title: Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment.
abstract: OBJECTIVE
  The objectives of this study were to determine whether 1) residents trained in the SEEK (A Safe Environment for Every Kid) model would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (parental depression, parental substance abuse, intimate partner violence, stress, corporal punishment, and food insecurity); 2) intervention residents would be more likely to screen for and assess those risk factors; and 3) families seen by intervention residents would report improved satisfaction with their child's doctor compared to families receiving standard care from control residents.
  
  
  METHODS
  Pediatric residents in a university-based pediatrics continuity clinic were enrolled onto a randomized controlled trial of the SEEK model. The model included resident training about psychosocial risk factors, a Parent Screening Questionnaire, and a study social worker. Outcome measures included: 1) residents' baseline, 6-month, and 18-month posttraining surveys, 2) medical record review, and 3) parents' satisfaction regarding doctor-parent interaction.
  
  
  RESULTS
  Ninety-five residents participated. In 4 of 6 risk areas, intervention residents scored higher on the self-assessment compared to control subjects, with sustained improvement at 18 months. Intervention residents were more likely than control subjects to screen and assess parents for targeted risk factors. Parents seen by intervention residents responded favorably regarding interactions with their doctor.
  
  
  CONCLUSIONS
  The SEEK model helped residents become more comfortable and competent in screening for and addressing psychosocial risk factors. The benefits were sustained. Parents viewed the intervention doctors favorably. The model shows promise as a way of helping address major psychosocial problems in pediatric primary care.
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. sfeigelm@umaryland.edu
authors.forename: Susan
authors.initials: S
authors.lastname: Feigelman
authors.forename: Howard
authors.initials: H
authors.lastname: Dubowitz
authors.forename: Wendy
authors.initials: W
authors.lastname: Lane
authors.forename: Lawrie
authors.initials: L
authors.lastname: Grube
authors.forename: Jeongeun
authors.initials: J
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000517:prevention & control*; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D017060:Patient Satisfaction; D010372:Pediatrics / Q000193:education*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires