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Objectives To evaluate the effectiveness of the EN-REACH parent group intervention in improving school readiness and related outcomes for children aged 4–6 years, including those with functional difficulties, across Bangladesh, Nepal, and Tanzania.Methods We conducted a cluster randomized controlled trial (cRCT) involving 1,550 parent-child pairs across 160 geospatially defined clusters, randomized to either intervention or standard of care (SOC). The intervention comprised nine group sessions delivered over five months. Primary outcomes were school readiness (MELQO scores) in children without cognitive difficulty and functioning (PEDI-CAT) in children with functional difficulty. Secondary outcomes included IQ (WPPSI), quality of life (PEDS-QL), and caregiver mental health (HSCL-25). Analyses followed intention-to-treat principles using linear mixed-effects regression models.Results A total of 1,380 (89.0%) pairs completed the trial. While school readiness scores improved in both arms, the between-group effect was modest and not statistically significant overall (adjusted β = 1.36; 95% CI: -2.95, 5.66; p=0.54). Notably, children not attending pre-primary education showed larger gains (adjusted β = 8.94; 95% CI: -0.65, 18.52; p=0.07). No significant changes were observed in IQ or functional outcomes, although quality-of-life trends were positive for children with disabilities.Conclusions EN-REACH demonstrated feasibility and high parental engagement across diverse settings. Findings support the need for targeted interventions for vulnerable families (e.g. with children who are not in pre-school) and underscore the importance of integrating parent-focused programs with primary school systems to close programming gaps between health and education, particularly for children aged 4–6 and those with disabilities.