TY - JOUR
T1 - Enhancing implementation and compliance of the Screening Instrument for Child Abuse and Neglect (SCAN) in emergency departments in the Netherlands
AU - van den Heuvel, Eline A L
AU - Vries, Erica de
AU - de Jong-van Kempen, Brita M
AU - Bakx, Roel
AU - Bos, Renske F
AU - van Empelen, Pepijn
AU - Hoedeman, Feline
AU - Kappen, Teus H
AU - Russel-Kampschoer, Ingrid M B
AU - Puiman, Patrycja
AU - Schouten, Maartje C M
AU - Teeuw, Rian
AU - Zwaans, Cecile J
AU - Nijhof, Sanne L
AU - van de Putte, Elise M
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
PY - 2026/2/24
Y1 - 2026/2/24
N2 - STUDY PURPOSE: This study examines the implementation of the Screening Instrument for Child Abuse and Neglect (SCAN) and the Structured Tool for Evaluating Positive Screened cases (STEPS) in nine emergency departments (EDs). The study aimed to assess whether implementation could enhance compliance with SCAN and to evaluate the usability of SCAN&STEPS within an implementation-focused design, in response to the decline in child maltreatment recognition observed in Dutch EDs over the past decade.METHODS: SCAN&STEPS was embedded in ED workflow and electronic health records (EHRs), supported by a selection of implementation strategies, including e-learning, policy manuals and an awareness campaign. Effectiveness was assessed through compliance with SCAN, comparing preimplementation and postimplementation screening rates, with a ≥10% increase defined as clinically relevant. Usability of SCAN&STEPS was examined using a mixed-method design combining the Measurement Instrument for Determinants of Innovations and semistructured interviews. Subgroup analyses were conducted by hospital type, EHR, profession and years of working experience.RESULTS: After implementation, the average compliance rate increased from 57.5% to 70.5%, with 3 of 8 sites achieving ≥10% improvement. Rates varied by site, with university hospital EDs having the highest improvement. Compliance was influenced by EHR configurations. Usability analysis identified five facilitators (perception of responsibility, social support, self-efficacy, knowledge and formal management ratification) and one barrier (unsettled organisation). Users considered SCAN&STEPS user-friendly, though perceived support differed between nurses and physicians due to role-specific factors.RELEVANCE: SCAN&STEPS can improve compliance in recognising child maltreatment concerns, but tailored strategies are needed for further implementation in Dutch hospitals. The standardised approach enhances uniform data collection, enabling comparative analysis and interdisciplinary collaboration, advancing early detection of child maltreatment. Broader international adoption should account for policy and system-level differences and requires further validation to ensure applicability beyond the Dutch context.
AB - STUDY PURPOSE: This study examines the implementation of the Screening Instrument for Child Abuse and Neglect (SCAN) and the Structured Tool for Evaluating Positive Screened cases (STEPS) in nine emergency departments (EDs). The study aimed to assess whether implementation could enhance compliance with SCAN and to evaluate the usability of SCAN&STEPS within an implementation-focused design, in response to the decline in child maltreatment recognition observed in Dutch EDs over the past decade.METHODS: SCAN&STEPS was embedded in ED workflow and electronic health records (EHRs), supported by a selection of implementation strategies, including e-learning, policy manuals and an awareness campaign. Effectiveness was assessed through compliance with SCAN, comparing preimplementation and postimplementation screening rates, with a ≥10% increase defined as clinically relevant. Usability of SCAN&STEPS was examined using a mixed-method design combining the Measurement Instrument for Determinants of Innovations and semistructured interviews. Subgroup analyses were conducted by hospital type, EHR, profession and years of working experience.RESULTS: After implementation, the average compliance rate increased from 57.5% to 70.5%, with 3 of 8 sites achieving ≥10% improvement. Rates varied by site, with university hospital EDs having the highest improvement. Compliance was influenced by EHR configurations. Usability analysis identified five facilitators (perception of responsibility, social support, self-efficacy, knowledge and formal management ratification) and one barrier (unsettled organisation). Users considered SCAN&STEPS user-friendly, though perceived support differed between nurses and physicians due to role-specific factors.RELEVANCE: SCAN&STEPS can improve compliance in recognising child maltreatment concerns, but tailored strategies are needed for further implementation in Dutch hospitals. The standardised approach enhances uniform data collection, enabling comparative analysis and interdisciplinary collaboration, advancing early detection of child maltreatment. Broader international adoption should account for policy and system-level differences and requires further validation to ensure applicability beyond the Dutch context.
KW - Child
KW - Child Abuse/diagnosis
KW - Electronic Health Records
KW - Emergency Service, Hospital
KW - Female
KW - Guideline Adherence/statistics & numerical data
KW - Humans
KW - Male
KW - Mass Screening/methods
KW - Netherlands
UR - https://www.scopus.com/pages/publications/105034371013
U2 - 10.1136/bmjpo-2025-003362
DO - 10.1136/bmjpo-2025-003362
M3 - Article
C2 - 41734914
SN - 2399-9772
VL - 10
JO - BMJ Paediatrics Open
JF - BMJ Paediatrics Open
IS - 1
ER -