Final analytical themes and their definitions
| Final analytical themes with subthemes | Definition | Stakeholder group, study | ||
| Children | Mothers | Professionals | ||
| 1. Precursors for acceptable identification and response | ||||
| 1.1. Satisfying and sustainable relationship | Patients know and trust professionals with whom they develop good long-term relationships. Trusting relationships enable patients to feel safe and comfortable to discuss sensitive issues. | 45 | 32 44–46 | 37 41 46 |
| 1.2. Desired professional attitudes and skills | When interacting with patients/clients, professionals demonstrate non-judgemental, non-threatening attitudes, show respect, actively listen, validate patient’s accounts, reassure confidentiality and provide practical help. | 35 45 | 32 35 42 44–46 | 37 41 42 |
| 1.3. Considering mother’s readiness | Professionals acknowledge individual mothers’ readiness to disclose IPV and engage with services, work towards increasing mothers’ readiness and match their approaches to the stage of mothers’ readiness. | 43 44 | 35 41 46 | |
| 1.4. Patient materials | Culturally sensitive materials on IPV and children’s exposure to IPV in different languages are displayed in healthcare settings. | 43 | 41 | |
| 1.5. Professional training | Professionals receive adequate training on communication with children, indicators of children’s exposure to IPV, especially psychological and non-direct physical IPV, professionals’ role in identifying and responding, documenting and reporting, interagency work. | 35 45 | 32 35 43–46 | 35–37 41 42 |
| 1.6. Professional resources | Professionals have clear guidance on local IPV resources, what constitutes children’s exposure to IPV, what is reportable and how to document children’s exposure to IPV in a way that keeps the child safe and ensures the safety and confidentiality of the mother. | 37 41 42 | ||
| 1.7. Professional supervision and support | Professionals have skilled supervision and ongoing support for coping with psychological consequences of working with children and mothers exposed to IPV and preventing vicarious trauma | 35 37 41 47 | ||
| 1.8. Addressing systems’ barriers | Professionals’ work of identifying and responding to children’s exposure to IPV fits into the organisational, local and national context of increased demands on healthcare and social services without commensurate resources. | 35 37 40 41 | ||
| 2. Acceptable identification | ||||
| 2.1. Space and time | It is ideal to give patients permission, space and time to discuss sensitive matters. | 45 | 45 | |
| 2.2. Vocabulary | It is preferable for HCPs to phrase questions about children’s exposure to IPV as a ‘safety-at-home’ matter. | 45 | 45 | |
| 2.2. Phased approach | When asking about children’s exposure to IPV, it is ideal for HCPs to initiate the enquiry, adapt it to the context of the consultation and use a phased approach—from presenting symptoms to general safety and well-being, then to safety at home. | 45 | 45 | 37 41 42 47 |
| 3. Acceptable initial response | ||||
| 3.1. Shifting focus | Professionals first focus their responses on the mother-child dyad and shift to the child if he/she is at risk of harm. Professionals need assistance with managing emotional burdens caused by the shift. | 35 37 41 | ||
| 3.2. Emotional support | When responding to disclosure, it is ideal to provide children and parents with encouragement and emotional support. | 46 | 37 39 47 | |
| 3.3. Education | It is acceptable to educate mothers about the impact of IPV on children, IPV dynamics, professionals’ roles and duties in responding. However, education should not jeopardise patient safety (eg, through sending materials home where the perpetrator can find them). | 43 | 35 37 41 42 46 | |
| 3.4. Signposting | It is acceptable for professionals to give children and mothers information about local IPV services. | 35 | 35 | 35 37 46 |
| 4. Conflicting perspectives on engagement with children and management of safety | ||||
| 4.1. Engaging directly with children | Stakeholders’ perspectives on the acceptability of talking directly to children exposed to IPV and seeing them alone are conflicting. Children are absent in the patient-professional communication. Mothers and children want direct engagement with children. Professionals do not see children as patients on their own and feel ill-equipped for communicating with children about IPV. | 34 35 45 | 45 | 35 37 40 |
| 4.2. Management of safety | Stakeholder preferences regarding risk assessment and safety planning are conflicting. Mothers and children are absent in the management of safety and want to be involved. Professionals are not satisfied with current risk assessment and safety planning approaches and want them to change. | 45 | 46 | 35 37 40 41 |
IPV, intimate partner violence; HCPs, healthcare professionals; SSPs, social care professionals.