Project KING: To Strengthen Parent-child Relationship and Adaptation

Project KING: A Randomized Controlled Trial of Parallel Group Interventions to Strengthen Parent-child Relationship and Adaptation in Newly Arrived and Cross-boundary Families

This study aims at improving the emotional regulation strategies, enhancing the parent-child relationship and preventing family conflict among newly arrived and cross-boundary families in Hong Kong. We will provide one of the interventions to the participants: (a) the emotion regulation arm, which aimed at improving the emotion management skill for parent and child; or (b) the information provision arm, which aimed at providing information about Hong Kong, such as education, community resources, medical care, employment, housing, and job-seeking. We aim to recruit 200 parent-child pairs to participate in the study. The participants will be randomly assigned into an emotion regulation arm or an information provision arm. The ratio of the two arms is 3:2. Specifically, 120 and 80 parent-child pairs will be assigned to the emotion regulation arm and the information provision arm, respectively. The two intervention arms will provide four 2-hour weekly sessions to the participants. Before the intervention (T1), immediately after the intervention (T2), and one month after completing the intervention (T3), the participants will finish the assessments to evaluate the effectiveness of the intervention.

Study Overview

• Status: Completed
• Conditions: Emotions; Family Conflict; Adaptation
• Intervention / Treatment: Behavioral: Emotion regulation; Behavioral: Information provision

Detailed Description

1. Context of the study About 123 people migrate from Mainland China to Hong Kong to reunite with family every day. Migration from Mainland China to Hong Kong can be highly stressful. Newly arrived mothers and their children experience adaptation-related stressors, such as lifestyle changes, unhealthy housing conditions, and family financial restrictions, and they tend to experience high levels of psychological distress.

   Among the migrant population in Hong Kong, a particular group is known as cross-boundary children who engage in everyday-migration. Most cross-boundary children live in Shenzhen with their parents, who are not Hong Kong citizens. To attend school in Hong Kong, these children have to cross the border checkpoints connecting Hong Kong with mainland China every day. Families with cross-boundary children experience adaptation-related stressors, such as language difficulties, economic burden, and unclear citizenship status. These families have weaker social support networks in Shenzhen and seldom use community services in Hong Kong. Thus, cross-boundary families face multiple challenges and stressors due to their situation, which also puts them at a high risk of mental health problems.

2. Target of emotion regulation Newly arrived and cross-boundary families face similar problems, such as discrimination, acculturative stress, mental health problems (e.g., depression). All these problems can result in family conflict between parents and child. For example, early interviews have revealed that conflict over schoolwork and academic performance between children and parents could threaten overall family harmony. Frustrated with their lack of emotion regulation strategies, the children and parents often vented their anger and anxiety on each other, which sometimes led to physical abuse.

   Previous studies have demonstrated that the identification, comprehension, expression, regulation, and use of emotions are important predictors of individual adaptation and are positively correlated with mental health (e.g., happiness and social functioning). Parents' emotional regulation and mental health can influence their children's emotional socialization by means of diffusion through the family emotional climate. Thus, a community-based intervention focused on emotion regulation might help decrease these conflicts and enhance family harmony.

3. Cultural and contextual considerations in the intervention feature Family system theory states that families function as interdependent individual systems in which each member can impact others. It has been found that children's emotional problems are related to the stressful experiences and emotional symptoms of their parents. Therefore, we involved both parents and children concurrently in the intervention to maximize the intervention benefits. The parallel-group model is widely advocated in family-based intervention, but its implementation has a certain degree of difficulty. A parallel-group comprises two concurrent, but separate intervention groups (e.g., a child group together with a parent group); participants from the two groups engage in similar activities in different rooms with corresponding goals and contents. Compared with an intervention for individuals alone, involving family members in a family-based intervention can lead to greater benefits. Separating parents from children could prevent children from their parents' over-control and let each group deal with their own problems. The parallel-group model has been used to deal with different problems in parents and children. For example, a parent-child parallel-group helped improve the psychological functioning of depressed mothers, the mothers' caregivers, and children in Latino immigrant families. Therefore, the parent-child parallel group is considered an appropriate format for addressing the needs of cross-boundary families Two intervention studies evaluated the effectiveness of emotional regulation strategies on the parent-child relationship. The parental emotional management program increased emotional management strategy during the parent-child interaction, positive affect, subjective happiness, satisfaction with the parent-child relationship, and family harmony and decreased negative emotion among mothers of 6-8 years child in Hong Kong. However, this study did not include children in the intervention. A parent-child parallel emotional regulation group intervention improved the positive affect, resilience, and family harmony and reduced depressive symptoms among both parents and children. However, this study did not include the control group and had a small sample size.

   In sum, the present study aims to test the effectiveness of an emotion regulation parallel-group intervention on strengthening parent-child relationship and adaptation in newly arrived and cross-boundary families in Hong Kong.

4. Procedure We aim to recruit 200 parent-child pairs to participate in the study. The participants will be randomly assigned into one of the following arms: a) the relationship enhancement arm, which aims at improving emotional regulation skills among parent and child; b) the information provision arm, which aims at providing information about Hong Kong, such as education, community resources, medical care, employment, housing, and job-seeking. The ratio of the two arms is 3:2. Specifically, 120 and 80 parent-child pairs will be assigned to the relationship enhancement arm or the information provision arm, respectively. The two intervention arms will provide four 2-hour weekly sessions to the participants. The participants will finish the assessments at baseline (T1), immediately after the intervention (T2), and one month after completing the intervention (T3).

• Study Type: Interventional
• Enrollment (Actual): 217
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Hong Kong, China
    • City University of Hong Kong

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 60 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

For parents:

Inclusion Criteria:

1. came to Hong Kong for less than three years (newly arrived only);
2. provide care to at least one cross-boundary child (cross-boundary only);
3. have a child aged between 6-14
4. can participate in the group with the children at the same time;

Exclusion Criteria:

1. have a history of severe psychotic symptoms;
2. have previously participated in a similar intervention program.

For children:

Inclusion Criteria:

1. are 6-14 years of age;
2. have lived in mainland China for more than six months, and commuted daily between mainland China and Hong Kong (cross-boundary only);
3. have been studing in Hong Kong.

Exclusion Criteria:

1. have a history of severe psychotic symptoms;
2. have previously participated in a similar intervention program.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Emotion regulation arm; The emotion regulation arm aims at improving emotional regulation skills among parents and children.	Behavioral: Emotion regulation; Emotion regulation arm will provide the parents and children with four 2-hour weekly sessions. For the parents, the main topics include raising awareness of emotions (e.g., learning emotions theories), developing skills to manage emotions (e.g., attention deployment, cognitive changes, response modification), and facilitating parent-child relationship (e.g., gratitude). For children, the main topics are similar to that in parents' intervention. In this arm, we give more specific examples and simple explanations to the children.
Active Comparator: Information provision arm; The information provision arm aims at providing information about Hong Kong, such as education, community resources, medical care, employment, housing, and job-seeking among parents and children.	Behavioral: Information provision; Information provision arm will provide the parents and children with four 2-hour weekly sessions. For the parents, the main topics in these four sessions include learning the general information about Hong Kong such as education and medical care, housing condition, employment and training. For children, the main topics include learning the general information about Hong Kong, such as education, community facility, and learning method.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Emotional Management Strategy Questionnaire to Week 4 and to Week 8	Emotional management strategy questionnaire is a 10-item scale assessing parents' and children's emotional management strategy. Possible scores range from 1 (not at all) to 6 (everyday). Higher scores indicate more frequent use of emotional management strategy.	Baseline, week 4, and week 8
Change from Baseline in Positive and Negative Affect Schedule to Week 4 and to Week 8	Positive and negative affect schedule is a 10-item scale assessing parents' and children's positive and negative affect. Possible scores range from 1 (not at all) to 6 (everyday). Higher scores indicate more positive or negative affect.	Baseline, week 4, and week 8
Change from Baseline in Subjective Happiness Scale to Week 4 and to Week 8	Subjective happiness scale is a 4-item scale assessing parents' and children's subjective happiness. Possible scores range from 1 (strongly disagree) to 6 (strongly agree). Higher scores indicate more subjective happiness.	Baseline, week 4, and week 8
Change from Baseline in Child-Parent Relationship Scale (Pianta) to Week 4 and to Week 8	Child-parent relationship scale is a 4-item scale assessing the relationship between parents and children. Possible scores range from 1 (very dissatisfied) to 6 (very satisfied). Higher scores indicate better satisfaction with parents (or child).	Baseline, week 4, and week 8
Change from Baseline in Family Harmony Scale to Week 4 and to Week 8	Family harmony scale is a 8-item scale assessing the family harmony. Possible scores range from 1 (strongly disagree) to 6 (strongly agree). Higher scores indicate better family harmony.	Baseline, week 4, and week 8
Change from Baseline in Adaptation Difficulties to Week 4 and to Week 8	Adaptation difficulties is a 24-item scale assessing the adaptation difficulties after parents and children come to Hong Kong. Possible scores range from 1 (strongly disagree) to 6 (strongly agree). Higher scores indicate greater adaptation difficulties.	Baseline, week 4, and week 8
Change from Baseline in Self-developed Knowledge Questionnaire to Week 4 and to Week 8	Knowledge questionnaire is a 18-item scale assessing how much parents and children know about Hong Kong (e.g., educaltional systems, community sevices). Possible scores include1 (right), 2 (wrong), and 3(don't know). Higher scores indicate greater knowledge about Hong Kong.	Baseline, week 4, and week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Generalized Anxiety Disorder Questionnaire-7 to Week 4 and to Week 8	Generalized anxiety disorder questionnaire assesses the anxiety symptoms among parents and children. Higher scores indicate more anxiety symptoms.	Baseline, week 4, and week 8
Change from Baseline in The Patient Health Questionnaire-9 to Week 4 and to Week 8	Patient health questionnaire assesses the depressive symptoms among parents and children. Higher scores indicate more depressive symptoms.	Baseline, week 4, and week 8
Change from Baseline in Mental Health Inventory-5 to Week 4 and to Week 8	Mental health inventory assesses the mental health among parents and children. Higher scores indicate better mental health.	Baseline, week 4, and week 8
Change from Baseline in 10-item Connor-Davidson Resilience Scale to Week 4 and to Week 8	Connor-Davidson resilience scale assesses the individual resilience among parents and children. Higher scores indicate greater resilience.	Baseline, week 4, and week 8
Change from Baseline in Childhood Trauma Questionnaire to Week 4 and to Week 8	Childhood trauma questionnaire whether parents spank their children. Higher scores indicate less physical abuse on children.	Baseline, week 4, and week 8
Change from Baseline in Child-Parent Relationship Scale (Driscoll & Pianta) to Week 4 and to Week 8	Child-parent relationship scale has two subscales assessesing the closeness and conflict between parents and children, respectively. Higher scores indicate greater closeness or greater conflict between parents and children.	Baseline, week 4, and week 8
Change from Baseline in Self-Developed Service Use Questionnaire to Week 4 and to Week 8	Self-developed service use questionnaire is a 14-item scale assessing whether parents and children use the social service in Hong Kong. Higher scores indicate more use of social service.	Baseline, week 4, and week 8
Change from Baseline in Self-Developed Capacity Questionnaire to Week 4 and to Week 8	Self-developed capacity questionnaire is a 11-item scale assessing whether parents and children have the capacity to use the social service in Hong Kong. Higher scores indicate greater capacity to use the social service.	Baseline, week 4, and week 8

Collaborators and Investigators

• Sponsor: City University of Hong Kong
• Collaborators: International Social Services Hong Kong Branch
• Investigators: Principal Investigator: Nancy YU, Dr., City University of Hong Kong

Publications and helpful links

General Publications

• Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988 Jun;54(6):1063-70. doi: 10.1037//0022-3514.54.6.1063.
• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.
• Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.
• Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress. 2007 Dec;20(6):1019-28. doi: 10.1002/jts.20271.
• Morris AS, Silk JS, Steinberg L, Myers SS, Robinson LR. The Role of the Family Context in the Development of Emotion Regulation. Soc Dev. 2007 May 1;16(2):361-388. doi: 10.1111/j.1467-9507.2007.00389.x.
• Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991 Feb;29(2):169-76. doi: 10.1097/00005650-199102000-00008.
• Brasseur S, Gregoire J, Bourdu R, Mikolajczak M. The Profile of Emotional Competence (PEC): development and validation of a self-reported measure that fits dimensions of emotional competence theory. PLoS One. 2013 May 6;8(5):e62635. doi: 10.1371/journal.pone.0062635. Print 2013.
• Chan, A. K.-W., & Ngan, L. L.-S. (2018). Investigating the differential mobility experiences of Chinese cross-border students. Mobilities, 13(1), 142-156. https://doi.org/10.1080/17450101.2017.1300452
• Chan, K. L., Yeung, K. C., Chu, C. K., Tsang, K. Y., & Leung, Y. K. (2002). An evaluative study on the effectiveness of a parent-child parallel group model. Research on Social Work Practice, 12(4), 546-557. https://doi.org/10.1177/1049731502012004006
• Chan, P. W. K., & Kabir, A. H. (2014). Education across borders in Hong Kong. In H. Zhang, P. W. K. Chan, & C. Boyle (Eds.), Equality in education: Fairness and inclusion (pp. 155-166). Brill Sense. https://doi.org/10.1007/978-94-6209-692-9_12
• Dowell KA, Ogles BM. The effects of parent participation on child psychotherapy outcome: a meta-analytic review. J Clin Child Adolesc Psychol. 2010;39(2):151-62. doi: 10.1080/15374410903532585.
• Driscoll, K., & Pianta, R. C. (2011). Mothers' and Fathers' Perceptions of Conflict and Closeness in Parent-Child Relationships during Early Childhood. Journal of Early Childhood & Infant Psychology.
• Fabrizio CS, Lam TH, Hirschmann MR, Pang I, Yu NX, Wang X, Stewart SM. Parental emotional management benefits family relationships: A randomized controlled trial in Hong Kong, China. Behav Res Ther. 2015 Aug;71:115-24. doi: 10.1016/j.brat.2015.05.011. Epub 2015 Jun 4.
• Lyubomirsky, S., & Lepper, H. S. (1999). A measure of subjective happiness: Preliminary reliability and construct validation. Social Indicators Research, 46(2), 137-155.
• Pianta, R. C. (1992). Child-parent relationship scale. Unpublished measure, University of Virginia, 11, 39-41.
• Qu D, Chen C, Kouros CD, Yu NX. Congruence and discrepancy in migrant children's and mothers' perceived discrimination: Using response surface analysis to examine the effects on psychological distress. Appl Psychol Health Well Being. 2021 Aug;13(3):602-619. doi: 10.1111/aphw.12249. Epub 2021 Feb 7.
• Valdez CR, Padilla B, Moore SM, Magana S. Feasibility, acceptability, and preliminary outcomes of the Fortalezas Familiares intervention for latino families facing maternal depression. Fam Process. 2013 Sep;52(3):394-410. doi: 10.1111/famp.12033. Epub 2013 Jun 27.
• Ward, C., & Kennedy, A. (1999). The measurement of sociocultural adaptation. International journal of intercultural relations, 23(4), 659-677. https://doi.org/10.1016/S0147-1767(99)00014-0
• White, J. M., & Klein, D. M. (2002). Family theories. Sage.
• Xu, Y., Ann M. Farver, J., Zhang, Z., Zeng, Q., Yu, L., & Cai, B. (2005). Mainland Chinese parenting styles and parent-child interaction. International Journal of Behavioral Development, 29(6), 524-531. https://doi.org/10.1177/01650250500147121
• Yap MB, Allen NB, Sheeber L. Using an emotion regulation framework to understand the role of temperament and family processes in risk for adolescent depressive disorders. Clin Child Fam Psychol Rev. 2007 Jun;10(2):180-96. doi: 10.1007/s10567-006-0014-0.
• Yu, N. X., Liu, I. K., & Bu, H. (2020). Enhancing resilience in cross-boundary families: A parent-child parallel group intervention. Journal of Social Work. https://doi.org/10.1177/1468017320919103
• Yu X, Stewart SM, Liu IK, Lam TH. Resilience and depressive symptoms in mainland Chinese immigrants to Hong Kong. Soc Psychiatry Psychiatr Epidemiol. 2014 Feb;49(2):241-9. doi: 10.1007/s00127-013-0733-8. Epub 2013 Jul 2.
• Zhao, X., Zhang, Y., Longfei, L., & Zhou, Y. (2005). Evaluation on reliability and validity of Chinese version of childhood trauma questionnaire. Chinese Journal of Tissue Engineering Research, 9(16), 209-211.

Helpful Links

• Home Affairs Department and Immigration Department statistics on new arrivals from the Mainland (Fourth quarter of 2019).
• Home Affairs Department and Immigration Department statistics on new arrivals from the Mainland (First quarter of 2020).

Study record dates

Study Major Dates

• Study Start (Actual): April 10, 2021
• Primary Completion (Actual): January 28, 2022
• Study Completion (Actual): February 17, 2022

Study Registration Dates

• First Submitted: April 12, 2021
• First Submitted That Met QC Criteria: June 1, 2021
• First Posted (Actual): June 8, 2021

Study Record Updates

• Last Update Posted (Actual): July 21, 2022
• Last Update Submitted That Met QC Criteria: July 19, 2022
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Keywords: new immigrants; cross-boundary family; parallel group intervention
• Other Study ID Numbers: Project KING

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: We will not make individual participant data available to other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No