The SEEK Approach
The core components of the SEEK approach are:
Training prepares primary care professionals (PCPs) to briefly assess and initially help address targeted problems.
- It is important that PCPs are adequately prepared to address psychosocial problems such as parental depression, major stress, substance use, intimate partner (or domestic) violence, food insecurity and harsh punishment.
- The free SEEK online training videos provide useful guidance. Supplemental materials are also available.
- Principles of motivational interviewing are incorporated to help engage parents as partners and in developing a plan. There are supplemental materials to learn more about motivational interviewing, an exciting advance in health care.
- PCPs are encouraged to also identify and utilize families' strengths and resources. These are often a “hook” to help engage parents constructively.
- Training and learning is naturally an ongoing process. Clinical experience and interacting with behavioral health professionals are valuable in enhancing competence.
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
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.
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.
- Home Safety
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:
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
Food Insecurity
PQ-R and 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
A behavioral or mental health professional is a valuable resource to help assess and address problems and facilitate referrals to community resources.
- PCPs can use discretion about whether to involve a behavioral health professional. Some parents prefer to confide in the PCP with whom they may have a longstanding relationship. The SEEK approach is deliberately flexible regarding the use of behavioral health professionals.
- Many primary care settings do not have behavioral health professionals on site. The initial assessment can be done by a PCP with staff facilitating referrals to community resources.
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.
The SEEK Parent Handouts reinforce what was likely covered during the visit. It’s useful for parents to have something in writing.
- The relatively simple SEEK Parent Handouts help address each of the targeted problems.
- These Handouts provide basic information in a user-friendly way and list national hotlines and websites of valuable organizations and agencies. There is space to customize these for one's practice and to include information on local resources. It is preferable to replace national resources with local ones.
- The Handouts are available in English and Spanish.
- PCPs may have good alternatives making it unnecessary to utilize the SEEK Handouts.
- Consider sending a handout to a parent’s care portal, and, posting the handouts on your practice’s website.
- Familiarity with local and national resources is important for the care of children and their families. However, locating resources can be time consuming. This document has helpful tips to find local resources and a partial list of national ones.
Please click on link that you wish to download below:
Parental Depression
English
Spanish
Parental Substance Use
English
Spanish
Major Parental Stress
English
Spanish
Intimate Partner (or Domestic) Violence
English
Spanish
Also available are these alternative Parent Handouts for Intimate Partner (or Domestic) Violence and Discipline: