Problem Gambling and Concurrent Disorders: A Customized Training for the Ontario WMS

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Problem Gambling and Concurrent Disorders A
Customized Training for the Ontario WMS
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Objectives

• To learn about the consultative process used to
  develop customized training for the Ontario
  Withdrawal Management System.
• To experience interactive activities used in the
  delivery of this training.
• To learn about problem gambling and concurrent
  disorders.

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Identified Need

• Working with PGTS, need was identified that
  clients with gambling problems are accessing WMS
  services
• Consultation with Managers confirmed need and
  interest
• Survey with Managers found that..

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Needs Assessment

• Conducted by region (central, east, north,
  southwest)
• Contact managers of each centre requesting
  support to have every staff complete and fax
  back.
• Survey was broad to identify all training needs
  re addiction and mental health
• Summaries provided regionally to allow
  customization in each region

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Survey Results

• Central (36) concurrent disorders, suicide,
  brief interventions,
• East (12) concurrent disorders, personality
  disorders, anxiety
• North (45) concurrent disorders, anxiety,
  depression/mood disorders
• Southwest (17) anxiety, depression/mood
  disorders, schizophrenia

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Survey Results (cont)

• Have you had contact with problem gambling
  clients and their families?
• Central no 31, yes 67,
• East no 41, yes 50,
• North no 38, yes 47
• Southwest no 47, yes 35

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Proposal Highlights

• Training Format
• Training Content
• Additional Resources
• Specific Considerations
• Timelines

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Challenges for Development and Delivery of
Training

• Concurrent Disorders not our specialty
• Different perspectives on addictions
• Training schedule format
• System in flux

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Barriers/Challenges

• Lack of CD resources
• Available resources dont fit the need
• PG not seen as a priority issue
• Range of experience and education
• Working beyond mandate
• Burnout

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Training Content Activities

• Attitudes Beliefs
• Rethinking Normal activity
• Gambling Problem Gambling
• Values around
• 2-Circles Exercise

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Training Content Activities (continued)

• Gambling Problem Gambling
• Introduction to gambling problem gambling
• Demonstrating key concepts video games
• Screening for Problem Gambling
• Referring to Problem Gambling Treatment

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Problem Gambling Treatment in Ontario

• 50 MOHLTC Funded Problem Gambling Treatment
  Agencies in Ontario
• Free Confidential
• Self-referral
• Services for significant others
• Community Treatment, Day Residential Treatment
  available.
• GA GamAnon

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Training Content Activities

• Mental Health Concurrent Disorders
• Definitions Prevalence rates
• Understanding Mental Health
• Understanding Concurrent Disorders
• Screening
• Brief Interventions
• Integrated Treatment
• Best Practices

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Group Activity

• Trying to Make Sense of
  Mental Health Disorders

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A Dimensional Model of Concurrent Disorders
Anxiety
Addiction
Psychosis
Mood
Impulsivity
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Mood

• Verbal Behaviour
• Self-critical, loser, hopeless
• Examples
• Mood Disorders and Substance-
  Induced Mood Disorders

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Anxiety

• Verbal Behaviour
• Fright, fear, danger
• Examples
• Anxiety disorders such as Panic Disorder,
  Agoraphobia, Social Phobia, PTSD and OCD

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Psychosis

• Verbal behaviour
• weird talk
• Examples
• Schizophrenia, other Psychotic Disorders and ,
  Substance-Induced Psychoses

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Impulsivity

• Verbal Behaviour
• Threat talk
• Mind Set
• Survival mode
• Examples
• Pathological Gambling, Sexual Addiction, Bulimia
  Nervosa and Substance Abuse

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Personality Disorders

• A - Odd Cluster (Psychosis Dimension)
• Schizoid, schizotypal, paranoia
• B - Impulsive Cluster (Impulsivity Dimension)
• Antisocial, narcissistic, borderline
• C - Anxious Cluster (Anxiety Dimension)
• Compulsive, avoidant, dependent

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The Quadrant Model
Specialized Integrated Quadrant IV
Specialized Addiction Quadrant III
High
Severity Of Addiction
Specialized Mental Health Quadrant II
Community Primary Care Quadrant 1
Low
Low
High
Severity of Mental Illness
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The Quadrant Model A Population View
High
Specialized Addiction
Integrated
Severity of Addiction
Specialized Mental Health
Primary care
Low
Low
High
Severity of Mental Illness
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The Quadrant Model Type of Care

• Collaborative Care

Integrated Care
High
Severity of Addiction
Low
Consultation
Collaborative Care
Low
High
Severity of Mental Illness
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Best Practises

• For a full copy of Health Canadas Best Practices
  Document

http//www.hc-sc.gc.ca/ahc-asc/pubs/drugs-drogues/
bp_disorder-mp_concomitants/index_e.html
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Evaluation Results

• Learning Objectives consistently 4 or higher
• Content and Format 4.5 and higher

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Participant Feedback

• What was not talked about that would have been
  helpful? What was missing?
• I would have preferred a little more info on
  gambling.
• Solution to the need for integrated addiction and
  mental health treatment options.
• More info on medications.

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Participant Feedback

• What is the most important thing you will take
  away from this training?
• The workshop design and implementation was
  excellent. Well paced interactive exercise,
  breaks, lectures. One of the best workshops I
  have attended.
• More knowledge and strategies, I feel positive
  about what I do and with a desire to learn more.

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Participant Feedback (cont)

• A clear understanding of what I can do to make a
  difference with my clients.
• The gambling aspect was informative and will be
  helpful, great handouts with good information.
• Learning about dimensional model for CD and brief
  interventions very practical information.
• Learning about other withdrawal centres and
  learning there are no differences with our
  challenges in client care.

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Resources

• http//www.camh.net/About_Addiction_Mental_Health/
  index.html
• www.ProblemGambling.ca
• Addiction Clinical Consultation Service
  1-888-720-2227
• Connex Ontario Health Services Information
  www.connexontario.ca
• Ontario Problem Gambling Helpline
  1-888-230-3505

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For More Information

• Colleen Tessier
• 416-535-8501, ext. 4550
• Colleen_Tessier_at_CAMH.net
• Chantal Dubois
• 416-535-8501, ext. 7423
• Chantal_Dubois_at_CAMH.net