title: Detecting child abuse based on parental characteristics: does the Hague Protocol cause parents to avoid the emergency department?
abstract: OBJECTIVE
  The Hague Protocol is used by professionals at the adult Emergency Departments (ED) in The Netherlands to detect child abuse based on three parental characteristics: (1) domestic violence, (2) substance abuse or (3) suicide attempt or self-harm. After detection, a referral is made to the Reporting Center for Child Abuse and Neglect (RCCAN). This study investigates whether implementing this Protocol will lead parents to avoid medical care.
  
  
  METHODS
  We compared the number of patients (for whom the Protocol applied) who attended the ED prior to implementation with those attending after implementation. We conducted telephone interviews (n = 14) with parents whose children were referred to the RCCAN to investigate their experience with the procedure.
  
  
  RESULTS
  We found no decline in the number of patients, included in the Protocol, visiting the ED during the 4 year implementation period (2008-2011). Most parents (n = 10 of the 14 interviewed) were positive and stated that they would, if necessary, re-attend the ED with the same complaints in the future.
  
  
  CONCLUSIONS
  ED nurses and doctors referring children based on parental characteristics do not have to fear losing these families as patients.
authors.affiliation: Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands. Electronic address: H.Diderich@mchaaglanden.nl.
authors.forename: Hester M
authors.initials: HM
authors.lastname: Diderich
authors.affiliation: Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands.
authors.forename: Minne
authors.initials: M
authors.lastname: Fekkes
authors.affiliation: Campus The Hague, Leiden University, Lange Houtstraat 11, 2511 CV The Hague, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Dechesne
authors.affiliation: Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors.forename: Simone E
authors.initials: SE
authors.lastname: Buitendijk
authors.affiliation: Social Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Oudesluys-Murphy
mesh_terms: D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D017579:Domestic Violence / Q000523:psychology; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D009426:Netherlands; D010290:Parents; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Avoiding medical care; Child abuse; Detecting child abuse; Parental characteristics