety, and how they can be briefly assessed and initially addressed. The initial training consisted of 1 four hour sessions. Use of the Parent Screening Questionnaire (PSQ) was discussed, as was the importance of applying it universally during regular checkups. HPs received laminated cards or an electronic version with salient information, and parent handouts on each targeted issues. We held one hour booster sessions approximately every 6 months over the subsequent 2.5 years.
Other: Model Care
The Model Care provided training to pediatric health care providers to assess parental psychosocial risk factors to child maltreatment.
No Intervention: Standard Care
Health Care providers in Standard Care group served as the controls. They continued to practice as usual.
Hide Detailed Description
The SEEK project, funded by a CDC grant to the Division of Child Protection at the University of Maryland School of Medicine, attempts to offer a comprehensive and practical office-based approach to the identification and assessment of risk factors for child maltreatment, integrated into the delivery of well child health care.
Review of the literature identifies four major risk factors leading to child maltreatment, 1) maternal depression, 2) alcohol and substance abuse, 3) domestic violence, and 4) parental stress and poor coping. The project has several "arms" to address these risk factors. Initially, there is an education program elucidating these factors and offering a hands-on approach to addressing them in the pediatric office setting. The second phase is the introduction of a brief screening questionnaire into selected well child visits to assess the presence of these risk factors in families. If risk factors are present, the health care provider will spend a small portion of the visit assessing the problem. A project social worker is available (by phone or in the office) to help assess the problem, and to aid the families in accessing community resources. Another part of the project assesses the validity of the screening questionnaire against several "gold standards" used to diagnose the targeted risk problems.
The education program focused on the four major factors described. We used realistic office scenarios and offered participants the opportunity to use newly learned management strategies in addressing them. Small group experience with adequate time for processing and practice were utilized. Scheduling was done in conjunction with the participating offices, attempting to meet individual office needs. An Advisory Board of practicing community pediatricians and office personnel offered consultation on all phases of the program, as well as strategies to efficiently integrate the program into office practice. The project enlisted 102 health care providers in 18 practices with half serving as controls. All have received the educational program. Study health care offices used the one-page screening questionnaire in their practices. Control pediatricians made no change to their current practice, and continued to provide standard care. Parents were given the questionnaire, in the office, before the 2 and 15 month, and 2, 3, 4, and 5 year well visits. Questionnaires were completed while the parent waited. Questionnaires were quickly and easily scored and evaluated by the pediatrician at the visit. Significant issues were briefly assessed and addressed during the visit. The project social worker was available to practices for consultation and for direct intervention with families. "Booster sessions," reviewing the educational and intervention materials were held four times during the 2.5 year study period. Pediatrician knowledge, attitudes, and perceived competence were assessed at the beginning and end of the education program and at the end of the 2nd and 3rd year. Control pediatricians will be offered the education at the end of the project.
The central objective of the SEEK project was to examine whether parent functioning was improved by addressing common risk factors for child maltreatment, thus strengthening families and helping prevent maltreatment. A subset of parents in the project practices - intervention and control - were approached to participate in the evaluation of the project. Interest in participating was briefly assessed in the practice. A member of the project team contacted interested parents to fully explain what is involved. Parents who agreed to participate completed a survey (on-line or paper) at three different points. Survey completion took about 60 minutes, for which they were modestly compensated.
In addition, to evaluate the project, members of the project team did a chart review, and direct observation of practice behavior. We also asked parents' permission to review Department of Social Services records for possible involvement. All participating pediatricians and practices were invited to share in the conclusions at the end of the project.
The SEEK team hopes that this intervention will be the basis for a new and practical approach to the assessment of serious psychosocial risk factors within the framework of health supervision visits. Ultimately, our hope is that the identification and amelioration of these risk factors will help prevent child maltreatment, and improve the lives of many families. We encourage you to join us in developing an innovative approach to help address psychosocial risk factors in pediatric practice.
|United States, Maryland|
|University of Maryland, School of Medicine|
|Baltimore, Maryland, United States, 21201|
|Principal Investigator:||Howard Dubowitz, MD MS||University of Maryland|