title: Support and monitoring of families after child abuse detection based on parental characteristics at the Emergency Department.
abstract: BACKGROUND
  The 'Hague Protocol' enables professionals at the adult Emergency Department (ED) to detect child abuse based on three parental characteristics: (i) suicide attempt or self-harm, (ii) domestic violence or (iii) substance abuse, and to refer them to the Reporting Centre for Child Abuse and Neglect (RCCAN). This study investigates what had happened to the families three months after this referral.
  
  
  METHODS
  ED referrals based on parental characteristics (N = 100) in which child abuse was confirmed after investigation by the RCCAN were analysed. Information was collected regarding type of child abuse, reason for reporting, duration of problems prior to the ED referral, previous involvement of support services or other agencies, re-occurrence of the problems and outcome of the RCCAN monitoring according to professionals and the families.
  
  
  RESULTS
  Of the 100 referred cases, 68 families were already known to the RCCAN, the police or family support services, prior to the ED referral. Of the 99 cases where information was available, existing support was continued or intensified in 31, a Child Protection Services (CPS) report had to be made in 24, new support was organized for 27 cases and in 17 cases support was not necessary, because the domestic problems were already resolved. Even though the RCCAN is mandated to monitor all referred families after three months, 31 cases which were referred internally were not followed up.
  
  
  CONCLUSIONS
  Before referral by the ED two thirds of these families were already known to organizations. Monitoring may help provide a better, more sustained service and prevent and resolve domestic problems. A national database could help to link data and to streamline care for victims and families. We recommend a Randomized Controlled Trial to test the effectiveness of this Protocol in combination with the outcomes of the provided family support.
authors.affiliation: Emergency Department, Medical Centre Haaglanden, The Hague, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Diderich
authors.forename: F D
authors.initials: FD
authors.lastname: Pannebakker
authors.forename: M
authors.initials: M
authors.lastname: Dechesne
authors.forename: S E
authors.initials: SE
authors.lastname: Buitendijk
authors.forename: A M
authors.initials: AM
authors.lastname: Oudesluys-Murphy
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000517:prevention & control; D002669:Child Welfare; D016241:Child of Impaired Parents / Q000523:psychology*; D002985:Clinical Protocols; D017579:Domestic Violence / Q000523:psychology; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005191:Family Characteristics; D005192:Family Health; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009426:Netherlands; D010290:Parents / Q000523:psychology*; D012017:Referral and Consultation / Q000458:organization & administration; D012307:Risk Factors; D012947:Social Work / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology
keywords: child abuse; emergency department; family support; monitoring; parental characteristics