Comparing two training approaches to scaling up the Safe Environment for Every Kid (SEEK) approach

Objective: To compare the impact of 2 common continuing medical education training modalities-independent online (IND) and a Maintenance of Certification-4 activity (MOC)-and primary care practice characteristics on scaling up (ie, the adoption, implementation, and sustainment) of the Safe Environment for Every Kid (SEEK) approach.

Methods: This longitudinal, multisite study involved 44 practices across the United States, 25 of whom were randomized to one of 2 training modalities. We ascertained the extent to which primary care professionals (PCPs) in each practice completed the assigned training (ie, "dose"). Practice personnel were surveyed up to 4 times over a 2-year period regarding their views on changing their practice, evidence-based practices, and their leadership. Predictors included training modality and dose and practice characteristics. Outcomes were startup, fidelity, and sustainment regarding SEEK.

Results: Only 31% of MOC and 25% of IND practices had most (≥75%) PCPs complete their training; 15% and 17% had an intermediate status with 50%-74%. Approximately half the practices achieved startup and most implemented SEEK with fidelity and sustained this for 2 years. There were few differences between the IND versus MOC practices; more training was associated with greater fidelity, especially in the IND practices. Practices that had greater baseline commitment and sense of efficacy were more likely to start implementing SEEK and do so with fidelity.

Conclusions: The findings support the simpler IND training approach and the value of sound preparation to foster commitment and a sense of efficacy. Improved strategies for encouraging PCPs to complete such training are needed. The study offers a valuable example of evaluating widely used training modalities as well as the scaling up of an evidence-based practice such as SEEK.