SEEK Materials

The SEEK materials are valuable for efficiently and reliably implementing the approach.

SEEK Parent Questionnaire-R
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The SEEK Parent Questionnaire-R (PQ-R) is a brief evidence-based questionnaire to screen for prevalent and targeted psychosocial problems such as parental depression and substance use.  The earlier version was revised in 2017 based on new knowledge and experience of those implementing the approach.​

The PQ-R has 16 “yes/no” questions on one side of a page, and takes 2-3 minutes to complete. It has a user-friendly format that's easy for both parents and professionals.

As the PQ-R solicits sensitive information, the screen starts with an introduction that conveys an empathic tone and an interest in helping. The introduction builds upon a longstanding concern about ensuring children's safety and it conveys concern that the targeted problems are ones facing many families. The voluntary nature of the PQ-R is made clear. It begins with commonly asked questions such as about smoke alarms, before screening for more difficult problems.

As of October 2022, a change has been made to the opening paragraph of the SEEK PQ-R that begins with “Dear Parent or Caregiver”. The sentence that has been removed is “This information will be kept confidential/private, unless we're worried about your child's safety”. Since one cannot guarantee that EHR information will be kept confidential/private, this change has been made to the PQ-Rs available on our website. The PQ-R that is available via CHADIS and Phreesia will also be updated.

Aggregate data from SEEK PQ-Rs offer a valuable needs assessment, documenting the prevalence of psychosocial problems in the families you serve. This can be used to improve the care you provide to children and their families, and to advocate for resources and services.

The SEEK PQ-R is:

A practical evidence-based tool to briefly and systematically screen parents for prevalent psychosocial problems that are risk factors for child maltreatment, and that generally jeopardize children's health, development and safety. The targeted problems are:

  • Parental Depression
  • Parental Substance Use
  • Major Parental Stress
  • Intimate Partner (or Domestic) Violence
  • Food Insecurity
  • Harsh Punishment

The SEEK PQ-R is also:

  • Designed to screen for, not diagnose, risk factors for child maltreatment
  • Validated for use in primary care practice
  • Intended for parents to complete, voluntarily, in advance of their child's regular checkup
  • Completed at selected checkups, such as at the 2, 9 and 15 month, and the 2, 3, 4, and 5 year visits
  • Available in English, Spanish, Italian, Chinese, Portuguese. Related versions available in Vietnamese, Swedish, Sorani, Thai, Tigrinya, Turkish, Arabic, Bengali, Dari, Finnish, Kurmanji, Russian and Somali. Note that these are moderately different from the PQ-R.

Administering the PQ-R:

We recommend using the improved SEEK PQ-R rather than the earlier version. The PQ-R should be given to parents 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. It may be easiest to use at each visit, but it needs to fit in with other questionnaires so as not to overly burden parents and professionals. Parents have not complained about completing it repeatedly. As a family's circumstances can naturally change, it is important to ask parents to complete the PQ-R periodically.

Provide parents with the PQ-R in advance of the well child visit. Usually the medical or nursing assistant provides the PQ-R on a clipboard to the parent when placing them in an exam room. They can introduce the PQ-R saying something like "we're trying 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 is best completed in privacy rather than in a waiting area.

When is the Screen Positive?

  • Food Insecurity: A ‘Yes’ to either food related question.
  • Harsh Punishment: A ‘Yes’ to the “slap or hit” question or “….. child is difficult …..”
  • Major Stress: A ‘Yes’ to “child is difficult”, “more help” or “extreme stress”.
  • Depression: A ‘Yes’ to “feeling down” or “little interest”.
  • Intimate Partner Violence: A ‘Yes’ to either of the two questions.
  • Substance Use: A ‘Yes’ to either question.

Possible Concerns

Regarding a false positive screen:

  • A screen is just a screen. A brief assessment should quickly help 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-R  English

SEEK PQ-R Spanish

SEEK PQ-R French

SEEK PQ-R Italian

SEEK PQ-R Chinese

SEEK PQ-R Portuguese

SEEK PQ-R Nepali

Related versions are available in Vietnamese, Swedish, Sorani, Thai, Tigrinya, Turkish, Arabic, Bengali, Dari, Finnish, Kurmanji, Russian and Somali. These are translations from the Parent Questionnaire - Swedish (PQ-S); an English version of this is available.

You may have questions you’d like to add to the PQ-R. Here are optional ones. We suggest prioritizing not more than two or three to keep the effort manageable.

If you need to translate the SEEK PQ-R to a language that is not currently available, please contact us.

 
SEEK Parent Questionnaire-Re
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Background

The SEEK Parent Questionnaire-Re (e for expanded) or PQ-Re, is the update 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 possible abuse and neglect, the 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 has been updated to include additional issues/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, formatting matters, so we’ve improved the design. We recommend replacing earlier versions with  the improved SEEK PQ-Re.

Importantly, your practice can now prioritize which issues to target; you may choose 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 may be without systematic screening. Aggregate data from the SEEK PQ-Re serves as a valuable needs assessment, documenting the prevalence of psychosocial 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

We regularly obtain feedback from professionals regarding their experience with SEEK. We also periodically consult with experts on specific issues, such as substance use and intimate partner violence re. advances in screening. 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. We’ve gotten useful feedback from both groups regarding the PQ-Re. 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 is:

  • Designed to screen for, not diagnose, risk factors for child maltreatment that are also ACEs or SDH.
  • Soliciting 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 about 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.
  • Targeting:
    • 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
    • Intended for parents or primary caregivers to complete, voluntarily, in advance of their child's regular checkup, not at “sick” visits.
    • A questionnaire with “yes/no” questions on 1 side of 1 page and takes 3 minutes to complete.
    • A user-friendly questionnaire that's easy for parents to complete and for professionals to assess.
    • 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.
    • Available in English and Spanish. If a translation in another language is needed, contact us.

Administering the PQ-Re

  • It should be given to parents 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 overly 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 should be regarded as 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.

See the expanded questionnaire below:

SEEK PQ-Re English

SEEK PQ-Re Spanish

 
SEEK Guidelines and Responses to Barriers
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These guidelines help assess and address positive screens. Key questions are prioritized to make the approach efficient and principles of Motivational Interviewing are incorporated. There are also suggested responses to possible barriers to parents engaging in help.

Click to download a guideline:

Parental Depression
PQ-R and PQ-Re

Unhealthy Substance Use
PQ-R
PQ-Re

Harsh Punishment
PQ-R
PQ-Re

Partner Conflict
PQ-R
PQ-Re

Food Insecurity
PQ-R and PQ-Re

Severe Stress
PQ-R
PQ-Re

Tobacco Use
PQ-R and PQ-Re

Poison Control
PQ-R and PQ-Re

Smoke Alarms
PQ-R and PQ-Re

Gun Safety
PQ-Re

SEEK Parent Handouts
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The SEEK Parent Handouts provide important and brief information that is easy for most to understand. The use of alternative handouts is still in keeping with the SEEK approach. The SEEK Handouts are adjuncts to advice given in your office or clinic.

They include national hotlines and websites for organizations with good parent resources. It may be better to replace these with information on local resources. To do so, staff can help by searching findhelp.org or utilizing our Helpful Tips for Finding Local Resources document which has tips to find local resources and a partial list of national ones. National resources can often identify local ones. The United Way’s 211 number is also valuable for identifying resources in many areas. Phone calls are recommended to ensure information is current, and the information needs periodic updating. We suggest doing so annually.

You may be able to send a handout to a parent’s careportal on your EHR. Also, you can post the handouts on your practice website.

If you need to translate the SEEK Parent Handouts, we’ve worked well with Southeast Spanish, Inc. They translate to/from Spanish, French, Italian, Portuguese, and perhaps other languages. Contact them to learn more.

Parental Depression
English
Spanish

Parental Substance Use
English
Spanish

Discipline
English
Spanish

Major Parental Stress
English
Spanish

Intimate Partner (or Domestic) Violence
English
Spanish

Food Insecurity
English
Spanish

Poison Control
English
Spanish

Smoke Alarms
English
Spanish

Tobacco Use
English
Spanish

Also available are these alternative Parent Handouts for Intimate Partner (or Domestic) Violence and Discipline:

SEEK Positive Discipline Handout

SEEK Healthy Relationships Handout

Supplemental Materials
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The following links and references are useful resources for additional information. Some of the material can also be suitable for parents.

Motivational Interviewing

Motivational Interviewing (MI) is a patient-centered approach to motivate someone who is ambivalent about changing their behavior or accepting an intervention. MI involves parents, as well as children older than 6 years, in a way that makes it more likely they’ll ‘own’ the plan and implement it. Instead of simply telling parents and/or patients what to do, MI solicits their views of an issue and what they think they can do to address it. In a fundamentally different approach, a partnership is forged to jointly develop a plan. Numerous studies have shown MI to be effective in fostering health behavior change around substance misuse, oral health, diet, weight reduction, exercise and smoking cessation. This can greatly help prevent heart disease, hypertension and diabetes.

Motivational Interviewing Network of Trainers (MINT)

  • Information regarding MI practice and training by the Motivational Interviewing Network of Trainers (MINT)
  • MINT is an international organization committed to disseminating MI information
  • MI role play videos on YouTube and Vimeo (bottom right of the home page)

American Academy of Pediatrics

  • Short article on why MI is effective and its use in clinical settings

Key article: Engaging families through motivational interviewing

  • Excellent introductory article on core principles of MI and how they can be applied to clinical practice

Center for Public Health Practice at the Colorado School of Public Health

  • The Center offers online learning opportunities to improve public health practice
  • The website has MI trainings that include slides, videos and recorded webinars. Some of these are free

Quality Improvement

  • Knowledge of Quality Improvement (QI) methods is not required to implement SEEK or to receive CME or MOC Part 2 credits, but utilizing QI methods will optimize implementing SEEK in your practice. The principles of QI can be valuable for introducing other innovations to improve one's practice.
  • QI involves the Plan-Do-Study-Act (PDSA) cycle - an approach for testing the effects of a change by (P) planning, (D) doing, (S) studying the results, and (A) acting on what is learned.
  • Knowledge of QI is recommended for participants who have little or no prior experience with QI methods. It is also strongly recommended for those who wish to receive SEEK MOC Part 4 credits.
  • The American Academy of Pediatrics EQIPP website has an excellent video, QI Basics 101 (27 minutes) for AAP members.
  • The Institute for Healthcare Improvement (IHI) provides resources, tools, and online trainings to health care professionals who want a better understanding of QI.
SEEK Video and Posters for Parents
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Explaining to parents the importance of social determinants of health: Introducing SEEK

Many parents are not accustomed to being asked about problems such as domestic violence or substance use when they bring children in for well visits. We’ve produced a short video that explains the importance of such information to help provide good health care for children and families. It will help parents understand why questions about social determinants of health are being asked and encourage them to respond forthrightly regarding sensitive, perhaps embarrassing, information.

The 2.5 minute video is ideal for playing on a loop in the waiting area.

Preview the SEEK parent video

In the same spirit, we’ve developed a poster regarding social determinants of health for waiting areas. This too conveys the message of why addressing such problems is valuable for optimizing children’s health. It gently and simply introduces parents to this concept.

Download the poster in English

Download the poster in Spanish

To receive an English or Spanish SEEK poster in the mail, please Contact Us.

SEEK Newsletters
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The free SEEK Newsletters are a good way to keep abreast of new developments. Please Contact Us if you’d like to be added to Newsletter listserv.

September 2019
The first SEEK Newsletter; info on the National SEEK Study

January 2020
The importance of screening for Social Determinants of Health in primary care

May 2020
Assisting parents implement positive discipline

September 2020
The importance of strengths and protective factors in helping families

January 2021
Helpful hints to improve your referral process and what to know about SEEK billing and reimbursement

April 2021
Helpful tips for finding local resources

June 2021
Helping families experiencing domestic violence

September 2021
Importance of Motivational Interviewing

February 2022
SEEK & Patient / Family-Centered Pediatric Primary Care

May 2022
Helping Parents Cope with Stress

September 2022
Documenting Psychosocial Problems in Children's Electronic Health Records

January 2023
Helping Families Experiencing Intimate Partner (or Domestic) Violence

May 2023
Addressing adverse childhood experiences and SDH in primary care: implementing the SEEK approach

October 2023
Supporting Parents Misusing Substances: A Suggested Approach

Spring 2024
An Introduction to Motivational Interviewing

SEEK Parent Pamphlet
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The SEEK Parent Pamphlet briefly describes SEEK, the Parent Questionnaire-R (PQ-R), what happens after a parent completes the PQ-R, and there’s a QR code leading to the SEEK parent video. It’s best given to parents before they complete the PQ-R. Click here for the pamphlet in English or Spanish.

SEEK Mini Manual
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The SEEK Mini Manual includes all the info you need to implement SEEK in one document.

Referrals and Resources
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Too many referrals don’t pan out. SEEK Helpful Hints offers useful ways to strengthen your referral process and improve the care you provide to children and families. This pertains to both in-house and community referrals and includes ways to easily find local resources.

SEEK Master Class
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The SEEK Master Class was presented by Dr. Howard Dubowitz, the developer of the SEEK approach. This presentation covers many aspects involved in the implementation of SEEK.

SEEK Webinars
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Coding for Maximum Value Care 

Dr. Susan Kressly presented a webinar on Coding for Maximum Value Care. She presented valuable info on coding regarding social determinants of health. The link for this webinar is below.

https://player.vimeo.com/video/816946225  

Sweetness, HOPE (Healthy Outcomes from Positive Experiences) and the Future of Pediatrics

Dr. Robert Sege, MD, PhD presented a webinar that focused on two innovations in pediatric practice of interest to the SEEK network. DULCE (Developmental Understanding and Legal Collaboration for Everyone) creates a special primary care team for infants and their families. The DULCE team is led by a trained community health worker, supported by a local team that includes the early childhood system, an attorney, and mental and physical health clinicians. This program is being piloted phase at about 20 clinical sites around the U.S. HOPE (Healthy Outcomes from Positive Experiences) focuses clinical attention on specific types of positive childhood experiences that support lifelong health, resilience, and healing. The HOPE framework has developed collaborative networks across the U.S. among health, early childhood, home visiting, schools, and child welfare sectors. The link to view this webinar is below.

https://player.vimeo.com/video/816948536  

Update on Discipline Guidance for Young Children

Dr. Barbara Howard, MD presented a webinar on how parents set their discipline practices when their children are quite young, often based on reactions to the discipline they received themselves. In this presentation an evidence-based approach to discipline practical primary care guidance was presented. The link to view this webinar is below.

https://player.vimeo.com/video/816944653

Supporting Intimate Partner Violence (IPV) Survivors in Pediatric Settings Using Healing-Centered Engagement

Dr. Maya Ragavan, MD, MPH, MS presented a webinar on supporting intimate partner violence (IPV) survivors in pediatric settings using healing-centered engagement.  The link to view this webinar is below.

https://player.vimeo.com/video/823045740

Supporting Families Impacted by Addiction in Primary Care Pediatrics

Natalie Spicyn, MD, MHS, FAAP, AAHIVS presented a webinar on supporting families impacted by addiction in primary care pediatrics using a harm reduction approach. The link for this webinar is below.

https://player.vimeo.com/video/866467883

Dr. Natalie Spicyn: Supporting Families Impacted by Addiction in Primary Care Pediatrics webinar slides.

Helping Parents Change Behaviors Using Motivational Interviewing

Christopher Wirt, LCSW-C presented a webinar regarding motivational interviewing and assisting parents to change behaviors.

https://player.vimeo.com/video/910122864

Christopher Wirt: Helping Parents Change Behaviors Using Motivational Interviewing slides.

Christopher Wirt: Motivational Interviewing - Evoking Questions document.