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

项目摘要 虐待儿童(CM)是一个重大的公共卫生问题，在短期和长期影响着许多人的生命， 并使个人、家庭和社会付出沉重代价。2020年健康人目标呼吁减少死亡和 非致命性心肌梗塞。实现这一目标取决于广泛实施有效的、循证的预防措施 干预措施，如为儿童初级保健开发的每个儿童的安全环境(SEEK)模式。 初级保健提供了一个极好的机会来帮助解决普遍存在的心理社会问题(例如，父母 抑郁)，这些都是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 美国民众的健康状况。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。 尽管有来自联邦政府资助的两个大型随机对照试验的强有力的支持证据，Seek 还没有被广泛采用。拟议研究的总体目标是检查两种技术驱动 实施战略，扩大儿科和家庭医学初级保健服务的范围。如中所示 根据PAR-16-238，这项提案的目标是“实施健康促进、预防、筛查、早期 检测和诊断干预，以及有效的治疗、临床程序或指南 现有护理系统“通过这些目标：1)评估有针对性的执行战略的有效性 在初级保健环境中实施Seek；2)评估成功的障碍和促进者 服务启动和Seek的维持；以及3)检查预防CM的有效性。 这项随机的III型混合混合方法设计将检验医疗培训的进步如何 支持Seek的采用和实施。利用5个主要医疗保健系统的承诺提供服务 在全美不同的人群中，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--独立的在线培训(IND)和深入的结构化 通过认证质量改进(QI)项目的维护进行培训，由美国批准 儿科和家庭医学委员会(MOC-4)。此外，我们将评估SEEKOnline，这是一款 帮助忙碌的初级保健从业者(PCP)忠实地实施该模式。这将被比作 “传统的”纸和笔战略对执行和防止CM的影响。 我们还将评估与实施Seek相关的经济成本，Seek是一种非常有前景的方法 帮助防止儿童受到虐待和忽视，以及许多后遗症。所获得的知识 应改善儿科初级保健，以更好地解决普遍存在的心理社会问题，造福儿童 以及他们的家人。成果还应有助于建立实施科学领域，并指导未来 针对儿童健康的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.