Safe Environment for Every Kid (SEEK)

About the program

Safe Environment for Every Kid (SEEK) was developed by the University of Maryland. It is a clinical model, delivered in paediatric clinics to families of children aged 0-5 years. The program goal is to significantly reduce maltreatment rates. It involves training medical residents to address targeted risk factors, screening all families with the brief parenting screening questionnaire, providing doctors and parents with resources in the form of handouts, and establishing a resident social worker team.

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

Who does it work for?

The target group for the program was socioeconomically disadvantaged primary caregivers of young children in the pre-school years. One study located at a university-based resident continuity clinic in the USA had 729 families in the original sample size, and 558 families in the final sample size (Dubowitz et al. 2009). The mean child age was 6 months for the intervention group, and 8 months for the control group. The mean parent age was 25.3 years. 93% of the intervention group, and 94% of the control group were Black. Approximately a third of the sample were employed. The study used participation in the Medical Assistance scheme as an indicator of socioeconomic status: 93% of the intervention group and 92% of the control group received Medical Assistance. In the intervention group, 36% did not complete high school, 36% completed high school, and 28% had at least some college education. In the control group, 42% did not complete high school, 38% completed high school, and 20% had at least some college education. The mean number of children in the home was 2.3, the mean number of adults in the home was 2.2.

The review did not identify any evidence that the program has been evaluated in Australia or with First Nations communities.

What outcomes does it contribute to?

Positive outcomes:

Child protection services reports, Medical chart documentation; Corporal/physical punishment/discipline: Dubowitz and colleagues (2009) demonstrated a positive effect of the program on child abuse and neglect outcomes including child protection reports, medical chart documentation and harsh discipline. There were significantly fewer child protection services reports for families in the intervention group compared to the control group (respectively 13.3% and 19.2%, p = .03). The intervention group had fewer items in their medical charts that suggested neglect, including fewer instances of non-adherence to medical care (4.6%) compared to the control group (8.4%), p =.05 and delayed immunisations (3.3%) compared to the control group (9.6%), p = 0.02. Parents in the intervention group reported fewer instances of severe or very severe physical assault.

No effect:

None.

Negative outcomes:

None.

Is the program effective?

Overall, the program had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer 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 components of the intervention are:

1. Training: Medical residents are trained in targeted risk factors such as maternal depression, alcohol and substance misuse, intimate partner violence, harsh punishment and major stress.
2. Parent and resident resources: Medical residents receive laminated pocket cards with salient information, and a handbook with comprehensive practical information including local resources, and user-friendly parent handouts.
3. Screening tool: The parents complete this tool while waiting for their check-up appointment.
4. The SEEK social worker: A certified social worker works closely with the residents and parents as requested.

Early intervention specialists, early childhood teachers, and other service professionals are consulted as needed for advice and referral.

How much does it cost?

Information not available

What else should I consider?

Clinical residents are trained over 2 half-days, with booster sessions every 6 months.

Where does the evidence come from?

A cluster RCT was conducted with an initial sample size of 729 families, and a final sample size of 558 families (Dubowitz et al., 2009).

Further resources

• https://seekwellbeing.org/
• Dubowitz, H., et al. (2009). “Pediatric primary care to help prevent child maltreatment: The safe environment for every kid (SEEK) Model.” Pediatrics 123(3): 858-864.