Subgroup considerations Very poor and vulnerable families living in humanitarian settings in low- and middle-income countries can be reached by parenting interventions and are likely to experience good outcomes in terms of improvement in parenting practices (4), Chapter 5. Indirect evidence, mainly from other low- and middle-income settings, suggests that by targeting families in humanitarian settings most in need, parenting interventions have the potential to narrow disparities between groups, in maltreatment and related risks (4), Chapter 2. During prolonged conflicts, displacement, or disasters, even the most caring parents face adversities that are highly likely to impact parent–child interactions. For instance, war-exposed parents have been found to show less warmth and more harshness towards their children. Moreover, parents who are unable to provide the necessary care and seek parenting support often have no or limited access to those services in humanitarian settings. There is also a high likelihood that children, parents and caregivers living in humanitarian contexts may be experiencing traumatic stress reactions, and parenting interventions should therefore be complemented with the provision of trauma-informed psychosocial care and mental health care services where indicated. While many immigrant and refugee parents and caregivers in low- and middle-income countries and high-income countries have observed that the content of parenting interventions does not conflict with their own cultural values and can aid them in learning about cultural parenting practices in their host countries, careful consideration must nonetheless be given to the sociocultural fit between parenting interventions and those they are intended to benefit.

Context and system considerations Accessibility of parenting interventions may be hampered by the humanitarian context. While parenting interventions may be easily accessible for families living in camp settings where parenting services are provided by humanitarian staff, it may be a challenge to reach families that are dispersed or living in an armed conflict zone. Additionally, formal health, social welfare and other service delivery systems are likely to be degraded or destroyed, necessitating the delivery of interventions through alternative mechanisms. To ensure that parenting interventions undertaken in these circumstances are integrated into the wider humanitarian effort, their selection, delivery, and monitoring should occur within the framework of established humanitarian coordination platforms. These include local coordination structures linked to the Child Protection Area of Responsibility of the Global Protection Cluster and Mental Health and Psychosocial Support (MHPSS) Technical Working Groups; Minimum Standards for Child Protection in Humanitarian Action, notably standards 10 and 16; and technical guidance provided in the Interagency Standing Committee Guidelines on Mental Health and Psychosocial Support in Emergency Settings, and the MHPSS Minimum Services Package.

Implementation considerations The evidence for effectiveness of parenting interventions in humanitarian settings is largely for interventions at a selective level of prevention delivered to parents and caregivers identified as being at elevated risk of maltreatment (4), Chapter 5. Indicated interventions are similar in content to those delivered on a universal and selective basis, but often have additional components. For example, indicated interventions may have 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, and parents who experienced individualized interventions appreciated the chance for a closer relationship with, and tailored help from, providers. Planning interventions for scale may not be feasible when parenting interventions are delivered rapidly to parents who have recently been affected by an emergency (5), Chapter 2.