BarnSäkert – a safe environment for every child

INTERVENTION: The BarnSäkert intervention starts after randomization of the child health centers. Randomization was performed at the child health centre level, such that all nurses at each centre either the SEEK model or current clinical routines. All child health centres in the county of Dalarna (n=36) agreed to participate in the study. The centres were matched pairwise based on the number of children enrolled and sociodemographic factors including proportion of families of non‐Swedish origin and Care Need Index. Allotment to the SEEK or control group was determined by coin‐toss. Six centres had previously participated in a pilot study during the development of the methodology and these centres were therefore allotted to the SEEK group and matched with centres of similar size and with sociodemographic characteristics that were allotted to the control group. Two members of the project leadership performed the randomization and had no detailed knowledge of the child health centres or the staff who worked there. The SEEK model consists of four elements: 1. Basic training of the CHS staff in the risk factors assessed in the SEEK parent questionnaire (child safety, financial problems, parental stress, depression, alcohol abuse, intimate partner violence) 2. Use of the SEEK parent questionnaire (PQ) in conjunction with predetermined routine visits to the CHS 3. Discussion of the parent’s responses and possible outcomes in connection with the CHS visit 4. Suggestions for advice or referral to relevant support or healthcare agencies. At SEEK centers, parents/guardians are offered to fill in a web‐based PQ in connection with regular child health visits when the child is 6‐8 wee CONDITION: Preventive child health care ; Not Applicable ; Prevention of child maltreatment PRIMARY OUTCOME: ; 1. Percentage of families reporting each respective psychosocial risk factor over the intervention period, determined from anonymous SEEK parent questionnaire (PQ) responses between at baseline and 24 months; 2. Survey responses from parents who have consented to participate in the longitudinal part of the study, regarding psychosocial risk factors (financial difficulties, depression and anxiety, extreme stress, alcohol problems, intimate partner violence), quality of life, parenting sense of competence, assessment of child difficultness. Assessed through a web‐based survey sent to parents at baseline, 12, and 24 months.; 3. Diagnoses among children in the SEEK and control groups assessed through data extracted from electronic clinical records collected from 24 months to 9 years.; 4. Social services reports for children in SEEK and control groups collected yearly from baseline to 9 years; 5. School attendance and needs for support/special education in preschool and school for children in SEEK and control groups aged 3 to 10 years, collected from baseline to 9 years; SECONDARY OUTCOME: ; 1. Nurses' experiences of addressing psychosocial risk factors in their contact with families, measured using focus group interviews and survey results from SEEK and control nurses at 2 years; 2. Parents' experiences of discussing psychosocial risk factors during the child health visit measured using focus group interviews with parents from the SEEK group at 2.5 years; INCLUSION CRITERIA: 1. Parents/guardians of children aged 0 to 18 months 2. Parents/guardians of children enrolled in the child health services in the county of Dalarna, Sweden