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Table 2 Themes, sub-themes (italicized), and selected supporting data identified through thematic analysis

From: Provider perspectives on the provision of safe, equitable, trauma-informed care for intimate partner violence survivors during the COVID-19 pandemic: a qualitative study

Theme or sub-theme

Supporting text from transcripts

I. Pandemic threat

Exacerbated external stressors

“I think it’s very similar [to an economic crisis] in that … folks that were basically on the cusp of survival now have fallen off that, … all of which we know increases stress within a relationship and then also increases vulnerability to intimate partner violence”

Restricted access to healthcare

“There’s no way to go to the doctor and speak with your PCP and tell them … ‘I’m in an abusive relatiionship’. No one is allowed to go to the hospital unless it’s a major issue”

Fewer interactions with mandatory reporters

“We are very worried about that, about people not connecting with services, and we do know that DCF has received many fewer reports of child maltreatment during the pandemic because a lot of the mandated reporters are not seeing the kids”

Fewer opportunities to leave abusive environment

“Our impression is that it’s worse, that people are not getting services and that they are trapped with their perpretrators in uncomfortable situations where people are stuck inside”

Fear of COVID-19 infection

“It felt like staff were concerned about their physical safety, so we’re able … provide services remotely”

“We saw a very dramatic reduction in our volume of patients willing to come into the hospital…they were afraid of the virus”

II. Community and system impacts

System-wide uncertainty and inconsistency

“We couldn’t keep up with who was supposed to do what in what court and how you applied…People just couldn’t navigate it…”

Strained systems and strapped resources

“[COVID is] just magnifying the issues that were already in place: housing insecurity, food insecurity, access to medical care, racism…”

Amplified inequities

“…racial inequality that has been exacerbated by COVID persists….My patients who live in certain communities I feel like have a harder time engaging in care”

Language barriers to accessing resources

“…if they didn’t speak English as a first language, if they were unfamiliar with how to apply for it, if they didn’t know to ask for it and we didn’t know to offer it, they were inherently less likely to be able to apply for, be accepted to, and have access to emergency rent relief funding”

Loss of community through isolation

“This is an isolating hard time for everyone but especially for somebody coming from a relationship where they’ve been isolated with… very little community support”

III. Individual impacts

Heightened consequences of limited technology access

“…there is this expectation that like, ‘Oh, this is Zoom. Everyone knows how to do it. Everyone has that access to Wi-Fi at home,’ and that’s just not the case”

Complications of childcare

“I’ve talked with a lot of survivors who get stuck in this pickle if they are displaced from their house, they’re trying to maintain their job while also taking care of their children while being remote…”

Compounding trauma

“Survivors are survivors of intimate partner violence, but they’re also survivors of intergenerational trauma, community trauma…state-sanctioned violence on our communities”

COVID as trauma

“When I think about survivors of domestic violence, and what they have already experienced when you add COVID and when you already add the trauma that they have already been living through, it just exacerbates depression, anxiety, and other mental health concerns as well”

Deterioration of mental health

“People have much less access to one-to-one private interactions with their therapists or their psychiatrists…They’re so isolated…Many of them are just sort of fraying around the edges generally”

Strain on providers

“We’re in COVID. Everyone is getting sick. Everyone is overworked and underpaid. Everyone is trying to get used to this new way of lifestyle that we weren’t used to before”

IV. Adaptations and innovations

Virtual interactions

“We have been using technology in a way that we didn't really use it before. We've been doing all our staff meetings using Zoom and we've all become very accustomed to speaking on Zoom”

Flexibility of virtual encounters and remote work

“I would love that option to remain. I think that there is some nice—it’s nice to have a little bit of flexibility, especially when you’re working with trauma survivors who may not get to court on time or may be facing all sorts of other barriers that makes it hard for them to get to the court on time”

Difficulty building relationships virutally

“Really with DV survivors, you really do depend on building up a trusting relationship with people. It’s hard to do that without in-person—it’s just harder without in-person contact”

Privacy concerns

“On the other hand, if they’re sitting at home and they don’t know if their partner is overhearing or even if their kids are overhearing or even a random—or whoever, their parents or their group home housemates, I think they don’t have the same opportunity for privacy that they get in the doctor’s office”

Loss of networking

It’s harder to network with somebody on Zoom. I remember I used to go to meetings or sit next to somebody and be like, ‘Oh, yeah. I actually have a client who speaks Russian and needs DV legal services. I’m so glad I sat down next to you,’ but that doesn’t happen”

Importance of hybrid care

“I think having the choice is gonna be really important and being ble to have clear criteria around which those choce are made, because …different patients have different needs”

Emphases on survival and emotional support

“Then after that, when people were home for a while, and it was just this monotony of unknown, we provided a lot of the emotional support, which we hadn’t anticipated to that degree”

A refocus on basic needs

“The other thing that we’re hearing is that they are also getting calls–when they do get calls, sometimes it’s for really basic stuff. It has nothing to do with the abuse.... No, it’s more, ‘We have no money. We both lost our jobs.’ They can’t even focus on the abuse right now. They’re just looking on to survive day-to-day”

Willingness to Modify Practices

“We made it a point never to do telehealth before this…That’s quite different now”

Creativity

“I think creativity goes a long way in this work”

Cooperation and coordination

“…we’ve created something called the Boston Partnership. It’s a collaborative with other domestic violence, sexual assault, and support entities within the city of Boston, so some of the hospitals, clinics, legal advocacy services are involved…it’s a way for all of us to connect and adapt to the changing system of COVID…”