Working in Problem Gambling Services: Orientation to Problem Gambling: Part 2

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Working in Problem Gambling ServicesOrientation
to Problem Gambling Part 2

• Abacus Counselling, Training and Supervision Ltd

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Gambling Harm

• Harm or distress of any kind arising from, or
  caused or exacerbated by, a persons gambling,
  and includes personal, social or economic harm
  suffered by the person, their spouse, family,
  whanau and wider community, or in their workplace
  or society at large (ref Practice Requirements
  Handbook, from Gambling Act, 2003)

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Service Specifications

• MoH introduced new service specifications Jan 1st
  2008, to deal with gambling-related harm
• Problem Gambling Intervention Service practice
  requirements handbook pathways to services,
  forms/screens, procedures
• Client intervention sessions take place within
  treatment episodes (brief episode, full
  intervention episode (which can contain
  facilitation sessions), and follow-up episode)

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Intervention Service Model

• Most services operate a multi-modal approach,
  acknowledging the varied impacts on gamblers and
  significant others
• Addresses clients gambling behaviour, but also
  the impacts of their gambling on others
• Brief interventions one-on-one intervention in a
  non-specialist setting, and typically one or two
  short MI sessions, involving people who do not
  acknowledge, recognise or accept the harms in
  their lives from their own or anothers gambling.
  They have not yet made a commitment to seek
  support for their gambling (formally or
  otherwise), or to make necessary changes in their
  lives

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Intervention Service Model

• Full intervention community-based assessment and
  psychosocial interventions for gambling-related
  problems to minimise harm
• Facilitation allows for the support of clients
  into other health and social services e g,
  financial, relationship, mental health, and AOD
  services
• Follow-up allows for 12 months support for
  clients who have completed full intervention with
  problem gambling intervention services

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Preferred pathways for intervention sessions
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Trans-theoretical Model of Change
Prochaska DiClemente Transtheoretical Model of
Behaviour Change
Contemplation
Preparation
Relapse
Action
Maintenance
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Intervention Services and the Model of Change

• In the Pre-contemplation stage, MI skills in a BI
  can assist in problem awareness
• Contemplation stage - MI skills in a BI can help
  shift clients towards a decision and Preparation
  for positive action
• Action stage can start in a BI and carry on
  through a full intervention and facilitation
• Follow-up and ongoing support assists clients in
  the Maintenance phase, and assists with relapse
  prevention can assist in re-entry in relapse

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Model of change and Interventions

• Most brief interventions will take place with
  people who are at a pre-contemplative or
  contemplative stage in their thinking about
  problems related to their gambling, and making
  changes to their gambling behaviour. Brief
  interventions accelerate movement to change
• Those who seek help directly for gambling related
  problems can also be contemplative (clients often
  attend as a result of pressure from elsewhere),
  be at an action stage, or may have already made
  changes and seek support to maintain changed
  behaviour

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Pathways of help-seeking

Facilitation to other resource
PG Provider Brief Intervention
Client motivated to access Full Intervention
Re-presenting client from Follow Up
Referral from BI trained non-PG specialist service
PG Provider
PG service
Re-presenting client self referring
Self referral motivated by advertising
Gambler motivated Family/Affected Other client
Family motivated by Gambler client
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Data Collection

• Information regarding problem gambling
  interventions is captured via the CLIC data
  system
• Paper based forms (completed and sent to PSAL for
  entry) or direct data entry
• Forms provided Client form Client multiple
  sessions form Batch submissions form.
• Computer data quality report feedback
• Confidentiality needs to be maintained for all
  client information and contacts verbal/written

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Brief interventions

• Their focus is upon improving the persons
  motivation to change their behaviour
• The aim of the brief intervention is to trigger a
  decision and a commitment to change, which can
  include referral to problem gambling intervention
  services
• They can happen in contact with individuals at
  any time or place in the community, and sometimes
  are prompted by education sessions, public health
  activities (incl ethnic-specific groups), or
  opportunistic health and social service
  interventions (by suitably trained staff)

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Brief Interventions

• Up to 3 sessions in a brief episode, usually 15
  30 minutes duration each individual session
• Usually in the community or in non-specialist
  settings, but could be in an unplanned brief
  visit or phone call to the specialist service
• Activities gambling screening and feedback
  (note screen can be done as written or as part
  of a conversation) education screening/risk
  management for other issues and appropriate
  referrals. The client may gain enough assistance
  at the end of a BI or may wish to begin full
  intervention

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Recording Brief Interventions

• If individuals in health promotion education or
  ethnic-specific groups (e g, Maori/Pacific) are
  screened and have a negative result, they are
  not counted as a Brief Intervention
• If no gambling problem is identified, but another
  issue causing distress/safety issue, then record
  as a Brief Intervention (client form), close, and
  open a Full intervention (for Facilitation
  activity). Report this in 6 monthly narrative
  report.
• Minimum data required is the primary mode of
  gambling, brief screen score, gender and setting.

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Brief Gambler Screen
Introduction/Opening Statement Most people in
New Zealand enjoy gambling, whether its Lotto,
track racing, the pokies or at the casino.
Sometimes however it can affect our health. To
help us to check your well-being, please answer
the questions below as truthfully as you are able
from your own experience. A no answer can also
mean that I dont gamble at all.

• (Record the number of positive responses to
  questions 1 to 4. If there are no positive
  responses, then record a zero 0)
• 1) Do you feel you have ever had a problem with
  gambling? (Only ask if not obvious)
• 2) If the answer to Q1 is yes, ask And do you
  feel you currently have a problem with gambling?
• 3) Have you ever felt the need to bet more and
  more money?
• 4) Have you ever had to lie to people about how
  much you gambled?
• 5) If you answered yes to any of the above, what
  would help? (response not recorded)
• ? I would like some information
• ? I would like to talk about it in confidence
  with someone
• ? I would like some support or help
• ? Nothing at this stage

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Brief Family/Affected Other Screen
Introduction/opening statement Sometimes someone
elses gambling can affect the health and
wellbeing of others who may be concerned. The
gambling behaviour is often hidden and
unexpected, while its effects can be confusing,
stressful and long-lasting. To help us identify
if this is affecting your well-being, could you
answer the questions below to the best of your
ability.

• 1. Awareness of the Effect of the Gamblers
  Gambling (record the number of the response)
• Do you think you have been affected by
  someone elses gambling?
• (0) No, never (you need not continue further)
• (1) I dont know for sure if their gambling
  affected me
• (2) Yes, in the past
• (3) Yes, thats happening to me now

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Brief Family/Affected Other Screen

• 2. Effect of gamblers gambling (record the total
  number of positive responses (ticks) between
  question 1 and 5. Record 0 or 6 if no other
  responses are ticked).
• How would you describe the effect of that
  persons gambling on you now? (tick one or more
  if they apply to you).
• (0) It doesnt affect me any more
• I worry about it sometimes
• It is affecting my health
• (1-5) It is hard to talk with anyone about
  it
• I am concerned about my or my
  familys safety
• Im still paying for it financially
• (6) It affects me but not in any of
  these ways
• 3. Support requested (response not recorded)
• What would you like to happen?
• I would like some information
• I would like to talk about it in
  confidence with someone
• I would like some support or help
• Nothing at this stage

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Brief Intervention Scenario

• Example Community Hui
• Form into small groups and read the scenario in
  the handout
• Discuss the questions following the scenario in
  the group and record your answers on the forms
  provided
• Feed back and discuss with the main group after
  checking your answers in handout no. 2

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Full Intervention

• Clinical intervention with people who are seeking
  help for gambling related harm
• Can be harm from their own or anothers gambling
  (family/whanau or affected other)
• Can include harm from their own gambling plus
  anothers gambling as well
• Can also be harm from past gambling, as well as
  present gambling behaviour
• Includes individual, couple, family and groups
• Confidentiality discussed and agreed

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Full Intervention Referrals

• From Helpline, after positive screening
• From brief interventions in community after
  screening, and assessment needed
• From client self/other service referral with
  gambling concerns expressed
• From follow-up process or client request for
  clinical re-engagement (further brief
  interventions not appropriate after Full)

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Full Intervention Service Specification

• A set of clinical intervention sessions (usually
  completed within 8 sessions and 3 months of the
  first session)
• At least one face-to-face session must be
  completed in a full intervention
• Sessions usually 60 minutes, but phone contacts
  may only be 15 minutes or more
• Groups usually 120 minutes, after assessment, and
  only in full intervention episode
• Groups over 2 hrs, record actual time (but only
  counted up to 4 hrs per day for contract)

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Comprehensive Assessment

• Done by qualified practitioner with skills and
  experience in problem gambling issues
• Includes MOH approved screens Gambler harm
  Screen, Control over gambling form, dollars
  lost, total household income, (gamblers)
  Family/Affected other Harm Screen for
  significant others, gamblers gambling frequency
  and coping with the gamblers gambling
• Comprehensive assessment also includes
• taking a gambling history and noting
  gambling impact
• on clients
• co-existing mental/other
  health/social, e g AOD,
• depression, anxiety, suicidal
  thoughts
• cultural issues
• Intervention plan/goals incl. budget, legal,
  housing, jobs.

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Gambler Harm Screen

• Gambler Harm (record the total score)
• The Gambler Harm Full Screen is scored by the
  clients response to each question (never 0,
  sometimes 1, most of the time 2, almost
  always 3)
• Thinking about the past 12 months, how often have
  you bet more than you could really afford to
  lose?
• Thinking about the past 12 months, how often have
  you needed to gamble with larger amounts of money
  to get the same feeling of excitement?
• Thinking about the past 12 months, how often have
  you gone back another day to try and win back the
  money you lost?
• Thinking about the past 12 months, how often have
  you borrowed money or sold anything to get money
  to gamble?

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Gambler Harm Screen (contd)

• Thinking about the past 12 months, how often have
  you felt that you might have a problem with
  gambling?
• Thinking about the past 12 months, how often have
  people criticised your betting or told you that
  you have a gambling problem, regardless of
  whether or not you thought it was true?
• Thinking about the past 12 months, how often have
  you felt guilty about the way you gamble or what
  happens to you when you gamble?
• Thinking about the past 12 months, how often have
  you felt that gambling has caused you any health
  problems, including stress or anxiety?
• Thinking about the past 12 months, how often have
  you felt your gambling has caused financial
  problems for you or your household?

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Family/Affected other Harm Screen
Introduction/opening statement Sometimes someone
elses gambling can affect the health and
wellbeing of others who may be concerned. The
gambling behaviour is often hidden and
unexpected, while its effects can be confusing,
stressful and long-lasting. To help us identify
if this is affecting your well-being, could you
answer the questions below to the best of your
ability.

• 1. Awareness of the Effect of the Gamblers
  Gambling (record the number of the response)
• Do you think you have been affected by
  someone elses gambling?
• (0) No, never (you need not continue further)
• (1) I dont know for sure if their gambling
  affected me
• (2) Yes, in the past
• (3) Yes, thats happening to me now

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Family/Affected other Harm Screen

• 2. Effect of gamblers gambling (record the total
  number of positive responses (ticks) between
  question 1 and 5. Record 0 or 6 if no other
  responses are ticked).
• How would you describe the effect of that
  persons gambling on you now? (tick one or more
  if they apply to you).
• (0) It doesnt affect me any more
• I worry about it sometimes
• It is affecting my health
• (1-5) It is hard to talk with anyone about
  it
• I am concerned about my or my
  familys safety
• Im still paying for it financially
• (6) It affects me but not in any of
  these ways
• 3. Support requested (response not recorded)
• What would you like to happen?
• I would like some information
• I would like to talk about it in
  confidence with someone
• I would like some support or help
• Nothing at this stage

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Full Intervention Scenario

• Example Affected family member who attends with
  gambler
• Form into small groups and read the scenario in
  the handout
• Discuss the questions following the scenario in
  the group and record your answers on forms
  provided
• Feed back and discuss with the main group after
  checking your answers in handout no. 2

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Facilitation

• Provides active support for clients who have
  experienced gambling related harms, to access
  relevant services to address problems identified
  during brief/comprehensive assessment and ongoing
  review (case management)
• May include supported access to cultural
  services, social/budget services, life-skills,
  self help, relationship counselling, other PG
  services and the Helpline includes education,
  relapse and problem prevention includes
  family/whanau
• May include facilitating clients identified in
  Brief Intervention settings who are in crisis and
  not suffering gambling harm, to access other
  services (any door right door)

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Facilitation Specification

• Requires minimum 15 minutes face-to-face or phone
  contact with client and another provider/agency
  in referral plan
• Facilitation services provide responsibility for
  client care until 12 months after exit
• Only counted in a Full Intervention episode

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Facilitation Scenario

• Example Gambling client
• Form into small groups and read the scenario in
  the handout
• Discuss the questions following the scenario in
  the group and record your answers on forms
  provided
• Feed back and discuss with the main group after
  checking your answers in handout no. 2

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Follow-Up

• Maintains client relationships to support
  positive outcomes and enables reconnection with
  services at earlier stage in event of relapse
• Updates progress/enhances motivation
• Reinforces positive change/maintains it
• Offers feedback on successful outcomes to inform
  future treatment process
• Can provide further advice/facilitation to other
  social/health services
• Follow-up is best practice for practitioners

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Follow-Up Service Specification

• Scheduled review session with clients by phone or
  face-to-face (not group)
• Follows Full Intervention episode (incl
  Facilitation sessions )
• Contact usually occurs at 1, 3, 6 and 12 months
  following discharge (provide flexible hours)
• Re-apply assessment screens for gamblers and
  family/whanau clients at intervals from 3 months
• Usually one session of 15-30 minutes
• If further in-depth support required, or if
  client contacts for further help open Full
  Intervention episode

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Follow-Up Instruments

• Gamblers re-screening (at 3, 6 and 12 months
  only) - Gambler Harm Screen (as for Full
  Intervention but since we last talked)
• Outcome measures (Gamblers) Control over
  gambling form, Dollars Lost, and Annual
  household income screen.
• For affected others Family/whanau (at 3, 6 and
  12 months) Family/Other Harm-awareness,
  Family/Other Harm-Effect, Gambling frequency and
  Coping with the gamblers gambling

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Follow-Up Scenario

• Example Re-opening a Full Intervention as a
  result of a scheduled Follow-up
• Form into small groups and read the scenario in
  the handout
• Discuss the questions following the scenario in
  the group and record your answers on forms
  provided
• Feed back and discuss with the main group after
  checking your answers in handout no. 2

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