Massachusetts Council on Compulsive Gambling

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1 Massachusetts Council on Compulsive Gambling We understand the problem. We can help. Building, Maintaining and Evaluating the California Gambling Education and Treatment Services (CALGETS) April 11, 2014

2 Building, Maintaining and Evaluating CALGETS Timothy Fong and Terri Sue Canale Massachusetts Conference on Gambling Problems April 10-11, 2014

3 Pre-Office of Problem Gambling 1958: Gambler s Anonymous founded in Los Angeles 1980s: Private residential programs 1986: CCPG Founded : Handful of certified gambling providers No federal or state funded support

4 : Office of Problem Gambling Established 2005: Situational Needs Assessment 2005: UCLA Gambling Studies Program Opens 2006: Prevalence Survey 2009: Development/Implementation of Problem Gambling Treatment

5 OPG Mandates Toll-free Telephone Helplines Training Health Care Providers, Non-profits, Educators Gambling Industry, Law Enforcement Agencies Empirically Driven Research Public Awareness Campaign Support Treatment Services

6 1-800-GAMBLER problemgambling.ca.gov

7 Who are our Partners UCLA Gambling Studies Program CA Council on Problem Gambling National Asian Pacific American Families Against Substance Abuse NICOS Chinese Health Coalition CA Friday Night Live Partnership OPG Advisory Group

8 OPG and our Partners Developing a Statewide Plan Building Prevention and Treatment Programs for our Diverse Population Maintaining Services Evaluating Service Effectiveness Implementing Changes to Maximize Effectiveness

9 California Prevalence Study (2005) n = 7,121 respondents; 18 years and older Problem gambling: 2.2% Pathological gambling: 1.5% ~1,000,000 problem/pathological cases ~9,000 14,000 seek treatment Highest Risk: African-Americans Disabled Unemployed

10

11 Freedom from PG Workbook Self Help Workbook Developed by UGSP Empirically Tested Not a substitute for professional help Available in 20 languages other than English 11

12 California Problem Gambling Treatment Services Program (CPGTSP) ( ) California Gambling Education and Treatment Services (CalGETS) (2014 Present)

13 Provider Training

14 Training Activities 510 individuals have completed the 30-hour Phase I Training. Five Phase II trainings (6-hour) were provided to authorized providers as of June As of June 30, 2013, there were 235 licensed, authorized outpatient providers and 636 supervision hours had been delivered.

15 Treatment Services Network

16 Problem Gambling Telephone Interventions (PGTI) GAMBLER (English, Spanish, AT&T Translation 200+ Languages) (Asian Languages) Weekly sessions over the phone Staffed by licensed trained therapists Goal is to engage and transition to outpatient treatment Gamblers and Affected Individuals 673 clients treated (02/2014)

17 Outpatient Provider Network 210 authorized providers MFT, LCSW, PhD Ongoing monitoring/support Therapeutic freedom Treatment blocks Access by: helplines or online directory Gamblers and Affected Individuals 4,649 clients treated (02/2014)

18 Intensive Outpatient Program 3 days/week for 4 weeks (12 days) Comprehensive, integrated treatment Separate gambling-specific treatment Utilizes evidenced-based care Referrals from/to OP and RTC Operates in Los Angeles Beit T Shuvah Right Action Program Gamblers Only 113 treated (02/2014)

19 Residential Treatment Provide highest level of care for most severely ill 30 days of treatment, >15 hrs./week Integrated treatment with SUD Located in Los Angeles and San Francisco Beit T Shuvah: Health Right 360: Gamblers Only 193 treated (02/2014)

20 Intensive Outpatient/Residential 20

21 Clinical Innovations at UCLA Efficacy of manualized treatment and determine best practices Enhancing effectiveness of counselors in providing treatment Mindfullness for problem gambling Manualized therapy for romantic partners of PG 140 participants (02/2014)

22 Program Maintenance Provider Annual CEU Requirement Yearly Summit Phase I & II Training Events Supervision Compliance Monitoring Reviews Stakeholders Meeting

23 Treatment Program Goals

24 Treatment Program Goals Goal 1: Provide training to counselors and therapists in treating problem and pathological gamblers and affected individuals

25 Treatment Program Goals Goal 1: Accomplishments Phase I and II Training Events Online Training Annual Statewide Problem Gambling Summit Telephone Supervision Network

26 Treatment Program Goals Goal 2: Execute the delivery of the stepped-care approach for a continuum of treatment services for problem and pathological gamblers and affected individuals

27 Treatment Program Goals Goal 2: Accomplishments Launched Treatment Components Problem Gambling Telephone Interventions Outpatient Treatment Network Intensive Outpatient Program Residential Treatment Program Clinical Innovations

28 Treatment Program Goals Goal 3: Establish and evaluate CPGTSP client recruitment and retention tools

29 Treatment Program Goals Goal 3 Accomplishments Developed standardized forms across all treatment components Utilized a Data Management System (online) Revised clinical forms with input from all stakeholders Annual Provider Survey Regular program feedback and quality assurance activities

30 Treatment Program Goals Goal 4: Convert CPGTSP pilot into permanent program

31 Treatment Program Goals Goal 4: Accomplishments Increased visibility of CPGTSP Met with legislative staff to determine program funding needs Additional funding sources identified (Internet poker)

32 Treatment Program Goals Goal 5: Identify treatment services best practices

33 Treatment Program Goals Goal 5 Accomplishments: Annual Treatment Report Legislative Report Stakeholders Annual Meeting National Conferences Compare with other States (APGSA)

34 Treatment Program Evaluation

35 Early Treatment Indicators Report (7/09-6/13) Characteristics of CPGTSP Clients Treatment Utilization Treatment Impact Client Feedback about the CPGTSP Characteristics of CPGTSP Providers

36 Treatment Program Data Large database on gamblers and affected individuals Some time required for the database to mature Capabilities of the data management system are still being explored Data collection processes

37 CalGETS Providers

38 2013 Provider Survey n= 208

39 2013 Provider Survey Degree MFT 135 (66%) LCSW 28 (14%) PhD 15 (7%) PsyD 10 (5%) MSW 4 (2%)

40 2013 Provider Characteristics Ave. number of years of licensure: 12 Clients are seen by providers in a relatively short amount of time: 1-2 days Majority (61%) of referrals: GAMBLER

41 Treatment Modalities Cognitive Behavioral Therapy (89%) Relapse Prevention (81%) Client-Centered Approach (75%) Motivational Interviewing 12-step Mindfulness

42 CalGETS Evaluation

43 CalGETS Treatment Component Number of Clients PGTI (English or Spanish) 176 PGTI (Asian Languages) 16 Outpatient 1072 Intensive Outpatient 30 Residential 44

44 Change in NODS Scores for Outpatients Variable N Mean SD At Intake Paired t Test Value Pr > t At End of Treatment Difference <.000 1

45 Highlights from Early Treatment Indicators Report Across all treatment components: Reduction in PG symptoms, gambling behavior, and the harm caused by gambling CPGTSP clients met 8 out of 10 DSM-IV criteria for pathological gambling Preferred form of gambling across all clients was slot machines, followed by casino table games

46 Highlights from Early Treatment Indicators Report AIs were mainly spouses or partners of gamblers AIs spent less time in treatment than gamblers More sessions received, better the outcomes Client feedback regarding their experience in the CalGETS was highly positive

47 Predictors to Complete Five or More Sessions Odds Ratio: 56 years or older: 1.79 Graduate / Professional Degree 2.97 Any GA Attendance 1.84

48 Very large sample Data Strengths Capturing information at point of entry Tracking in-treatment information Overlapping data points across forms Universal forms allow some comparisons across treatment modality Broadness of data collection can generate questions for in-depth study

49 Lessons Learned 1. Invest in quality assurance practices 2. Empower workforce to take ownership 3. Providing ongoing supervision is critical 4. Clients using Internet for main source of information 5. Continually involve stakeholders

50 Lessons Learned 6. Add 30% time to administrative changes / policies 7. Evaluate outreach techniques 8. Treatment supply and demand fluctuates rapidly 9. Prepare for unexpected events in advance by having flexibility in administration and operations 10.Reduce healthcare bureaucracy

51 Future Directions Research partners needed! Ongoing quality assurance Increase visibility of CalGETS Seek permanent funding Balance supply and demand Forge more collaborations

52 Contact Information Timothy Fong Terri Sue Canale

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