Peer-reviewed article
The Safe Environment for Every Kid (SEEK) Approach: Two Training Modalities and Child Maltreatment Prevention.
Howard Dubowitz, Rose Belanger, Laurence Magder, Hannah Kim, Mark Campbell ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether a more intensive training program (Maintenance of Certification) was better than simpler online learning for helping primary care practices implement SEEK, an approach to identify and prevent child abuse. Fourteen US pediatric practices were followed for two years before and after SEEK implementation. The study found a modest decline in possible abuse cases overall, but no significant difference between the two training methods, and neither approach substantially changed how much time doctors spent addressing children's social needs.
Key points
- Possible child abuse rates declined slightly after SEEK implementation (OR=0.81, P=0.09), showing a trend rather than a statistically significant result
- Maintenance of Certification and independent online learning training modalities produced no significant difference in outcomes (P=0.31)
- Rates of unmet child needs remained unchanged after implementation (OR=1.12, P=0.36)
- Implementation costs were low ($896–$1955 per practice), and primary care provider time per visit decreased slightly (3.8 to 3.4 minutes)
- Simpler independent online training was recommended over the more intensive Maintenance of Certification approach based on similar outcomes
Limitations
The study had high attrition, with only 14 of 25 practices providing complete data, which may affect generalizability. The modest and non-significant trend in abuse reduction makes it difficult to draw firm conclusions about SEEK's effectiveness, and the study cannot determine whether any observed changes were due to the intervention or other factors.
Abstract
OBJECTIVE: A Maintenance of Certification-4 activity (MOC) will help primary care practices implement the Safe Environment for Every Kid (SEEK) approach to prevent child maltreatment more effectively than simpler independent online learning (IND). A secondary aim compared costs and effort. METHODS: This longitudinal, multisite study randomized 25 practices to MOC or IND training groups. Of 19 practices that continued in the study, 14 provided electronic health record (EHR) data for 2-year periods prior to and after implementing SEEK. Pediatric primary care practices across the US, included solo practices and large university training clinics. The outcome measure included possible child abuse and unmet child needs, using ICD-10 codes. We estimated costs and primary care professional (PCP) time. RESULTS: There was a trend with rates for possible abuse declining in the overall sample from pre- to post-SEEK (Post/Pre OR=0.81, CI=0.63,1.04, P=0.09). MOC and IND practices did not differ significantly (P=0.31). Rates regarding unmet needs held steady in the overall sample (OR=1.12, CI=0.87,1.44, P=0.36) and did not differ between groups (P=0.68). Pre-implementation costs were $896 and $1955 for IND and MOC practices. PCPs averaged 3.8 min addressing social drivers of health during well visits prior to SEEK vs. 3.4 min afterwards. CONCLUSIONS: The study offers an example of evaluating common training strategies. The few differences between MOC and IND training supports the simpler IND modality. The findings add limited support to prior studies of SEEK's effectiveness in preventing child abuse. The costs were minor and PCP time for routine visits decreased slightly, demonstrating SEEK's practicability.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- SEEK (Safe Environment for Every Kid) approach implementation with two training modalities: Maintenance of Certification (MOC) intensive training versus independent online learning (IND)
- Population
- Pediatric primary care practices across the United States (solo practices and large university training clinics); 14 practices with complete data
Key finding
Possible child abuse rates declined from pre- to post-SEEK with a trend-level result (Post/Pre OR=0.81, CI=0.63–1.04, P=0.09)