Safe Environment for Every Kid: Screening Tool Implementation for Quality Improvement in a Primary Care Pediatric Clinic

Background Child abuse and neglect are significant issues in our world today with over 700,000 substantiated cases annually, costing our country more than 124 billion each year. More than four children die daily in the United States due to child maltreatment and yet it is rarely addressed in the primary care setting. The University of Maryland School of medicine and Dr. Howard Dubowitz created the Safe Environment for Every Kid (SEEK) screening tool to identify children at risk for child abuse and neglect, as well as follow-up handouts for each concern the tool might identify.MethodsThis project outlines initial implementation of the SEEK screening tool in a primary care pediatric clinic covering suburban and rural areas. Target population included well child check patients from two weeks to five years, and their caregivers. This project aims to identify and address risk factors that lead to child abuse and neglect, in an attempt to lower those risk factors. Target objectives were twofold; increasing the rate at which the designated population are screened and charted in the EMR and increasing the rate at which the provider addresses an identified risk using the follow-up resources and charts interventions in the EMR. InterventionsMultiple PDSA cycles were utilized to guide implementation and improvement of interventions including; visual reminders, convenient system for follow-up forms, condensed paperwork, standardized SEEK questions, and MA/MD education and training. Reminders were adhered to the workstations of each staff member to remind them of the ages that should receive the screening tool. Follow-up forms were customized to local resources and labeled clearly to correspond to the question it addresses for easy access. Paperwork for caregivers to fill out was condensed to one page front and back. Questions on the handout and EMR documentation were streamlined to be uniform for accurate documentation. Education occurred continuously throughout the three-month project period regarding staff expectations and areas for growth. Data regarding the target objectives were collected utilizing the clinic EMR and analyzed with the assistance of a statistician. ResultsBaseline compliance rates were zero at SEEK tool go-live date on October 1st, 2019. Clinic administration compliance rates improved to 86%, and follow-up care compliance rates improved to 60% by the end of the project period. Wilcoxon Signed-Rank Tests concluded results were statistically significant (p < .05). An unexpected benefit of this project was that additional screening tools were completed at a higher rate due to the project intervention of condensing the paperwork caregivers fill out at each visit. ConclusionThis quality improvement project demonstrated the effectiveness of interventions in increasing SEEK tool administration and follow-up care compliance. Identifying child abuse and neglect risks at increased rates resulted in more families receiving follow-up care to address these risks. Addressing risk factors identified by the SEEK tool can lead to decreased child maltreatment rates.