Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) model. Pediatrics, 123(3) 858–864. https://doi.org/10.1542/peds.2008-1376

Type of Study: Randomized controlled trial
Number of Participants: 558

Population:

• Age — Children: 0–5 years; Parents: Mean=25 years
• Race/Ethnicity — 92% Black
• Gender — 48% Female
• Status — Participants were clients of a pediatric primary care resident continuity clinic serving a low income urban community of families involved with child protective services.

Location/Institution: Baltimore, Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of Safe Environment for Every Kid (SEEK) in reducing the occurrence of child maltreatment. Participants were randomly assigned to SEEK or standard care (control) groups. Measures utilized include the Parent Screening Questionnaire (now called the Parent Questionnaire) and the Parent-Child Conflict Tactics Scale (CTSPC). Child protective services data were also examined, along with the child’s medical record. Results indicate that SEEK resulted in significantly lower rates of child maltreatment in all outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. Limitations include relatively small sample size, concerns regarding generalizability to other populations, and lack true baseline data. In addition, families with prior child welfare involvement were not excluded from the study sample, blending results for primary, secondary, and tertiary prevention (intervention) samples.

Length of controlled postintervention follow-up: Varied by individual - between 7 months and 3.5 years.

Dubowitz, H., Lane, W. G., Semiatin, J. N., Magder, L. S., Venepally, M., & Jans, M. (2011). The Safe Environment for Every Kid model: Impact on pediatric primary care professionals. Pediatrics, 127(4), 962–970. https://doi.org/10.1542/peds.2010-1845

Type of Study: Randomized controlled trial
Number of Participants: 102

Population:

• Age — Health Care Professionals: Mean=45 years
• Race/Ethnicity — Not specified
• Gender — Health Care Professionals: 68% Female
• Status — Participants were child health care professionals that dealt with major risk factors addressing child maltreatment.

Location/Institution: 18 private practices in central Maryland, loosely associated with the University of Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine whether Safe Environment for Every Kid (SEEK) with 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). Participants were randomly assigned to SEEK or control groups. Measures utilized were the Parent Screening Questionnaire (PSQ, now called the Parent Questionnaire) and the Health Professional Questionnaire (HPQ). The child’s medical record was also examined, and check-up visits were observed. Results indicate that SEEK led to significant and sustained improvement in several areas. Results revealed significant improvement in the SEEK group compared with controls in addressing depression, substance abuse, intimate partner violence, and major parental stress and in their comfort level and perceived competence. SEEK HPs screened for targeted problems more often than did controls -up to 24 months after the initial training. Limitations include relatively small sample size, possibility of socially desirable responses on self-reported measures, and lack of information on whether SEEK was related to prevention of child abuse and neglect.

Length of controlled postintervention follow-up: 6, 18, and 36 months.

Feigelman, S., Dubowitz, H., Lane, W., Grube, L., & Kim, J. (2011). Training pediatric residents in a primary care clinic to help address psychosocial problems and prevent child maltreatment. Academic Pediatrics, 11(6), 474–480. https://doi.org/10.1016/j.acap.2011.07.005

Type of Study: Randomized controlled trial
Number of Participants: 95

Population:

• Age — Pediatric Residents: Mean=28 years
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were pediatric residents in a primary care resident continuity clinic serving a low income urban community.

Location/Institution: Baltimore, Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The study used a sample from the same practice sites examined in Dubowitz, et al. (2009). The purpose of the study was to determine whether 1) Residents trained in Safe Environment for Every Kid (SEEK) model would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (e.g., 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. Participants were randomly assigned to either SEEK or the control group on the basis of their assigned clinic day. Measures utilized include the Parent Screening Questionnaire (PSQ, now called the Parent Questionnaire) and the Physician Questionnaire (PQ). Results indicate that SEEK improved residents’ level of comfort, perceived competence, and practice behavior regarding prevalent psychosocial problems that are risk factors for child maltreatment. Limitations include generalizability of the findings may not apply to lower risk communities, private practice, or other settings; possible sharing of information between participants; and lack of information on whether SEEK was related to prevention of child abuse and neglect.

Length of controlled postintervention follow-up: 6 and 18 months.

Dubowitz, H., Lane, W. G., Semiatin, J. N., & Magder, L. S. (2012). The SEEK model of pediatric primary care: Can child maltreatment be prevented in a low-risk population?. Academic Pediatrics, 12(4), 259–268. https://doi.org/10.1016/j.acap.2012.03.005

Type of Study: Randomized controlled trial
Number of Participants: 1,119 Mothers

Population:

• Age — SEEK Parents: Mean=33.4 years; Control Parents: Mean=34.5 years; SEEK Children: Mean=25 months; Control Children: Mean=26.7 months
• Race/Ethnicity — SEEK Parents: Not specified; SEEK Children: 86% White, 8% Other, 4% African American, 2% Asian, and 1% Latino; Control Children: 75% White, 12% Other, 7% African American, 5% Asian, and 1% Latino
• Gender — SEEK Parents: 100% Female; Seek Children: 50% Female; Control Children: 47% Female
• Status — Participants were families at private pediatric practices loosely associated with the University of Maryland.

Location/Institution: University of Maryland

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Dubowitz et al. (2011). The purpose of the study was to examine the effectiveness of Safe Environment for Every Kid (SEEK) with enhanced pediatric primary care to help reduce child maltreatment in a relatively low-risk population. Participants were assigned to SEEK or control groups. Measures utilized include the Parent Screening Questionnaire (PSQ), [now called the Parent Questionnaire] and the Parent-Child Conflict Tactics Scales (CTSPC). Children’s medical records and child protective services data were reviewed. Maltreatment was assessed 3 ways: maternal self-report using the CTSPC, children’s medical records, and child protective services reports. Results indicate that in the initial and 12-month assessments, SEEK mothers reported less Psychological Aggression than controls and SEEK mothers reported fewer Minor Physical Assaults than controls. There were few instances of maltreatment documented in the medical records and few child protective services reports. Limitations include inability to collect true baseline data, some issues with the randomization process, and the study sample was primarily low-risk and thus provides limited information on secondary prevention for high risk populations.

Length of controlled postintervention follow-up: 6 and 12 months.

Lane, W. G., Dubowitz, H., Frick, K. D., Semiatin, J., & Magder, L. (2021). Cost effectiveness of SEEK: A primary care-based child maltreatment prevention model. Child Abuse & Neglect, 111, Article104809. https://doi.org/10.1016/j.chiabu.2020.104809

Type of Study: Randomized controlled trial
Number of Participants: 102 pediatric providers and 924 families

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were pediatric providers at 18 pediatric primary care practices, and families with children < 6 years receiving care by those providers.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine the (1) overall cost for implementing the Safe Environment for Every Kid (SEEK) model, (2) cost of implementation per child, and (3) cost per case of maltreatment averted. Participants were randomly assigned to either SEEK training and implementation or usual care. Measures utilized include the Conflict Tactics Scale Parent-Child version (CTSPC) and data from the U.S. Department of Labor, Bureau of Labor Statistics (BLS) was used to determine physician, social worker, and psychologist salaries. Results indicate that implementing SEEK in all 18 practices would have cost approximately $265,892 over 2.5 years; $3.59 per child per year; or $305.58 ($229.18–$381.97) to prevent one incident. Based on a very conservative cost estimate of $2779 per maltreatment incident, SEEK would save an estimated $2,151,878 in health care costs for 29,610 children. Adjusted rates of maltreatment (parent endorsing Psychological Aggression or Physical Assault on the PCCTS) were lower in SEEK families compared to control families. Extrapolating these rates to the entire SEEK and control patient populations, there were an estimated 2759 episodes of maltreatment among children age 0–5 years in SEEK practices vs. 3630 in control practices. Limitations include the intervention was implemented in a relatively low-risk population, significant differences in maltreatment between SEEK and control groups when using a continuous measure of maltreatment severity (CTSPC score), and lack of follow-up.

Length of controlled postintervention follow-up: None.