- 作者：Howard Dubowitz ; Wendy G. Lane ; Joshua N. Semiatin ; Laurence S. Magder
- 关键词：child maltreatment ; prevention ; primary care ; screening ; risk factors
- 刊名：Academic Pediatrics
- 出版年：2012
- 出版时间：July-August, 2012
- 年：2012
- 卷：12
- 期：4
- 页码：259-268
- 全文大小：400 K
lass=""h4"">Objective
To examine the effectiveness of the Safe Environment for Every Kid (SEEK) model of enhanced pediatric primary care to help reduce child maltreatment in a relatively low-risk population.lass=""h4"">Methods
A total of 18 pediatric practices were assigned to intervention or control groups, and 1119 mothers of children ages 0 to 5 years were recruited to help evaluate SEEK by completing assessments initially and after 6 and 12 months. Children¡¯s medical records and Child Protective Services data were reviewed. The SEEK model included training health professionals to address targeted risk factors (eg, maternal depression), the Parent Screening Questionnaire, parent handouts, and a social worker. Maltreatment was assessed 3 ways: 1) maternal self-report, 2) children¡¯s medical records, and 3) Child Protective Services reports.
lass=""h4"">Results
In the initial and 12-month assessments, SEEK mothers reported less Psychological Aggression than controls (initial effect size = ?0.16, 95 % confidence interval [95 % CI] ?0.27, ?0.05, P = .006; 12-month effect size = ?0.12, 95 % CI ?0.24, ?0.002, P = .047). Similarly, SEEK mothers reported fewer Minor Physical Assaults than controls (initial effect size = ?0.16, 95 % CI ?0.29, ?0.03, P = .019; 12-month effect size = ?0.14, 95 % CI ?0.28, ?0.005, P = .043). There were trends in the same positive direction at 6 months, albeit not statistically significant. There were few instances of maltreatment documented in the medical records and few Child Protective Services reports.
lass=""h4"">Conclusions
The SEEK model was associated with reduced maternal Psychological Aggression and Minor Physical Assaults. Although such experiences may not be reported to protective services, ample evidence indicates their potential harm. SEEK offers a promising and practical enhancement of pediatric primary care.