Frequently Asked Questions
Parents
The PQ-R / PQ-Re should be given to parents at regular checkups between 0-5 years of age, such as at: 2, 9, 15, 24, 36, 48 and 60 months. We don't suggest giving it at the first visit when you’re establishing rapport with the parent. Logistically, it may be easiest to use at each visit, but it needs to fit in with other questionnaires in the practice. Thus far, parents have not complained about completing it repeatedly. As a family's circumstances can naturally change, it is important to continue asking parents to complete the PQ-R / PQ-Re periodically. While the SEEK studies focused on the 0-5 age group, the approach can be adapted for older children.
Provide parents with the SEEK PQ-R / PQ-Re in advance of the visit. Usually the medical or nursing assistant who first sees the child provides the PQ-R / PQ-Re on a clipboard to the parent, with brief encouragement, such as “we want to improve the care we give to kids and families. Please fill this out and give it to your doctor/nurse at the start of the visit.” The PQ-R / PQ-Re should be completed in a private room while waiting for the medical professional.
Electronic versions of SEEK enable a parent to complete the PQ-R / PQ-Re at home online or on an iPad or computer in the office. Responses are available to PCPs at the start of the visit.
No, it can be completed by any primary caregiver who lives with the child. We do not suggest giving the SEEK PQ-R / PQ-Re to a caregiver who has limited or intermittent responsibility for a child. The intent is to probe possible problems in the child's regular home environment.
Participating in SEEK is entirely voluntary. The PQ-R / PQ-Re makes this clear in the introduction.
It is also OK if parents do not answer some questions. It is possible that parents who initially refuse may be willing to share information in the future. Just asking the questions signals to parents that you care about them too, and that you’re a valuable resource. A seed may have been sown.
If a parent objects to the entire PQ-R / PQ-Re, this naturally needs to be respected. One may ask for permission to offer the PQ-R / PQ-Re at a future visit. Again, the parent’s request must be respected and if ‘no’, it’s important to mark the record so that the PQ-R / PQ-Re is not offered again. We are not aware of this situation ever occurring.
The SEEK approach was designed to encourage a dialogue between health professionals and parents. The SEEK online training includes key principles of Motivational Interviewing (MI) to encourage adherence to recommendations. MI helps a parent to acknowledge their risk behavior, decide on a personal plan of action, and put their plan into effect.
The child health professional does not have primary responsibility for example to ensure that a possibly depressed parent engages in therapy. However, it is recommended to enquire about the problem and plan at the subsequent visit. It’s also helpful to indicate to the parent that they can request help from you, or from their own primary care provider. This situation is different for family medicine professionals who are caring for both a child(ren) and the parent(s).
You may want to review Modules 8 and 9 of the SEEK training. Module 8 includes: relationship building, MI, addressing barriers to engagement, and probing suicidality. Module 9 focuses on some core principles for behavioral health approaches in child health care settings. This module focuses largely on MI and “readiness to change” which are central to so much of our work.
It is also useful to recognize that engaging in help is a process that may take considerable time, for many reasons. Understanding the “stages of change” incorporated in MI is helpful. It helps to be patient, supportive and offer continued encouragement.
In our experience parents’ responses have been overwhelmingly positive. If a parent does express concern that it is too intrusive, we convey what’s in the PQ-R / PQ-Re introduction: these are problems facing many families and that this is an effort to help families and kids. Remind such parents that participation is voluntary, and they have the option of not answering all questions.
If a parent objects to the entire PQ-R / PQ-Re, this naturally needs to be respected. One may ask for permission to offer the PQ-R / PQ-Re at a future visit. Again, the parent’s request must be respected and if ‘no’, it’s important to mark the record so that the PQ-R / PQ-Re is not offered again. We are not aware of this situation ever occurring.
In our experience this has not been a problem, although it could occur. The SEEK PQ-R / PQ-Re addresses problems some of which have long been considered standard pediatric care (e.g., screening for parental substance abuse) or which have been recommended in American Academy of Pediatrics policies (e.g., domestic violence). In most states, parents or legal guardians can access their child’s medical record. Thus the concern about the other parent accessing the record exists - with or without SEEK. It appears that the remote likelihood of a problem (e.g., a parent discovering that the spouse disclosed domestic violence) should not supersede the potential benefit of child health professionals helping address these problems that occur in many families. The risk of aggravating domestic violence may be mitigated by documentation using code terms such as “family conflict discussed.”
Since one cannot guarantee that EHR information will be kept confidential/private, a change has been made to the opening paragraph of the SEEK PQ-R / PQ-Re that begins with “Dear Parent or Caregiver”. The sentence that was removed is “This information will be kept confidential/private unless we’re worried about your child’s safety”. This change was made as of October 2022.