Assessment of adoption and early implementation barriers and facilitators of the safe environment for every kid (SEEK) model

OBJECTIVE: Although use of interventions for screening for social determinants of health (SDOH) of families in pediatric primary care clinics has increased in the past decade, research on the barriers and facilitators of implementing such interventions has been limited. We explored barriers and facilitators and the mechanisms clarifying their roles in the adoption and implementation of the Safe Environment for Every Kid (SEEK) model, an approach to strengthening families, promoting children's health and development, and preventing child maltreatment. METHODS: A total of 28 semi-structured interviews were completed with 9 practice champions, 11 primary care professionals, 5 behavioral health professionals, and 3 nursing/administrative staff representing 12 pediatric primary care practices participating in a larger randomized control trial of implementing SEEK. RESULTS: We identified several barriers and facilitators in the stages of SEEK's adoption and early implementation. Barriers associated with outer and inner setting determinants and poor innovation-organization fit declined in importance over time while facilitators associated with SEEK characteristics increased in importance based on participants' responses. Barriers and facilitators were linked by mechanisms of comparison and contrast of burdens and benefits and problem-solving to address limited capacity with available resources. CONCLUSIONS: Any screening for and addressing SDOH demands greater attention to adoption and implementation mechanisms and the processes by which primary care professionals assess and utilize facilitators to address barriers. This occurs in a context defined by perceived burdens and benefits of innovation adoption and implementation, the capacity of the practice, and changes in perception with experiencing the innovation. WHAT'S NEW: Successful implementation of screening and referral interventions to address social determinants of health in pediatric primary care settings involves minimizing barriers and maximizing facilitators through comparison/contrast of burdens and benefits and problem-solving capacity limitations through available resources and supports.