TABLE 1

Recommendations for Clinicians in Their Patient Interactions and Recommendations To Make to Parents

Recommendations for clinicians
 Make violence potential part of every assessment.
 Inquire about family stress levels and how parents manage stress.
 Inquire about the coparenting relationship.
 Inquire about social supports available to and being used by the family.
 Inquire about substance use and any recent increases.
 Look for signs of stress, irritability, or depression in the parent.
 Look for harsh responses to child behaviors in parents.
 Look for signs of fearfulness or dysregulation in children.
 Look for indicators of controlling behaviors by one partner.
 Identify families who are more at risk for violence based on previous encounters and conduct check-ins if there are no scheduled appointments for them in the near-term to reduce the likelihood that otherwise high-risk families would be undetected.
Recommendations to make to parents
 Recognize that feelings of stress, anger, worry, and irritability are expected given the demands of care of young children, especially if coupled with job demands, income loss, or job uncertainty.
 Use consistent wake, bed, and mealtimes to provide structure for both children and parents.
 Consider structuring the day in specific segments, for example, reading, inside or outside playtime, naptime, exercise, screen time, etc.
 If 2 parents are home, consider a “tag team” approach to child care.
 Understand that increases in children’s challenging behaviors and limit testing are developmentally typical responses that likely reflect distress and disruptions from typical routines.
 Identify when feeling activated and use a coping strategy that helps (eg, deep breaths, considering the things that they are grateful for), and if those do not help, institute a household “quiet time” for rest.
 Develop a plan to call a friend or family member to avoid engaging in violent behaviors.
 Use reliable resources for parenting during the COVID-19 pandemic, such as www.healthychildren.org and https://www.nctsn.org/resources/parent-caregiver-guide-to-helping-families-cope-with-the-coronavirus-disease-2019.