SEEK: Dissemination and Implementation

NCT03642327 | Completed Results DMC

• 1 other identifier: HP-00078770
• Study Type: interventional
• Target: 360
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to understand what influences the adoption and implementation of an innovative approach to pediatric primary care by medical professionals and staff providing that care. The innovation concerns addressing common psychosocial problems such as parental depression and substance abuse. Different approaches to training medical professionals will be examined as well as the use of software versus traditional 'paper and pencil' to facilitate implementation.

Conditions

Child Maltreatment

Keywords

Child Abuse Prevention; Primary Care; Professional Education in Primary Care

Outcome Measures

Primary Outcomes (3)

• Stages of SEEK Implementation Completion (SIC) - Startup (at a Practice Level)

  The SIC is an assessment tool with 8 stages extending from Engagement to achievement of Competency. Each stage maps onto 3 phases of implementation (Pre-Implementation, Implementation and Sustainment). Startup reflects whether the practice implemented SEEK - Yes/No. Yes = practice started implemented SEEK. Practices that did start are reported.

  up to 30 months

• Stages of Implementation Completion (SIC) - as Assessed by the Safe Environment for Every Kid (SEEK) Fidelity Score (at a Practice Level)

  The SIC is an assessment tool with 8 stages extending from Engagement to achievement of Fidelity. Each stage maps onto 3 phases of implementation (Pre-Implementation, Implementation and Sustainment). Competence/Fidelity score reflects the extent to which a practice implemented the intervention as intended. Score range: 0-100; higher is better fidelity to the intervention as planned.

  up to 30 months

• Stages of SEEK Implementation Completion (SIC) - Sustainability

  The SIC is an assessment tool with 8 stages extending from Engagement to achievement of Competency. Each stage maps onto 3 phases of implementation (Pre-Implementation, Implementation and Sustainability). Sustainability was determined if the practice was implementing SEEK 24 months after initiation and doing so with fidelity. Reporting the number of practices that achieved sustainability.

  up to 30 months

Secondary Outcomes (20)

• Overall Rates of Children With Possible Abuse and Neglect.

  2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.

• Rates of Children With Possible Neglect.

  2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.

• Rates of Children With Non-adherence to Medical Care

  2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.

• Rates of Under Immunized Children

  2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.

• Rates of Children With Possible Abuse.

  2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.

Study Arms (2)

Independent online training (IND)

ACTIVE COMPARATOR

IND refers to practitioners Independently doing the online training.

Other: Independent online training (IND)

Maintenance of Certification (MOC)

EXPERIMENTAL

MOC involves a guided learning experience, approved by the American Board of Pediatrics and the American Board of Family Medicine for Maintenance of Certification credits. This involves a Quality Improvement project with 3 waves of data collection to assess and improve implementation while participating in 4 monthly webinars led by Dr. Dubowitz.

Behavioral: Experimental: Maintenance of Certification (MOC)

Interventions

Experimental: Maintenance of Certification (MOC) BEHAVIORAL

MOC training will lead to more positive attitudes, comfort level and competence in addressing risk factors for Child Maltreatment.

Maintenance of Certification (MOC)

Independent online training (IND) OTHER

IND refers to practitioners Independently doing the online training.

Independent online training (IND)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Practice not already implementing the SEEK model.
• The practice provides primary care to children.
• The practice agrees to participate in the study.
• PCPs, office staff and parents of children 0-5 years agree to participate.
• Able to comprehend basic English
• Access to a computer to complete online surveys.

You may not qualify if:

• None

Sponsors & Collaborators

• University of Maryland, Baltimore: lead
• Chestnut Health Systems: collaborator
• University of California, San Diego: collaborator

Study Sites (1)

University of Maryland, Baltimore

Baltimore, Maryland, 21201, United States

Location

Related Publications (4)

• Dubowitz H, Belanger R, Magder L, Palinkas LA, Kim H, Muralidharan V. Comparing 2 Training Modalities Supporting the Adoption of the Safe Environment for Every Kid Approach in Pediatric Primary Care. Acad Pediatr. 2025 Jan-Feb;25(1):102534. doi: 10.1016/j.acap.2024.07.001. Epub 2024 Jul 14.

  PMID: 39004298 BACKGROUND

• Dubowitz H, Finkelhor D, Zolotor A, Kleven J, Davis N. Addressing Adverse Childhood Experiences in Primary Care: Challenges and Considerations. Pediatrics. 2022 Apr 1;149(4):e2021052641. doi: 10.1542/peds.2021-052641.

  PMID: 35362065 BACKGROUND

• Dubowitz H, Saldana L, Magder LA, Palinkas LA, Landsverk JA, Belanger RL, Nwosu US. Protocol for comparing two training approaches for primary care professionals implementing the Safe Environment for Every Kid (SEEK) model. Implement Sci Commun. 2020 Sep 22;1:78. doi: 10.1186/s43058-020-00059-9. eCollection 2020.

  PMID: 32974614 BACKGROUND

• Palinkas LA, Belanger R, Newton S, Saldana L, Landsverk J, Dubowitz H. Assessment of Adoption and Early Implementation Barriers and Facilitators of the Safe Environment for Every Kid (SEEK) Model. Acad Pediatr. 2023 Sep-Oct;23(7):1434-1445. doi: 10.1016/j.acap.2023.06.024. Epub 2023 Jun 22.

  PMID: 37354951 BACKGROUND

Limitations and Caveats

The Covid pandemic affected practices and personnel and consequently the study. The sample is relatively small. ICD-codes from EHR data are a limited proxy for possible child abuse and neglect.

Results Point of Contact

• Title: Howard Dubowitz, MD, Professor of Pediatrics
• Organization: University of Maryland School of Medicine

hdubowitz@som.umaryland.edu

4107066144

Study Officials

• Howard Dubowitz, MD, MD

  University of Maryland, Baltimore

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Pediatrics

Model Details: RCT

Study Record Dates

• First Submitted: August 1, 2018
• First Posted: August 22, 2018
• Study Start: March 15, 2019
• Primary Completion: March 31, 2024
• Study Completion: March 31, 2024
• Last Updated: May 29, 2025
• Results First Posted: May 29, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)