Elsevier

Academic Pediatrics

Volume 11, Issue 6, November–December 2011, Pages 474-480
Academic Pediatrics

Child Protection
Training Pediatric Residents in a Primary Care Clinic to Help Address Psychosocial Problems and Prevent Child Maltreatment

https://doi.org/10.1016/j.acap.2011.07.005Get rights and content

Abstract

Objective

The objectives of this study were to determine whether 1) residents trained in the SEEK (A Safe Environment for Every Kid) model would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (parental depression, parental substance abuse, intimate partner violence, stress, corporal punishment, and food insecurity); 2) intervention residents would be more likely to screen for and assess those risk factors; and 3) families seen by intervention residents would report improved satisfaction with their child’s doctor compared to families receiving standard care from control residents.

Methods

Pediatric residents in a university-based pediatrics continuity clinic were enrolled onto a randomized controlled trial of the SEEK model. The model included resident training about psychosocial risk factors, a Parent Screening Questionnaire, and a study social worker. Outcome measures included: 1) residents’ baseline, 6-month, and 18-month posttraining surveys, 2) medical record review, and 3) parents’ satisfaction regarding doctor-parent interaction.

Results

Ninety-five residents participated. In 4 of 6 risk areas, intervention residents scored higher on the self-assessment compared to control subjects, with sustained improvement at 18 months. Intervention residents were more likely than control subjects to screen and assess parents for targeted risk factors. Parents seen by intervention residents responded favorably regarding interactions with their doctor.

Conclusions

The SEEK model helped residents become more comfortable and competent in screening for and addressing psychosocial risk factors. The benefits were sustained. Parents viewed the intervention doctors favorably. The model shows promise as a way of helping address major psychosocial problems in pediatric primary care.

Section snippets

Setting

The study took place in the primary care continuity clinics of a medium-sized, inner-city pediatric practice, serving children 0–18 years of age. The clinic had approximately 9,000 registered children, with 14,000 visits per year. Eighty percent of the families received Medicaid insurance.

Sample

The pediatric residency program has approximately 60 residents annually. The study sample consisted of the categorical pediatric and combined medicine-pediatrics residents who provided care in the continuity

Results

The sample consisted of 95 residents (50 intervention and 45 control) (Fig. 2). Three residents did not complete the PQ at baseline, but completed subsequent questionnaires. One resident completed only the pretest. Ninety-one completed questionnaires at 6 months; 84 (88%) did so at 18 months. There were no group differences in baseline characteristics, or in prior experience addressing child maltreatment and IPV (Table 2).

Demographic characteristics of families in the intervention (N = 308) and

Discussion

This study demonstrates that the SEEK model improved residents’ level of comfort, perceived competence, and practice behavior regarding prevalent psychosocial problems that are risk factors for child maltreatment. Indeed, the improvement in the areas of depression, IPV, stress, and food insecurity remained significant even 18 months after the initial training, despite the fact that long-term retention of educational material is difficult to achieve.19 In addition to the training, use of the

Acknowledgment

We thank Leslie Prescott, BA, J. Kathleen Tracy, PhD, Walter Meyer, MA, Joshua N. Semiatin, MS, and members of the research team for their contributions. The participation of the residents was instrumental in this study. We wish to thank the physicians and residents at Children’s Hospital of Philadelphia and University of Oklahoma in piloting the Physician Questionnaire and giving us feedback. Pamela Singer assisted with manuscript preparation.

The study was funded by a grant from the U.S.

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    The authors have no conflicts of interest to disclose.

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