7 minute read
Motivation to change
•A totally new approach has been developed to assess youth at risk in Hong Kong.
• Prof Daniel Wong joined forces with HKFYG in a project that may prevent them getting into trouble.
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•Participants learned to recognize triggers for delinquency and other unsocial behavior and control their emotions. • 一套專為本港高風險青年而設的評估工具及輔導手 法在過去兩年正在發展。 • 黃富強教授跟香港青年協會合作，透過計劃防止高 風險青年犯罪。 • 參加計劃的高風險青年學習如何辨識自己犯罪的因 素，並嘗試透過改善其行為及控制情緒來降低犯罪 的機會。
Frontline social workers regularly make contact with young people who hang out late at night and risk getting into trouble. If they are on the margins of society, they often have nothing much to do but get mixed up with gangs and then get trapped in a web of violence, drugs and theft. They bend all too easily to peer pressure and lose sight of right and wrong.
What can be done to help them find a better way?
One approach is cognitive behaviour therapy (CBT). It is used with people who have various problems and teaches them to challenge their own negativity, control their emotions and develop coping strategies. A few years ago, the Federation’s workers consulted Prof Daniel Wong, an expert in the field of CBT, on how to refine their counselling approach and since then, young people at risk who are supported by HKFYG have been gaining the motivation to change.
“When the social workers at HKFYG told me about cases they work with and when I saw that many young delinquents in Hong Kong had emotional health issues, it all suddenly clicked,” Prof Wong recalls. “Seeing the consistent connection between delinquency and dysfunctional ways of thinking was the start of a new study which looked at the interaction of these factors in Hong Kong youth.”
No other such assessment tool exists in Chinese or any other language. This is a new approch.
“If youth at risk are willing to listen to advice, they can learn lessons that stop them acting purely on impulse,” Prof Wong continues. Instead of getting arrested and ending up in jail, they find out how to control their anger and frustration by recognizing the triggers that set off a chain reaction. They learn how to stop, think and remember the possible consequences of acting impulsively. These lessons are taught and reinforced through CBT.
Although the spotlight in the study was on the two interlinked factors, the researchers are very careful to point out that they are not necessarily connected. “I would never say that young delinquents are mentally ill.” To do so would be misleading and would lead to unintended labelling and stigmatization. Instead, the mental health status of delinquent or marginal youth is taken into consideration when looking for ways to help them. The emphasis is on the ways in which a tendency to delinquency interacts with a tendency to feel and think differently from most people.
The work done by Prof Wong’s team with HKFYG led to a series of projects and publications. The most recent project* concerns using CBT with a group of 300 marginal youth supported by the Federation. “There are five mental health risk factors connected with the negative psychological states that can lead to delinquency,” Prof Wong explains. Among the five factors, the most consistently significant is impulsivity. Anger and aggression, low self-esteem and loneliness are others.
In the study, an assessment tool in the form of a questionnaire in Chinese asked the participants about these risk factors. “When the data was analyzed by the team at the University of Hong Kong, we saw that we could identify, the young people most at risk of delinquency by using the assessment tool,” says Prof Wong. “As far as we know, no other such assessment This is a new approach. No tool exists in Chinese or any other language.” other assessment tool like this The next step was to help those young people build the exists in Chinese or any other motivation needed to control their own feelings, impulses, reactions and behaviour. With CBT’s guiding principles to language. the fore, the emphasis was on helping individuals learn to help themselves. Through a set of exercises, they developed skills for thinking and behaving. These coping skills helped them learn how to change, start to see themselves differently and set positive goals for the future. “With CBT, we can teach young people at risk to identify the triggers for their impulsive behaviour and control their reaction.” Learning how to curb one’s own impulsive behaviour involves recognizing and understanding the benefits. The key to the success of this approach lies in the active
What is CBT? involvement of clients but they must also believe that their
Cognitive behaviour therapy (CBT) is used to treat thinking and behaving has been distorted. Only then will people with mental health problems. Aaron Beck, often they have the willpower to change and the motivation considered to be the father of CBT, realized that the that makes changing worthwhile. For young delinquents, link between thoughts and feelings was very important the threat of prison and rejection by family could be and CBT is based on the interactions between how enough to provide motivation. For more disengaged we think with how we feel and how we behave. Beck marginal youth, the process could be more complex. invented the term “automatic thoughts” to describe the emotion-filled thoughts that can occur suddenly. He In all cases, success will also depend on the skills of found that identifying and shaping these thoughts was social workers or other experts. The long-term outcome the key to understanding and overcoming difficulties. of CBT as a therapy for young delinquents in Hong Kong is not yet fully established. It will take further research over a longer period to produce more solid
How CBT helps young offenders evidence that CBT with juvenile delinquents and
Neurobiology tells us that young people’s brains are still developing so CBT can be effective in shaping the other youth at risk has long-lasting benefits. For that, more funding is needed, Prof Wong reminds us. thinking patterns of youth predisposed to impulsive delinquent behaviour. CBT has also proved helpful for drug and alcohol abuse, mental illness, panic attacks, insomnia and clinical depression. It aims Potential partners for such research are invited to to reduce self-destructive behaviour by teaching contact Wilson Chan, the first supervisor of the how to evaluate and modify ways of thinking and Federation's Youth Crime Prevention Centre and now decision-making. It offers practical strategies that Deputy Executive Director of HKFYG. help people avoid impulsive actions, improve their self-image and adapt to their environment. Contact wilson.chan@hkfyg.org.hk
Mental health issues can be a catalyst for behaviour even if there is no causal relationship between them. Recognizing the link, analytical tools that enabled identification of youth at risk were developed by Hong Kong academics and HKFYG and the E.Positive education and counselling service was launched.
A research and counselling team headed by the University of Hong Kong’s Professor Daniel Wong studied a sample of 3,400 10-24-year-olds over a period of two years. [see interview opposite.] The study included screening and assessment, cognitive therapy and mindfulness training to support mental health. It looked at five areas: impulsiveness, aggressive tendencies, self-esteem, loneliness and negativity. The young participants answered 25 questions and a score indicating risk-level for developing delinquent behaviour was assigned to each of them.
With their answers, it was possible to identify those at high risk of developing delinquent or deviant behaviour and provide them with further services. 545 young people were eligible and spent another 4 to 8 weeks with the counselling team. 85 of them were identified as being in the top risk-level category and this group were given cognitive behaviour therapy and mindfulness cognitive behaviour therapy by social workers.
The therapy helped them to understand their emotions and how they reacted. Through a series of exercises and practice, they gradually learnt how to deal with their emotional problems. Instead of venting emotion as delinquent behaviour, hurting themselves or other people, the social workers showed them how to release their anger and stress in a positive way. For young participants who experienced either very low self-esteem or extreme loneliness, they offered help to develop positive social networks. After the therapy, the young participants were asked to answer the same 25 questions again and answers were compared to their previous responses. These showed that their thought patterns had changed as a result of counselling and a relationship between their mental health issues and deviant or delinquent behaviour was also revealed. Nevertheless, the team stressed that the relationship was not causal. On the other hand, the high-risk young people who took part had learned to understand themselves better and knew in consequence how to recognize triggers of undesirable behaviour and avoid straying into delinquency and deviancy.
A new chapter in the E.Positive project began in September 2020 serving at-risk children aged 10-18 with screening and counselling
Prof Daniel Wong Fu-keung is a clinical psychologist and mental health social work researcher at the University of Hong Kong. His major research interests include evidencebased practice in mental health and CBT. His pioneering work in these fields has involved adapting CBT for Chinese people including youth.
Partners The D. H. Chen Foundation Save the Children More details ycpc.hkfyg.org.hk Enquiries Kenneth Yeung 2701 8866
