Evaluating the Impact of a Tutoring and Counseling Program for Low Income Secondary School Students With Mental Challenges in Hong Kong During COVID-19: A Randomized Control Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 170
- Locations
- 1
- Primary Endpoint
- Depression, anxiety, and stress
Study Overview
Brief Summary
The tutoring and counseling program for adolescents from low socioeconomic backgrounds facing mental health challenges during the COVID-19 pandemic will be assessed using a randomized controlled trial. The study will recruit secondary students with confirmed or suspected mental illnesses and trained university student tutors with backgrounds in education or psychology. The program provides both online and in-person support. Various measures, including surveys on depression, anxiety, stress, academic performance, executive function, emotional and behavioral issues, and tutor efficacy, will be used. Qualitative feedback will be gathered through open-ended questions. It is hoped that the findings will contribute valuable insights into effective support strategies for this vulnerable population.
Detailed Description
The COVID-19 pandemic significantly affected the academic performance and mental well-being of adolescents, especially those facing both low socioeconomic status (SES) and mental health challenges. Research shows that disparities in educational access experienced from low SES families were exacerbated four times by the shift to remote learning during the pandemic. This lack of access to essential technology and conducive learning environments, further impeding their academic progress and mental well-being. Additionally, the pandemic intensified the mental health struggles of this group of vulnerable adolescents, leading to increased feelings of isolation, uncertainty, and anxiety. Such profound impact of the pandemic underscores the critical need for comprehensive support in both academic performance and mental well-being. It is imperative to adopt a holistic approach that addresses both dimensions.
This study evaluates the effectiveness of an innovative tutoring and counseling program. This program involves university students who have undergone 39 hours of training, serving as tutors to provide online and face-to-face support to low SES adolescents with mental health challenges. To equip the university students for their roles, a web-based online training platform was developed by the first author. This platform includes 14 courses, each comprising a) teaching video clips by the course lecturer, b) relevant reading materials in Chinese and English, and c) 1-2 online quizzes. The content of these modules covers effective pedagogies, counseling and psychotherapy, and mental health knowledge, ensuring that the tutors are well-prepared to address the diverse needs of the adolescents they support. This paper begins by discussing the exacerbated academic disparities and mental health challenges encountered by this targeted group amid the COVID-19 pandemic. Subsequently, it investigates the unique challenges faced by this group of adolescents in Hong Kong (HK) and the need for a comprehensive intervention program tailored to their specific needs.
During the pandemic, the extended closure of schools and strict social distancing measures worsened the psychosocial well-being of adolescents. This impact extended to various social aspects, including compromised learning opportunities, diminished social relationships and connectedness, and heightened concerns about the pandemic, coupled with a sense of financial insecurity. In particular, the pandemic has disproportionately affected adolescents coming from low SES backgrounds. These challenges, arising from a combination of economic disparities and disruptions in educational paradigms, have significantly compromised both academic performance and overall well-being within this demographic cohort. Early in the pandemic, Kuhfeld et al. estimated that students from marginalized backgrounds would experience more pronounced academic setbacks, diverting them further from their educational objectives. Previous study substantiates this claim, revealing that disruptions induced by the pandemic in the education system led to substantial learning regression, particularly affecting students from low SES backgrounds.
In fact, adolescents from low SES backgrounds undeniably encounter significant impediments in accessing educational resources and opportunities, encompassing essential technology, stable internet connections, or conducive learning environments. A recent study by Agostinelli et al. scrutinized the impact of school closures on student learning, revealing that students from lower-income households experienced more profound learning losses as compared to their more affluent peers, signifying an exacerbation of educational disparities post-pandemic. A study in Australia revealed that during the pandemic, the achievement gap widens threefold in remote schooling compared to traditional classrooms. Even when remote learning is effective, students facing disadvantages are estimated to progress at approximately 50 percent compared to their affluent peers.
Moreover, the regression in learning has further intensified stress within this demographic group, amplifying their sense of inadequacy and frustration. A recent investigation in HK suggested that adolescents with lower SES face heightened vulnerability to psychosocial distress during the pandemic due to increased difficulties in learning and a sense of isolation. Dawson and Golijiani-Moghaddam proposed that students from low SES bear a disproportionate burden, with an elevated likelihood of experiencing challenges such as food insecurity and housing instability during the pandemic, further complicating their mental health issues. The intricate interplay of the pandemic's effects on academic disparities and mental well-being among adolescents with low SES underscores the necessity for targeted interventions and the establishment of comprehensive support frameworks.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 12 Years to 18 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •aged between 12 and 18 years
- •studying at secondary schools in HK
- •low socioeconomic status
- •confirmed or suspected mental illness
Exclusion Criteria
- •diagnosed with neurological needs
- •received tutoring and counselling
Arms & Interventions
Experimental Group
Students allocated to the experimental group begin receiving the tutoring and counseling program.
Intervention: Tutoring and Counselling (1) (Other)
Waitlist Control Group
Students assigned to the waitlist control group receive the program after the experimental group completes it.
Intervention: Tutoring and Counselling (2) (Other)
Outcomes
Primary Outcomes
Depression, anxiety, and stress
Time Frame: One week after the intervention
The Depression, Anxiety and Stress Scale (DASS-21) is a set of three self-report scales designed to measure the emotional states of depression, anxiety, and stress. Each of the three DASS-21 scales contains seven items, divided into subscales with similar content. Students are asked to rate on a 4-point Likert scale from 0 (never) to 3 (almost always).
Executive function
Time Frame: One week after the intervention
The Behavior Rating Inventory of Executive Function (BRIEF) is designed to assess executive function in the home environment. A short version of the BRIEF consists of nine items, with the following three scales obtained: Working memory, inhibition, and cognitive flexibility. Parents are asked to rate their child's behavior on a 3-point Likert scale ranging from 1 (never) to 3 (often).
Conduct problem and emotional symptoms
Time Frame: One week after the intervention
The emotional symptoms and conduct problems subscales of the Strengths and Difficulties Questionnaire (SDQ) are administered to parents to assess the child's behavior over the last six months. Each subscale consists of five items using a 3-point Likert scale: 0 (not true), 1 (somewhat true), and 2 (certainly true). Higher scores reflect more severe difficulties.
Teacher-reported academic achievement
Time Frame: One week after the intervention
Students' academic achievement in Chinese, English, and Mathematics is rated by teachers using a 5-point scale. The scale ranged from 1 (bottom 20% of the performance) to 5 (top 20% of performance).
Parental stress
Time Frame: One week after the intervention
The Parental Stress Scale (PSS) has 18 items using a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). A composite score is calculated by adding all items (after the 7 items were reversed). A higher PSS score indicates higher stress levels.
Tutor efficacy for inclusive practice
Time Frame: One week after the intervention
The Teacher Efficacy for Inclusive Practices scale (TEIP) is designed to measure perceived tutor efficacy in teaching in inclusive classrooms. The scale consists of 18 items scored on a 6-point Likert scale, from 1 (strongly disagree) to 6 (strongly agree). The 18 items are divided into three subscales: Efficacy to use inclusive instructions, efficacy in collaboration, and efficacy in managing behaviors.
Open-Ended Questions
Time Frame: One week after the intervention
Open-ended questions are also included in the questionnaire to gather written feedback from the students regarding their expectations and experiences of participating in the tutoring and counseling program. Examples of open-ended questions for students include: "What difficulties have you encountered in study and life?", "What are your expectations for taking part in this tutoring and counseling program?", and "In what ways do you believe this tutoring and counseling program has been most helpful to you?". Examples of open-ended questions for tutors include: "What have you learned as a well-being tutor?", and "What are your thoughts on implementing the tutoring and counseling program for students with psychological needs?".
Depression, anxiety, and stress
Time Frame: One week before the intervention
The Depression, Anxiety and Stress Scale (DASS-21) is a set of three self-report scales designed to measure the emotional states of depression, anxiety, and stress. Each of the three DASS-21 scales contains seven items, divided into subscales with similar content. Students are asked to rate on a 4-point Likert scale from 0 (never) to 3 (almost always).
Executive function
Time Frame: One week before the intervention
The Behavior Rating Inventory of Executive Function (BRIEF) is designed to assess executive function in the home environment. A short version of the BRIEF consists of nine items, with the following three scales obtained: Working memory, inhibition, and cognitive flexibility. Parents are asked to rate their child's behavior on a 3-point Likert scale ranging from 1 (never) to 3 (often).
Conduct problem and emotional symptoms
Time Frame: One week before the intervention
The emotional symptoms and conduct problems subscales of the Strengths and Difficulties Questionnaire (SDQ) are administered to parents to assess the child's behavior over the last six months. Each subscale consists of five items using a 3-point Likert scale: 0 (not true), 1 (somewhat true), and 2 (certainly true). Higher scores reflect more severe difficulties.
Teacher-reported academic achievement
Time Frame: One week before the intervention
Students' academic achievement in Chinese, English, and Mathematics is rated by teachers using a 5-point scale. The scale ranged from 1 (bottom 20% of the performance) to 5 (top 20% of performance).
Parental stress
Time Frame: One week before the intervention
The Parental Stress Scale (PSS) has 18 items using a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). A composite score is calculated by adding all items (after the 7 items were reversed). A higher PSS score indicates higher stress levels.
Tutor efficacy for inclusive practice
Time Frame: One week before the intervention
The Teacher Efficacy for Inclusive Practices scale (TEIP) is designed to measure perceived tutor efficacy in teaching in inclusive classrooms. The scale consists of 18 items scored on a 6-point Likert scale, from 1 (strongly disagree) to 6 (strongly agree). The 18 items are divided into three subscales: Efficacy to use inclusive instructions, efficacy in collaboration, and efficacy in managing behaviors.
Open-Ended Questions
Time Frame: One week before the intervention
Open-ended questions are also included in the questionnaire to gather written feedback from the students regarding their expectations and experiences of participating in the tutoring and counseling program. Examples of open-ended questions for students include: "What difficulties have you encountered in study and life?", "What are your expectations for taking part in this tutoring and counseling program?", and "In what ways do you believe this tutoring and counseling program has been most helpful to you?". Examples of open-ended questions for tutors include: "What have you learned as a well-being tutor?", and "What are your thoughts on implementing the tutoring and counseling program for students with psychological needs?".
Secondary Outcomes
No secondary outcomes reported