Background: Childhood emotional abuse is an invisible epidemic. Approximately 700,000 children are subjected to abuse and neglect annually in the United States and nearly 16,000 of these children are emotionally abused (Children’s Bureau 2021). Children affected by emotional abuse can experience significant negative outcomes later on, some examples being mental health disorders, substance use, and intimate partner violence. Pediatric primary care providers have the role of ensuring the safety, health, and wellness of their patients; yet, they face significant barriers in the successful detection and subsequent treatment of emotional abuse. This study aimed to identify barriers to addressing emotional abuse in the pediatric primary care setting. These findings will inform recommendations and interventions to screen for and treat emotional abuse in children.
Methods: Pediatric primary care providers in the Greater Portland Maine area were invited to participate in structured interviews. Three pediatric primary care providers completed structured interviews on the topic of emotional abuse in their professional setting. These interviews were recorded, transcribed, and thematically analyzed.
Results: Five themes emerged from the study regarding barriers that providers are faced with: lack of training, discrepancy in definitions, the nature of the primary care setting, physical and sexual abuse taking precedence, and lack of comfort levels. Among these, four sub-themes were developed: difficult to detect, limited amount of time, desire to protect parents and avoid confrontation, and negative connotation with calling CPS.
Conclusions: These findings provide a deeper understanding of barriers for successfully detecting emotional abuse in pediatric primary care, while also offering insight into the range of interventions needed to close the gaps.
Keywords: child maltreatment, childhood emotional abuse, pediatric primary care, screening