Send to

Choose Destination
Child Abuse Negl. 2014 Nov;38(11):1822-31. doi: 10.1016/j.chiabu.2014.07.016. Epub 2014 Sep 2.

Facilitators and barriers to the successful implementation of a protocol to detect child abuse based on parental characteristics.

Author information

Emergency Department, Medical Center Haaglanden, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
Leiden University-Campus The Hague Lange Houtstraat 11, 2511 CV The Hague, The Netherlands.
Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands.
Women's and Family Health, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Social Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.


To determine the critical facilitating and impeding factors underlying successful implementation of a method to detect child abuse based on parental rather than child characteristics known as the Hague Protocol. The original implementation region of the protocol (The Hague) was compared to a new implementation region (Friesland), using analysis of referrals, focus group interviews (n=6) at the Emergency departments (ED) and at the Reporting Centers for Child abuse and Neglect (RCCAN) as well as questionnaires (n=76) at the EDs. Implementation of the Hague Protocol substantially increased the number of referrals to the RCCAN in both regions. In Friesland, the new implementation region, the number of referrals increased from 2 out of 92,464 patients (three per 100,000) to 108 out of 167,037 patients (62 per 100,000). However in Friesland, child abuse was confirmed in a substantially lower percentage of cases relative to the initial implementation region (62% vs. 91%, respectively). Follow-up analyses suggest that this lower positive predictive value may be due to the lack of training for RCCAN professionals concerning the Hague Protocol. The focus group interviews and questionnaires point to time limitations as the main impediment for implementation, whereas an implementation coach has been mentioned as the most important facilitating factor for success. The Hague Protocol can be used to detect child abuse beyond the initial implementation region. However, training is essential in order to assure a consistent evaluation by the RCCAN.


Child maltreatment; Emergency department; Facilitating factor; Impeding factor; Implementation; Parental characteristic

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center