Más contenido relacionado

Presentaciones para ti(20)


Más de Oregon Problem Gambling Services(20)


Monthly Treatment Call Presentation/Minutes -Mar 2015

  1. Problem Gambling Treatment Providers Monthly Call/Webinar March 4, 2015 Facilitated by Greta Coe
  2. 2 Agenda Time Topic 3:00pm-3:10pm Introductions/County Roll Call   3:10pm-3:15pm AMH Update/Announcements •PG System Improvement Community Forums 3:15pm-3:45pm Presentation •GBIRT Screening Project- Presented by Alicia Bartz (Multnomah County) and David Corse (VOA/InAct- Mult. Co.) 3:45pm-3:55pm Discussion Topics •PGS Treatment Provider Discussion-Updates from the field 3:55pm-4:00pm Wrap Up Items for next meeting? Future agenda items: •Quality Improvement Reports- as statewide look and performance based contracting (April) •MH clinicians not knowing how to refer and screen •Treating gambling addiction and co-occurring disorders •Ideas for increasing enrollments  
  3. 3 AMH Updates  PGS System Improvement Community Forums March 10, 2015- Lake Oswego March 12, 2015- Grants Pass March 13. 2015- Albany March 17, 2015- Bend  Contact for registration flyer. Registration closes on Friday, March 6.
  4. 4 Presentation GBIRT Screening Project Presented by Alicia Bartz (Multnomah County) and David Corse (VOA/InAct- Mult. Co.)
  5. 1. Evidence of high risk of gambling problems among individuals diagnosed with substance use and mental health disorders. 2. Not addressing gambling issues decreases treatment effectiveness and adds to treatment costs 3. Early intervention and treatment work! Why bother screening for gambling disorders?
  6. • Per DSM5, those with gambling disorder have high rates of substance use disorders, depressive disorders, anxiety disorders, and personality disorders. • Up to nearly 1/3 of individuals in SUD treatment identified as problem gamblers (Ledgerwood et al, 2002) • The more severe the past year’s SUD, the higher the prevalence of gambling problems (Rush et al, 2008) • Individuals with lifetime history of mental health disorder had 2-3 times rate of problem gambling (Rush et al, 2008) Comorbidity
  7. OSAM Survey 27.6% gambled more when using alcohol or other drugs 16.7% used more alcohol or drugs when gambling 15.6% gambled to buy alcohol or drugs
  8. • What happens in actual clinical practice • Use screen • No one endorses items • What does counselor think? • None of my clients have any gambling problems • Don’t care about the research, my clients are different • NIMBY (Not in my back yard (or treatment program)) Typical results of use of brief screens
  9. Need to define what is meant by gambling – list types of gambling Use diagnostic criteria Developed to screen for most severe gambling problems Differing ways questions are addressed by counselors; many factors including counselor workload, length of intake assessments, counselor priorities, and counselor comfort with problem gambling all may contribute to minimizing importance of gambling questions Issues with brief screens
  10. Counselor thinking: “I can save time on these…That’s not why she is here anyway.” “ You’ve never lied about gambling or wanted to spend more money on it, have you? “ Client thinking: “Phew! Nobody cares about gambling here! No, that’s not a problem” PG screening: what often happens
  11. • For the purpose of the next questions, “gambling” means buying lottery tickets, gambling at a casino, playing cards or dice for money, betting on sports games, playing slot machines, video poker or other video gambling, gambling on the internet, betting on horses or dogs, playing bingo or keno. • During the past 12 months, have you gambled 5 or more times? • If yes, continue to next 3 questions: Strategy adapted from IL SBIRT* *from DSM-5, BBGS, and Elizabeth Hartney, PhD
  12. During the past 12 months: 1. Have you tried to hide how much you have gambled from your family or friends? 2. Have you had to ask other people for money to help deal with financial problems that had been caused by gambling? 3. Have you ever felt restless, on edge or irritable when trying to stop or cut down on gambling? If yes to any of the above, proceed to next 6 questions: Screening strategy
  13. 4. Have you tried to cut down or stop your gambling? 5. Have you increased your bet or how much you would spend, in order to feel the same kind of excitement as before? 6. Did you think about gambling even when you were not doing it? (Remembering past gambling experiences, or planning future gambling?) 7. Did you go to gamble when you were feeling down, stressed, angry or bored? 8. Did you ever try to win back the money that you had recently lost? 9. Has your gambling caused problems in your relationships or with work? Total “yes” responses? Screening strategy, continued
  14. A “yes” response to any of questions 1, 2, or 3 results in asking all the questions (4-9) and Gambling Brief Intervention. •A “yes” response to a total of 4 questions (out of 9) results in a Gambling Brief Intervention and Referral to Gambling Treatment Brief intervention
  15. • Give feedback on personal gambling • Define levels of gambling and gambling disorder • Go over risk factors for problem gambling/gambling disorder (i.e., being in recovery, dealing with grief or loneliness, or immediate financial pressures) • Offer steps to keep gambling fun and problem-free: set a time and money limit and stick to it; learn how the games work and what they cost to play; balance with other leisure activities • “If you gamble and spend more time and money than you can afford, a good strategy is to take a break and look at your gambling. Consider seeking help if this is a concern.” Brief advice on reducing gambling
  16. The key to this approach is to raise the issue of gambling and its role in your client’s recovery in multiple contexts and repeatedly over time. It is also key to include the topic of gambling in a non- judgmental or labeling manner, in order to minimize defensiveness or resistance. Integrated assessment
  17. What we’re doing GBIRT Utilize previously-described gambling screening techniques with clear routes to referral Peer mentors Educate A&D (alcohol and drug) providers and conduct outreach to A&D clients with gambling issues to provide support and link to treatment
  18. Planning and evaluation Two of our providers have both gambling and A&D branches in their organizations The issue: minimal overlap/communication Piloting GBIRT and mentors at one organization (VOA), not the other (Cascadia, control group) Also piloting mentors at A&D-only organizations
  19. Examining the need Conducted gambling attitude and knowledge surveys at VOA among all consenting staff and clients to establish baseline, Dec. 2014 Questionnaire adapted and expanded from Lori Rugel’s GBIRT evaluation, available online. Similar baseline conducted at Cascadia, Mar. 2015, for comparison (data forthcoming) Both organizations tracking the number of identifications and referrals for gambling issues discovered among A&D clients each month
  20. The need 31 staff and 83 clients participated at VOA, with a median time in treatment of 3 to 6 months Results Nearly 90% of clinical staff indicated that they had spoken with clients about gambling problems before; however, only 34% of clients recalled their counselor ever mentioning it. Clients for whom this would not be relevant may have difficulty remembering; however, this also held for active gamblers—one-third of those who gambled at least once a month reported never having been asked about it before. Nearly 22% of clients gambled at least once a month; 10% gambled weekly or more.  Games of choice: in-person machine games (such as slots and video poker) and lotteries (such as PowerBall and scratch tickets) were the top two games among weekly to daily gamblers.
  21. The need Results, continued Knowing where to get help for gambling problems: while 100% of staff reported of available resources they could access if they needed help, only 60% of clients did (despite receiving treatment at an organization with a gambling program). Ready to help: staff were near-neutral on their self-perceptions of their ability to help clients with gambling issues, as well as on if a client would feel comfortable coming to them with such an issue. There was some agreement that their department needed to do more to address gambling, as well as acknowledgment that they had heard leadership address gambling as an issue.
  22. The need Results, continued Community impact: over 90% of staff acknowledged that at least one form of gambling had a negative impact on their community; only 35% of clients believed this to be true. In-person machine games, such as slots, keno, or video poker, was identified as the number one problematic type of game. Personal beliefs: clients and staff strongly believed gambling to be as addictive as alcohol or drugs and that it was important to provide professional help, although clients were more neutral on the origins of gambling problems than staff (whether it is a simple result of greed/lack of self-control), and on whether addressing gambling addictions should be as high a priority as A&D addictions.
  23. In summary This baseline shows receptiveness to learning more about gambling and improving outreach, but a lack of comfort among staff with addressing gambling issues, a lack of knowledge among clients as to how harmful it can be, and a disconnect between client and staff knowledge of what assistance is available Thus, room to grow!
  24. 24 Questions
  25. 25 Future Agenda Items APRIL: Quality Improvement Reports- as statewide look and performance based contracting MH clinicians not knowing how to refer and screen Treating gambling addiction and co-occurring disorders Ideas for increasing enrollments
  26. 26