After the COVID-19 pandemic, mental health problems in children ages 6–17 years in Hong Kong increased from 16.4% in pre-COVID 2017 to 24.4% in post-COVID 2022 (Wing-man, 2017; Wong et al., 2023). Unfortunately, the children of low-income Hong Kong parents tend to have higher rates of externalizing (e.g., attention deficit hyperactivity disorder and oppositional defiant disorder) and internalizing (e.g., anxiety and depression) behavior problems (Lam & Chung, 2017; Zhang, 2014). Li and colleagues’ (2021) survey of 21,526 Hong Kong children during COVID-19 showed that 32% had mental health problems; however, if children were from low-income families, this rate rose to 41%.
Tang’s (2006) study of 1,662 Chinese parents found that 57.5% used corporal punishment when responding to children’s behavior problems and that low-income parents were more likely to use harsh discipline. Unfortunately, harsh parental discipline can exacerbate children’s behavior problems (Ho, 2015; Ren & Zhang, 2018; Siu, 2008) and increase their mental health issues. In contrast, mothers’ nurturing and intimate relationships with their children contributed to mentally healthy children.
One effective parenting strategy to improve children’s behavior and mental health is child–parent relationship therapy (CPRT), which trains parents in child-centered play therapy principles and procedures to conduct play sessions with their own children (Landreth & Bratton, 2019; Parker et al., 2021). Meta-analyses have demonstrated the effectiveness of CPRT (Bratton et al., 2005; Lin & Bratton, 2015; Parker et al., 2021). CPRT studies with Chinese parents also have shown positive results (Chau & Baggerly, 2024; Chau & Landreth, 1997; Yuen et al., 2002).
In a 2025 preexperimental quantitative study published in the International Journal of Play Therapy, Iris Chau and Jennifer Baggerly investigated the feasibility of using online CPRT to improve the behavior of Chinese children of low-income parents in Hong Kong. A total of 107 parents of a 6-to-8-year-old child completed a Chinese translation of Achenbach and Rescorla’s (2001) Child Behavior Checklist (CBCL) before and after participating in CPRT groups for 7 weekly synchronous sessions led by a trained Hong Kong play therapist. Supervision and fidelity checks were provided throughout the process. Of the 107 children, 25 had pretest CBCL total scores in the borderline or clinical range. After CPRT, results of a Wilcoxon signed-rank test revealed statistically and practically significant decreases in those children’s posttest CBCL scores for total problems, internalizing or externalizing, anxiety or depression, and aggression.
Chau and Baggerly’s findings are consistent with previous research on CPRT such as Yuen et al.’s (2002) study with Chinese parents in Canada and Leung’s (2015) study with teachers in Hong Kong. Their results expand on Chau and Baggerly’s (2024) finding that low-income parents in Hong Kong using online CPRT improved acceptance of their children, respect for their children’s feelings, and their children’s autonomy. Overall, the results indicate that CPRT may be helpful in improving 6- and 7-year-old children’s behaviors. To the researchers’ knowledge, theirs is the first study demonstrating that children’s behavior improved after their parents participated in CPRT in an online format. Given the study’s positive results, Chau and Baggerly encourage other mental health providers in Hong Kong to obtain CPRT training so they can deliver this approach to additional low-income parents.
Chau and Baggerly recommend that future researchers who study the impact of CPRT on Hong Kong parents and children conduct a randomized control trial, seek teacher or direct observation of children’s behavior through the CBCL Teacher Report Form or Direct Observation Form, randomly select therapists’ videos for review, and have an independent Chinese play therapist trained in CPRT review the translated manual.