Hoytema van Konijnenburg Eva M M, Diderich Hester M, Teeuw Arianne H, Klein Velderman Mariska, Oudesluys-Murphy Anne Marie, van der Lee Johanna H
Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, 2501 CK Den-Haag, The Netherlands.
Child Abuse Negl. 2016 Mar;53:81-94. doi: 10.1016/j.chiabu.2015.11.012. Epub 2015 Dec 21.
To improve identification of child maltreatment, a new policy ('Hague protocol') was implemented in hospitals in The Netherlands, stating that adults attending the hospital emergency department after intimate partner violence, substance abuse or a suicide attempt should be asked whether they care for children. If so, these children are referred to the Reporting Center for Child Abuse and Neglect (RCCAN), for assessment and referrals to support services. An adapted, hospital-based version of this protocol ('Amsterdam protocol') was implemented in another region. Children are identified in the same manner, but, instead of a RCCAN referral, they are referred to the pediatric outpatient department for an assessment, including a physical examination, and referrals to services. We compared results of both protocols to assess how differences between the protocols affect the outcomes on implementation, detection of child maltreatment and referrals to services. Furthermore, we assessed social validity and results of a screening physical examination. We included 212 families from the Amsterdam protocol (cohort study with reports by pediatric staff and parents) and 565 families from the Hague protocol (study of RCCAN records and telephone interviews with parents). We found that the RCCAN identified more maltreatment than pediatric staff (98% versus at least 51%), but referrals to services were similar (82% versus 80% of the total sample) and parents were positive about both interventions. Physical examination revealed signs of maltreatment in 5%. We conclude that, despite the differences, both procedures can serve as suitable methods to identify and refer children at risk for maltreatment.
为了改进对儿童虐待行为的识别，荷兰的医院实施了一项新政策（“海牙议定书”），规定在医院急诊科就诊的成年人，若曾遭受亲密伴侣暴力、药物滥用或有自杀企图，应被询问是否照顾儿童。如果是，则这些儿童会被转介至虐待与忽视儿童举报中心（RCCAN），以便进行评估并转介至支持服务机构。该议定书的一个经过调整的、基于医院的版本（“阿姆斯特丹议定书”）在另一个地区实施。儿童的识别方式相同，但不是转介至RCCAN，而是被转介至儿科门诊进行评估，包括体格检查，并转介至相关服务机构。我们比较了这两种议定书的结果，以评估议定书之间的差异如何影响实施结果、儿童虐待行为的发现以及服务转介情况。此外，我们评估了筛查体格检查的社会效度和结果。我们纳入了来自阿姆斯特丹议定书的212个家庭（由儿科工作人员和家长报告的队列研究）以及来自海牙议定书的565个家庭（对RCCAN记录的研究以及对家长的电话访谈）。我们发现，RCCAN识别出的虐待行为比儿科工作人员更多（98%对至少51%），但服务转介情况相似（占总样本的82%对80%），并且家长对这两种干预措施都持积极态度。体格检查发现5%的儿童有虐待迹象。我们得出结论，尽管存在差异，但这两种程序都可作为识别和转介有受虐待风险儿童的合适方法。
