The Hague Protocol: Identifying kids at risk by interviewing parents in the ER

In the summer of 2007, a woman was brought by ambulance to the emergency department of the Medical Center Haaglanden, a hospital that serves an inner city area of The Hague. The woman was drunk and had a severe head injury. Her 8-year-old son was with her.

Hester Diderich, an emergency nurse, and other hospital staff members looked after the boy while they attended to his mother. “We were very nice to him,” Diderich remembers.

After treating the woman’s injuries, they were ready to release her and her son. What happened next led Diderich and her colleagues to realize they needed a better way to protect children and evaluate the risks they face. They created a new process, known as The Hague Protocol, and started a study to evaluate it. The protocol is now in use throughout the Netherlands and is being adopted by other European countries as well.

The idea is that hospital emergency departments are places where, by asking adults a few of the right questions, families in which children may be experiencing violence or abuse can be identified with surprising accuracy and ease.

I spoke to Diderich recently about the Hague protocol and its origins.

Rob Waters: Looking back now, this event in 2007 was really a pivotal moment. Tell us how it happened.

Hester Diderich

Hester Diderich: This mother had a head wound, and we took good care of her and the boy. After a few hours, she was set to leave. The boy climbed on top of us, and the security guard, and asked if he could please stay with us. His mother was screaming at him that he should come with her and we had no clue what to do. He was not our patient, and we couldn’t see any injuries on him, so we let him leave with the mother. We felt bad about that for a few days, then somebody said, “Shouldn’t you have called the Reporting Center for Child Abuse and Neglect (RCCAN) for advice?”

(Note: The RCCAN is a private organization, funded by the Dutch government. It dates back to the 1970s to offer services to families experiencing problems. Professionals can refer cases of suspected child neglect or abuse to the RCCAN, which will conduct interviews and an evaluation and help families get help. Serious cases that may warrant removing a child from the family home are referred to Child Protective Services.)

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