# Enhancing implementation and compliance of the Screening Instrument for Child Abuse and Neglect (SCAN) in emergency departments in the Netherlands

## TL;DR

This study evaluates how implementing the SCAN&STEPS tools in Dutch emergency departments improves child maltreatment recognition and compliance.

## Contribution

The study introduces a tailored implementation strategy for SCAN&STEPS to enhance child maltreatment screening in emergency departments.

## Key findings

- Compliance with SCAN increased from 57.5% to 70.5% after implementation.
- Usability analysis identified five facilitators and one barrier to effective tool use.
- University hospital EDs showed the highest improvement in compliance.

## Abstract

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.

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.

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.

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.