Background

The SEEK Parent Questionnaire-Re ('e' for expanded) or PQ-Re, is the updated brief questionnaire to screen for prevalent and targeted psychosocial problems that are risk factors for child maltreatment and also Adverse Childhood Experiences (ACEs) or Social Determinants of Health (SDH). Aside from preventing possible abuse and neglect, addressing the targeted problems promotes children's health, development, wellbeing and safety, as well as the functioning of their parents and family.

Why the update? The PQ-Re was updated to include additional problems that primary care professionals (PCPs) have requested, such as gun safety and transportation. Further, we regularly reevaluate feedback from those in practice and consult with experts re. new knowledge. Finally, we’ve improved the design. We recommend replacing earlier versions with  the improved SEEK PQ-Re.

Importantly, your practice can prioritize which issues to target or you can keep all that are there. This decision should be guided by the prevalence of the problem in the community served as well as the availability of a resource(s) to address it. It’s generally hard however to know how prevalent a problem is without systematic screening. Aggregate data from administering the SEEK PQ-Re for a few months serves as a valuable needs assessment, documenting the prevalence of problems in patients’ families. This information can be used to prioritize problems to target, to improve the care you provide to children and their families, and to advocate for resources.

Methodology: As stated above, we regularly obtain PCPs’ feedback regarding their experience with SEEK. We also periodically consult with experts on specific issues, such as substance use. Recognizing the time constraints in a busy practice, we aim to be practical, keeping the screener brief and easy to read and use – for parents and professionals. Of note, the PQ-Re has not been validated, meaning we have not examined the extent to which the screening questions accurately identify who has the problem and who does not.

The SEEK PQ-Re:

• Screens for, but does not diagnose, health-related social problems or risk factors for child maltreatment that are also ACEs or SDH.
• Solicits sensitive information, so the screener starts with an introduction that conveys an empathic tone and an interest in helping. It builds upon a longstanding concern about children's safety, beginning with commonly asked questions such as poison control before easing into more difficult problems. The introduction also conveys concern that the problems are ones facing many families; “normalizing” a problem helps reduce the possible stigma. Finally, the voluntary nature of answering questions is made clear.
• Targets:
  • Home Safety
    • Poison control info, smoke alarms, smoking, gun safety
  • Child Behavior
    • Difficult behavior, physical punishment, needing help
  • Parental Wellness
    • Stress, depression, partner violence, substance misuse, need for support
  • Food Insecurity
  • Other Needs
    • Transportation, utility company, housing, childcare, immigration, employment, adult education, accessing healthcare, public benefits
• Is intended for parents or primary caregivers to complete, voluntarily, in advance of their child's regular checkup, not at “sick” visits.
• Has “yes/no” questions on 1 side of 1 page and takes 3 minutes to complete.
• Is user-friendly and easy for parents to complete and for professionals to assess.
• Is completed at selected checkups, such as at the 2-, 9- and 15-month visits, and at the 2-, 3-, 4-, and 5-year visits. A practice can select which visits fit with their schedule.
• Is available in English and Spanish.

Administering the PQ-Re

• It should be given to parents or primary caregivers at regular checkups between 0-5 years of age. We don't suggest giving it at the first visit if there is not yet a relationship with the parent. Some use the screener with parents of older children.
• It may be easiest to use at each checkup. It should fit in with other questionnaires so as not to over burden parents and PCPs.
• As a family's circumstances can naturally change, it is important to ask parents to complete the PQ-Re periodically. Parents have not complained about completing it repeatedly. On the contrary, many have expressed gratitude that there is concern about the parent and family as well as the child.
• Administer the PQ-Re in advance of the visit – on paper or electronically.
• Usually a medical or nursing assistant provides the PQ-Re on a clipboard to the parent when placing them in an exam room; it’s best completed in privacy rather than in a waiting area. They can introduce it saying "we're trying to improve the care we provide to kids and families. Please fill this out and give it to your doctor/nurse at the start of the visit.”
• There are materials to help address positive screens, including for the recently added issues/problems: SEEK Guidelines, Responses to Barriers, and Parent Handouts.

When is a Screen Positive?

• A few problems have 2 screening questions (e.g., food insecurity). A ‘Yes’ to either question is a ‘positive’ screen (i.e., potentially having that problem).
• Most of the problems have only 1 screening question (e.g., intimate partner violence). For these, a ‘Yes’ is a positive screen.

Possible Concerns

• Regarding a false positive screen:
  • A screen is just a screen. A brief assessment should quickly clarify whether this was falsely positive.
  • Be careful not to convey a diagnosis, for example, of depression. Further evaluation should clarify that.
• Regarding a false negative screen:
  • It’s inevitable that some problems will be missed. There are many reasons why someone may choose not to disclose a problem.
  • It’s possible that by asking the question(s), you've shown your interest, and sown a seed. They may disclose in the future.
  • Parents who choose not to disclose are probably not amenable to intervention at this time.

For more information, please visit the FAQs.

SEEK PQ-Re English

SEEK PQ-Re Spanish