Case Study

Pioneering anti-aggression interventions: Reducing bullying behaviour in a range of settings

1. Summary of the impact

In 2015, Hong Kong was found to have the highest rate of school bullying among 72 countries worldwide. In response to the alarming level of aggressive behaviour among Hong Kong schoolchildren, Dr. Fung and her team have developed innovative anti-aggression approaches and pioneering evidence-based interventions for reducing bullying and aggressive behaviour. Her research has since been applied across a range of other sectors and has impacted directly on policy and practice in government departments in social welfare, education, offender rehabilitation, and policing. Also, her findings have been widely implemented in various regions, including the US, Europe, Asia, and Africa.

2. Underpinning research

Previous interventions for reducing bullying, aggressive behaviour and peer victimisation used a simple one-factor model of bullies and victims with a single intervention for each, but the treatment effects were poor. In 2006, Fung pioneered the shift from the one-factor model to the two-factor model of aggression. She developed and validated a new assessment tool to distinguish two subtypes of aggressors and victims – reactive and proactive aggressors and pure and aggressive victims – and tailored a specific intervention for each subtype based on its specific features and characteristics [R1]. The concept of proactive aggression, which is commonly unprovoked, intentional, goal-oriented and motivated by the anticipation of reward, is influenced by social learning theory and represents the instrumental function of aggression [R2]. Reactive aggression, which refers to defensive and retaliatory behaviour in response to threat or provocation, is consistent with the frustration-anger theory of aggression [R2]. The effectiveness of each intervention has been well-proven and published in high-tier peer-review international journals.

Fung has adopted innovative approaches to develop evidence-based interventions for reducing proactive/reactive aggression and pure/aggressive victimisation based on the psychotherapeutic approach (cognitive-behavioural therapy), physio-moral approach (Chinese martial arts and ethics), neurobiological approach (Omega-3 supplementation), social informational-processing approach (storytelling), social learning approach (fathering) and constructivist approach (filmmaking). Scientific evidence of the positive outcomes from longitudinal studies has been published [R3]. Fung and her team have carried out interventions in 120 out of 1,013 primary and secondary schools in Hong Kong with 110,000 participants, over 64,000 of whom were schoolchildren. In these studies, the Reactive-Proactive Aggression Questionnaire (RPQ) was used to screen high-risk students using a strict scoring criterion of more than one standard deviation away from the mean. This method identified 9,600 at-risk proactive aggressors with psychopathic features and reactive aggressors characterised by the hostile attributional bias of cognitive distortion, who were then effectively treated using different intervention approaches [R4]. A further, 36,000 parents and 6,500 teachers have participated and received training through these studies. Hence, the studies represent the largest empirical test of the two-factor model of aggression worldwide. The outcomes of the scientific evidence-based intervention have been published in 25 Q1- and Q2-ranked multidisciplinary journal articles since 2007.

Many parents, educators and helping professionals have benefitted from her original findings on the underlying correlates of aggression and victimisation, including parenting styles, personality traits and biosocial and physiological factors, and the finding that the relationship between schizotypy and aggression in children is mediated by peer victimisation [R5]. Fung found alarming evidence that Hong Kong adolescents who displayed proactive aggression were even more narcissistic than young offenders in the US and Canada. Narcissism is a main feature of psychopathy and can lead to homicide. A significant positive relationship was found between a child’s narcissism and permissive/authoritarian parenting styles (‘monster parents’) in Hong Kong, which in turn increase the child’s risk of engaging in proactive aggression and homicidal behaviour as adults. This finding could help parents, educators and helping professionals to recognise that these parenting styles may have negative impacts on children [R6].

3. References to the research

[R1] Fung, A. L. C. (2017). Intervention for reactive/proactive aggressors and aggressive/pure victims of school bullying in Hong Kong: A review and new developments. Neuropsychiatry, 7, 956-960.

[R2] Fung, A. L. C., Gao, Y., & Raine, A. (2009). The utility of the child and adolescent psychopathy construct in Hong Kong, China. Journal of Clinical Child & Adolescent Psychology, 39 (1), 134-140.

[R3] Fung, A. L. C. (2012). Group treatment of reactive aggressors by social workers in a Hong Kong school setting: A two-year longitudinal study adopting quantitative and qualitative approaches. British Journal of Social Work, 42 (8), 1533-1555.

[R4] Fung, A. L. C. (2019). Adolescent reactive and proactive aggression, and bullying in Hong Kong: Prevalence, psychosocial correlates, and prevention. Journal of Adolescent Health, 64 (6), S65-S72.

[R5] Raine, A., Fung, A. L. C., & Lam, B. Y. H. (2011). Peer victimization partially mediates the schizotypy-aggression relationship in children and adolescents. Schizophrenia Bulletin, 37(5), 937-945.

[R6] Fung, A. L. C. (2018). Reducing reactive aggression in schoolchildren through child, parent, and conjoint parent‐child group interventions: An efficacy study of longitudinal outcomes. Family Process, 57 (3), 594-612.

Key grants awarded as a role of Principal Investigator (PI):

Group Storytelling Intervention Based on Social Information Processing (SIP) Model to Reduce Reactive and Proactive Aggression in Schoolchildren (2018-2020, HKD $717,360)
Omega-3 Supplementation to Reduce Externalizing Behaviour Problems in Risk-taking Adolescents: A Randomized, Placebo-controlled, Double-blind Trial (2015-2018, HKD $761,183)
Traditional Chinese Martial Arts Training in Reducing Aggression: An Evidence-based Evaluation on the Effectiveness of Traditional Chinese Martial Arts Training in Reducing Schoolchildren Aggression (2014-2018, HKD $410,225)

All above projects were funded by UGC General Research Fund (GRF)

Enhancement of Innovative Counselling Knowledge and Skills in Youth Aggression and Victimization Across Family and School Contexts for Practitioners (2013-2015, Principal Investigator, HKD $179,315) funded by Teaching Development Grant at City University of Hong Kong
C.A.R.E. Home Cares Children and Adolescents at Risk Education (2012-2014, Principal Investigator, HKD $199,860) funded by UGC Knowledge Transfer Earmarked Fund
Children and Adolescents at Risk Education (C.A.R.E.) (2006-2011, HKD $10,931,100) funded by the Quality Education Fund (QEF) of the Education Bureau H.K.S.A.R.

4. Details of the impact

Educational Packages, DVDs, Websites

Fung has developed a series of anti-bullying educational packages in traditional Chinese, simplified Chinese, and English, including 13 handbook volumes containing details of each specific intervention in hard and online soft copies, and 23 DVD volumes containing case demonstrations and skills training [S1]. She has been invited to provide training by various local government departments, schools and NGOs, and also by countries and regions such as Singapore, South Korea, China, Macau, India, the Republic of Trinidad and Tobago, Spain, Finland, Switzerland, Italy, Azerbaijan, the US, and the UK. Also, she received the “Hero Award, School-University Leader” at the Third Annual Anti-Bullying Summit in the US in 2013 for her effective interventions and extensive findings on bullying in Hong Kong [S2]. To date, a Google search for her interventions and works brings up 32,400 results on international websites or news [S3].

Impact on Frontline Practitioners

In 2011, the Education Bureau (EDB) of the HKSAR invited Fung to serve as the consultant on the implementation of its anti-bullying campaign for all 1,031 local primary and secondary schools in Hong Kong. Since then, Fung has conducted a series of training sessions for principals, teachers, school social workers, educational psychologists, and other helping professionals to adopt the well- developed assessments tools and respective interventions for reactive and proactive aggressors [S4]. To date, at least 7,000 participants have been served, and very positive comments were received. The training gives all participants the opportunity to apply new concepts, practical counselling skills, and strategies for handling school bullying cases that save considerable time and resources and reduce the stress of practitioners. In response to the Programme for International Students Assessment’s ranking of Hong Kong as the worst for school bullying among 72 countries and regions, the EDB recently uploaded all of Fung’s educational packages to the official EDB website, advocating its benefits and helping professionals to handle bullying cases [S4]. Positive feedback has been received with users reporting that implementing the innovative approaches for reducing aggressive behaviour among schoolchildren [S4].

In 2016, the Social Welfare Department (SWD) of the HKSAR invited Fung to be the speaker at the training programmes organised by the Staff Development and Training Section of the SWD [S5]. Since then, she has been involved in training approximately 660 staff members from the Family and Child Welfare Branch, Rehabilitation and Medical Social Services Branch, Youth and Corrections Branch, and Clinical Psychological Service Branch at the SWD, and various non-government organisations.

In 2012, the Hong Kong Police Force appointed Fung to provide training for all police inspectors and officers in the use of the validated assessment tool to differentiate among suspects with reactive and proactive aggression in assaults, family violence and homicide cases [S6]. To date, around 3,500 out of the 15,000 workforces have been trained, and the training course will continue until all colleagues have been trained. The police find the early identification of and intervention for reactive and proactive aggressors very useful in helping them to understand suspects’ specific cognitive and behavioural traits. The tool has unquestionably aided police officers in gathering evidence for the investigation of criminal cases and apprehension of suspects [S6].

Impact on Policy Implantation

The Director of the Social Welfare Department appointed Fung as one of the 17 members of the Legislative Council Panel on the Annual Welfare Services Child Fatality Review Panel for two years, from 1 June 2018 to 31 May 2020 [S7]. The objective of the panel is to change the current policy by facilitating inter-sectoral collaboration and multi-disciplinary cooperation for the prevention of avoidable child deaths. After completing the review, the panel will make suggestions as well as recommendations on policy changes to different government departments for preventing child suicide. A final report will be published publicly together with the comments, responses, and updates on the improved measure [S7].

In February 2018, the Commissioner of the Correctional Services Department (CSD) invited Fung to provide training for over 50 senior management colleagues, including the Commissioner, Deputy Commissioner, Assistant Commissioners, and all senior superintendents [S8]. They found it insightful that taking Omega-3 supplements could reduce adolescents’ aggressive, impulsive, and externalising behaviour as well as could decreasing recidivism.

Impact on Public

Fung has been interviewed by numerous newspapers, television, and radio programmes. Notably, Fung’s work was filmed by the Education Bureau and Radio Television Hong Kong. The educational videos were made accessible to the public online on the EDB website [S9]. Nine press releases have been conducted to draw for the public concerns [S10].

5. Sources to corroborate the impact

[S1] The Education Package and Project C. A. R. E. & Impact Case Website

[S2] “2013 Hero Award, School-University Leader”, Third Annual Anti-Bullying Summit, United States

[S3] Google Search Indication.

[S4] Proof from the Education Bureau (EDB) of the HKSAR and Website that EDB adopted Project CARE materials

[S5] Proof from the Social Welfare Department (SWD) of the HKSAR.

http://deptss01.cityuhk.acsitefactory.com/research-impact/pioneering-anti-aggression-interventions-evidence-based-effective-outcomes/invited

[S6] Proof from the Hong Kong Police Force.

http://deptss01.cityuhk.acsitefactory.com/research-impact/pioneering-anti-aggression-interventions-evidence-based-effective-outcomes-0

[S7] Proof from the Child Fatality Review Panel, Legislative Council Panel on Welfare Service.

[S8] Proof from the Correctional Services Department (CSD) of the HKSAR.

http://deptss01.cityuhk.acsitefactory.com/research-impact/pioneering-anti-aggression-interventions-evidence-based-effective-outcomes-2

[S9] Education Bureau’s Educational Television.

[S10] Nine Press Releases.

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