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Background: Safe Environment for Every Kid (SEEK) is one of few evidence-based approaches to identify psychosocial problems and facilitate support to families within pediatric primary care. The Swedish version of SEEK, called BarnSäkert (“Child Safe”), is being evaluated as a complex intervention in the Swedish child health services (CHS) for children aged 0–6 years.

Objective: Assessment of parents’ views of the acceptability and efficacy of the BarnSäkert SEEK model within the CHS in Sweden.

Participants and setting: Mothers and fathers (n = 353) whose children were enrolled in the CHS.

Methods: An anonymous web-based survey posed questions regarding how parents perceived BarnSäkert/SEEK and whether services had been offered, accessed or planned as a result. Efficacy was measured as parents’ reports of an improved life situation or having been helped by the model.

Results: Among parents who discussed their situation with the nurse, 80 % reported that it had helped, 24 % had received help that they otherwise would not have and 20 % that their situation had improved. Appropriateness of the model was scored at 91/100 by mothers and 86/100 by fathers. Logistic regression showed significantly higher odds ratios for efficacy measures and service uptake for parents who were younger, born outside of Sweden or had lower levels of education.

Conclusions: Parents reported that the model was highly acceptable and efficacious in meeting their psychosocial needs. The findings lend support for application of the BarnSäkert/SEEK model in the Swedish CHS as an equitable approach to address psychosocial problems in families with young children.

Background: Individual histories of abuse characteristics and other adversities must be considered to understand poly-victimization and its impact on ill-health, which suggests the importance of understanding how experiences of violence are interconnected over a life-course.

Objective: To explore gendered patterns of lifetime poly-victimization-physical, emotional, and sexual-and examine how distinct exposure profiles relate to adult health outcomes. The analysis is guided by the TraumaInformed Theory of Individual Health Behavior (TTB) framework to deepen understanding of gendered trauma trajectories and their long-term effects.

Methods: 10 337 Swedish women and men aged 18-74 participated in a combined online and postal survey. Attrition bias was controlled for based on official registry information. Latent Class Analysis (LCA) was used for identification of groups. Associations between mental and physical health indicators and health-related risk behaviors were analyzed using logistic regression, adjusting for background variables including age, selfreported parental immigrant status, and parental educational attainment. Results: Patterns of lifetime poly-victimization were more complex among women (7 classes) than men (4 classes). Among men, exposure was primarily characterized by childhood physical and emotional violence, as well as adult non-partner physical violence. In contrast, women's profiles often included childhood sexual violence and partner violence in adulthood, with stronger associations to multiple health problems and risk behaviors, and generally higher odds ratios compared to men. Among women, three unique clusters were identified, one of which may reflect more advanced resilience capacities compared to other clusters with similar trajectories of childhood violence exposure.

Conclusions: Gendered patterns of poly-victimization and their health-related consequences underscore the importance of early intervention to prevent revictimization. The identification of unique and resilient clusters among women, despite similar childhood violence exposure, highlights the need for further research into protective mechanisms and trauma-to-benefit pathways, as conceptualized within the TTB framework.

BackgroundAlthough experiences of violence are detrimental and may occur throughout the lifespan, few studies have examined the long-term health correlates of violence in both childhood and adulthood.ObjectiveTo examine the association of exposure to child maltreatment (CM) as well as severe violence in adulthood with mental and physical health problems and health-related risk behaviors in adulthood.MethodsThe study was cross-sectional and applied a novel survey instrument among a random sample of 10 337 Swedish women and men aged 18-74. Logistic regression was applied to calculate odds ratios.ResultsExposure to 0, 1, 2 or 3 or more types of CM showed graded associations for depression, anxiety, self-harm and PTSD in adulthood. Irritable bowel syndrome, fibromyalgia and obesity showed modest correlations. No significant associations were found between CM and ischemic heart disease (IHD), type 2 diabetes or cancer, although the ORs were in line with several previous ACE studies. When exposure to severe violence in adulthood was added to CM, odds ratios increased dramatically for mental health problems and health-related risk behaviors, suggesting that revictimization may moderate or mediate this relationship.ConclusionsThe results underscore the importance of studying violence exposure in a life-course perspective and suggest that the relationship between childhood adversities and long-term physical health problems in adulthood may be affected by the traumatic effects of revictimization in adult life. This points to the importance of early identification of child maltreatment and provision of robust services to protect children, treat symtoms of trauma, and enhance resilience to decrease the risk of poor health outcomes.

Improved prediction of physical child abuse could aid in developing preventive measures. Parental physical disease has been tested previously as a predictor of documented physical child abuse but in broad categories and with differing results. No prior studies have tested clinically recognizable categories of parental disease in a high-powered dataset. Using Danish registries, data on children and their parents from the years 1997-2018 were used to explore several parental physical disease categories' associations with documented physical child abuse. For each disease category, survival analysis using pseudovalues was applied. When a parent of a child was diagnosed or received medication that qualified for a category, this family and five comparison families not in this disease category were included, creating separate cohorts for each category of disease. Multiple analyses used samples drawn from 2,705,770 children. Estimates were produced for 32 categories of physical diseases. Using Bonferroni-corrected confidence intervals (CIc), ischemic heart disease showed a relative risk (RR) of 1.44 (CIc 1.13-1.84); peripheral artery occlusive disease, RR 1.39 (CIc 1.01-1.90); stroke, RR 1.19 (1.01-1.41); chronic pulmonary disease, RR 1.33 (CIc 1.18-1.51); ulcer/chronic gastritis, RR 1.27 (CIc 1.08-1.49); painful condition, 1.17 (CIc 1.00-1.37); epilepsy, RR 1.24 (CIc 1.00-1.52); and unspecific somatic symptoms, RR 1.37 (CIc 1.21-1.55). Unspecific somatic symptoms were present in 71.87% of families at some point during the study period.

Conclusion: Most parental physical disease categories did not show statistically significant associations, but some showed predictive ability. Further research is needed to explore preventive potential.

What is Known:center dot Few and broad categories of parental physical disease have been examined as risk factors for severe physical child abuse; no prior study has used several categories as predictors.What is New:center dot Unspecific symptoms, ischemic heart disease, peripheral artery occlusive disease, stroke, chronic pulmonary disease, stomach ulcer/chronic gastritis, painful condition, and epilepsy all showed to be potential predictors, with unspecific symptoms being the most prevalent.

Successful prevention of physical child abuse is dependent on improvements in risk assessment. The risk of abuse is assumed to increase when family stressors overcome resources. Severe physical disease can increase stress, and parental physical disease has been studied as a risk factor for physical child abuse, but with heterogeneous definitions. This study evaluated the relation between parental physical disease severity and severe documented physical child abuse. Models were based on data on children aged 0–17 years in Denmark between 1997 and 2018, and their parents. Severe documented physical child abuse was modeled as violence against a child registered by either health authorities in treatment or mortality registries, or police authorities in cases confirmed by the courts. Parental physical disease severity was modeled as the sum of Charlson Comorbidity Index scores for the child’s parents. The causal connection was examined in two model types: a survival model comparing exposed with non-exposed children, adjusted for covariates at baseline, and a G-model, taking time-varying covariates, including income and parental psychiatric disease into account. Neither model showed an association between parental physical disease severity and severe documented physical child abuse, with RR 0.99 and 95% CI (0.93–1.05) for the survival model and RR 1.08 for the G-model (CI not calculated).

Conclusion: In the model studied, parental physical disease severity was not a risk factor for severe documented physical child abuse. Individual categories of physical disease remain to be examined.

Background: The Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.

Objective: The aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.

Participants and setting: Eighteen parents (13 women and five men) in two Swedish counties participated in the study.

Methods: Semi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.

Results: Three themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.

Conclusions: The study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

A comprehensive overview of all studied individual, relational, community, and societal risk factors that precede severe physical child abuse is critical to inform preventive efforts. All available studies of substantiated, diagnosed, self-reported, or caretaker-reported physical child abuse were reviewed and assessed for risk of bias, and meta-analyses of risk factors were carried out when feasible. The review was pre-registered: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018094317. Observational studies were included. PubMed, Embase, PsycINFO, Scopus, EBSCOhost, ProQuest, OpenGrey, and Bielefeld were searched. No limits were placed on language or publication year. A total of 29,060 records were found on the 18th of December, 2018, screened and extracted by two reviewers. Ninety-one reports were included, and of these, 37 reports were left out of results due to high risk of bias. A total of 139 risk factors were reported. The results suggest that attention to families with underweight infants, low parental education, multiple births, and former reports to social services may provide opportunities for prevention of severe physical child abuse. Overall, results showed a deficiency of evidence with low risk of bias, and a lack of any evidence from low-income countries.

Background: Physical revictimization has been sparsely examined, and in particular the risk of revictimization within the context of closely related perpetrators.

Objective: To elucidate the relative contributions of exposure to physical violence in childhood and in youth by perpetrators close to the victim and situational factors in childhood to the risk of physical IPV in adulthood against the social-ecological background of the Trauma-Informed Theory of Individual Health Behavior (TTB). Trust was used as a proxy for resilience.

Participants and setting: A representative sample of 10,337 women and men aged 18-74 in Sweden.

Methods: A combined online and postal survey was used. Attrition bias was adjusted for by a calibration and weighting procedure based on official register information. Logistic regression was applied to calculate odds ratios (OR).

Results: Physical abuse by a parent before the age of 15 was associated with approximately 2-3 fold increased odds of physical adult partner violence. The strongest correlation applied to victimization by a partner at age 15-17, where the risk for men was three times that for women. Dysfunctional family conditions and social risk behaviors in adolescence were also associated with adult IPV, while sociodemographic variables had no explanatory value.

Conclusions: Our results indicated that exposure to physical violence by perpetrators close to the victim was the most potent risk factor for exposure to physical IPV in adulthood and that exposure at multiple ages increased this risk. Trust was clearly associated with lower odds of revictimization. Our findings support the tenets of TTB and suggest that they may be extended to the concept of revictimization.

Background

Psychosocial risk factors in the home may impair children’s health and development and increase their risk of maltreatment. The Safe Environment for Every Kid (SEEK) model helps address these problems, and aims to strengthen families, support parents and parenting, and thereby promote children’s health, development, wellbeing and safety. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, assessment of their responses and, when indicated, referral to relevant services. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the SEEK-PSQ (PSQ-S). 

Methods

This study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n=852) with children 0-18 months of age were invited to complete a survey comprising the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors. Data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor.

Results

As a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81-99%) and PPV values were low to moderate (22-69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers). 

Conclusion

The SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified.

Trial registration

ISRCTN registry, study record 14429952 (https://doi.org/10.1186/ISRCTN14429952)

Registration date 27/05/2020.