Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model
Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model
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DOI：
10.1542/peds.2008-1376
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发表时间：
2009-03-01
期刊：
影响因子：
8
通讯作者：
Kim, Jeongeun
中科院分区：
文献类型：
--
作者：
Dubowitz, Howard;Feigelman, Susan;Kim, Jeongeun
上下文。需要采取有效的战略来防止虐待儿童。目的：我们的目标是评估儿科初级保健的安全环境模式在减少虐待儿童的发生方面的有效性。方法：2002年6月至2005年11月，在马里兰州巴尔的摩的一所大学的居民连续性诊所进行了一项随机试验。研究人群由儿童(0-5岁)的说英语的父母组成，他们被带到这里进行儿童健康监督。在1118名参与者中，有729人同意参与，其中558人完成了研究方案。居民连续性诊所按星期随机分为模型组(干预组)或标准护理组(对照组)。模式护理由(1)接受过特殊培训的住院医生、(2)家长筛查问卷和(3)一名社会工作者组成。驻院医生和/或社会工作者确定并解决了虐待儿童的风险因素。标准护理包括常规的儿科初级护理。临床人群的一个子集被抽样进行评估。虐待儿童的衡量方法有3种：(1)儿童保护服务机构使用州机构数据的报告；(2)可能虐待或忽视的病历记录；(3)父母通过亲子冲突策略量表报告严厉惩罚的情况。结果：在所有结果指标中，模范护理导致儿童虐待发生率显著降低：儿童保护服务报告减少，被记录为治疗不坚持的可能的医疗疏忽事件减少，延迟接种疫苗的儿童更少，父母报告的严厉惩罚更少。单尾检验是根据研究假设进行的。结论：儿科初级保健的安全环境(SEEK)模式似乎是一种有助于防止虐待儿童的实用策略。建议对该模型进行复制和额外评估。儿科2009；123：858-864
CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated.OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended. Pediatrics 2009; 123: 858-864