A Problem Gambling Telephone Intervention Program

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A Problem Gambling Telephone Intervention
Program for the Chinese Community

• Initial Successes, Challenges and Lessons Learned

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About NICOS

• NICOS Chinese Health Coalition is a
  public-private-community partnership of more than
  30 health and human service organizations. The
  mission of NICOS is to enhance the health and
  well-being of San Franciscos Chinese community.

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Background

• Chinese Community Health Study
• (NICOS/ Four Winds, 1997)
• Telephone Survey of 1,808 Chinese American adults
  in San Francisco
• Purpose Health profile
• 70 identified gambling as a problem

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NICOS PG Programs

• Chinese Community Problem Gambling Project
  (CCPGP)
• Chinese Statewide Problem Gambling Helpline
• Problem Gambling Technical Assistance and
  Training Project (PGTAT)
• Problem Gambling Telephone Intervention (PGTI)

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Project Overview
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PGTI - Overview

• 8 sessions telephone counseling
• Licensed providers
• Utilizes self-help workbook
• Linked to helpline services
• Cantonese, Mandarin (English, Spanish BDA)
• Follow-up/ evaluation component
• Goal
• Provide time-limited, telephone treatment to
  non-English PG and Affected Individuals
• transition to outpatient face-to-face

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Whos Eligible for PGTI Services?

• Gamblers must meet the following criteria
• Must be 18 years or older and
• Meet at least one of the diagnostic criteria for
  Pathological Gambling described in the Diagnostic
  and Statistical Manual-IV (DSM-IV) or
• Receive approval from OPG for services on a
  case-by-case basis.
• Affected individual(s) (including but not limited
  to spouses, domestic partners, cohabitants,
  family members, work or school colleagues, or
  neighbors) of pathological/problem gamblers must
  meet the following criteria
• The affected person is 18 years or older and
• Affected individual(s) must report an adverse
  psychiatric or physical impact experienced due to
  ongoing problem or pathological gambling
  behaviors.

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Players Involved in PGTI
Office of Problem Gambling Overall oversight of
the CPGTSP including PGTI. Reimburses providers
and its subcontractors.
UCLA Gambling Studies Program Clinical and
research oversight including the design of
tools for treatment and data collection.
Bensinger Dupond Associates 1-800-GAMBLER will
refer clients to the PGTI Program.
BDA
Richmond Area Multi-Services 1-888-968-7888 will
refer clients to the PGTI Program.
NICOS Subcontractor to administer the
Chinese/Asian Language PGTI Program.
NICOS PGTI Providers will provide
telephone-based counseling services to problem
gamblers and affected individuals.
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Provider Qualifications

• Licensed in California to engage in the practice
  of mental health (MD, PhD, PsyD, LCSW, MFT, etc.)
• License must be current and in good standing and
  possess no violations or pending actions
• Completion of Phase I Provider Training (30
  hours)
• Completion of NICOS language assessment
  certification
• Current and viable professional malpractice
  insurance
• Clinical office policies must be HIPAA compliant
  and
• Access to a personal computer, with high-speed
  Internet access

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Cultural Linguistic Adaptations

• Translated client consent forms (Release of
  Info., Rights Responsibilities, Telephone
  Follow-up, Revoke Consent, Client Handbook, etc.)
• Providers
• Providers utilize UCLAs Chinese-translated
  Freedom from Gambling handbook
• In the process of developing treatment module for
  affected individuals
• NICOS and providers offer linguistic/cultural
  support to clients to navigate PGTI program

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Program Accomplishments
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NICOS PGTI Program Provider Overview

• Developed program policies procedures manual
• Developed training curriculum (incl. how to work
  with clients on the phone)
• 8 providers trained Nov. 3, 2010 through 2011
• Currently 5 active providers, 1 pending
• English, Cantonese, Mandarin, Taiwanese,
  Vietnamese, Teo-Chow

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Percentage of PGTI Enrollment
Referral from Helpline
n 10
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NICOS PGTI Program Client Overview

• 7 clients enrolled to date
• 4 gamblers 3 affected individuals
• Average NODS score 7.33 out of 10
• Chinese ethnicity(100)
• Cantonese (57), Mandarin (43)
• Speaks English Very Well (17) Well (17) Not
  Well (50) Not Well At All (17)
• Full Time Employed (100)

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Number of Treatment Sessions
Block 1 Block 1 Block 1 Block 1 Block 1 Block 1 Block 1 Block 2 Block 2 Block 2 Block 2 Block 2 Block 2 Block 2 Block 2
Client ID 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
WYT0001 x
DT1968 x
DC1955 x
EW1957 x
AC1955 x
WH1967 x
FY???? x
As of 2/11/2011
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Overall Life Satisfaction
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Urge/Craving to Gamble
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Perceived Control over Gambling
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Impact of Gambling
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Challenges
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Challenges for the PGTI Program

• Telemedicine is a relatively new mode of
  psychotherapy delivery, esp. for PG
• Both must work to eliminate distractions not
  found in conventional therapeutic settings

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Challenges for the PGTI Program

• Telemedicine is a relatively new mode of
  psychotherapy delivery, esp. for PG
• Both the consumer and the provider must adapt to
  a new therapeutic interaction, incl. the absence
  of visual/facial cues, etc.

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Challenges for the PGTI Program

• Community stigma towards mental health and
  professional help
• Qualitative research in Chinese community shows
  that many equate MH with insanity and do not
  believe in seeking help
• Reticence of seeking outside help for PG,
  unless/until situation is exacerbated by large
  debts
• Chinese PGs may not seek help until problems have
  progressed to greater degree of severity

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Challenges for the PGTI Program

• Clients linguistic cultural needs, and
  socioeconomic status poses challenges for
  transition
• Several clients are uninsured, and holding
  multiple low-end jobs, making out-of-pocket
  therapeutic expenses difficult
• Limited linguistically specific resources

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Challenges

• Cultural acceptance
• Immigration-related issues
• Environmental prevalence
• Target marketing

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Lessons Learned
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Lessons Learned

• Telephone treatment poses fewer barriers for
  consumers to access
• Client urgency for immediate provision of
  services
• Preliminary data shows PGTI program to be
  promising
• Telemedicine requires specialized
  psychotherapeutic approach
• Consumers linguistic and other needs pose
  challenges to transition
• Paperwork challenges (in-language is helpful,
  and personal assistance helpful)

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Next Steps
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Next Steps

• Engage Chinese media in promoting program (e.g., 
  press conference or press release, TV/ radio
  interviews, etc.)
• Develop webinar trainings for providers
• Adapt NICOS successful affected individual
  treatment module for the PGTI program
• Investigate possibilities of integrating existing
  PGTAT curriculum on Asian Americans into PGTI
  training curriculum

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THANK YOU!!!NICOS Chinese Health Coalition1208
Mason StreetSan Francisco, CA 94108Chinese
Helpline 1-888-968-7888http//www.nicoschc.org