There is an increasingly widespread realisation that child abuse requires an integrated approach, and that cooperation between agencies is an essential prerequisite for success. This is partly reflected in several new initiatives to foster extensive collaboration, and in an integrated approach to problems arising from child abuse.
One example of a new partnership is the Covenant on an Intersectoral Approach to Child Abuse in the province of Gelderland.194 In the spring of 2011, thirty-two youth organisations for youth care services, for the Moderately Mentally Handicapped (LVG), the mental health care association (GGZ) and the province of Gelderland addiction treatment and care service signed the covenant, to provide greater safety for children. This involves incorporating the safety of children into care protocols. It also requires effective coordination and coopera- tion between the institutions involved. In addition, all mental health care institu- tions in Gelderland have signed up to the link with the Referral Index. A project plan is currently being prepared that will enable every point of the agreement to be implemented. This plan is scheduled for completion in the autumn of 2011. One type of integrated approach is exemplified by those institutions that have set up a Family Psychiatry Hotline, like Yulius (formerly the Rotterdam Medisch Pedagogisch Instituut – RMPI) in the Rotterdam region, the province of Drenthe mental health care association, and de Bascule in Amsterdam. Within the field of family psychiatry, this relates to families with multiple problems, in which child abuse is taking place. The procedures used involve problem-solving methods and Signs of Safety.
Another collaborative initiative is the multidisciplinary centre for the treatment of victims of child abuse in the province of Friesland.195 This initiative goes beyond simply improving cooperation and coordination of the available care. Within the multidisciplinary centre for the treatment of victims of child abuse, a multi-disciplinary team will be set up to tackle child abuse issues on the basis of a shared view of child abuse cases. This team will consist of representatives from various organisations with expertise in the field of child abuse and domestic violence. Also, research will be carried out into the effectiveness of the integrated approach. The goal of this initiative is to create a multidisciplinary child abuse centre, modelled along the lines of the Chadwick Center in San Diego, California. There they have everything under one roof. When a report of
suspected abuse is received, testing, assessment and treatment all take place there. The forensic examination, too, is carried out at the centre. The advantages of this approach are: short lines of communication, fast turnaround times, and rapid assistance for children and parents.
During 2011, many agencies gave their backing to the plan, including the province of Friesland Youth Care Agency, the Friesland mental health care association, the Leeuwarden Medical Centre and Fier Fryslân. The chief constable and the chief public prosecutor in the province of Friesland are closely involved in the further development and discussion of various plans. The target date for launch is 15 September 2011. The pivotal points are primarily research and diagnosis, together with the establishment of a plan of action/treatment programme that facilitates multidisciplinary collaboration within a clear framework around the child and its system. The principle is that the plan of action/treatment programme be carried out within mainstream organisations, agencies and partnerships.195
It is worth noting that this is not the first such initiative for a multidi- sciplinary centre for the treatment of victims of child abuse. In the year 2000, various parties in Twente agreed a business plan for a centre for the treatment of victims of child abuse in that province. The plan came to nothing and was forgotten, a victim of unfortunate political timing, policy discussions about the new Youth Care Act, and of the fine-tuning of procedures for tackling child abuse and domestic violence.196
Finally, the Committee points to the Academic Collaborative Centre on Child Abuse (AWK) of the KJTC Haarlem (centre for traumatized children and young people) and the VU University Amsterdam (together, these two institutions represent a partnership of all care and judicial institutions in the Zuid
Kennemerland area that deal with child abuse), plus the local authorities in Zuid Kennemerland and the university. The goal of this initiative is to promote collaboration between knowledge institutions, institutions involved in everyday practice, and government bodies in the Noord-Holland-Zuid region. It focuses specifically on knowledge development, knowledge transfer, and the
implementation of science-based and best practice methods in the areas of child abuse and of the treatment of children who have experienced abuse (together with their parents/guardians). Three sub-projects are being set up within the AWK:197
• The creation of a Child Abuse Team to achieve improved collaboration and to deliver care more rapidly, plus research into the effectiveness of these
measures. This team consists of experts from the collaborative care and judicial institutions. It is similar to the Fier Fryslân multidisciplinary centre for the treatment of victims of child abuse (KJTC and Fier Fryslân are pooling their resources for research on this topic)
• Efficacy studies on interventions for the victims of sexual abuse or domestic violence
• Knowledge transfer and implementation within the Landelijk
Opleidingscentrum Aanpak Kindermishandeling (National Training Centre for Tackling Child Abuse Issues, or LOAK). The treatment methods will be made transferable for professionals working in this area (both now and in the future). The Fier Fryslân MDC (multidisciplinary centre for the treatment of victims of child abuse) will also participate in LOAK.198,199
The Child Abuse MDC in Friesland and the Academic Collaborative Centre on Child Abuse in Noord-Holland-Zuid are the first to combine efficacy studies of interventions with research into the efficacy of the type of collaboration and integrated approach used in cases of child abuse.
4.7 Conclusions
When treating a victim of child abuse, it is necessary to involve the entire social system surrounding the child in question. The parents or guardians are
enormously important in terms of providing safety and support. Treatment should be integrated, as simultaneous interventions in various domains are needed.
As yet, very few interventions for treating the effects of child abuse are adequately supported by scientific evidence. TF-CBT and EMDR are currently the best studied and most effective treatment for children with PTSD symptoms resulting from child abuse. PCIT has been shown to be the best evidence- supported intervention for improving the parent-child relationship after physical abuse. The evidence for the other available interventions for treatment is disappointing. Further studies of good quality and sufficient scope are required. The infrastructure for assessment and treatment is highly complex in nature, and – sadly – does not always perform as it should. The main bottlenecks involve the need for specialised knowledge and experience, and the need for an integrated approach.
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Chapter