Towards uniform recognition of child abuse in the Netherlands: implementing the Screening instrument for Child Abuse and Neglect (SCAN)

STUDY PURPOSEThis study investigates compliance with the Screening Instrument for Child Abuse and Neglect (SCAN screening) and the usability of SCAN screening and its follow-up tool (SCAN-FU) for SCAN-positive outcomes, in 9 Emergency Departments (EDs). It aims to address the decline in child maltreatment recognition observed over the past decade in Dutch EDs. METHODSSCAN screening and SCAN-FU were integrated into the ED-workflow and electronic health records (EHRs), supported by an implementation strategy, e-learning, policy manuals, and an awareness campaign. Compliance was evaluated by comparing pre- and post-implementation screening rates, with clinically relevant improvement defined as a [≥]10% increase. Usability was assessed using the Measurement Instrument for Determinants of Innovations and semi-structured interviews. Subgroup analyses were conducted by hospital type, EHR, profession type, and years of working experience. RESULTSAfter implementation the average compliance rate increased from 57.5% to 70.5%, with 3 of 8 sites achieving a [≥]10% improvement. Compliance rates varied by site, with academic EDs benefiting most. Compliance was influenced by EHR configurations. Usability analysis identified five facilitators (perception of responsibility, social support, self-efficacy, knowledge, and formal ratification by management) and one barrier (unsettled organisation). Users considered SCAN screening and SCAN-FU user-friendly, though perceived support differed between nurses and physicians due to role-specific factors. RELEVANCESCAN screening can improve compliance in recognising child maltreatment, but tailored strategies are needed for further implementation. SCANs standardised approach enhances uniform data collection, enabling comparative analysis and interdisciplinary collaboration, advancing early detection of child maltreatment.