Providing a Culturally Relevant and Effective Therapeutic Gambling Help Services For Migrants And Re

1
Providing a Culturally Relevant and Effective
Therapeutic Gambling Help Services For Migrants
And Refugees

• Enaam Oudih
• Manager
• PEACE Multicultural Services
• (Personal Education And Community Empowerment)

2

• I acknowledge this Land as the Traditional Lands
  of the Kaurna People and that I as a new comer to
  Australia respect and support their Spiritual,
  Physical, Economical, Mental and Emotional
  relationship with their Country
• PEACE Multicultural gambling Help Service based
  at Relationships Australia and funded by the
  Gambling Rehabilitation Fund through the Office
  Of Problem Gambling

3
Overview

• Why should we be concerned about the culturally
  and linguistically diverse (CALD) background
  people??
• What is the PEACE Service Development Project?
  and what did we learn from it?
• PEACE multicultural gambling Help Model
• This presentation is not about you and us, it is
  about CALD people and their experiences

4
Understanding the culture of others is a moral
and ethical obligation

• Five of six people in the world are of
  non-European/Caucasian ancestry
• There are estimated 40,000,000 refugees
• 90 of the birth rate increases are in developing
  countries.
• Ethnic populations in Australia are increasing
  through birth rates and migration
• There are more than 5000 identifiable
  ethno-cultural groups in the world
• Over 200 different cultural groups live in
  Australia.
• 45 of the Australian population were born
  overseas or at least have one parent born
  overseas
• Legal and illegal migration is emerging as a
  powerful source of change and social upheaval
• The shape of our society is greatly influenced by
  economic and political trends and cultural
  factors

5
Gambling Affects Some Of The Most Vulnerable
Communities including CALD population

• Levels of problem gambling is perceived to be
  disproportionately higher than the general
  population
• Ethnic minorities are seen to be characterised by
  multiple risk factors, such as isolation, trauma
  of migration and pressures on family
  relationships, grief and loss, unrealistic
  expectation about making money, language
  barriers.....etc
• Impact is exacerbated by the above factors,
  disconnection from mainstream cultural mores and
  shame

6
Is the Gambling Help and other Community
Services System working well for CALD people????
7
(No Transcript)
8
Is it working well???????

• Access to gambling help services is very low
• The Australian Welfare System is built for a
  culture that relies on self-management and
  responsibility
• There is no evidence that Gambling Help Services
  are effectively meeting the needs of CALD people
  in the same way that they do for English speaking
  Australians

9
Other anecdotes..

• Mainstream services are rarely understood and
  are provided in a way that reflects western
  values, individualistic, clear and formal
  processes, very private and behind close doors at
  the service venue with structured time
• Help-seeking behaviors of migrants and refugees
  and their expectation of care is different from
  mainstream populations (Migrants do not
  necessarily understand the roles of the diverse
  allied health professionals, or the different
  levels of care and how to access them)
• Gambling is seen in isolation from general
  settlement and specific cultural issues. Equally
  so, settlement workers do not understand the
  complexities of gambling

10
The PEACE Service Development Project

• Stage one
• Extensive literature review
• Examining appropriate multicultural counselling
  and therapeutic theories and methodologies
• Interviewing SA gambling Help Services
• Employment of a senior multicultural Counsellor
• Stage Two
• A small Qualitative study of 13 CALD people
  affected by problem gabling
• Share our learning and develop training packages
  for mainstream workers

11
The Projects Aim

• To improve the way we engage therapeutically with
  CALD people affected by problem gambling

12
The literature review

• Much of the literature reviewed was similar in
  its emphases and conclusions. Mostly emphasized
  the need for culturally appropriate treatments
  and services. Many indicated that community
  education programs should be widely introduced
• Very little is written about the cultural
  applicability of counseling therapies
  particularly in relation to problem gambling.
  Much of the text books focused not so much on any
  specific theory of counseling framework, but on
  the counselors themselves.
• However,

13
The literature reviewed did not discuss

• How CALD people with gambling problems can be
  identified and reached?
• How should a culturally appropriate gambling help
  service look like?
• Should culturally appropriate service be
  developed within existing mainstream agency or
  within CALD organization? or in partnership
  between the two?
• Should therapy always be provided through formal
  counseling methodologies? In other words, how
  therapeutic support could perhaps be provided
  through non-counseling methodologies and still be
  recognised as legitimate?

14
Interviews with SA Gambling Help Services

• 14 managers and clinicians from 9 different
  agencies (72) were interviewed (11 agencies were
  approached)
• Similar therapeutic approaches used by all
  service providers with one agency focused mainly
  on CBT. Most mainstream workers focus their work
  mainly on the individual, but require
  opportunities and resources to create the
  necessary space for broader family and community
  involvement in therapeutic processes.
  Ethno-specific workers have stronger emphasis on
  CALD community aspects.

15
Interviews with SA Gambling Help
Services.(Continue)

• Mainstream service providers stated that they do
  not approach people of CALD background
  differently !!! But acknowledged that outreach
  programs and community education need to be
  developed with CALD communities
• PEACEs role is crucial in the community
  Education field but unsure of its role within the
  therapeutic services

16
The Qualitative Study

• An advisory Committee was established in
  collaboration with University of SA and RASA
  staff (complementary skills and expertise)
• Ethics approval was gained from RASAs ethics
  Committee while University of SA offered guidance
  and approval of research processes through 2 of
  their academics.
• Researchers were of CALD background and have
  extensive experience of working with CALD people
  and considerable knowledge of counseling theories
  and practices.
• We used action research approach using semi
  structured interviews with open ended questions.
  However, researchers were free to follow lines of
  enquiry introduced by the participants

17
The Qualitative StudyContinue

• Main focus questions were
• What are the practices that would improve access
  of CALD people affected by problem gambling to
  culturally appropriate therapeutic services?
• What are the participants views about how people
  affected by gambling can be best supported and
  helped?

18
The Sample

• 13 people (8 F 5 M)
• Age between 27 to 65 years old
• 1 person had no English skills at all
• 2 people did not ask for an interpreter but
  researcher identified the need for one
• All participants were born overseas except for
  one , Southern European, European, South
  American, Middle Eastern, central Asian
• 12 were gamblers but not all admitted to having a
  big problem and 1 affected by someone elses
  gambling
• We had potentially 5 more people who were
  interested but due to time constraint we did not
  continue

19
Recruitments

• We advertised through some ethnic media, ethnic
  organisation, mainstream gambling help services
  and through our (RASA) multicultural workforce
  mainly PEACE community Educators
• The 13 participants were recruited through
  Community Educators and other connections with
  RASA through our education programs. Also through
  family members who were keen to help others in
  their family and through the research
  participants themselves

20
Lesson learnt from processes

• Our ethical values were challenged and had the
  potential to be a significant barrier
• CALD people need time to develop trust with the
  researcher and the research assistance
  (Interpreters)
• importance of cross cultural communication
• Right processes and strong relationships led to a
  very positive outcomes for participants

21
Key Findings

• Responses were analysed and clustered under some
  broad headings
• Motivation to begin gambling
• Transition from social to problematic gambling
• Barriers to seeking help
• Attitudes to professional help
• The impetus to seek help
• Maintaining change-strategies and challenges
• Perception of counselors , their role and
  qualities
• When help services were useful
• Ideal help services
• Promoting help services in CALD communities

22
Motivation to begin gambling

• Responses were consistent with the literature,
  for example financial incentive, social contact,
  relaxation..etc
• All participants knew their behavior was
  irrational and counter-productive

23

• (F6)
• Its an escape. Its an escape of emotional
  problems and problems of identity who you are,
  where you are, where do you want to be, and where
  are you goingIve lived here a long time, but I
  feel like I dont belong anywhere. I dont
  belong there and I dont belong here. And I felt
  really lost. And thats when it just got me
• (M4)
• Its like playground for kids, but youre an
  adult with a kids mind and youre just wasting
  your money. And youre obsessed with the
  machine.

24
Transition from social to problematic gambling

• Difficulty of navigating between the gambling
  identity and other identities
• Addictive qualities that others can not
  understand
• Often did not call themselves as a problem
  gambler or as someone who has gambling problem,
  but described themselves as stupid
• (F6)
• I was just trying to live both lives. It
  wasnt the same person. It wasnt me Im
  trying to do that and then trying to be the real
  me, but it wasnt working

25
Barriers to seeking Help

• Emotional barriers
• shame and embarrassment, confidence and keeping
  to yourself
• Its like a false pride you have the problem,
  you need help, you try to keep it to yourself.
  (M4)

26

• (M5)
• Maybe you have a need for help but you dont
  want to go and share with someone that stupid
  little thing with so much money. laughing
  Youre just trying to translate to yourself,
  Its not that bad. Or, It will be a better
  day. So no, I never felt like, Ill go
  somewhere and tell someone about my stupidity.
  laughing I think thats the biggest problem.
  Yeah, I took the card with the gambling helpline
  number, I put it in my pocket and I thought,
  Well, I will call And again I thought, Oh,
  this is the end. Then, Its just a really bad
  day and I will come back. The next day, the
  feeling just comes back, just Oh, okay, the
  world is unfair, laughing it has to change.
  

27
Barriers related to community Affiliations

• Community expectation of the gender role
• Community labels Gambler
• Isolating the person as it is contagion
• Community can not help you have to help
  yourself
• (M4)
• Instead of helping you the community want you
  to be helpful to yourself in the first place.
  Not to do it. So they have nothing to offer
  except staying away from you. Its like a
  cancer, a tumour that they try stay away as much
  as they can because sooner or later you may tempt
  them or their children or their partners into
  that

28
Barriers relating to experiences in the country
of origin

• non-existent in their home country
• government control of gambling practices in
  participants country of origin differed markedly
  from Australias
• Participants were often unaware of any government
  gambling help services in their country of
  origin. Help came from more informal sources

29

• (M3)
• You want to gamble, in my country of origin
  they have casinos you have to show them a tax
  return, how much you make. They screen you
  before you get inside and gambling. You must
  have an income, enough income to support your
  family and to support yourself before you go
  gambling. Its not like in Australia, walk into
  the casino, lose your money, and see you later.
  If you have a passport you can go in and gamble.
  They dont worry about the tourists. They worry
  about the people that are living there. And they
  dont want to lose the money

30
Attitudes to professional help

• intergenerational differences
• embarrassment or pride, some mentioned that
  seeking professional help was equated with being
  sick
• resistance to professional help was attributed to
  the primacy of family as the ideal source of
  support, as well as the need to be known before
  accepting help
• fear that formal help services dont in fact help
• perceptions that helpline did not take issues
  seriously and computerised private information
  can jeopardise confidentiality

31

• deep sense of self-reliance
• Several perceived help services such as
  counselling as a last resort
• lack of awareness of help services
• language barriers or practicalities such as
  transport

32

• (M5)
• You know, I believe that this comes from the
  belief that if youre not related to someone,
  youre not going to want to share your problems.
  You know. Thats why I mentioned the family.
  Its a different story. I would quicker share my
  problem with someone I know
• (F2)
• Like a friend of mine, when I see her and she
  went to get help. Thats stopped me as well.
  Oh, if she went and she didnt get help, so if I
  go, then nothing different. That stopped me as
  well

33
The impetus to seek help

• derived from feelings of despair and fear, and a
  sense that seeking help was their only chance.
• came from external sources, including trusted
  professionals such as doctors or interpreters.
• Participants partners offered different styles
  of support
• Friends were important to maintaining change
• inhibiting effect of imagining that help services
  may not help. Others spoke of the hope that
  would accompany evidence of successful change
• One person emphasised the importance of venue
  staff being skilled in recognising people and
  help them
• not all participants wanted to stop gambling
  completely

34

• (M3)
• If someone was very intelligent and strong and
  couldnot teach me, but show me. Tell me. Show
  me! You know, How?! You know, Youve got
  the brains, so tell me, how do I stop gambling?

35
Maintaining change strategies and challenges

• ongoing challenge of maintaining change
• described strategies that they found to be
  helpful
• keeping occupied by developing new hobbies or
  interests
• planning and saving for a specific goal
• desire for longer contact with professional staff
• Develop a sense of purpose in life and feel
  useful

36
Perceptions of counsellors their role and
qualities

• Counseling is a new concept
• the role of counsellors included a range of
  different emphases,
• Qualities of the Counselor included
  understanding, sympathy, respect and a
  non-judgemental attitude. Friendliness, humour,
  and the ability to get clients feeling relaxed
  and comfortable
• Lack of trust led to a lie to prevent deeper
  conversation and loss of face
• Confidentiality and privacy

37

• (M4)
• Its the ethics that you expect. The
  confidentiality, theyre not judging you. Not
  trying to make you a sample, a guinea pig for the
  others. You really need to keep your privacy to
  yourself, you dont want it to be that after a
  few years they start to use you as a sample of
  what you were or what you are now
• (M5)
• There was nothing new. Nothing new at all.I
  dont think it helped in my case. Well, maybe it
  did, but I didnt feel like I was learning
  something new or I really needed it. I had a go
  at the exercises at the end, but I did as well on
  the one at the beginning as the one at the end
  I just faked it. laughing So.

38
When help services were helpful?

• the sense of hope, joy or optimism
• described the therapeutic importance of feeling
  similarity, community and belonging
• preferred individual counselling rather than
  group settings
• broadly-based therapeutic agenda, that wasnt
  just focused on gambling
• valuing the way that the service was negotiated
  in partnership, and the maintaining of contact
  with service providers

39
Ideal help services

• Gender of a counsellor is not an issue
• Age as long as there is evidence for life
  experience, personal and professional qualities
• Views on the ideal ethnicity or cultural
  orientation of counsellors were divided, with
  some participants really valuing an understanding
  of culture and others seeing language as the only
  important issue.
• Some view that seeing someone from same
  background is a barrier, particularly around
  issues of privacy and confidentiality

40

• Some participants preferred to meet outside of an
  office setting particularly those who had
  experienced interrogation or other traumas in
  their country of origin
• Some (women in particular) preferred home visit
  while others were comfortable travelling to a
  service
• some participants felt that the timing of
  appointments would not inhibit those who really
  desired help, others preferred flexibility in the
  timing so as to accommodate other commitments

41

• Some participants found the qualities of the
  counsellor significantly more important than the
  physical setting, others noted the qualities of
  an environment that facilitated a more conducive
  therapeutic experience. These included
  brightness, a small room, and a comfortable and
  equitable physical alignment with the counsellor
•  social connection and support with employment
  would be more useful than solely counselling
  services
• Limiting access or get rid of venues

42

• (F2)
• The way I want it is like, is like more people
  to help there. Like even, every person with a
  problem, like one person is to look after him.
  And guide me as well. And plus the counsellor,
  she look after you like, shed try to ring you
  even if you dont ring her. Become more of a
  friend to you than a counsellor. You know, more
  like a friend. And not always put the issue of
  gambling always at the front. Like as a friend
  completely. And with everything. Even visit and
  go out and become more a friend to you and that
  would help a lot
• (M2)
• Create different opportunities for people to
  connect. Help people get a job and be connected

43
Promoting help services in culturally and
linguistically diverse communities

• Enormous need for community education using
  churches, local Ethnic radio programs, DVD, use
  true testimonial stories

44
We ask ourselves

• How can mainstream practices be varied and
  flexible enough to meet CALD needs rather than
  how can CALD individuals be assisted to fit the
  mainstream system
• How can we make space for the client to construct
  successful counselling practices with us,
  rather than do successful counselling to the
  client
• How can therapeutic strategies be delivered in
  non-clinical, non western ways and still be
  acknowledged by Funders?

45
Perhaps

• We can provide formal therapeutic interventions
  that may be delivered in community settings and
  at home, spontaneously alongside education and
  community development activities rather than
  separating counseling from other types of
  engagement
• we can engage with clients explicitly about their
  cultural world view
• A partnership between ethno specific and
  mainstream service providers is the best way to
  address the challenges

46

• PEACE Service Model

47
Conclusion.

•  
• This research has highlighted the invisibility of
  cultural and linguistic diversity in the
  discussion of therapeutic approaches to problem
  gambling.
•  
• One of the most positive outcomes of this
  research has been the therapeutic value of the
  action research process itself. The engagement
  and the relationships which the interviews
  established or enhanced, were in themselves
  empowering and therapeutic. It is notable that a
  large proportion of participants would not attend
  counselling services but were willing to engage
  in research to help others.
•  

48

•  
• The final words on helpful interventions come
  from one of our research participants
•  
• Counsellors need to not be so formal and
  serious, they need to be friendly smile and use
  their sense of humour. I can give you an
  example. A counsellor who knows who I am and
  where I come from can engage with me saying, Did
  you bring water with you from your country?
  Australia is very dry I would find this to be
  funny and it will help me connect a lot better
  than using a pen and paper and ask me question
  after question without me understanding what he
  does (M2)
•  
•