Problem Gambling Forum: Orientation to Problem Gambling: Part 2 Presented by ABACUS Counselling Training & Supervision Ltd to the Problem Gambling National Provider Forum May 2012

1. Working in Problem Gambling
Services:
Orientation to Problem Gambling: Part 2
ABACUS
1
Counselling, Training and Supervision Ltd

2. 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)

3. 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)

4. 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

5. 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

6. Preferred pathways for
intervention sessions

7. Trans-theoretical Model of Change
Prochaska & DiClemente
Transtheoretical Model of Behaviour Change
Pre-contemplation
Relapse
Permanent exit

8. 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

9. 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

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

11. 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

12. 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)

13. 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; appropriate
referrals (incl. facilitation). The client may gain enough
assistance at the end of a BI or may wish to begin full
intervention

14. 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)
• Minimum data required is the primary mode of gambling and
brief screen score

15. Brief Gambler Screen
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’.
(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

16. Brief Family/Affected Other Screen
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.
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

17. 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

18. 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

19. 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

20. 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”)

21. 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)

22. 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
• 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.

23. 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?

24. 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?

25. Family/Affected Other Harm Screen
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.
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

26. 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

27. 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

28. 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)

29. 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
• If not positive for gambling but positive for co-existing
conditions/other issues, facilitation to the appropriate service
is counted

30. 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

31. 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

32. 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 15-30 minutes
• If further in-depth support required, or if client contacts for
further help – open Full Intervention episode

33. 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 3 month follow-up –
Gambling frequency and Coping with the gambler’s gambling

34. 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