The current research aims to evaluate the effectiveness and feasibility of the Strong Families Through Art Therapy (SFAT) programme, which was developed to improve the parent-child relationship in vulnerable families. The main questions it aims to answer are:

1. Is the programme effective in enhancing quality of life and family resilience among parents?
2. Is the programme effective in enhancing quality of life among children?
3. Is the programme feasible and acceptable for large scale implementation in Singapore?

Researchers will compare the status of family participants (caregivers and children) before and after they take the programme and compare family participants who take the programme with family participants who have not yet taken the programme to see if the programme is effective in benefiting the participants. Researchers will also invite family participants to discuss about the programme.

Family participants will

1. Take the 10-week SFAT programme
2. Complete assessment survey for 3 times
3. Attend a focus group discussion (optional)

To assess the programme feasibility, researchers will additional invite art therapist participants to evaluate the programme and invite community staff participants to discuss about the programme implementation.

Art therapist participants will complete programme and session evaluation reports.

Community staff participants will attend a focus group discussion.

The current research aims to evaluate the effectiveness and feasibility of the Strong Families Through Art Therapy (SFAT) programme, which was developed to improve the parent-child relationship in vulnerable families. Service users of the SFAT programme will receive a progressive support from workshops, dyad art therapy, and an innovative art-based self-care tool developed with a multidisciplinary team to meet the needs of enhancing family communication and strengthening emotional bonding. The current research utilizes a pragmatic mixed method research paradigm to evaluate the programme. For the quantitative component, a single-site, open label, Waitlist Randomized Control Trial (RCT) design, comprising two arms: (i) treatment group and (ii) waitlist control group, will be adopted to evaluate the efficacy of the Strong Families Through Art Therapy (SFAT) for improving quality of life and family resilience among parents and children. For the qualitative component, an embedded qualitative focus group evaluation study with participants who complete the SFAT programme, together with analysis of intervention session evaluation forms completed by art therapists who conduct the SFAT programme and focus group discussion completed by community staff who support to implement the programme, will be conducted to evaluate programme acceptability and feasibility. After signing the informed consent form, the recruited family (consisting of one parent and one to three children dyads) will be asked to complete a baseline assessment before randomization and the start of the SFAT programme [T1]. Family participants in the treatment group will then undergo an 10-week SFAT programme conducted by the Red Pencil (Singapore) team, complete an immediate post-intervention assessment [T2], with a final follow-up assessment at 20-weeks [T3]. Family participants in the waitlist control group will complete a pre-intervention assessment before start of the SFAT programme at 10-weeks [T2], then undergo the same 10-week SFAT programme conducted by the Red Pencil (Singapore) team and complete an immediate post-intervention assessment at 20-weeks [T3]. Moreover, selected family participants will be invited to take part in an acceptability focus group study after T3 assessments. Post-session evaluation forms will also be completed by art therapist participants after session completion and focus group discussion will be held for community staff participants to discuss on the programme implementation. Figure 1 details the study procedures.

Inclusion Criteria (family participant):

• the caregiver (including parents, grandparents, family members or foster parents who perform the main caretaking responsibilities of the children taking part in SFAT) of a young child who can communicate in English and provide informed consent
• the child is aged 7-14 years and can communicate in English
• the family have one or more of the following identified challenges: (1) caregiver stress such as finances, household management, work and childcare arrangements, (2) caregiver struggles to find time for self-care and quality time with children, (3) caregiver has minimal understanding of the psychological and emotional needs of their children, (4) children face difficulties with emotional regulation and anger management
• caregivers and children are from low-income families who receive financial assistance under the CHAS Blue card, ComCare financial assistance, and/or the MOE Financial Assistance Scheme

Inclusion criteria (art therapist participant) registered art therapist based in the Red Pencil (Singapore) who are in charge of delivering the SFAT programme

Inclusion criteria (community staff participant)

- community staff who provides assistance to the implementation of the SFAT programme

Exclusion Criteria:

• individuals who are suffering from depression or other major mental health conditions that would render their participation highly disruptive to others in a group setting, and/or cannot provide informed consent. Families will also be excluded if they are currently unstable (i.e. circumstances related to abuse/neglect), and/or have high risk of suicidal and self-harm behaviours. In the cases that individuals referred to the programme are not eligible, the partner organisations will assess their needs and refer them to programmes based on these needs.
• participant is unable to provide informed consent