Normally child maltreatment is being detected thru child characteristics at the Emergency department: a unexplained delay, a wound or fracture with an unclear or inconsistent explanation, a baby with a fracture e.g.
The gap between the prevalence of child maltreatment versus the number of referred cases of child maltreatment has always been insurmountably large. It is still only the tip of the iceberg we seem to detect, although the ED is the ideal detection location.
Since 2008 we started in the Haaglanden Medical Center a pilot to add the detection of child maltreatment based on parental characteristics to the already existing protocol of detecting thru child characteristics.
Every patient that visited the ED after domestic violence, substance abuse of severe psychiatric problems was asked by a nurse or doctor if they were pregnant of if they were responsible for minors (or lived in a house with minors). If the answer was YES, the children were referred to the Reporting Center for Child abuse and neglect (RCCAN). This is a non-jurisdictional organization who investigates the family and domestic situation and, if necessary, organizes voluntary community based services for the parents and the children. Only in severe cases of child maltreatment they will contact Social Services (CPS) to intervene.
In 2011-2013 scientific research was carried out to evaluate the effectiveness of this so called Hague Protocol. The results were astoundingly: after investigating 565 referrals (this is number of parents, so x the number of children in the family) in 91% of the cases child maltreatment was found and help was needed and arranged. In almost 75% of the cases these children were unknown to the RCCAN or the CPS.
In 2013 the Hague Protocol (detecting child maltreatment based on parental characteristics) was mandated by Law for all professionals working with adults, for teachers and professionals working in the Justice system; it was re-named and is now known as; The Child Check.
In 2017 Norway and Switzerland are the first countries to join the international multi-center study. Please follow their lead and join!
Goal is to add the Hague protocol to existing protocols in the detection on child maltreatment at ED’s in many different countries. Every country can organize their own community based services, as the differ from country to country.
We have already written a research proposal which can be used and e-learning made by the Augeo Foundation to educate your ED professionals on this subject is ready for use. It has been translated in German and English but it is possible to add other languages.
Please think about the difference you and your colleagues can make for your patients by starting this pilot. We can provide you with all the help and support you need! I am more than willing to come over and explain everything in detail and help you to convince the appropriate partners needed in and outside your hospital!
Please e-mail me at: H.Diderich@haaglandenmc.nl and I will answer all your questions and sent you more information.