1. Initial Successes, Challenges and Lessons Learned
A Problem Gambling Telephone Intervention Program for the Chinese Community
Initial Successes, Challenges and Lessons Learned

2. 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 Francisco’s Chinese community.

3. 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

4. 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)

5. Information & Literature GA or Gam-Anon Telephone Counseling
Gambling Helpline
Information & Literature
GA or Gam-Anon
Telephone Counseling
Outpatient
Refer to Resources
Case Coordinator
(NICOS)
Refer to Services
Assigns Case to Appropriate Provider
Approved Provider
Schedules Intake Session & Subsequent Sessions w/Client
UGSP / Office of Problem Gambling
Submits Client Data via DMS
Inpatient
Sends Reg. Packet to Client
Receives Signed Consent
Administrative Tasks
Chinese Community Problem Gambling Helpline
NICOS Chinese Health Coalition
NICOS PGTI Providers
UGSP / OPG

6. Project Overview 6

7. Overview of the CPGTSP
California Problem Gambling Treatment Services Program (CPGTSP)
Stepped-care approach
Continuum of services
Fee-for-service reimbursement
3-year limited-term “pilot program”

8. Components of Stepped-Care Program
Component 1 : Training
Component 2 : Brief Interventions
Component 3 : Outpatient Care
Component 4: Intensive Outpatient Program
Component 5: Residential Treatment
Component 6: Clinical Innovations 8

9. PGTI - Overview 8 sessions telephone counseling
Licensed clinical providers
Utilizes manualized intervention
Linked to helpline services
Cantonese, Mandarin (English, Spanish – BDA)
Follow-up/ evaluation component
Goal is to:
provide time-limited, telephone treatment to non-English PG and Affected Individuals;
transition to higher levels of care if clinical indicated

10. Who’s 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.

11. 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: GAMBLER will refer clients to the PGTI Program.
BDA
Richmond Area Multi-Services: 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.

12. 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

13. Cultural & Linguistic Adaptations
Translated client consent forms (Release of Info., Rights & Responsibilities, Telephone Follow-up, Revoke Consent, Client Handbook, etc.)
Providers
Providers utilize UCLA’s 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

14. Program Outcomes

15. 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
Currently 1 PGTI-approved supervisor
English, Cantonese, Mandarin, Taiwanese, Vietnamese, Teo-Chow, (pending: Korean)

16. NICOS PGTI Program Client Overview
26 clients served to date (13 in Y1; 13 in Y2)
16 gamblers & 10 affected individuals
Mean CPGTSP Assessment Score = 8 out of 10, Range: 5 – 10
Ethnicity: Chinese (23; 88%), Vietnamese (2; 8%), Korean (1; 4%)

17. Gender
n = 16
n = 10

18. Age
n = 16
Mean = 46
n = 9
Missing = 1
Mean = 50

19. Languages Top Languages Spoken:
Cantonese n=14 (9 gamblers, 5 affected ind.)
Mandarin n=11 (7 gamblers, 4 affected ind.)
Vietnamese n=3 (0 gamblers, 3 affected ind.)
Taiwanese n=1 (0 gamblers, 1 affected ind.)
5 clients speak at least 2 languages/dialects

20. English Proficiency
n = 14
Missing = 2
n = 9
Missing = 1

21. Employment
n = 16
n = 9
Missing = 1

22. Gross Income
n = 22
Missing = 4

23. Total Debt
n = 18
Missing = 8

24. Money Lost in the Past Year
Missing = 11

25. Occupants Under 18
n = 25
Missing = 1

26. Program Statistics Year 1 (Jul. 2010 – Jun. 2011)
Year 2 (Jul – Present)
33 total requests for PGTI services
24 requests YTD for PGTI services

27. Treatment Sessions as of 12/30/2011
CLOSED
Block 1
Block 2
Client ID
1&2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
DC1955
DT1968
DZ1959
RZ1962
CH1957
AC1955
EW1957
KG1964
FY1958
BO1967
LK1961
n=131
ACTIVE
Block 1
Block 2
Client ID
1&2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
WYT0001 +5
WH1967
DP1973
PL1963
LC1977
SK1961
LS1974
WH1954
TK1968
JL1979
TL1979
QH0001
LC1980
n=96

28. Program Statistics Total sessions provided YTD: 227 (as of 12/30/11)
Sessions provided in Y1: 118
Sessions provided in Y2: 109
Completed: Average ~10 sessions per client
12 (46%) clients require additional PGTI services beyond the 1st block (8 sessions)

29. SoCal NorCal San Gabriel, CA Beautmont, CA Aliso Viejo, CA
El Monte, CA
Alhambra, CA
Garden Grove, CA
Redondo Beach, CA
Hercules, CA
Fullerton, CA
Millbrae, CA
Sacramento, CA
Fremont, CA
Alameda, CA
San Mateo, CA
Daly City, CA
San Francisco, CA
SoCal
NorCal

30. Overall Life Satisfaction - Gamblers Treatment Phase

31. Urges/Cravings to Gamble - Gamblers Treatment Phase

32. Perceived Control Over Gambling - Gamblers Treatment Phase

33. Impact of Gambling - Gamblers Treatment Phase

34. Overall Life Satisfaction - AI Treatment Phase

35. Urges/Cravings to Gamble – AI Treatment Phase

36. Perceived Control Over Gambling - AI Treatment Phase

37. Impact of Gambling - AI Treatment Phase

38. Challenges

39. 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

40. 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.

41. 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

42. Challenges for the PGTI Program
Client’s 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

43. Challenges Cultural acceptance Immigration-related issues
Environmental prevalence
Target marketing
When working with Asian American problem gamblers, there may be several challenges and barriers that we must face. One of which has to do with cultural acceptance of gambling. Within many Asian cultures, gambling has strong historical roots. People have gambled for centuries, and it has traditionally been regarded as an acceptance activity. When an activity is so accepted as a normal part of the culture, it becomes more difficult to identify when there is a problem.
Amongst immigrants and refugees, there may also be a high prevalence of gambling. Gambling may serve many purposes—it may provides relief from the stresses of immigration and day-to-day life, it may provide a sense of importance and self-worth because of the special treatment they may receive from the casinos, as discussed, they may not need to speak English to participate, and for many marginalized populations, gambling may provide a false sense of power and control because of the opportunities to make decisions.
Asian Americans, especially more recent immigrants but often also of those who have been here for many generations, are reluctant to seek help for various problems, including problem gambling. There is a mental health stigma, that seeking help for anything like that means you are crazy.

44. Lessons Learned

45. Lessons Learned
Telephone treatment poses fewer barriers for consumers to access
Client urgency for immediate provision of services (warm transfer, enrollment assistance, case management)
Preliminary data shows PGTI program to be promising
Telemedicine requires specialized psychotherapeutic approach
Consumer’s linguistic and other needs pose challenges to transition
Paperwork challenges – (in-language is helpful, and personal assistance helpful)

46. Next Steps

47. 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

48. THANK YOU!!! NICOS Chinese Health Coalition 1208 Mason Street San Francisco, CA Chinese Helpline: