Subgroup considerations Low-income or vulnerable families in low- and middle-income countries can be reached by parenting interventions and are likely to obtain good outcomes in terms of reduction in harsh parenting and 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 2. Parents and caregivers in low- and middle-income countries may be experiencing additional strains related to household poverty, unemployment, and challenges in ensuring that they and their children have access to adequate health care and education. Special attention must therefore be given to ensuring that, where needed, parenting interventions include provisions that will facilitate parents’ participation (e.g. meals, food coupons, payment of transport costs; accessible location and timing) to alleviate household strains and assist with ensuring access to essential services (5), Chapter 2. The GDG cautioned that in families where serious maltreatment and parent–child conflict is occurring, specialized 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 As with other interventions, challenges to 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 sustaining interventions. Although these challenges may apply in every country, they are particularly marked in low- and middle-income countries. 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 effective when universally available to all parents and caregivers and when selectively delivered to parents and caregivers at high risk of maltreating their children (4), Chapter 2. There were too few child maltreatment interventions delivered on an indicated basis in lowand middle-income countries to analyse their effects. Effects on positive parenting and child behaviour problem outcomes, however, are likely greater when interventions are delivered on an indicated basis to children showing high levels of problem behaviour. Indicated interventions are similar in content to those delivered on a universal and selective basis, but often have additional components. For example, interventions in response to child maltreatment may include parent mental health and anger management elements over and above routine parenting components, and these interventions 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; 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.