With the generosity of the Doris Duke Charitable Foundation (DDCF), the American Academy of Pediatrics (AAP) launched Practicing Safety in January 2003 aimed at decreasing child abuse and neglect by enhancing anticipatory guidance and increasing screening provided by pediatric practices to children ages 0-3. In Phase I, six pediatric practices in New Jersey and two in Pennsylvania implemented a tool kit with 7 modules focused on increasing screening and improving anticipatory guidance provided for seven “healthy indicators” of primary and secondary prevention: coping with crying, parenting, safety in other care, family environment, effective discipline, sleeping and eating, and toilet training.
The materials, many in Spanish, were easily adaptable to well child care and many were well received by the physicians, office staff and patients. The practice change methodology employed by Practicing Safety, Complex Adaptive Systems, enabled a range of functional and dysfunctional, small and large, private and public, teaching and non-teaching practices, to undergo a reflective process about their practice and engage in the work of child abuse and neglect prevention. Results showed practices screened for maternal depression and improved in discussing the issues of coping with crying, maternal bonding, toilet training and discipline.