Frequently Asked Questions
Miscellaneous
SEEK was found to be cost saving in the 2nd randomized controlled trial. It cost $3.38 per child per year and $210.20 per incident of maltreatment prevented. The medical and mental health costs alone associated with abuse are considerably higher, conservatively estimated at $2908 per maltreatment incident.
Lane W, Dubowitz H, Frick K, Semiatin J, Magder L. (2011) The Safe Environment For Every Kid (SEEK) Program: A Cost-Effectiveness Analysis. 139th Annual Meeting of the American Public Health Association. Washington, D.C.
The SEEK PQ-R / PQ-Re screens for possible problems. In assessing and addressing positive screens, however, the SEEK training and materials point to the need to identify strengths and resources. These are invariably present and help buffer the impact of stressors; they provide a useful handle to engage families constructively.
Strengths may be “internal” such as a parent’s wish to be a good parent or the support offered by a grandparent. Clinicians can for example encourage greater involvement of the father in his child’s life. Strengths may be “external” such as the support by a health professional or a drug treatment program. By showing concern for the family, you signal something valuable, that you are a resource – someone interested in helping. Thus, identifying and working with strengths is important to effectively help parents engage in help.
SEEK was developed for and evaluated in pediatric primary care settings. The thinking was that this fits naturally with goals of primary care and builds on the usually close relationship between primary care professionals and families. Although it has not been tested in family medicine settings, these may be optimal for SEEK given that the same clinician often cares for the child(ren) and parent(s).
There has been interest in adapting the SEEK approach for other settings. For example, hospitalists have pointed out that there is more time during inpatient admissions and also that there may be more social work and/or behavioral health resources. Emergency department physicians and professionals in Child Advocacy Centers have also been interested in adapting SEEK for those settings. While SEEK has not been evaluated in these other settings, it is possible that the approach could be adapted for broader use. If interested, please first contact the SEEK office. Evaluation of any adaptation is strongly recommended.
Instead of the traditional approach where health professionals tell parents or patients what to do, MI recognizes the value of the parent helping develop the plan. It begins with assessing how the parent views the issue and what they think they can do. Evidence indicates this is a more effective approach for ensuring that parents or patients “own” the plan and follow through with it.
We recommend viewing the SEEK training videos 8 and 9 and the other resources on MI.
SEEK focuses on risk factors for maltreatment rather than maltreatment per se. However, it is possible that in probing “harsh punishment,” sufficient concern for abuse may arise requiring referral to CPS. To the best of our knowledge this has been exceedingly rare. If a referral is made, as always, this should be conveyed as an opportunity to clarify the situation and provide help if needed. Understandably, some parents will not be reassured and may be upset.
There is also the possibility of needing to refer certain circumstances when children are involved in intimate (or domestic) partner violence. Clinicians need to know their state law and local policy regarding this.
Electronic versions of SEEK offer a way to implement the approach online with parents completing the SEEK PQ-R in advance and medical professionals having the responses at the start of the visit. SEEK software also offers guidance for addressing identified problems, and automated documentation in an EHR.
Using a Paper Form: The SEEK PQ-R / PQ-Re can be completed by a parent on paper while waiting to be seen. The completed PQ-R is then given to the medical professional at the start of the well child visit. After the visit, the SEEK PQ-R can be placed in the child's medical record or scanned into an EHR. Some practices have vendors who can program the PQ-R as a pre-visit questionnaire into an EHR. This may be integrated into an EHR with a standalone presentation on a kiosk or tablet or within the EHR directly.
Integrating SEEK Into Your Practice’s Electronic Health Record (EHR)