title: The safe environment for every kid model: impact on pediatric primary care professionals.
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 < .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence (6 and 18 months), and stress (6, 18, and 36 months), and in their comfort 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 < .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.
authors: Department of Pediatrics, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201, USA. hdubowitz@peds.umaryland.edu
authors: Howard
authors: H
authors: Dubowitz
authors: Wendy G
authors: WG
authors: Lane
authors: Joshua N
authors: JN
authors: Semiatin
authors: Laurence S
authors: LS
authors: Magder
authors: Mamata
authors: M
authors: Venepally
authors: Merel
authors: M
authors: Jans
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002649:Child Abuse / Q000517:prevention & control*; D002675:Child, Preschool; D002983:Clinical Competence; D003479:Curriculum; D003866:Depressive Disorder / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D007318:Inservice Training; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010372:Pediatrics / Q000193:education*; D011320:Primary Health Care; D012307:Risk Factors; D012449:Safety; D012931:Social Environment; D012947:Social Work; D013179:Spouse Abuse / Q000517:prevention & control; D019966:Substance-Related Disorders / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014481:United States