Detecting Risk vs. Change: An Evaluation of the Seek Screen's Use in the HealthySteps Model

Introduction: HealthySteps (HS) is a risk-stratified population-based model that focuses on universal screening and intervention for child development, social–emotional well-being, post-partum depression, and other social determinants of health at the well child check for patients ages 0 to 3. At our Midwestern academic medical center’s urban pediatric primary care clinic, the Safe Environment for Every Kid (SEEK) was chosen to screen for psychosocial risk factors to inform tier-based HS services. We sought to examine the SEEK’s ability to detect change in psychosocial risk factors following HS intervention in alignment with the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework.

Methods: Retrospective chart review of children ages 13-24 months seen in the practice with at least two SEEKs completed at well visits from September 2024 to September 2025. Descriptive statistics (frequencies and percents) were used to assess changes in SEEK scores pre-post HS intervention as well as to characterize patient demographics and referrals made following consultation.

Results: Of 198 children meeting inclusion criteria, 51 families received HS services. SEEK parental mood and parenting stress subscales showed minimal pre–post difference and were heavily concentrated at the floor at both timepoints (mood: 96.1%→86.3% scoring 0; parenting stress: 80.4%→82.4% scoring 0) limiting the tool's ability to detect meaningful change. Notably, 15.7% of families were referred to maternal mental health services and early childhood intervention, consistent with the 10-15% benchmark for providing Tier 2/3 services.

Conclusions: While this referral rate may reflect broader clinical judgment rather than SEEK scores specifically, it still points to an active detection-and-response process at the Adoption/Implementation level. However, floor effects constrain the SEEK’s usefulness in measuring the Effectiveness and Maintenance dimensions of RE-AIM. Practices implementing similar models should weigh screener utility for risk identification against its ability to detect change and consider complementary outcome measures where feasible.