Dissemination and Implementation of the Safe Environment for Every Kid(SEEK) Model for Preventing Child Abuse and Neglect

项目概要 虐待儿童（CM）是一个重大的公共卫生问题，在短期和长期内影响着许多人的生命。 并使个人、家庭和社会付出高昂的代价。 2020 年健康人民目标呼吁减少死亡和 非致命性CM。实现这一目标取决于广泛实施有效的、基于证据的预防措施 干预措施，例如为儿科初级保健开发的“每个孩子的安全环境”(SEEK) 模型。 初级保健提供了一个极好的机会来帮助解决普遍的心理社会问题（例如，父母的 抑郁症）是 CM 的危险因素。通过解决这些问题，SEEK 可以加强家庭和 支持父母，从而促进儿童的健康、发展和安全，帮助预防 CM，并受益 美国人民的健康。拟议的研究重点是检查旨在 优化 SEEK 的采用、实施和维持及其在帮助预防 CM 方面的有效性。 尽管两项大型联邦资助的随机对照试验提供了强有力的支持证据，SEEK 尚未被广泛采用。拟议研究的总体目标是检查两种技术驱动的 在儿科和家庭医学初级保健机构中扩大 SEEK 的实施战略。如在 与 PAR-16-238 一样，该提案的目标是“实施健康促进、预防、筛查、早期 检测和诊断干预措施，以及有效的治疗、临床程序或指南 现有的护理系统”通过以下目标： 1) 评估有针对性的实施策略的有效性 关于在初级保健机构中实施 SEEK 的问题； 2) 评估成功的障碍和促进因素 SEEK 的服务启动和维护； 3) 检查预防 CM 的有效性。 这种随机的 III 型混合方法设计将研究医学培训的进步如何能够 支持 SEEK 的采用和实施。利用 5 个主要医疗保健系统的承诺来服务 美国各地的不同人群，我们有一个宝贵的机会来评估关键的培训方法 在医学教育中越来越普遍——独立在线培训（IND）和深度结构化 通过美国批准的认证质量改进 (QI) 项目维护进行培训 儿科和家庭医学委员会 (MOC-4)。此外，我们还将评估 SEEKonline 软件 帮助忙碌的初级保健从业者 (PCP) 忠实地实施该模型。这将与 “传统”纸笔策略对实施和预防 CM 的影响。 我们还将评估与实施 SEEK 相关的经济成本，这是一种非常有前途的方法 有助于防止儿童受到虐待和忽视，以及产生许多后遗症。获得的知识 应改善儿科初级保健，以更好地解决普遍的心理社会问题并使儿童受益 和他们的家人。研究结果还应有助于建立实施科学领域，并指导未来 解决儿童健康社会决定因素的干预措施。

Project Summary Child maltreatment (CM) is a major public health problem, affecting many lives, in the short-and long-term, and costing individuals, families and society dearly. The Healthy People Goals 2020 call for reducing fatal and nonfatal CM. Achieving this hinges on broad implementation of effective, evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents, and thereby promote children’s health, development and safety, help prevent CM, and benefit the health of the US population. The proposed research focuses on examining intervention strategies aimed at optimizing SEEK’s adoption, implementation and sustainment and their effectiveness in helping prevent CM. Despite the strong supporting evidence from two large federally-funded randomized controlled trials, SEEK has not been widely adopted. The overarching goal of the proposed study is examine two technology driven implementation strategies to scale-up SEEK - in pediatric and family medicine primary care settings. As in withPAR-16-238, this proposal targets “strategies to implement health promotion, prevention, screening, early detection, and diagnostic interventions, as well as effective treatments, clinical procedures, or guidelines into existing care systems” through these aims: 1) Evaluate the effectiveness of targeted implementation strategies on the implementation of SEEK in primary care settings; 2) Evaluate barriers and facilitators to successful service start-up and sustainment of SEEK; and 3) Examine effectiveness in preventing CM. This randomized Type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK’s adoption and implementation. Leveraging a commitment by 5 major healthcare systems serving diverse populations across the US, we have a valuable opportunity to evaluate key training approaches increasingly common in medical education – independent online training (IND) and in-depth structured training via a Maintenance of Certification Quality Improvement (QI) project, approved by the American Boards of Pediatrics and of Family Medicine (MOC-4). In addition, we will evaluate SEEKonline, software that assists busy primary care practitioners (PCPs) implement the model, with fidelity. This will be compared to a “Traditional” paper and pencil strategy in terms of their impact on implementation and in preventing CM. We will also assess the economic costs associated with implementing SEEK, a very promising approach for helping prevent children from being abused and neglected, and the many sequelae. The knowledge gained should improve pediatric primary care to better address prevalent psychosocial problems and benefit children and their families. The outcomes should also help build the field of implementation science, and guide future interventions addressing social determinants of child health.