1. July 11, 2012 National Conference on Problem Gambling Presenter: Jennifer Clegg, LSW, MSW, NCGC-II, OCPS-II Recovery Resources 3950 Chester Ave. Cleveland, OH 44114 216-923-4021 Jclegg@recres.org 1

2.  Prevention is an ordered set of steps along a continuum to promote individual, family and community health, prevent mental and behavioral disorders, support resilience and recovery and prevent relapse.  Prevention is prevention is prevention!  Common risk and protective factors exist for many addictions and mental health problems. Good prevention focuses on these common risk factors that can be altered 2

3.  Resilience is built be developing assets in individual, families and communities through evidenced based health promotion and prevention strategies  Systems of prevention services work better than service silos  Baseline data, common assessment tools and outcomes are shared across service systems can promote accountability and effectiveness of prevention efforts (The Guiding Principals of the Strategic Prevention Framework, SAMHSA) 3

4.  1950’s- early 1960’s  Scare tactics Mock crashes Recovery speakers Graphic pictures  Research indicated that these strategies are not effective 4

5.  Late 1960’s to early 1970’s  Information Factual information “medicine show’s” Teaching what drugs are used and how they are used This strategies was found to be counter productive and actually glamorized drug use 5

6.  1970’s- mid1980’s  Develop curricula providing effective education and alternative activities and trainings Just Say No MADD  Mid 1980’s - mid 1990’s  Research based curricula and peer prevention programs SADD DARE 6

7.  Mid 1990’s - Today  The gap between research and application are gradually bridged  Evidences based curricula developed Utilizing environmental approaches Comprehensive programming targeting many domains, strategies evaluation of prevention programs, media campaigns and culturally sensitive programs 7

8.  Adolescents today are the first generation of youth exposed to accessible and various types of gaming.  Gambling has become a new rite of passage  Typically 50-80% of teens reports gambling for money during their lifetime 8

9.  Cards  Sports Bets  Games of Skill (like betting each other in hoops, pool)  Video/Arcade Games  Lottery  Internet  Bingo Common Types of Gambling Among Teens Source: Carlson & Moore, 1998 9

10. Tardiness Missing school Stealing Mood swings Criminal activity Theft/Robbery Embezzlement Drug dealing Shoplifting Secrecy/withdrawal Unexplained debts/cash Missing money Increased anxiety Substance use FAMILYCOMMUNITY Work Work 10

11.  Can’t think of anything else but doing drugs  Need more and more to maintain a high  Will do drugs at any cost  Can’t stop even if they want to  Lying and stealing to keep using drugs  Drugs help to escape life’s problem, allows to forget  Consequences:  Failing School  Problems with friends/family  Risk of ending up in jail Can’t think of anything else but doing gambling Need to gamble more and more to maintain a high Will gamble at any cost Can’t stop even if they want to Lying and stealing to keep gambling Gambling help to escape life’s problem, allows to forget Consequences: –Failing School –Problems with friends/family –Risk of ending up in jail McGill University 11

12.  Students who gamble are more likely to participate in other risk behaviors  Gambling is one of many activities that carry risk and should be addressed as such in school and community prevention efforts  Casino nights in schools and other forms of gambling should be reconsidered.  Parents need to talk with their kids about gambling and gambling related consequences 12

13.  What prevention model do you follow?  Public Health Model  Environmental Management  Youth Empowerment and development  Social ecological theory 13

14. Agent Environmen t Host 14

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16.  Universal Intervention refer to efforts focused on every eligible member of a community.  · Selective Intervention are more focused at a more systems domain where higher-risk subgroups are targeted  · Indicated intervention are prevention efforts targeted at individuals, for example those who show signs of developing problems. 16

17. Prevention is not just about “preventing” something from happening: “ Prevention is a proactive process that promotes the well-being of people and empowers an individual, group, or community to create and reinforce healthy lifestyles and behaviors to meet the challenges, events and transitions of life.” Prevention is building healthy people and healthy communities. DMHAS Problem Gambling Services 2009 17

18. delinquency sexual behavior smoking violent behavior drug use gambling High Risk Behaviors  We know that high risk behaviors tend to cluster and gambling appears to fit within a risk behavior matrix (Marotta, J, 2007) 18

19.  Create awareness of gambling attitudes & behaviors;  Increase protective factors; DMHAS Problem Gambling Services 2009 19

20. Information Dissemination Prevention Education Alternative Activities Community-Based Processes Problem Identification/Referral Environmental Approaches Our Approach: Uses CSAP Prevention Strategies Research shows that it takes ongoing efforts in all 6 areas for prevention to really work (Marotta, J, 2007) 20

21.  This strategy provides awareness and knowledge of the nature and extent of substance use, abuse, and addiction and their effects on individuals, families, and communities. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two. [Note: Information dissemination alone has not been shown to be effective at preventing substance abuse.] 21

22.  Clearinghouses and other information resources centers  Resource directories  Media campaigns  Brochures  PSA’s  Speaking engagements  Health fairs 22

23.  This strategy involves two-way communication and is distinguished from the information dissemination strategy by the fact that interaction between the educator/ facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g., of media messages), and systematic judgment abilities. 23

24.  Classroom or small group sessions  Peer leadership and peer helper groups  Parenting and family management classes  Educations sessions for youth groups  Groups for children of addicts 24

25.  This strategy provides for the participation of target populations in activities that exclude substance use. The assumption is that constructive and healthy activities offset the attraction to--or otherwise meet the needs usually filled by--alcohol and drugs and would, therefore, minimize or obviate resort to the latter. [Note: Alternative activities alone have not been shown to be effective at preventing substance abuse.] 25

26.  Social and recreational activities  Youth and adult leadership activities  Community drop in centers  Mentoring programs 26

27.  This strategy aims to enhance the ability of the community to more effectively provide prevention and treatment services for substance abuse disorders. Activities in this strategy include organizing, planning, enhancing efficiency and effectiveness of services implementation, interagency collaboration, coalition building, and networking. 27

28.  Community and volunteer training  Systematic planning  Multi agency collaboration and coordination  Accessing services and funding  Community team building 28

29.  Individualized environment  Seek to socialize, instruct, guide, & counsel  children to increase their resistance to health  risks  Shared environment  Support healthy behavior, prevent risky  behavior for all children  Environmental strategies  Price interventions, minimum -purchase-age,  deterrence, location & density, counter-ads 29

30.  This strategy aims at identification of those who have indulged in illegal/age- inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person is in need of treatment. 30

31.  Employee assistance programs  Student assistance programs  DUI education programs 31

32.  Individual  Peer  Family  School/work  Community  Society/environmental 32

33.  USE MULTIPLE STRATEGIES OVER MULTIPLE DOMAIN 33

34.  37.9% - non-gamblers  49.3% Social gamblers  7.8% at risk gambler’s  9.5% males  1.6%females  5% Probable pathological gamblers  11.7%males  4.9% females Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D. 34

35.  Similar to public health model of disease prevention: focus on decreasing risk and increasing protection  Risk factors predict addictive behaviors and protective factors can buffer risk factors  To prevent high risk behaviors, such as gambling or substance abuse, reduce risk factors and increase protective factors throughout a child ’ s life 35

36.  Child of a compulsive gambler  Belief that skill is involved  An early big win  Feeling that one must chase gambling loss with more gambling  Early age of onset  Large first bets  Otherwise addicted 36

37.  Emotional difficulties  Stress  Distorted expectations about winning  Social pressure to gamble  Risky gambling behavior  Attention deficits  Impulsivity  Illusion of control over outcomes  Addiction history 37

38. Plays with $ that is needed or borrowed. Expects to win; keeps playing to win back losses. Is revolved around gambling. Frequent, or spends more time gambling. Sticks to limits of money to play with. Hopes to win but expects to lose. Can take it or leave it. Occasional gambler. PROBLEM GAMBLINGSOCIAL GAMBLING 38

39.  At-risk for a substance abuse problem  Having a parent, sibling, relative, friend, or significant person with either a gambling problem or substance use problem  Having or knowing peers with substance use problems is a risk correlate of youth problem gambling  Anxiety  High risk propensity  Low perception of risk regarding problem gambling  Early onset of gambling behavior Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D. 39

40.  Family connectedness  Designing school-based prevention programs that seek to develop student’s attachment, trust, and identification with larger groups (e.g., school clubs and sports teams, Scouts or Guides). Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D. 40

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42.  Assessment  Capacity Building  Planning  Implementation  Evaluation  All under the umbrella of cultural competence and sustainability 42

43. 43 What is Assessment?  Assessment of high risk behavior and related problems Assessment requires us to explore rates and patterns of high risk behavior as well as related problems (consequences). Prevalence data Incidence data Consequence data (Adapted from CSAP Strategic Planning Framework)

44. 44 How do we know if our needs assessment data is valid? Next- Stare at the black "+" in the center. What color are the moving dots now? First- What color dots do you see? Lastly- Keep staring at the black "+" in the center of the picture. What happens to moving dots now?

45. 45 There really is no green dot, and the pink ones really don't disappear. What does this optical illusion have to do with conducting a needs assessment?

46. (Adapted from CSAP Strategic Planning Framework ) Gamblingtown, USA “We have a problem, but we don’t care.”

47. PERCEPTION OF PROBLEM YOUTH ACCESS COMMUNITY COMMITMENT PERMISSIVE ATTITUDES SUPPORT FOR ATOD PREVENTION HIGH LOW Poised For Action “We ha aprobl, but we don’t know what to do!” “We have a problem, but we don’t know what to do.” (Adapted from CSAP Strategic Planning Framework )

48. PERCEPTION OF PROBLEM YOUTH ACCESS COMMUNITY COMMITMENT PERMISSIVE ATTITUDES SUPPORT FOR ATOD PREVENTION HIGH LOW Utopia “No problem, high support and commitment” “No problem, high support and commitment.” (Adapted from CSAP Strategic Planning Framework )

49. 49 Increase Awareness Change in Attitude Change in Behavior (Adapted from CSAP Strategic Planning Framework )

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51. (Adapted from CSAP Strategic Planning Framework ) Types and levels of resources needed to address identified needs including: Human resources Technical resources Management and Evaluation resources Financial resources

52. 52 What is a Comprehensive Strategic Plan?  A comprehensive, logical, and data driven plan to address the problems identified in phase 1 using the capacity built or mobilized in phase 2  The plan includes Strategic Goals, Objectives, and Outcomes, as well as Logic Models and in some cases Action Plans (Adapted from CSAP Strategic Planning Framework )

53.  Taking action as guided by the Strategic Plan developed in phase 3  Developing detailed action plans for elements of your intervention  Developing a final detailed evaluation plan that includes process and outcome measurements and continual monitoring of implementation fidelity (Adapted from CSAP Strategic Planning Framework ) 53

54. What does the Evaluation phase include?  Process evaluation  Collection of required outcome data  Review of policy, program, and practice effectiveness  Development of recommendations for quality improvement (Adapted from CSAP Strategic Planning Framework ) 54

55. 55 Why cultural competence?  To eliminate service and participation disparities for people of diverse racial, ethnic, and linguistic populations  To consider culture, gender, ability levels, and sexual orientation in all aspects of the SPF  To improve the effectiveness and the quality of the programs, policies and practices chosen to achieve outcomes

56. 56 Can be defined as “a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals and enable that system agency or those professionals to work effectively in cross-cultural situations.” (The Lewin Group, 2002)

57. 57  Structures and formal linkages  Champion and leadership actions  Resources  Administrative policies and procedures  Expertise  Ownership among stakeholders

58. 58  Prevention is a continuum  Prevention is prevention is prevention  Successful prevention decreases risk factors and enhances protective factors  Prevention requires adoption of known effective prevention practices within a framework that works

59.  Why invent the wheel?  We spent many years learning what works and what doesn’t in substance abuse prevention, let’s adapt it to gambling prevention 59