1 Enhancing Helpline Services: Designing and Evaluating Helplines to Improve Access to Treatment for Problem Gamblers and Their Families Presented by The Connecticut Council on Problem Gambling 47 Clapboard Hill Road, Guilford, CT Tamara Petro, M.P.H., Program Director Sarah McClure, B.S., Prevention Educator Marvin Steinberg, Ph.D., Executive Director Barbara Raimundo, CT DMHAS, Problem Gambling Services, Family Intervention Specialist For the NCPG 18 th National Conference on Problem Gambling June 17-19, 2004 Phoenix, AZ
2 Connecticut Council on Problem Gambling (CCPG) CCPG: Private, not-for-profit organization founded in 1980 and located in Guilford, Connecticut Mission: To reduce the prevalence and impact of problem and compulsive gambling on individuals, families, and society Program activities: Helpline, prevention education, intervention, public awareness campaigns, information clearinghouse, legislative advocacy & research
3 Learning Objectives: 1. To learn of an effective model for providing Helpline services 2. To learn the results, processes and instruments of a recent evaluation of CCPG s Problem Gambling Helpline 3. To learn how to use Helpline and evaluation data to strengthen services, including linkages to treatment services
4 Why Evaluate? Provide valuable information: service delivery systems, strengths/ gaps; clients and their needs; advocacy Provides data to support need for services/ programs Tool for continuous quality improvement (CQI) for HL operations, programming Helps to examine and eliminate barriers to access, utilization, etc. Information for staffing: training, development, etc. Substantiate or secure future funding
5 CCPG s Problem Gambling Helpline Flowchart Gambler Significant/ Concerned Other* NO BET (Answering Service) HL Staff Initial Caller HELP!
6 CCPG s Problem Gambling Helpline Referral Services Network Self-help/ Support Clinical Treatment Caller In Distress Call HL again Other services
7 EVALUATION: Service Delivery Points Gambler Caller s overall Satisfaction w/ timeliness, staff, services? S.O. Overall Satisfaction w/ timeliness, staff, service? NO BET Answering Service Satisfaction w/ promptness, response? Ease of locating number? HL Staff Satisfaction w/ promptness, acceptance, support, helpfulness, knowledge?
8 EVALUATION: Service Delivery Points Self-help/ Support Offered? Type (GA or Gam-Anon), utilization, helpfulness, barriers? Still receiving help? Why/ why not? Clinical Treatment Offered? Location, utilization, helpfulness, barriers, other TX? Still receiving help? Why/ why not? Caller (PG or SO) Degree of amelioration of problem -Time spent? -Perception of problem? -Any changes? -And Why? Call HL again Other services Referrals for pervasive or new concerns?
9 METHODOLGY N=100 (59 / 41 ) Calls between April and Sept Initial calls were 3-5 months (max.) prior Each completed call represents 3-4 attempts to reach live caller 120-item survey Interviews min. ea. Qualitative and Quantitative data Indicators at most service delivery points Both Process and Outcome indicators
10 METHODOLGY Evaluation (N=100) Gamblers Significant Others
11 METHODOLOGY Spouse Parent Friend Adult Child Relative Other Sibling 0 Significant Others (N=30)
12 EVALUATION RESULTS: Satisfaction with Services INITIAL CONTACT 1-800# (Ans. Service) 98% of callers found HL number easy to find 95% reported call answered promptly HELPLINE STAFF 98% reported staff were accepting and supportive 98% said staff seemed knowledgeable 98% said staff made helpful suggestions 98% satisfied with operator s response 52% of calls returned w/in 0-15 min; 30% w/in 1 hr.
13 Satisfaction with Services 93% Satisfied to very satisfied with overall HL service 96% Satisfied to very satisfied with amount of information asked 95% Felt questions were related to very related to their concerns at time of call
14 Where help was initially sought for Gambler 60% 50% 51% Don't know 40% 38% Did not seek 30% 20% 29% 28% 24% 25% State-sponsored TX GA 10% 0% 3% Asked All 5% Asked Gambler Other TX
15 Where help was initially sought for S.O. 70% 67% 60% Don't know 50% Did not seek 40% 30% 20% 18% 18% 31%30% State-sponsored TX Gam-Anon 10% 0% 9% 3% 4% Asked All Asked S.O. Other TX
16 Those still receiving help at F/U 30% 25% 29% 25% 20% 15% 10% 17% 12% 10% GA State Tx Other Tx Gam-Anon 5% 3% 0% Gambler S.O.
17 Reasons Why Not Still Receiving Help (GA) Moved Not comfortable Never got there but tried Has kids/ can t get to meetings Problem not that bad Doing better/ feeling better No time Not helpful, not a group person Doesn t need help any longer
18 Reasons Why Not Still Receiving Help (Gam-Anon) Didn t find it productive Joined Al-Anon instead Husband refuses to go, so she doesn t go Distance & low-turnout at meeting Concentrating on marriage counseling Very unsupportive; a lot of times no one showed Stopped over the summer
19 Reasons Why Not Still Receiving Help (State-Sponsored TX) Gambler Didn t make it Too far Has kids Stopped gambling No time Don t need help any longer S.O. Seeing a social worker Didn t need it. Son moved out-of-state
20 Reasons Why Not Still Receiving Help (Other TX) Gambler Kids Wasn t helpful They didn t get it S.O. No reasons indicated, but other sources named: Individual or couple s counselors/ psychologists/ therapists
21 Perception of Barriers to Accessing & Utilizing Assistance (Gamblers) Barrier* GA State TX Other TX Distance 83% 80% 94% Transportation 97% 87% 100% Confidentiality 100% 93% 100% Hours 86% 100% 100% Family Support 100% 100% 100% Cost N/a 93% 83% *Percentages of those who responded Not difficult
22 Perception of Barriers to Accessing & Utilizing Assistance (S.O.s) Barrier* Gam-Anon State TX Other TX Distance 63% 80% 100% Transportation 75% 80% 100% Confidentiality 100% 100% 100% Hours N/a? 100% 100% Family Support 88% 100% 100% Cost N/a 100% 89% *Percentages of those who responded Not difficult
23 Degree of Amelioration: Time spent gambling now 70% 60% 61% 50% 40% 30% 20% 30% 25% 22% 22% 25% Not at all Much less Slightly less Same Don't know 10% 0% 4%4% Gambler 6% S.O.
24 Degree of Amelioration: Perception of problems now 70% 69% 60% 50% 40% 30% 20% 10% 0% 23% 7% 1% 0% Gambler 29% 19% 16% 16% 13% S.O. Much better Somehwat better Same Somewhat worse Much worse Don't know Refused
25 Linkages to Other Services 26% of callers (All) had concerns for which they requested more assistance: 4- Clinical Tx 2 -Credit Counseling Service 3 -More Literature 1 -Legal Services 9 -To call the Helpline again
26 Perceptions of the Evaluation as a F/U call: Approved of a f/u call: 98% said yes Most approved of call, Felt some one cared about their problems, It helped them Preferred timing of the f/u call: 17% said sooner 80% now is a good time 2% said later
27 Results: Summary of HL Evaluation The majority of callers found the HL services to be highly satisfactory. Barriers to access and utilization for treatment and self-help were minimal in the sample. Perceived barriers, and individual s stage of change or readiness, seem to play a larger role in utilizing services and recidivism. There seem to be differences between gamblers and SOs in service utilization, that have implications for programming and coordinating the spectrum of services.
28 Results: Summary of HL Evaluation SOs of gamblers in the sample reported lower rates of utilizing treatment and self-help/ support services than did gamblers, and SOs reported higher rates than gamblers of using other forms of treatment. Gamblers in the sample reported higher degrees of amelioration of the problem than SOs at time of eval. Disparities highlight the importance of services for families/ SOs as well as those for problem gamblers.
29 Limitations & Considerations Sample size Data collection & methodology Self-reporting bias Recall bias Time Extrapolation
30 Recommendations & Conclusions Data: -Collection tool should stand by itself in the information it provides -Establish indicators across all service areas Evaluation: -Build into the program planning stage if possible -Review tools, methodology prior to implementation -Report results and examine indicators and trends -Use as a continuous feedback mechanism -Further HL evaluations should be conducted
31 Recommendations & Conclusions HL Evaluation offers valuable information for: Re-establishing or creating new linkages to the appropriate services Staff training/ development Programming areas Prevention, outreach, support, treatment & advocacy For problem gamblers and families/ SOs (as systems vs. individuals) Addressing the needs of problem gamblers and their families/ SOs where they are at
32 Recommendations & Conclusions HL Evaluation offers valuable information for: Collaboration- along the continuum of services for PGs and their families/ SOs (prevention, treatment, self-help/ support groups and recovery) Sharing information (re: services, client needs, data) Towards a seamless coordination of a variety of needed services Reducing or eliminating barriers at various levels of services Collaborative Studies (I.e., 2004 CCPG/ DMHAS service delivery study)
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