Gambling problems amongst those in need of social services: a project to target assistance for highr

1
Gambling problems amongst those in need of social
services a project to target assistance for
high-risk clients

• Lynette Hutson (Salvation Army)
• Sean Sullivan (Abacus)
• George Willdridge (Oasis)

2
Salvation Army Social Services

• Providing practical responses to community need
  internationally
• Specialist and generic services
• Specialist services for example, The Addiction
  Supportive Accommodation Services which
  includes The Bridge, Oasis, homeless
  accommodation
• Generic social work by Community Family
  Services (C FS)
• C FS are located in most larger towns and
  cities 37 service centres

3
Salvation Army Community Family Services

• Community Family Services provided either from
  the Salvation Armys own resources or linked with
  other agencies
• Services provided include
• Food parcels
• Budgeting
• Advocacy
• Housing support
• Counselling
• Community meals
• Life skills programmes
• Parenting
• Nutrition

4
Gambling problems indicated amongst these clients

• Anecdotal reports of financial difficulties being
  attributed to gambling problems
• Problems experienced by both those that gambled
  and their families
• Evidence of higher levels of gambling problems
  amongst lower socio-economic groups found in
  research was evident in the C FS clients
• In November 2003 project was initiated to screen
  all clients attending 3 C FS programmes

5
The Project

• Three Auckland C FS centres at Manukau, Royal
  Oak and Waitakere collborated
• Information invited from clients included age,
  ethnicity and numbers of children in family
  settings
• Also invited to complete two brief screens to
  identify problems rising from their own gambling
  and problems arising from the gambling of others
• Within the first two weeks there was an alarming
  trend that confirmed the previous anecdotal
  evidence
• The majority of those affected by problem
  gambling were in families with dependent children
  

6
A new project to address need

• Evidence identified further support was necessary
  for those affected by gambling
• A new model of services was initiated in January
  2004
• Resources focused upon the largest C FS centre
  at Manukau
• An effective response was determined to include
  an opportunity for brief counselling, and an
  Oasis counsellor was based at the C FS centre

7
A comprehensive intervention

• The new service model to address the needs of
  clients affected by gambling includes
• Brief intervention
• Motivational interviewing
• Health promotion
• Social work
• Referral

8
An evolving response
9
Results to datePart 2

• 774 social service clients have been screened in
  Auckland and 184 clients in Christchurch
• Three quarters of Auckland clients and just over
  half of Christchurch clients were female
• Approximately two-thirds of clients had children
  (between one and ten children)

10
Wide range of ethnicities in Auckland

• In Auckland ethnicity of clients varied widely,
  with just under half identifying as Maori
• Majority of clients were from South Auckland and
  reflected the ethnicity of that community

11
Narrow range of ethnicities in Christchurch

• Almost ¾ of clients were European and almost ¼
  Maori, with only 5 other ethnicity
• Again reflects the Christchurch community
  ethnicity range

12
Screening

• Clients were invited to complete a brief
  questionnaire comprising two screens
• Early Intervention Gambling Health Test (EIGHT)
  identified gambling problems rising from the
  clients own gambling
• Concerned Others Gambling Screen (COGS)
  identified gambling problems from anothers
  gambling usually a family/whanau member
• Only a small percentage chose not to participate

13
EIGHT Screen

• 1. Sometimes Ive felt depressed or anxious after
  a session of gambling
• A.Yes, thats true B.No, I havent
• 2. Sometimes Ive felt guilty about the way I
  gamble
• A.Yes, thats so B.No, that isnt so
• 3. When I think about it, gambling has sometimes
  caused me problems
• A.Yes thats so B.No, that isnt so
• 4. Sometimes Ive found it better not to tell
  others, especially my family,
• about the amount of time or money I spend
  gambling
• A.Yes, thats true B.No, I havent
• 5. I often find that when I stop gambling Ive
  run out of money
• A.Yes, thats so B.No, that isnt so
• 6. Often I get the urge to return to gambling to
  win back losses from a past session A.Yes,
  thats so B.No, I havent
• 7. Yes, I have received criticism about my
  gambling in the past
• A.Yes, thats true B.No I havent
• 8. Yes, I have tried to win money to pay debts
  A.Yes, thats true B.No, I havent

14
Screened as problem gambling Auckland

• 13 of Auckland clients were identified as having
  gambling problems (13 of women, 14 of males)
  age range 18-67 years
• Three quarters of those with gambling problems
  were female (in proportion to the gender
  proportion of all clients)
• 69 of those with gambling problems had children
  at home
• Two-thirds also identified that they were
  affected by anothers gambling at some time

15
Screened as problem gambling Christchurch

• 21 of Christchurch clients were identified as
  having gambling problems (13 of women, 30 of
  males) age range 20-63 years
• Two-thirds of those with gambling problems were
  female (women comprised 55 of all clients)
• 59 of those with gambling problems had children
  at home
• Four-fifths also identified that they were
  affected by anothers gambling at some time

16
Ethnicity of Problem Gamblers Auckland
Christchurch
17
High prevalence of gambling problems

• Although prevalence varied between centres,
  smaller Christchurch numbers enable distortion
• Environment differs geographically with one
  constant being poverty
• When combined, ethnic groups have very similar
  prevalence of problem gambling
• Prevalence of problem gambling 14.6 for
  population vs 1.35 problem gamblers in National
  Prevalence Survey 1999

18
Affected by others problem gambling

• Far more people are affected by anothers
  gambling than by their own gambling
• Few seek help for these effects
• Estimate by Productivity Commission 1999 that
  seven others affected by each problem gambler
• About one in six attending specialist
  face-to-face counselling services, and around one
  in three new callers to the Gambling Helpline are
  these others
• No specialist services for these clients
• Assumption may be that these others are less in
  need of assistance, while they may under-estimate
  the effect on themselves

19
Concerned Others Gambling Screen (COGS)

• Do you think you have been affected by someone
  elses gambling? a. Dont know for sure
  b.Yes, in the past
• c.Yes, thats happening to me now d.No,
  never
• How would you describe the effect of that
  persons gambling on you now?
• a.Im uncertain b.I worry about it sometimes
  c.I am nervous about it d.It is affecting my
  health e.It is hard to talk with anyone
  about it
• f.I am concerned about my, or my familys,
  safety
• g.It doesnt affect me any more
• What would you like to happen?
• a.I would like some information b.I would like
  to talk about it in confidence with
  someone
• c.I would like some support or help d.Nothing
  at this stage

20
Affected by anothers gambling (combined)

• Those who responded dont know for sure, in
  the past or yes, now were noted as possible
  positives
• 34 of Auckland clients may be affected by
  anothers gambling, one in six themselves problem
  gambling
• Half of Christchurch gamblers may be affected,
  with one in three themselves problem gambling

21
Current affect of anothers gambling (combined)

• One in three overall of those affected by
  anothers gambling were unsure if ever
  affected, but less than one in six overall were
  unsure of current effects
• Although 56 stated affected in the past, only
  29 chose doesnt affect me anymore

22
What help affected clients wanted

• 42 wanted help
• 58 didnt want help at this stage
• Most wanted support or information, with few
  wanting to talk in confidence (counselling)

23
Results summary

• Even removing problem gamblers from the affected
  by others gambling, 27 of all clients were
  affected by anothers gambling
• 14.6 were problem gambling compared with 1.35
  of 1999 National Prevalence Survey
• Majority had children at home
• Little apparent ethnic or gender differences
  suggesting poverty the main effect
• Wide age range 18-67 years for problem gamblers
• Ready willingness to disclose a gambling problem
• An opportunity to offer targeted help for a
  population highly at-risk for gambling problems

24
A brief interventionPart 3

• The high prevalence of problem gambling harm
  indicated appropriate opportunity for clients to
  be offered help
• Case workers and Oasis discussed providing brief
  intervention on-site by a trained therapist in
  problem gambling
• Single sites trial of the process established in
  South Auckland and Christchurch
• Experiences of the process to date

25
The screening process
Client reports to reception The client receives
the gambling screen with other in-house forms
from the receptionist on reporting their primary
issues of concern. The gambling screens are
requested to be completed whist awaiting their
interview with the Salvation Army case-worker.
The client is advised that the completion of the
gambling screen is voluntary.
26
Allocated Salvation Army caseworker The client
is then allocated a Salvation Army case worker
who has undergone in-house training regarding the
sensitivity of intervening should a gambling
related problem be identified. The case worker
attends to the primary concerns of the client
during which time they view the gambling
screen. If there appears to be some gambling
concerns identified by the client, the case
worker offers the option of talking to the
in-house Oasis community worker who is trained in
gambling assessment to determine whether further
intervention is required. If the client agrees,
an immediate appointment is arranged or if not
convenient, at some later time more suitable for
the client.
27
Allocated Oasis Community worker The client will
be referred to the in-house Oasis community
worker (trained in gambling assessment) where an
informal discussion will be initiated to
determine the seriousness of the problem. If the
problem in the opinion of the community worker
and the client is considered to be requiring of
further intervention, the client is invited to
complete the SOGS or COGS screen. At this stage,
if the problem is minimal, a brief intervention
is administered. If the problem is assessed to be
serious, the client will be invited to take up
the option of therapy with an Oasis therapist. If
the client agrees then an appointment is arranged
with an Oasis therapist where ongoing counselling
is commenced.