Child MaltreatmentNCT03642327
SEEK: Dissemination and Implementation
A study testing Experimental: Maintenance of Certification (MOC) and Independent online training (IND) in people with Child Maltreatment, run by University of Maryland, Baltimore at 1 site in United States.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Child Maltreatment
- What is being tested?
- Experimental: Maintenance of Certification (MOC) and Independent online training (IND)
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 360 participants
- Where
- 1 siteUnited States
- Study dates
- 15 Mar 2019to 31 Mar 2024
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- None
Trial locations and contacts
1 site in 1 country.
United States1 site
University of Maryland, Baltimore
Baltimore, Maryland, 21201
About this study
Official title: The Safe Environment for Every Kid (SEEK) Model: Dissemination and Implementation
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.
Read the detailed description
The proposed study, based on SEEK I and II findings is designed to study the effectiveness of technology driven training strategies to facilitate use of SEEK in helping prevent child maltreatment (CM) and its adoption and implementation in pediatric and family medicine settings. The implementation approach is anchored in four stages of the EPIS conceptual model: Exploration, adoption/Preparation, Implementation, and Sustainment. The strong evidence for SEEK's effectiveness has been underscored by its listing on the websites of the CDC, AHRQ, AAP, and by the California Clearinghouse for Evidence-Based Interventions in Child Welfare. Early adopters are increasingly implementing SEEK in primary care settings, including in Sweden. Four of the 5 healthcare systems in this proposal have implemented SEEK in some of their practices. However, practices within these systems operate independently of one another, and there should not be contamination among them. Each practice has its own lead physician, primary care providers (PCPs) and administrative staff and several have integrated behavioral health.
Design. The investigator selected a rigorous Hybrid Type III design which is an approach to examine implementation outcomes while also examining SEEK's effectiveness in preventing CM, measured by electron health record (EHR) indicators. Type III designs are facilitated by good EHR systems due to the low cost of data routinely gathered for clinical, services, and financial purposes. Five healthcare systems have committed to participating in the project, without committing individual practices and primary care providers (PCPs). Professionals, office staff and parents are nested within practices which are nested within the 5 participating healthcare systems. Practices will choose whether to participate, as will medical professionals within those practices. Participating practices will be randomized to one of the two training strategies for PCPs - Independent online training vs. a Maintenance of Certification (MOC) activity approved by the Boards of Pediatrics and of Family Physicians. Practices will be able to select the facilitation strategy (SEEKonline software or Traditional 'paper and pencil'). Participating professionals and staff within practices will need to adhere to the approach adopted by the practice. The design accounts for heterogeneity in geography, size of healthcare systems, type of primary care (pediatric and family medicine), and presence of integrated behavioral health. A small random sample of parents will be recruited from each practice.
For Aim 1, practices and PCPs will be randomized to one of the two training approaches. Using baseline and follow-up surveys, the investigators will assess the impact of each approach on PCPs' attitudes, knowledge, sense of competence, level of comfort and practice behavior with regard to addressing the targeted problems (e.g., parental depression).
Aim 2 focuses on the implementation of the SEEK model in pediatric and family medicine primary care practices. Practices will have the option of implementing the model using the SEEKonline software or the "traditional" paper and pencil approach. The evaluation involves measuring aspects of implementation such rates of adoption, fidelity to the model, and sustainment beyond the training. In addition, qualitative interviews will provide data regarding what facilitates or impedes optimal implementation.
For Aim 3, The investigators will assess the impact of the interventions on rates of child maltreatment (CM) based on ICD 10 diagnoses in EHRs. The investigators will include a cost-effectiveness analysis by estimating the costs associated with the different approaches to implementing SEEK.
- Conditions
- Child Maltreatment
- Being tested
- Experimental: Maintenance of Certification (MOC), Independent online training (IND)
- Keywords
- Child Abuse Prevention, Primary Care, Professional Education in Primary Care
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Experimental: Maintenance of Certification (MOC)Behavioural
MOC training will lead to more positive attitudes, comfort level and competence in addressing risk factors for Child Maltreatment.
Independent online training (IND)Other
IND refers to practitioners Independently doing the online training.
| Study group | Role | What they receive |
|---|---|---|
| Independent online training (IND) | Active comparator | IND refers to practitioners Independently doing the online training. Receives: 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. Receives: Behavioral: Experimental: Maintenance of Certification (MOC) |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 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.
Measured: 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.
Measured: up to 30 months
Secondary outcomes (20)
Overall Rates of Children With Possible Abuse and Neglect.
International Classification of Diseases - 10 (ICD-10) codes related to possible child maltreatment (CM or child abuse and neglect) are readily accessible through EHRs. De-identified aggregate data were gathered towards the end of the study for all children in the practice 0-66 months of age.
Measured: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Children With Possible Neglect.
ICD-10 codes related to possible maltreatment (child abuse and neglect) are readily accessible through EHRs. De-identified aggregate data were gathered towards the end of the study for all children in the practice 0-66 months of age.
Measured: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Children With Non-adherence to Medical Care
ICD-10 codes related to possible maltreatment (child abuse and neglect) are readily accessible through EHRs. De-identified aggregate data were gathered towards the end of the study for all children in the practice 0-66 months of age.
Measured: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Under Immunized Children
ICD-10 codes related to possible maltreatment (child abuse and neglect) are readily accessible through EHRs. De-identified aggregate data were gathered towards the end of the study for all children in the practice 0-66 months of age.
Measured: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Children With Possible Abuse.
ICD-10 codes related to possible maltreatment (child abuse and neglect) are readily accessible through EHRs. De-identified aggregate data were gathered towards the end of the study for all children in the practice 0-66 months of age.
Measured: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
The Safe Environment for Every Kid (SEEK) PCP Questionnaire (PCPQ) - Addressing Depression Subscale
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Food Insecurity
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Major Stress
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Intimate Partner Violence
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Harsh Punishment
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Substance Abuse
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Attitudes Regarding Addressing Health-related Social Needs
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Comfort Level Regarding Addressing Health-related Social Needs
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Perceived Competence Regarding Addressing Health-related Social Needs
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Knowledge Regarding Addressing Health-related Social Needs
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK PCP Questionnaire (PCPQ) - Practice Behavior Regarding Addressing Health-related Social Needs
The PCPQ, used in both SEEK RCTs has 5 vignettes, with 7-12 statements assessing PCPs' thinking and practice with regard to addressing the targeted CM risk factors. Items were grouped conceptually into 6 topical scales (e.g., Substance Abuse) and 5 cross-cutting themes (e.g., Perceived Competence).
The mean subscale scores ranged from 0-3. Higher scores reflect PCPs more optimal capability to address the problem.
Measured: 30 months
SEEK Parent View of Relationship With Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Parents rate their child's PCP on this measure adapted for pediatric practice from the Patient-Doctor Interaction Scale. The Likert scale included 8 questions; the response set was from 1 (no) to 4 (always).
Subscale mean scores range from 1 - 4; higher scores indicate greater satisfaction.
The mean of the Likert subscale response is reported.
Measured: 24 months
SEEK Parent View of the Attentiveness of the Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Parents rate their child's PCP on this measure adapted for pediatric practice from the Patient-Doctor Interaction Scale. The Likert scale included 8 questions; the response set was from 1 (no) to 4 (always).
Subscale mean scores range from 1 - 4; higher scores indicate greater satisfaction.
The mean of the Likert subscale response is reported.
Measured: 24 months
SEEK Parent View of the Comprehensiveness of the Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Parents rate their child's PCP on this measure adapted for pediatric practice from the Patient-Doctor Interaction Scale. The Likert scale included 8 questions; the response set was from 1 (no) to 4 (always).
Subscale mean scores range from 1 - 4; higher scores indicate greater satisfaction.
The mean of the Likert subscale response is reported.
Measured: 24 months
SEEK Parent View of the Communication Skills of the Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Parents rate their child's PCP on this measure adapted for pediatric practice from the Patient-Doctor Interaction Scale. The Likert scale included 8 questions; the response set was from 1 (no) to 4 (always).
Subscale mean scores range from 1 - 4; higher scores indicate greater satisfaction.
The mean of the Likert subscale response is reported.
Measured: 24 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Aug 2018
- Study start15 Mar 2019
- Primary completion31 Mar 2024
- Study completion31 Mar 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Child MaltreatmentStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- RCT
- Masking
- None (open label)
- Enrolment
- 360 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Maryland, Baltimore
- Sponsor type
- University, hospital or other
- Collaborators
- Chestnut Health Systems, University of California, San Diego
- Responsible party
- Principal investigator, Howard Dubowitz, University of Maryland, Baltimore
- Investigators
- Howard Dubowitz, MD, MD, Principal investigator, University of Maryland, Baltimore
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03642327
- Sponsor's protocol ID
- HP-00078770
- Status last verified
- May 2025
- First submitted
- 1 Aug 2018
- Last updated
- 29 May 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
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.
PubMed 39004298Dubowitz 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.
PubMed 35362065Dubowitz 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.
PubMed 32974614Palinkas 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.
PubMed 37354951
Study at a glance
From the registry record, last updated by the sponsor on 29 May 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Safe Environment for Every Kid (SEEK) Model: Dissemination and Implementation
- ClinicalTrials.gov ID
- NCT03642327
- Acronym / sponsor ID
- HP-00078770
- Conditions
- Child Maltreatment
- Keywords
- Child Abuse Prevention, Primary Care, Professional Education in Primary Care
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 360 participants (actual)
- Lead sponsor
- University of Maryland, BaltimoreUniversity, hospital or other
- Collaborators
- Chestnut Health Systems, University of California, San Diego
- Study start
- 15 Mar 2019 (actual)
- Primary completion
- 31 Mar 2024 (actual)
- Study completion
- 31 Mar 2024 (actual)
- First posted
- 22 Aug 2018 (actual)
- Results
- Posted 29 May 2025
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
The proposed study, based on SEEK I and II findings is designed to study the effectiveness of technology driven training strategies to facilitate use of SEEK in helping prevent child maltreatment (CM) and its adoption and implementation in pediatric and family medicine settings. The implementation approach is anchored in four stages of the EPIS conceptual model: Exploration, adoption/Preparation, Implementation, and Sustainment. The strong evidence for SEEK's effectiveness has been underscored by its listing on the websites of the CDC, AHRQ, AAP, and by the California Clearinghouse for Evidence-Based Interventions in Child Welfare. Early adopters are increasingly implementing SEEK in primary care settings, including in Sweden. Four of the 5 healthcare systems in this proposal have implemented SEEK in some of their practices. However, practices within these systems operate independently of one another, and there should not be contamination among them. Each practice has its own lead physician, primary care providers (PCPs) and administrative staff and several have integrated behavioral health.
Design. The investigator selected a rigorous Hybrid Type III design which is an approach to examine implementation outcomes while also examining SEEK's effectiveness in preventing CM, measured by electron health record (EHR) indicators. Type III designs are facilitated by good EHR systems due to the low cost of data routinely gathered for clinical, services, and financial purposes. Five healthcare systems have committed to participating in the project, without committing individual practices and primary care providers (PCPs). Professionals, office staff and parents are nested within practices which are nested within the 5 participating healthcare systems. Practices will choose whether to participate, as will medical professionals within those practices. Participating practices will be randomized to one of the two training strategies for PCPs - Independent online training vs. a Maintenance of Certification (MOC) activity approved by the Boards of Pediatrics and of Family Physicians. Practices will be able to select the facilitation strategy (SEEKonline software or Traditional 'paper and pencil'). Participating professionals and staff within practices will need to adhere to the approach adopted by the practice. The design accounts for heterogeneity in geography, size of healthcare systems, type of primary care (pediatric and family medicine), and presence of integrated behavioral health. A small random sample of parents will be recruited from each practice.
For Aim 1, practices and PCPs will be randomized to one of the two training approaches. Using baseline and follow-up surveys, the investigators will assess the impact of each approach on PCPs' attitudes, knowledge, sense of competence, level of comfort and practice behavior with regard to addressing the targeted problems (e.g., parental depression).
Aim 2 focuses on the implementation of the SEEK model in pediatric and family medicine primary care practices. Practices will have the option of implementing the model using the SEEKonline software or the "traditional" paper and pencil approach. The evaluation involves measuring aspects of implementation such rates of adoption, fidelity to the model, and sustainment beyond the training. In addition, qualitative interviews will provide data regarding what facilitates or impedes optimal implementation.
For Aim 3, The investigators will assess the impact of the interventions on rates of child maltreatment (CM) based on ICD 10 diagnoses in EHRs. The investigators will include a cost-effectiveness analysis by estimating the costs associated with the different approaches to implementing SEEK.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- RCT
| Arm | Type | Receives |
|---|---|---|
| Independent online training (IND) | Active comparator | Other: Independent online training (IND)IND refers to practitioners Independently doing the online training. |
| Maintenance of Certification (MOC) | Experimental | Behavioral: Experimental: Maintenance of Certification (MOC)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. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- 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
Key exclusion criteria (1 listed)
- None
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Experimental: Maintenance of Certification (MOC)MOC training will lead to more positive attitudes, comfort level and competence in addressing risk factors for Child Maltreatment. | Behavioural | Maintenance of Certification (MOC) |
| Independent online training (IND)IND refers to practitioners Independently doing the online training. | Other | Independent online training (IND) |
Primary outcome
Stages of SEEK Implementation Completion (SIC) - Startup (at a Practice Level)
Time frame: up to 30 months
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.
Stages of Implementation Completion (SIC) - as Assessed by the Safe Environment for Every Kid (SEEK) Fidelity Score (at a Practice Level)
Time frame: up to 30 months
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.
Stages of SEEK Implementation Completion (SIC) - Sustainability
Time frame: up to 30 months
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.
20 secondary outcomes
Overall Rates of Children With Possible Abuse and Neglect.
Time frame: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Children With Possible Neglect.
Time frame: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Children With Non-adherence to Medical Care
Time frame: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Under Immunized Children
Time frame: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
Rates of Children With Possible Abuse.
Time frame: 2 years prior to implementing SEEK, 2 years after implementing SEEK., 48 months total.
The Safe Environment for Every Kid (SEEK) PCP Questionnaire (PCPQ) - Addressing Depression Subscale
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Food Insecurity
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Major Stress
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Intimate Partner Violence
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Harsh Punishment
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Addressing Substance Abuse
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Attitudes Regarding Addressing Health-related Social Needs
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Comfort Level Regarding Addressing Health-related Social Needs
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Perceived Competence Regarding Addressing Health-related Social Needs
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Knowledge Regarding Addressing Health-related Social Needs
Time frame: 30 months
SEEK PCP Questionnaire (PCPQ) - Practice Behavior Regarding Addressing Health-related Social Needs
Time frame: 30 months
SEEK Parent View of Relationship With Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Time frame: 24 months
SEEK Parent View of the Attentiveness of the Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Time frame: 24 months
SEEK Parent View of the Comprehensiveness of the Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Time frame: 24 months
SEEK Parent View of the Communication Skills of the Child's PCP Subscale - Adapted From the Patient-Doctor Interaction Scale
Time frame: 24 months
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 May 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 39004298Dubowitz 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.
- Background: PubMed 35362065Dubowitz 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.
- Background: PubMed 32974614Dubowitz 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.
- Background: PubMed 37354951Palinkas 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.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Howard Dubowitz, MD, MD principal investigator
University of Maryland, Baltimore
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Experimental: Maintenance of Certification (MOC) and Independent online training (IND) in people with Child Maltreatment, run by University of Maryland, Baltimore at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 29 May 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 29 May 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Stages of SEEK Implementation Completion (SIC) - Startup (at a Practice Level) (time frame: up to 30 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03642327, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 May 2025; AzTrials last refreshed its copy on 28 Oct 2026.