aftERcare.

Evaluation of a hospital-based guidance policy for children whose parents present at the emergency department because of domestic violence, substance abuse and/or a suicide attempt: Study protocol.



Background:

Child maltreatment is a major social problem with many adverse consequences. A substantial number of maltreated children is not identified by health care professionals. To improve identification of maltreated children in hospitals, a new hospital-based policy is developed. In this policy, all adults who present at the emergency department because of domestic violence, substance abuse and/or a suicide attempt are asked whether they have children in their care. If so, parents are coerced to visit the outpatient pediatric department together with all their children. During this visit, problems are evaluated and voluntary support can be arranged. The aim of this study is to assess: 1) psychosocial outcomes of the children and 2) supportive care pathways that are initiated as a result of this policy.



Methods:

We will conduct a prospective registry study including all children 0-17 years who are referred according to the Amsterdam policy during one year. Information about care pathways will be provided by different health care organizations. Furthermore, all children and parents that give informed consent are included in a multi-center, prospective cohort study, involving questionnaires on psychosocial complaints. Outcomes will be assessed at baseline and 1-year follow-up. Primary outcome measures are: psychosocial outcomes in children and the type of and compliance with supportive care pathways for children and parents.



Discussion:

This is the first study to evaluate this hospital-based guidance policy. The most important strength of this study is the use of multiple measures and informants, combined with follow-up. The most important limitation is the expected selection of patients that are willing to participate in the prospective cohort study. The registry part of the study will provide information about a non-selective group. Results of this study will be used to improve the current policies.

Child maltreatment is a major social problem with many adverse consequences. A substantial number of maltreated children is not identified by health care professionals. To improve identification of maltreated children in hospitals, a new hospital-based policy is developed. In this policy, all adults who present at the emergency department because of domestic violence, substance abuse and/or a suicide attempt are asked whether they have children in their care. If so, parents are coerced to visit the outpatient pediatric department together with all their children. During this visit, problems are evaluated and voluntary support can be arranged. We hypothesize that the children who are identified in the Amsterdam policy experience serious psychosocial problems and can benefit from supportive care, either for themselves or for their parents. Furthermore, we hypothesize that in the Amsterdam policy, the majority of children and parents are compliant with supportive care on a voluntary basis.

Baseline and 1 year follow-up.

Only usual care. Questionnaires will be administred at baseline and 1 year follow-up, to children >7 years, parents and health care providers.