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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Adverse Childhood Experiences Response Team in Manchester, NH, helps children grapple with trauma, violence, addicted parents

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Angela Delyani, community health worker; Mariah Cahill, crisis services advocate; and Sgt. Matthew Larochelle knock on the door of a family with children who witnessed a domestic violence incident just days before.

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An often-overlooked aspect of the opioid epidemic that has exploded across the U.S. in recent years is how often the abuse of heroin or prescription opiates is accompanied by domestic violence. This is tragic enough for the adults involved, but it’s a ticking time bomb for children who are exposed to these adversities, raising their risk for future drug use and multiple health and mental health conditions. Here’s how one community is trying to address the problem.

Police officers and emergency dispatchers are a pretty tough bunch but about three years ago, 911 operators in Manchester, NH, began noticing an uptick of an exceptionally distressing call—from children reporting the overdose of their parents.

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San Diego’s stop-and-go progress to becoming a trauma-informed community

At Teralta Park, Arturo Soriano (l) with his wife, Gabby, holding baby Joshua, and their kids Daniella (between them) and Adrian (kneeling), spend time with Kenneth (arms folded), Claudia Ruiz and her mother, Michelle Massett. Behind them, Coach, wearing red gloves, comes to the park to spar with the youth.

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It’s a warm spring afternoon and Arturo Soriano is in his old stomping grounds—at Teralta Park, a small urban park atop a sunken freeway in San Diego’s City Heights neighborhood. As a teenage gang member in the 1980s, Soriano roamed the park and the surrounding streets before spending the better part of two decades in prison. Now 40, he has returned with a different mission.

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