Prevention and intervention of child abuse: An evaluation of services at the Dr. Arturo Grullon Children's Hospital in the Dominican Republic

Child abuse is a significant, but under addressed issue in many countries, including the Dominican Republic. A recent UNICEF report estimates that 83.4% of Dominican children ages 2-14 experience some form of violent discipline. This may be underestimated, as an unknown proportion of abuse goes unreported. This paper describes an assessment of child abuse service delivery at one Dominican hospital. We describe current abuse-related services, evaluate the hospital's strengths and weaknesses in addressing abuse, and conclude with recommended actions for improving child abuse services overall. In assessing current services, we utilized the National Association of Children's Hospitals and Related Institutions (NACHRI) model to identify the level of care currently feasible within the hospital. Additionally, we incorporated a logic model to examine organizational strengths and limitations with particular attention to inputs and activities in several areas including: Hospital Administration and Organization, Clinical Services, Employee Education, Policies and Protocols, Research, Fundraising and Community Collaboration. We also identified staff characteristics that can be leveraged to strengthen services and develop policy aimed at preventing and treating child abuse. Based on these analyses, we made concrete recommendations for improving child abuse services within the hospital. Qualitative data were collected by a series of observations, in-depth interviews with key informants at the hospital (9), and discussions with community stakeholders (3). The study generated interest in strengthening existing hospital services to confront and prevent child abuse, and can serve as a model for other hospitals to develop or expand child abuse prevention teams and services.