Department of Pediatrics, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201, USA.
Pediatrics. 2011 Apr;127(4):e962-70. doi: 10.1542/peds.2010-1845. Epub 2011 Mar 28.
To examine whether the Safe Environment for Every Kid (SEEK) model of enhanced primary care would improve the attitudes, knowledge, comfort, competence, and behavior of child health care professionals (HPs) regarding addressing major risk factors for child maltreatment (CM).
In a cluster randomized controlled trial, 18 private practices were assigned to intervention (SEEK) or control groups. SEEK HPs received training on CM risk factors (eg, maternal depression). The SEEK model included the parent screening questionnaire and the participation of a social worker. SEEK's impact was evaluated in 3 ways: (1) the health professional questionnaire (HPQ), which assessed HPs' attitudes and practice regarding the targeted problems; (2) observations of HPs conducting checkups; and (3) review of children's medical records.
The 102 HPs averaged 45 years of age; 68% were female, and 74% were in suburban practices. Comparing baseline scores with 6-, 18-, and 36-month follow-up data, the HPQ revealed significant (P < .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence (6 and 18 months), and stress (6, 18, and 36 months), and in their comfort level and perceived competence (both at 6, 18, and 36 months). SEEK HPs screened for targeted problems more often than did controls based on observations 24 months after the initial training and the medical records (P < .001).
The SEEK model led to significant and sustained improvement in several areas. This is a crucial first step in helping HPs address major psychosocial problems that confront many families. SEEK offers a modest yet promising enhancement of primary care.
检验强化初级保健的安全环境（SEEK）模式是否会改善儿童保健专业人员（HPs）对解决儿童虐待（CM）主要风险因素的态度、知识、舒适度、能力和行为。
在一项集群随机对照试验中，将 18 家私人诊所分配到干预（SEEK）或对照组。SEEK HPs 接受了关于 CM 危险因素（例如，产妇抑郁）的培训。SEEK 模式包括家长筛选问卷和社会工作者的参与。以三种方式评估 SEEK 的影响：（1）健康专业人员问卷（HPQ），评估 HPs 针对目标问题的态度和实践；（2）观察 HPs 进行体检；（3）审查儿童的医疗记录。
102 名 HPs 的平均年龄为 45 岁；68%为女性，74%在郊区执业。与基线得分相比，6、18 和 36 个月的随访数据显示，与对照组相比，HPQ 显示 SEEK 组在处理抑郁（6 个月）、药物滥用（18 个月）、亲密伴侣暴力（6 和 18 个月）和压力（6、18 和 36 个月）方面以及舒适度和感知能力方面（6、18 和 36 个月）均有显著改善（P<.05）。基于观察到的 24 个月后初始培训和医疗记录，与对照组相比，SEEK HPs 更经常针对目标问题进行筛查（P<.001）。
SEEK 模式在多个领域取得了显著和持续的改善。这是帮助 HPs 解决许多家庭面临的主要心理社会问题的关键第一步。SEEK 为初级保健提供了适度但有希望的增强。
