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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: 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.

Objective: This study had two aims: (1) to determine the prevalence of musculoskeletal complaints among staff in primary care and (2) to determine to what extent lean maturity of the primary care unit can predict musculoskeletal complaints 1 year later.

Design: Descriptive, correlational and longitudinal design.

Setting: Primary care units in mid-Sweden.

Participants: In 2015, staff members responded to a web survey addressing lean maturity and musculoskeletal complaints. The survey was completed by 481 staff members (response rate 46%) at 48 units; 260 staff members at 46 units also completed the survey in 2016.

Outcome measures: Associations with musculoskeletal complaints were determined both for lean maturity in total and for four Lean domains entered separately in a multivariate model, that is, philosophy, processes, people and partners, and problem solving.

Results: The shoulders (12-month prevalence: 58%), neck (54%) and low back (50%) were the most common sites of 12-month retrospective musculoskeletal complaints at baseline. Shoulders, neck and low back also showed the most complaints for the preceding 7 days (37%, 33% and 25%, respectively). The prevalence of complaints was similar at the 1-year follow-up. Total lean maturity in 2015 was not associated with musculoskeletal complaints, neither cross-sectionally nor 1 year later, for shoulders (1 year beta: -0.002, 95% CI -0.03 to 0.02), neck (beta: 0.006, 95% CI -0.01 to 0.03), low back (beta: 0.004, 95% CI -0.02 to 0.03) and upper back (beta: 0.002, 95% CI -0.02 to 0.02).

Conclusion: The prevalence of musculoskeletal complaints among primary care staff was high and did not change within a year. The extent of lean maturity at the care unit was not associated with complaints among staff, neither in cross-sectional analyses nor in a 1-year predictive analysis.

Psychosocial risk factors in the home environment may impair children’s health and development and increase the risk of child maltreatment. The Swedish child health services (CHS), provide health-promoting and primary preventive services for all children 0-6 years of age. However, the national CHS lack evidence-based tools to universally screen for the most common psychosocial risk factors. The Safe Environment for Every Kid (SEEK) model provides a method for identifying children who live in families with economic worries, depressive symptoms, parental stress, intimate partner violence (IPV) and alcohol misuse in order to offer relevant support and assistance to the family.  The overarching aim of this thesis was to assess validity, clinical utility and outcomes of the Safe Environment for Every Kid model when applied in the Swedish Child Health Services setting. The SEEK model has been tested in a cluster randomized controlled trial within the CHS in the county of Dalarna. 

Studies I and II examined CHS nurses’ perception of their routine assessment of psychosocial risk factors in the family environment as well as their self-reported competence and the present organizational conditions in this context. Both studies used the same mixed method design, including surveys and focus group interviews. Study II analyzed the experiences of CHS nurses using the SEEK model in contrast to those using current standard practice. CHS nurses had extensive experience in dealing with the targeted risk factors, but using the SEEK model strengthened their sense of competence in identifying and responding to the needs of families with such problems. Using the SEEK model seems to have narrowed the gap between the nurses’ perception that it is both important and suitable to address psychosocial risk factors within the CHS and their previously limited ability to do so.  

Study III evaluated the psychometric properties of the Swedish version of the Parent Screening Questionnaire (PSQ-S) using data from surveys answered by parents (n=611). The PSQ-S was compared to standardized instruments for the targeted psychosocial risk factors. The PSQ-S showed a sensitivity of 93%, specificity of 52% and a positive and negative predictive values of 67% and 87%, respectively. 

 Study IV examined the self-reported rates of the targeted risk factors among parents who completed the PSQ-S at age-specific CHS visits during the intervention period. A total of 7483 PSQ-S were analysed. Over half of the PSQ-S had a positive screen for at least one risk factor. The problems were common throughout the child’s first five years of life and were about as common among mothers and fathers. The proportion of PSQ-S with a positive screen decreased significantly from the beginning to the end of the intervention.

The results suggest that the SEEK model, as applied in these studies, shows a high degree of validity and clinical utility in the CHS setting. The experience of SEEK nurses showed that the model was helpful in their daily work. There is room for improvement with respect to sensitivity regarding IPV and how the nurses address parents with alcohol misuse. Many parents were willing to disclose the targeted risk factors in the context of the CHS visits and use of the SEEK model likely provided opportunities for assistance that may otherwise have been missed.

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.

Background: Child maltreatment (CM) is often hidden, and the youngest children are often thosemost exposed. CM can be prevented through programs that address risk factors, but few primaryprevention strategies have been evaluated.Objective: To examine the experiences of nurses using the Safe Environment for Every Kid (SEEK)model compared to nurses using current standard practice in the Swedish child health services(CHS) to address psychosocial risk factors in the family environment.Participants and setting: Nurses at 27 child health centers in the CHS in the county of Dalarna,Sweden participated in the study. A survey was answered by 55 nurses and 18 nurses participatedin focus-group interviews.Methods: A convergent mixed methods research design with focus-group interviews and surveydata was used. Qualitative Content Analysis was used to analyze the interview data and MannWhitney U test was used to analyze the survey data.Results: The qualitative analysis identified four categories – “Framing the prerequisites for suc-cessful practice”; “Managing the mission of the CHS”; “Meeting the family as a professional”; and“Working with psychosocial risk factors can be emotional” – under the overarching theme“Universal application of a structured method adds value to experience-based knowledge whenaddressing psychosocial risk factors”. Survey data showed that SEEK nurses rated to a greaterdegree that they possessed adequate knowledge, competence and sense of security to addresspsychosocial risk factors in their work.Conclusions: This study indicates that using SEEK can strengthen the nurses in identifying andresponding to families in need of psychosocial support.

Aim To examine how child health nurses perceive the routine assessment of psychosocial risk factors in the family environment as well as their self-reported competence and the present organisational conditions in this context. Method A mixed-methods design was used, including three focus group interviews and a web-based survey. Qualitative data were analysed using systematic text condensation. Quantitative data were analysed at the descriptive level. Results Nurses expressed that identifying psychosocial risk factors was both important and relevant to their work. They had little formal training and education on most psychosocial risk factors, and they lacked structured methods to address them. In areas where nurses reported more formal education and a structured methodology (depression, parental stress), they rated to a higher degree that they possessed sufficient skills and sense of security. The nurses perceived that they seldom came into contact with families with financial problems, hazardous alcohol use or intimate partner violence. Conclusions There is a gap between the nurses' attitudes regarding the importance of helping families in need and their ability to do so with the current level of training and methodological support. The results suggest that, in many cases, psychosocial problems remain undetected.

Background

The Safe Environment for Every Kid (SEEK) model is a structured, evidence-based approach that helps identify and address prevalent psychosocial problems among caregivers and facilitates support and services. The aim of the present study was to analyze self-reported financial worries, depressive symptoms, parental stress, alcohol misuse and intimate partner violence in families of children <6 years of age as expressed in the SEEK Parent Screen Questionnaire - Sweden (PSQ-S) completed at regular child health visits.  

Methods

This study has a longitudinal design with consecutive, clinical-encounter-based sampling, and is part of a cluster-randomized controlled trial evaluating the SEEK model in Swedish child health services (CHS). Data were collected from parents’ responses to the Swedish SEEK Parent Screening Questionnaire (PSQ-S) used universally at five age-specific health visits during the intervention period from April 2018 through March 2020. Fully completed PSQ-S (n=7483) were analyzed using descriptive statistics regarding each respective risk factor and potential differences between groups with respect to child age and parent gender were analysed using Pearson’s Chi-square. Trends over time for each risk factor were analysed using the Mantel-Haenszel test.

Findings

Over half of the PSQ-S (53%) had at least one positive screen and the problems were common among both mothers and fathers throughout the child’s first five years of life. Overall rates of positive screens decreased by 41% for child safety problems, 52% for economic worries, 52% for depressive symptoms, 66% for parental stress and 73% for IPV during the intervention period (p-values ranged from 0.028 to <0.001) but not for alcohol misuse.

Conclusion

Parents of young children frequently reported psychosocial risk factors in their encounters with the CHS nurse when the SEEK model was used. There was a significant decrease in positive screens over the course of the intervention, possibly because problems had been addressed and families’ psychosocial situation indeed had improved. 

Background: Child maltreatment is linked to poorer health outcomes for children, including obesity. The Safe Environment for Every Kid (SEEK) model aims to detect and ameliorate parental psychosocial risk factors of child maltreatment through primary health care. The objective of our study is to evaluate its impact on early Body Mass Index (BMI) development in a population-based sample of children aged 0 to 4 years. 

Methods: In this cluster randomised controlled trial, Child Health Services units in Dalarna Region, Sweden, were randomized to SEEK intervention (n = 8) or control (n = 7) conditions. The trial was conducted between April 2018 and March 2020. Longitudinal height and weight records were retrieved from electronic health records. Rate of change of adjusted World Health Organization BMI SD over 2 years was the primary outcome. Information on parent psychosocial risk factors and sociodemographic factors were retrieved from the study database. Trends and interaction coefficients were modelled using Linear Mixed Models. 

Findings: A total of 374 children aged 0 to 4 years were analysed for the primary outcome (Intervention: n = 237). The rate of BMI change was 0.48 SD lower for the SEEK group over 2 years (95% CI: -0.6 to -0.29, p < 0.00) compared to the control group. The intervention had a stronger effect (-1.40 SD, 95% CI: -2.41, -0.38, p = 0.01) among children with baseline BMI >2 SD compared to those with BMI 0 – 1 SD (-0.26, 95% CI -0.55, 0.04, p = 0.09).

Interpretation: The SEEK model, aimed at addressing psychosocial risk factors in the home, promoted a healthy BMI development in preschool-aged children, and thus may decrease the risk of later obesity development.