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

Background: Child maltreatment (CM) is often hidden, and the youngest children are often those most exposed. CM can be prevented through programs that address risk factors, but few primary prevention 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 participated in focus-group interviews. Methods: A convergent mixed methods research design with focus-group interviews and survey data was used. Qualitative Content Analysis was used to analyze the interview data and Mann Whitney U test was used to analyze the survey data. Results: The qualitative analysis identified four categories - "Framing the prerequisites for successful 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 when addressing psychosocial risk factors". Survey data showed that SEEK nurses rated to a greater degree that they possessed adequate knowledge, competence and sense of security to address psychosocial risk factors in their work. Conclusions: This study indicates that using SEEK can strengthen the nurses in identifying and responding to families in need of psychosocial support.