Safe Environment for Every Kid

About the program

Safe Environment for Every Kid (SEEK) is an intervention to enhance pediatric primary care and better address major risk factors for child maltreatment in order to significantly reduce child maltreatment rates (Dubowitz et al. 2009; 2012).

The SEEK model includes:

• training residents to address targeted risk factors
• resources for doctors and parents
• the Parenting Screening Questionnaire (PSQ) completed by parents
• a resident-social worker team to address concerns

See also the Safe Environment for Every Kid Program Summary in the Reducing Child Harm and Maltreatment Evidence Review.

Who does it work for?

The SEEK program is designed to target parents with children 5 years or younger who receive pediatric care. The aim of the intervention is to quickly find and address identified problems associated with child maltreatment (Dubowitz et al. 2009, 2012).

The program has only been tested in the USA (Dubowitz et al. 2009; 2012).

Two randomised control trials were conducted:

• One with 558 people (308 people were in the intervention group and 250 people were in the control group). On average, parents were 25 years old. Most parents were African American and from low-income families.
• One with 1,089 people (583 people were in the intervention group and 506 people were in the control group). On average, parents were 34 years old. Most parents were Caucasian. Income status was not reported in this study.

SEEK has not been tested in Australia, or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• Child’s medical care: children whose parents received the SEEK intervention have fewer medical care problems, including instances of non-adherence to medical care and delayed immunisations, than those who received standard pediatric care (Dubowitz et al. 2009)
• Harsh parenting:
  • there are fewer reported minor physical assaults and psychological aggression instances in parents who receive the SEEK program, compared to those who just received standard pediatric care (Dubowitz et al. 2012).
  • parents who receive the SEEK program report fewer instances of severe to very severe physical assaults on their children, compared to those who received standard pediatric care (Dubowitz et al. 2009).

No effects:

• Child hospitalisations (child abuse suspected): the program did not have an effect on the number of hospitalisations due to suspected child abuse in families who received the SEEK program (Dubowitz et al. 2012).

There is mixed research evidence on the impact of the program on child abuse reports (substantiated/unsubstantiated). A 2009 evaluation of the program found there are fewer reports of child abuse for parents who receive the SEEK program, compared to parents who just received standard pediatric care (Dubowitz et al. 2009). However, a 2012 evaluation of the program shows no effect on the number of child abuse reports received by child protective services (Dubowitz et al. 2012).

Negative outcomes:

• No negative effects have been found.

How effective is it?

Overall, the SEEK program has mixed effects for client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse outcomes):

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

The SEEK model program consists of:

• specially training residents
• resources for the doctors and parents (handouts)
• the Parenting Screening Questionnaire (PSQ)
• a social worker.

Resident training: intervention residents are trained to address targeted risk factors for maltreatment such as maternal depression, alcohol and substance abuse, intimate partner violence, harsh punishment and major stress. They are taught the relevance of these problems to children's health, as well as how to briefly assess and address them. Additional training or 'booster' sessions are conducted every 6 months.

Parent and physician resources: Residents receive laminated pocket cards with salient information, a handbook with comprehensive practical information including local resources, and user-friendly parent handouts.

The Parenting Screening Questionnaire (PSQ): The 20-item PSQ was developed to screen for targeted risk factors. The The PSQ has a brief introduction empathising with the challenges of parenting, expressing an interest in children’s health and safety, and an interest in helping. Parents give the PSQ to residents so they can address identified problems.

The SEEK Social worker: The intervention clinics have a social worker who works closely with the residents and families. Residents and parents choose whether to involve the social worker. Management often involves guidance and support in the clinic and referrals to community agencies.

How much does it cost?

Not reported

Where does the evidence come from?

Two RCTs:

• One conducted in the USA, involving 558 participants (Dubowitz et al. 2009).
• One conducted in the USA, involving 1089 participants (Dubowitz et al. 2012).

Further resources

SEEK model website: https://seekwellbeing.org

Dubowitz et al. (2009), Pediatric primary care to help prevent child maltreatment: The Safe Environment for Every Kid (SEEK) model. Pediatrics, Vol. 123, No. 3, pp. 858-864.

Dubowitz et al. (2012), The SEEK model of pediatric primary care: Can child maltreatment be prevented in a low-risk population? Academic Pediatrics, Vol. 12, No. 4, pp. 259-268.