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

传播和实施“为每个孩子提供安全环境”（SEEK）模型以防止虐待和忽视儿童

• 批准号: 10005392
• 负责人: HOWARD DUBOWITZ
• 金额: $ 84.89万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005392
• 关键词: Address; Adopted; Adoption; Affect; American; California; Centers for Disease Control and Prevention (U.S.); Certification; Child; Child Abuse and Neglect; Child Health; Child Welfare; Childhood; Clinic; Clinical; Code; Competence; Computer software; Data; Development; Diagnostic; Distance Learning; Documentation; Early Diagnosis; Economics; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Elements; Environment; Evaluation; Evidence based intervention; Evidence based practice; Family; Family Practice; Funding; Future; Goals; Guidelines; Happiness; Health Benefit; Health Promotion; Healthcare Systems; Hybrids; Incidence; Individual; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); Intervention; Interview; Knowledge; Learning; Maintenance; Measures; Medical; Medical Education; Mental Depression; Methods; Modality; Modeling; Outcome; Paper; Parents; Pediatrics; Penetration; Population; Population Heterogeneity; Prevalence; Prevention; Preventive Intervention; Primary Health Care; Procedures; Process; Provider; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research; Risk Factors; Safety; Self-Direction; Services; Societies; Structure; Surgeon; Technology; Time; Training; United States Agency for Healthcare Research and Quality; Variant; Visit; abuse neglect; care systems; cost; design; economic cost; effective therapy; effectiveness evaluation; effectiveness testing; evidence base; family support; implementation science; implementation strategy; improved; prevent; primary care setting; psychosocial; satisfaction; scale up; screening; social determinants; standardize measure; success; uptake; webinar

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.

项目摘要 儿童虐待（CM）是一个主要的公共卫生问题，在短期内影响许多生命 并使个人，家庭和社会造成了巨大的代价。 2020年健康的人目标要求减少致命和 非致命CM。实现这一点，取决于广泛实施有效的，基于证据的预防性 干预措施，例如为小儿初级保健开发的每个孩子（寻求）模型的安全环境。 初级保健提供了一个极好的机会，可以帮助解决普遍的社会心理问题（例如，父母 抑郁症是CM的危险因素。通过解决此类问题，寻求可以加强家庭和 支持父母，从而促进儿童的健康，发展和安全，有助于预防广告并受益 美国人口的健康。拟议的研究重点是研究针对的干预策略 优化Seek的采用，实施和维持及其在帮助预防广告方面的有效性。 尽管来自两个大型联邦资助的随机对照试验有强有力的证据，但 尚未被广泛采用。拟议的研究的总体目标进行了研究 在小儿和家庭医学初级保健环境中实施扩展寻求的策略。如 与PAR-16-238一起，该提案针对“实施健康促进，预防，筛查，早期的策略 检测和诊断干预措施以及有效的治疗，临床程序或指南 通过这些目标：1）评估目标实施策略的有效性 在初级保健环境中实施SEEK； 2）评估成功的障碍和促进者 服务创业和探索的维持； 3）检查预防商业的有效性。 这种随机类型III混合混合方法设计将研究医学培训的进步如何 支持Seek的采用和实施。利用5个主要医疗系统服务的承诺 美国各地的各种人群，我们有一个宝贵的机会来评估关键培训方法 越来越普遍的医学教育 - 独立在线培训（IND）和深入结构化的 通过美国批准的认证质量改进（QI）项目的维护培训 儿科和家庭医学委员会（MOC-4）。此外，我们将评估SeekOnline，软件 协助忙碌的初级保健从业人员（PCP）以保真度来实现该模型。这将与 “传统”纸和铅笔策略在对实施和预防广告方面的影响方面。 我们还将评估与实施寻求相关的经济成本，这是一种非常有前途的方法 帮助防止儿童被虐待和忽视，以及许多后遗症。知识获得了 应该改善小儿初级保健以更好地解决普遍的社会心理问题并使儿童受益 和他们的家人。结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者的干预措施。