Frequently Asked Questions
Implementing SEEK
Implementing SEEK includes the following steps:
- Complete the online training; this will provide a good sense of the approach
- Download the License Agreement, complete and submit it. Contact us with any questions including a possible fee.
- Encourage other professionals in the practice to participate, and do the training
- If the practice has a behavioral health professional, include them in the planning. This person can identify local resources to help address the targeted problems, and this information should be included on the SEEK Parent Handouts, together with the practice name and address
- If the practice does not have a behavioral health professional, identify the person who facilitates referrals, and ask them to perform the above function
- Prepare office staff for this modification in the practice
- Develop a system for when and how to ask parents to complete the SEEK PQ-Re and, whether and how to include completed screeners in the children's medical records
- Provide parents with the 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'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 / PQ-Re should be completed in a private room while waiting for the medical professional.
- Briefly assess and initially address positive screens. See the SEEK Guidelines and Responses to Barriers for guidance.
- Provide parents the SEEK Parent Handouts (or alternative ones) with local resources, consider referral and follow up.
It’s not necessary, but OK if they would both like to complete it. This raises the possibility of differing responses and addressing them in both.
The SEEK PQ-R / PQ-Re can be completed by any primary caregiver who lives with the child. We do not suggest giving it to a caregiver who has limited or intermittent responsibility for a child. The intent is to probe potential problems in the child's regular home environment.
A screen is just a screen. A brief assessment should help clarify whether this was falsely positive. Be careful not to convey a diagnosis, for example, of depression. Further evaluation should clarify that.
It’s understood that some parents prefer not to share sensitive information. They are likely at a point where they are not ready or able to engage in help. Nevertheless, by asking the question, you may sow a seed and signal the importance of the issue and your interest in helping. At a future time, the parent may view you as a resource and be more willing to disclose their problem.
Consider the PQ-R / PQ-Re as part of a good social history. It contains useful information pertinent to the child's health and wellbeing. It can be included in the child's medical record in a section with similar social information. Alternatively, one can separately document what was identified and done. Intimate (or domestic) partner violence is an especially sensitive problem. Some document code terms such as “family conflict discussed.” Identified problems can also be added to the Problem List.
Initially we incorporated this into the SEEK approach; it seemed important not to ignore this possibility. To the best of our knowledge, however, it appears to be exceedingly rare for suicidality to be identified as a current and critical concern. After consulting with mental health colleagues, we decided to no longer recommend routinely probing suicidality in those screening positive for depression.
Not necessarily. The SEEK approach is deliberately flexible in this regard, recognizing:
- Some clinicians prefer addressing the problem themselves
- Some parents prefer to talk with the professional they know
- Some parents are uncomfortable talking to social workers or mental health clinicians
The SEEK Project requires that those implementing SEEK sign a license agreement. Modifications of copyrighted material requires written approval by the SEEK project team. The SEEK Parent Handouts, however, should be customized with information on local resources and the practice. There is also flexibility with the SEEK PQ-Re to prioritize which problems will be targeted.
Ideally, yes. This can make a valuable contribution, building knowledge on whether and how SEEK works in different settings.
In addition to funded research projects, implementing SEEK can be a useful QI project for Maintenance of Certification (MOC) Part 4 credits by the American Board of Pediatrics and Performance Improvement from the American Board of Family Medicine. It can be relatively straightforward to evaluate SEEK. For example, you could evaluate: (1) the percentage of visits in which screening should have occurred and did; (2) the frequency with which professionals documented an action for a positive screen, and (3) the types of actions taken. Another example is assessing parents’ view of their child’s healthcare before and after implementing SEEK.
Please click here for more information on evaluating SEEK.
Too many referrals don’t pan out. SEEK Helpful Hints offers useful ways to strengthen your referral process and improve the care you provide children and families. This pertains to both in-house and community referrals and includes ways to easily find local resources.