Subgroup considerations Very poor and vulnerable families in low- and middleincome countries and high-income countries can be reached by parenting interventions and are likely to experience good outcomes in terms of improvement in parenting practices, as well as reduction in child behaviour problems. By targeting families, communities, and countries most in need, parenting interventions have good potential for narrowing disparities between groups in child maltreatment and related risks (4), Chapter 3. The GDG cautioned that within families where serious maltreatment and parent–child conflict is occurring, indicated parenting interventions coupled with child protection service interventions should always be considered to prevent further harms from occurring and mitigate the consequences of previous abuse and neglect.

Context and system considerations Parenting interventions informed by social learning theory are feasible to implement across the globe and can be deployed across contexts with modest cultural and contextual adaptations. As with other interventions, challenges in scale-up include political will, funding, training, supervision and support of workforce, workforce capacity, maintaining fidelity over time, and finding appropriate systems for governance and for ensuring sustainability. Workforce issues and costs are considerable if interventions are taken to scale in any system. Evidence from qualitative studies with staff and managers suggests that staff must be given adequate time and support to prepare and deliver interventions as part of their core duties, and technical support to ensure that intervention fidelity is maintained (5), Chapter 2.

Implementation considerations Parent and caregiver interventions are likely to be effective when universally available to all parents and caregivers; when selectively delivered to parents and caregivers at high risk of maltreating their children; and when delivered on an indicated basis to parents and caregivers where maltreatment is already occurring (4), Chapter 3. Moreover, effects on positive parenting and child behaviour outcomes are greater when interventions are delivered on an indicated basis to children showing high levels of behaviour problems. Indicated interventions are similar in parenting content to those delivered on a universal and selective basis, but often have additional components. For example, in maltreatment response interventions there may be trauma-care elements over and above routine parenting components, and they are likely to require a higher level of professional skill and training, compared to delivery on a universal or selective basis. Group delivery appears beneficial for sharing problems and solutions with other parents, and parents who experienced individualized interventions (such as home visits and phone calls) appreciated the chance for a closer relationship with and tailored help from providers (5), Chapter 2. There are some examples of interventions going to scale in high-income countries, and a smaller number of examples in low- and middleincome countries. Digital and hybrid interventions may help to enhance feasibility at scale (5), Chapter 2. The GDG noted that parenting interventions should be made available on a long-term, sustainable basis.