Working in Problem Gambling Services: Orientation to Problem Gambling: Part 2 Abacus Counselling, Training and Supervision Ltd

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

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)

Intervention Service Model  Most services operate a multi-modal approach, acknowledging the varied impacts on gamblers and significant others  Addresses client’s 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 another’s 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

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 month’s support for clients who have completed full intervention with problem gambling intervention services

Preferred pathways for intervention sessions

Trans-theoretical Model of Change Permanent exit Pre-contemplation Prochaska & DiClemente Transtheoretical Model of Behaviour Change Contemplation Relapse Preparation Maintenance Action

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

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

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

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

Brief interventions  Their focus is upon improving the person’s 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)

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

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.

Brief Gambler Screen (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 Introduction/Opening Statement: Most people in New Zealand enjoy gambling, whether it’s 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 don’t gamble at all’.

Brief Family/Affected Other Screen 1. Awareness of the Effect of the Gambler’s Gambling (record the number of the response) Do you think you have been affected by someone else’s gambling? (0) No, never (you need not continue further) (1) I don’t know for sure if their gambling affected me (2) Yes, in the past (3) Yes, that’s happening to me now Introduction/opening statement: Sometimes someone else’s 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.

Brief Family/Affected Other Screen 2. Effect of gambler’s 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 person’s gambling on you now? (tick one or more if they apply to you). (0) It doesn’t 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 family’s safety I’m 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

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

Full Intervention  Clinical intervention with people who are seeking help for gambling related harm  Can be harm from their own or another’s gambling (family/whanau or affected other)  Can include harm from their own gambling plus another’s 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

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”)

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)

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.

Gambler Harm Screen Gambler Harm (record the total score) The Gambler Harm Full Screen is scored by the client’s 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?

Gambler Harm Screen (cont’d) 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?

Family/Affected other Harm Screen 1. Awareness of the Effect of the Gambler’s Gambling (record the number of the response) Do you think you have been affected by someone else’s gambling? (0) No, never (you need not continue further) (1) I don’t know for sure if their gambling affected me (2) Yes, in the past (3) Yes, that’s happening to me now Introduction/opening statement: Sometimes someone else’s 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.

Family/Affected other Harm Screen 2. Effect of gambler’s 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 person’s gambling on you now? (tick one or more if they apply to you). (0) It doesn’t 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 family’s safety I’m 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

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

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)

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

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

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

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 minutes  If further in-depth support required, or if client contacts for further help – open Full Intervention episode

Follow-Up Instruments  Gambler’s 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 gambler’s gambling

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