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BarnSäkert: Studies of the Safe Environment for Every Kid model in the Swedish Child Health Services for early identification of psychosocial risk factors in the home environment of young children
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Pediatrisk inflammations- och metabolismforskning samt barnhälsa, Paediatric Inflammation, Metabolism and Child Health Research)ORCID iD: 0000-0003-3551-0046
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2023. , p. 108
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1966
Keywords [en]
Public health, Child health, Prevention, Health promotion, Child health services, Child health nursers, Nursing, Psychosocial risk factors, Child maltreatment, Psychometrics, Validation, Evidence-based practice, Women, Men
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
URN: urn:nbn:se:uu:diva-508374ISBN: 978-91-513-1866-0 (print)OAI: oai:DiVA.org:uu-508374DiVA, id: diva2:1787183
Public defence
2023-09-29, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-09-07 Created: 2023-08-11 Last updated: 2023-09-07
List of papers
1. Child Health Nurses' experiences of addressing psychosocial risk factors with the families they meet
Open this publication in new window or tab >>Child Health Nurses' experiences of addressing psychosocial risk factors with the families they meet
2021 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 110, no 2, p. 574-583Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & SonsWILEY, 2021
Keywords
child health care, child maltreatment, health promotion, prevention, psychosocial risk factors
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-439126 (URN)10.1111/apa.15492 (DOI)000572264800001 ()32716528 (PubMedID)
Funder
Gillbergska stiftelsen
Available from: 2021-03-30 Created: 2021-03-30 Last updated: 2024-01-15Bibliographically approved
2. Child health nurses' experiences of using the Safe Environment for Every Kid (SEEK) model or current standard practice in the Swedish child health services to address psychosocial risk factors in families with young children – A mixed-methods study
Open this publication in new window or tab >>Child health nurses' experiences of using the Safe Environment for Every Kid (SEEK) model or current standard practice in the Swedish child health services to address psychosocial risk factors in families with young children – A mixed-methods study
2022 (English)In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 132, article id 105820Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Child health care Child maltreatment, Health promotion, Prevention, Psychosocial risk factors, Nursing
National Category
Health Sciences
Research subject
Social Work
Identifiers
urn:nbn:se:uu:diva-486570 (URN)10.1016/j.chiabu.2022.105820 (DOI)000923554300013 ()35932659 (PubMedID)2-s2.0-85135532674 (Scopus ID)
Available from: 2022-10-12 Created: 2022-10-12 Last updated: 2023-08-11Bibliographically approved
3. Validation of the Swedish Version of the Safe Environment for Every Kid (SEEK) Parent Screening Questionnaire
Open this publication in new window or tab >>Validation of the Swedish Version of the Safe Environment for Every Kid (SEEK) Parent Screening Questionnaire
Show others...
2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, article id 1989Article in journal (Refereed) Published
Abstract [en]

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.

 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Psychosocial risk factors, Child health, Child maltreatment, Prevention, Health promotion, Psychometrics, Validation, Child health services, Evidence-based practice, Women, Men
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-508708 (URN)10.1186/s12889-023-16792-4 (DOI)001127122200006 ()37828478 (PubMedID)
Funder
Region Uppsala
Available from: 2023-08-08 Created: 2023-08-08 Last updated: 2024-01-31Bibliographically approved
4. Psychosocial risk factors in families of young children: A trial of the Safe Environment for Every Kid (SEEK) Model in Sweden
Open this publication in new window or tab >>Psychosocial risk factors in families of young children: A trial of the Safe Environment for Every Kid (SEEK) Model in Sweden
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

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. 

Keywords
Psychosocial risk factors, Child health, Child maltreatment, Prevention, Health promotion, Child health services, Evidence-based practice, Women, Men
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-508740 (URN)
Funder
Region Uppsala
Available from: 2023-08-08 Created: 2023-08-08 Last updated: 2023-08-14Bibliographically approved

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