Since Haggerty et al's description of the "new morbidity" in 1975, pediatricians have been trying to integrate the screening and management of psychosocial issues into the delivery of well child health care. The American Academy of Pediatrics participated in a national effort, "Bright Futures," to develop practical recommendations for pediatricians, urging consideration of the child's critical environment in the family and in the community. When surveyed, however, many pediatricians feel that they have neither the knowledge nor competency to deal with several of these issues, such as maternal depression or intimate partner violence.
The SEEK project, funded by the US DHHS, Administration on Children and Families, the CDC, and the Doris Duke Foundation, offers a practical approach to the identification and management of targeted risk factors for child maltreatment for families with children aged 0-5, integrated into pediatric primary care. By addressing these problems, SEEK aims to strengthen families, support parents, and thereby enhance children's health, development and safety, while helping to prevent child maltreatment.
The main components of the SEEK model include:
- Training health professionals to briefly assess and initially manage identified problems.
- It seems important that the professionals feel adequately prepared to handle issues they may not have been trained in. Initial training was between 4-8 hours, taught in an interactive way by an interdisciplinary faculty, and with 1-hour boosters approximately every 6 months. SEEK training materials are available for others to use. In SEEK II, we added a module on motivational interviewing.
- Use of the Parent Screening Questionnaire to identify targeted problems.
- We developed a questionnaire for the SEEK I, conducted in a low-income population and modified it for SEEK II, conducted in a mostly middle-class population. Several papers have been published on SEEK I PSQ (see references). The PSQ is one side of one page with a user friendly format that is easy for professionals to review. It should be handed to parents at select well-child visits for them to complete voluntarily while waiting, and then given to the health professional at the start of the visit.
- The PSQ attempted to screen (not diagnose) several common problems that are risk factors for child maltreatment: (1) maternal depression, (2) alcohol and substance abuse, (3) intimate partner (or domestic) violence, and (4) parental stress and difficulty coping. In SEEK I, we also addressed food insecurity.
- In SEEK I, the clinic thought it easiest to simply hand out the PSQ at each checkup starting at 2 months - 5 years. In SEEK II, the PSQ was handed out at the 2, 9 and 15 month, and 2, 3, 4, and 5 year visits.
- Collaboration with a social worker to help address problems, including referrals to community resources.
- This has been a valuable component of the SEEK model. In SEEK II, one social worker divided her time across 7 practices, but still available to others by phone. Health professionals and parents naturally have discretion regarding how and when to involve the social worker. The social worker tailored her involvement to meet the needs of individual parents, but did not engage in extended therapy.
- Parent Handouts -- specially developed as adjuncts to advice given in the office.
- Relatively simple one side of one page handouts were developed covering approximately 10 common problems. These were customized for each practice/location, including information on local resources.
Dubowitz H., Prescott L., Feigelman S., Lane W., Kim J. Screening for Intimate Partner Violence in an Urban Pediatric Primary Care Clinic. Pediatrics. 2008: 121(1): e85-91.
Lane W., Dubowitz H., Feigelman S., Kim J., Prescott L., Meyer W., Tracy JK. Screening for Parental Substance Abuse in an Urban Pediatric Primary Care Clinic. Ambulatory Pediatrics. 2007; 7: 458-462.
Dubowitz H., Feigelman S., Lane W., Prescott L., Blackman K., Grube L., Meyer W., Tracy JK. Screening for Depression in an Urban Pediatric Primary Care Clinic. Pediatrics. 2007; 119(3): 435-43.
Kim J., Dubowitz H., Hudson-Martin E., Lane W. Comparison of 3 Data Collection Methods for Gathering Sensitive and Less Sensitive Information. Ambulatory Pediatrics. 2008; 8(4): 255-60.
Dubowitz H., Feigelman S., Lane W., Kim J. Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009; 123: 858-64.
Feigelman S., Dubowitz H., Lane W., Kim J. Screening for Harsh Punishment in a Pediatric Primary Care Clinic. Child Abuse Neglect. In press.
For more information, please contact:
Howard Dubowitz, MD, MS
Phone: (410) 706-6144