Research Evidence
Two large randomized controlled trials (RCTs) were conducted on the SEEK approach. The first (SEEK I) was in pediatric resident (trainee) primary care clinics serving a very low-income urban population. The 2nd (SEEK II) was in 18 suburban private pediatric practices serving a mostly middle-income and relatively low risk population. The main findings were:
- Less child maltreatment. In SEEK I, children in families exposed to SEEK were significantly less likely to be abused or neglected - assessed three ways: by parents’ reports of how they handled conflict with their child, by review of medical records, and by child protective services (CPS) reports. For example, over a 36-month period, SEEK families were far less likely to be reported to CPS than controls (13.3% vs. 19.2%). This translates to preventing a CPS report in one out of every 13 such high risk families. In SEEK II, mothers exposed to SEEK reported less harsh physical punishment and psychological aggression, reasonably considered as child maltreatment, compared to controls.
- Primary Care Professionals (PCPs) benefit. In both RCTs, PCPs improved significantly in their thinking and practice with regard to addressing the targeted risk factors. Some improvements were sustained for up to 18 - 36 months beyond the initial training.
- No added PCP time. SEEK did not require significantly additional time for PCPs to address psychosocial problems. Clearly, parents with problems would require more time. However, this can be offset by parents completing the SEEK Parent Questionnaire-R in advance, obviating the need to probe those areas during the visit.
- Parents’ positive perceptions of their PCP. Parents in SEEK I who were exposed to SEEK had a more positive view of their child’s doctor, appreciating the broad concern about the family.
- Cost Savings. In SEEK II, SEEK cost $3.59 per child per year or $306 to prevent one incident of psychological aggression or physical assault. This is far less than the estimated costs of responding after a child has been abused or neglected. Costs may be offset by reimbursement via CPT code 96161.