Break Even Services Gambling Helpline Tasmania 2010 Review

Department of Health and Human Services GAMBLING SUPPORT PROGRAM DISABILITY AND COMMUNITY SERVICES File No.: GHT Review 2010 Break Even Services Gambling Helpline Tasmania 2010 Review

Acknowledgements Acknowledgements The authors would like to thank all of those who have contributed to the evaluation of the Gambling Helpline Tasmania, in particular staff from Anglicare and Relationships Australia Tasmania, and Simone Rodda of Turning Point HealthLink management. Glenn Mitchell John Sexton February 2011 NOTE: There have been a number of initiatives addressed in the months after the consultants completed their submissions. Editorial comment from Gambling Support Program (GSP) on these items is included in square brackets [ ]. Page 2 of 69

Contents A. Background and overview of the services Acknowledgements 3 Executive summary 6 A. Background and overview of the services 8 Page 3 of 69 Provision of information and services by the Break Even network 10 Tasmanian gambling prevalence figures 11 Awareness of gambling services 12 Interstate Comparisons, Long Term Trends 13 Why people seek help 18 Barriers to help-seeking 24 B. Review of operations 26 Services available to those affected by gambling 27 Service take-up 29 Referral pathway and flow of referrals 30 Service complaints 33 Mystery shopping 36 Turning Point s credentials 38 Summary of client outcomes and Helpline effectiveness 40 New complementary service Gambling Help Online 42 Recommendations 44 C. Communications review 48 1. The communication challenge 50 2. Promotional vehicles currently in use to promote gambling services and the Helpline 52 Who are these promotional vehicles intended to influence? 58 3. Survey of the target audiences 60 Primary target audiences 66 Young people 67 Source of referrals to the Helpline 68 Referral source to Break Even counselling (not including Helpline) 69 4. Conclusions and recommendations 71 Summary of conclusions 76 References 77 Appendices 79 1. Request from Treasury to undertake a review of the Helpline 48 2. Service Agreement with Gambling Helpline Tasmania and the Crown 49 3. Project Brief Review of operations 58 4. Project Brief Review of promotion 63 5. Stakeholder discussion 68

A. Background and overview of the services Executive summary This review of the Gambling Helpline Tasmania was undertaken between May and September 2010 and responds to the Treasurer s request of 17 July 2009 to the then Minister for Human Services Lin Thorp to review the effectiveness of the gambling helpline service (Appendix 1). The review was undertaken in two distinct components (operations and communications) and two separate specialists were engaged. Glenn Mitchell, the Program Manager of Quit Tasmania, was appointed to consider the operational side of the telephone Helpline and John Sexton, an expert in change communications, was appointed to handle the communications component. The Gambling Helpline Tasmania is a free, state-wide, 24/7 telephone counselling and referral service. The current contract is with Turning Point HealthLink (operating out of Victoria) and currently costs $140,750 per year. The Gambling Helpline Tasmania is a key component of the Break Even network, which also includes: personal and family counselling; financial counselling; and facilitated group support. These components are provided by Anglicare (in partnership with Relationships Australia Tasmania). Gambling Help Online, offering comprehensive self-help and counselling via email or chat facility (also provided by Turning Point HealthLink). Contractual arrangements between Turning Point and the Crown are set out in a funding service agreement attached to this report (Appendix 2). This covers such items as service description, operational requirements, standards, the referral process and reporting requirements. The operation of the Helpline appears to be satisfactory in terms of volume of calls, quality of service, access to the service and client outcomes. There are areas for potential improvement however: a call-back facility would offer the client ongoing contact with a counsellor to offer support and encouragement during the initial stages of making changes; ongoing sessional telephone counselling would provide flexible and free therapeutic counselling to eligible callers; introduction of a text 4 help service would enable a client to send a text message to receive a call back from a counsellor, thereby minimising mobile phone call costs for the client; mystery shopping at regular intervals would assist with ongoing quality assurance; and the Yellow Pages online advertisement should be updated with the new number (even though the old number is still operable). The marketing of the Helpline is also generally satisfactory, but simpler messages, and Helpline material being better available, particularly in casinos, are issues for consideration. Key recommendations are: messages could be more consistent to address the key demographic; messages and branding could be simplified to encourage easier acceptance; the Helpline could be positioned as the initial point of contact and should be better integrated with the other Break Even services; targeted advertising and take away cards in public and venue conveniences (toilets) should be considered; and The casinos could be encouraged to be more proactive with harm minimisation. Page 4 of 69

A. Background and overview of the services A. Background and overview of the services Under the Gaming Control Act 1993, a percentage of the Community Support Levy (CSL) is allocated to the provision of services for people affected by problem gambling. This includes funding for support services such as professional counselling, group support and a gambling Helpline. The Gambling Helpline Tasmania provided by Turning Point provides a free, state-wide, 24/7 telephone counselling, information and referral service. The current contract is for 1 July 2007 to 30 June 2011 and costs $140,750 p.a. (not including GST). The request from Treasury to review the effectiveness of the Helpline is based on the apparent falling away of Helpline awareness. However the request is in terms of review the effectiveness of the Helpline service rather than review the effectiveness of the publicity of the Helpline service. The Social and Economic Impact Study into Gambling in Tasmania 2008 (SEIS study) reported: A potentially concerning result from the 2007 Tasmanian prevalence survey was a significant decrease in people s awareness of services or sources of help as compared with the 2005 results. 1 As can be noted in the table below, awareness of the Helpline fell from 68% in 2005 to 58.3% in 2007. From Table 12.1 in the SEIS study: Awareness of Help-services 2 The request from Treasury is to review the Helpline and not the whole suite of Break Even services (although Gambling Support Program staff are aware of the need to periodically review these). 1 South Australian Centre for Economic Studies, 2008, Social and Economic Impact Study into Gambling in Tasmania 2008, pg. 185. 2 South Australian Centre for Economic Studies, 2008, Social and Economic Impact Study into Gambling in Tasmania 2008, pg. 186. Page 5 of 69

A. Background and overview of the services Provision of information and services by the Break Even network The components of the Break Even network are illustrated below. Referrals travel between the different services with the majority coming from the Helpline to the face-to-face counselling services. Telephone Helpline Information Initial contact for many Counselling and support Break Even services Face-to-face services Therapeutic counselling Facilitated group sessions Financial counselling Some community education Gambling Help Online Self-help Counselling via email or chat The Helpline is currently operated out of Victoria and the possibility of having a Tasmanian service is frequently raised by the community sector. The cost of running a 24 hour service with Tasmania s volume of calls makes it prohibitively costly to place the operation locally and there is limited choice for suitable partners. Turning Point achieves economy of scale by handling the gambling helplines for Tasmania, Victoria, Queensland and the Northern Territory, along with the national service of Gambling Help Online. The phone software is capable of identifying the state of the callers, ensuring the counsellor can answer calls with Gambling Helpline Tasmania. As there are two distinct components to the review (operational and communications), two separate specialists were engaged and their respective briefings are attached (See Appendix 2). Glenn Mitchell, the Program Manager of Quit Tasmania, was appointed to consider the operational side of the telephone Helpline. This includes such things as: a literature review; reporting against the service agreement; and a review of the services and approaches within other jurisdictions. John Sexton was appointed to handle the communications component. He has expertise in social marketing and has worked on gambling-related projects in the past (including the development of gambling fact sheets and production of the booklet Your Guide for Safer Gambling). Page 6 of 69

A. Background and overview of the services Tasmanian gambling prevalence figures The 2007 prevalence survey that comprises part of the Social and Economic Impact Study into Gambling in Tasmania 2008 (SEIS) determined the prevalence of people experiencing gambling-related problems or who might be at risk of experiencing such problems. The SEIS survey found that 0.86% of the adult population in Tasmania are in the moderate risk group; and a small proportion of the population, 0.54%, are experiencing problems due to gambling and fall into the problem gambling group. This equates to 3113 and 1955 Tasmanian adults respectively. 3 The total number of moderate risk plus problems gamblers is 1.4% of the adult Tasmanian population, equating to 5068 Tasmanians. It is important to note that the Productivity Commission estimates that for every problem gambler, between five to 10 other people are adversely impacted. 4 The survey utilised the Canadian Problem Gambling Index (CPGI). A description of this instrument is provided below: Canadian Problem Gambling Index (CPGI). The CPGI was developed specifically for use in epidemiological surveys by Ferris and Wynne (2001) although its content reflects a mixture of the previously used South Oaks Gambling Screen (SOGS) and the DSM-IV classification for pathological gambling. Although it is not without its limitations, it has been endorsed as the best currently available measure by Gambling Research Australia (Neal, Delfabbro, & O Neil, 2006) and has been used in almost all recent Australian prevalence surveys. The CPGI is a 9-item scale. For each item, respondents are asked to indicate how often the statement applied to them in the previous 12 months, where 0 = Never, 1 = Sometimes, 2 = Most of the time, and 3 = Always. Scores can range from 0-27, with scores of 0 indicating no risk, 1-2 low risk, 3-7 moderate risk, and 8+ high risk or problem gambling. Respondents classified as non-gamblers or non-regular gamblers are not required to complete this component of the survey and thus do not record a score. 5 Awareness of gambling services The SEIS report 6 found that most gambling support services enjoy a moderate level of awareness amongst the Tasmanian population, namely: overall, the Gambling Helpline Tasmania was the most well-known gambling support service by adult Tasmanians, with just over a quarter (26%) aware of the service; the proportion of Tasmanian adults who were aware of gambling counsellors at various services such as Anglicare, Relationships Australia, or Group Support at Gambling and Betting Addiction (GABA), was similar to the Gambling Helpline Tasmania, with a quarter aware of this support service; only 15% of Tasmanian adults considered family and friends as a potential source of help; a low number (12%) of Tasmanian adults considered a doctor or physician as a potential support service for gambling problems; and only 3% of the Tasmanian adult population were aware that they can ask an employee at a gambling venue for help. 3 Calculated on data from the ABS 2006 Census figures for the adult population and the SEIS prevalence rates. 4 Productivity Commission, 1999, Australian s Gambling Industries, pg. 23. 5 Prevalence Study Fact Sheet 1: Group Classifications, based on material from the Social and Economic Impact Study into Gambling in Tasmania 2008. Published by the Gambling Support Program, DHHS. 6 Prevalence Study Fact Sheet 5: Adverse consequences of problem gambling, help seeking knowledge and behaviour, based on material from the Social and Economic Impact Study into Gambling in Tasmania 2008. Published by the Gambling Support Program, DHHS. Page 7 of 69

A. Background and overview of the services Interstate Comparisons, Long Term Trends The Productivity Commission Report into Gambling 2010 considered gambling services in Appendix J. Section J2 covered Gambling Help Calls, and it is reproduced here. Gambling help calls Gambling helplines are an important first port of call for people experiencing problems with gambling. The helplines provide 24 hour services including referrals, counselling and support for people experiencing problems with gambling. In 2007-08, there were around 31 000 calls made to gambling helplines in Australia. The majority of callers were from the target group (gamblers, family and friends, table J.1). In Tasmania, around 77 per cent of target group callers to the gambling helpline were first time callers. Table J.1 Gambling Helpline, 2007-08 NSW Vic a Qld SA WA Tas ACT NT c Total Target callers Nontarget callers Total calls 6757 - - 1536 885 536-52d 4789 - - 641 b 536 404-64e 11 546 11 153 3376 2177 1421 940 266 116 30 995 a Includes 183 contacts associated with the RTC program. b Includes prank calls, hangups, wrong numbers.. c Includes only calls made outside normal business hours. d Gambling related calls (counselling, information or referral). e Calls answered. Data sources: RGF Annual Report 2007-08, Lifeline Canberra Annual Report 2007-08, Lifeline Canberra (sub. 123), Gambling Helpline Tasmania, Annual Report 2007-08, data provided by state and territory governments. In a number of jurisdictions (New South Wales, Victoria, Queensland and South Australia), calls to the gambling helpline have trended downwards in recent years (figure J.1). The total number of calls to the gambling helpline in New South Wales, for example, almost halved over the period 2002-03 to 2008-09 (over the same period the target group calls declined from over 13 000 to around 6 400 calls). The Victorian Government, commenting on the decline in calls to the Gambler s Help Line in that state (where the total number of calls declined from around 19 000 in 2002-03 to around 11 000 in 2008-09), said: It is difficult to accurately identify the reasons behind the reduction in calls to the Gambler s Help Line. This trend may be attributed to a number of factors, including (but not limited to) a decline in the number of people requiring problem gambling services in Victoria, a decline in help-seeking of problem gamblers, a larger cohort of problem gamblers seeking alternative sources of assistance and/or gamblers displaying natural recovery from their gambling issues. (Victorian Government, sub. 205, p. 74). Page 8 of 69

A. Background and overview of the services Figure J.1 Trends in gambling helpline calls a For Tasmania calls are target group calls only. Data sources: RGF Annual Reports, data provided by State and Territory Governments. In Western Australia, the number of calls to the gambling helpline more than doubled over the period 2001-02 to 2007-08. In Tasmania, the number of target group calls to the gambling helpline declined from over 700 calls in 2002-03 to around 320 calls in 2005-06 before increasing to almost 540 calls in 2007-08 (figure J.1). While it is tempting to try and compare rates of calls against the adult population, or even against the gambling expenditure in the various states, there are other variables which make comparisons difficult. Problem gambling prevalence rates are different among the states and as well the rate changes over the years. Another difference is how states promote their services, and yet another is the overall level of promotion. In Victoria in recent years, the Helpline has been promoted as the single entry point for both immediate help and counselling assistance. In Tasmania, both the counselling services and the Helpline have been promoted more equally and prospective clients can choose where they would like to enter the service. In the Victoria we would expect relatively higher calls to the Helpline than in Tasmania. In Tasmania monthly figures are available from 2001 to date. The long term average calls is approximately 400 calls per year. The graph below shows calls steadily building in the 2001 to 2003 phase, peaking in conjunction with a large awareness campaign run in mid-2003. This campaign utilised successful Victorian television commercials and created both awareness of gambling issues and a flow of clients to the Helpline and the counselling services that lasted well into 2004. The period 2004 to 2007 inclusive produced a relatively lower flow of calls. In mid-2008 there was a new peak, for which both Turning Point and Gambling Support Program have no ready explanation. That was followed by a more volatile pattern of flows, and in 2010 the calls fell away as did both gaming machine expenditure and the number of counselling sessions handled by the Break Even services. The introduction of smoking bans in gaming areas in February 2005, and in hotels generally in February 2006, both resulted in increasing calls for the next months. However there is no notable driver for the mid- 2008 spike which may be an anomaly. Nor did the Rudd Government stimulation package of December 2008 result in any logical change in the pattern. Overall, calls to the Tasmanian Helpline can be characterised as changeable, with the obvious exception being the 2003 awareness campaign which may have motivated a group of problem gamblers to become aware of the nature of their difficulties, and that help was available. After that key event, the flow settles to a lower rate in the medium term. Lastly, in 2010 gaming machine gambling may be on the wane, with problem gambling falling away as well. Page 9 of 69

A. Background and overview of the services Clinical Calls to the Gambling Helpline Tasmania 100 Total Calls (first time and repeat calls) 90 80 70 60 50 40 30 20 10 0 Apr-01 Jul-01 Oct-01 Jan-02 Apr-02 Jul-02 Oct-02 Jan-03 Apr-03 Jul-03 Oct-03 Jan-04 Apr-04 Jul-04 Oct-04 Month - April 2001 to December 2010 Jan-05 Apr-05 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Page 10 of 69

A. Background and overview of the services Why people seek help Data in the following table and graphs is based on data from the Gambling Helpline Tasmania Annual Report 2008-09 provided by Turning Point. The table below highlights the reasons for calls to the Helpline (more than one reason for the call may be recorded per caller). Reason/s for call 7 Presenting issue/reason for call No. % Gambling problem 280 58.9% Agency information/referral 168 35.4% Information 128 26.9% Financial 70 14.7% Interpersonal problems (relationships, etc) 70 14.7% Personal problems (anxiety, depression, etc) 38 8.0% Self exclusion 34 7.2% Leisure-related issues 13 2.7% Employment/work-related issues 10 2.1% Welfare/material aid 7 1.5% Legal 4 0.8% Suicide 4 0.8% Other 13 2.7% n=839 (presenting issues) n=475 (client population) A total of 280 callers requested immediate assistance in managing a gambling problem, 168 requested agency information or referral and 128 callers requested information related to a gambling problem. A total of 249 callers were provided with immediate brief intervention counselling and support responses from the Helpline (52.6%), 288 callers were referred to treatment and support services (60.9%), and 201 callers received verbal gambling related information and/or education (42.5%). 8 Page 11 of 69 7 Gambling Helpline Tasmania Annual Report 2008/09, Turning Point, p. 14. 8 Gambling Helpline Tasmania Annual Report 2008/09, Turning Point, p. 15.

A. Background and overview of the services Impacts of problem gambling 9 Where one or more consequence associated with the gambling behaviour was reported (n=275), the majority of callers reported financial concerns as a significant factor (88.7%). Approximately 55% of callers reported impacts in relation to family, relationships and/or social functioning associated with the gambling issue. Other Medical/health Legal Employment Mental health % experiencing consequence Leisure/recreation Family/r'ship/social Financial 0 20 40 60 80 100 % Source of referral 10 The most commonly cited source of referral to the Helpline was information provided in telephone books and/or other directories (35.1%). Thirty-nine callers reported sourcing gambling referral information from a venue notice/poster (13.7 %) and information provided by family and friends was reported in 37 contacts (13%). Other Television Other professional Casino staff Support services Gaming venue staff Brochure/card Gambler Family/friends Poster/venue notice Directories/phone book 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Page 12 of 69 9 Turning Point, 2009, Caller Profile in Gambling Helpline Tasmania Annual Report 2008/09, pg 16. 10 Turning Point, 2009, Source of Referral in Gambling Helpline Tasmania Annual Report 2008/09, pg 17.

A. Background and overview of the services Caller profile 11 Of 479 calls to the Helpline that involved a gambling-related concern in 2008/09, 311 calls were received from a gambler concerned about their own gambling, 120 calls were from a family member concerned about the gambling of another and 35 calls were from health professionals. Health professional Other 7% 3% Significant other 25% Gambler Significant other Health professional Other Gambler 65% Interestingly, significant others are far more likely to use the Helpline than face-to-face counselling. As can be seen in the chart above, approximately one quarter of all gambling concern related calls to the Helpline in 2008/09 were from significant others. In contrast, only 15.4% of clients using Break Even services from July 2000 to June 2007 were significant others. 12 This indicates that this group is significantly more comfortable dealing with issues via the telephone, probably due to the widespread stigma associated with gambling. Gender Males Females Females 265 55% Males 214 45% In 2008/09, 55% of calls to the Helpline were female and 45% were male, representing 214 males and 265 females. 13 This is comparable to the gender mix of the Break Even client group (where men accounted for 43.3% and women 56.7% between July 2000 and June 2007). 14 11 Turning Point, 2009, Caller Profile in Gambling Helpline Tasmania Annual Report 2008/09, pg. 10. 12 DHHS, Client Type in Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007, pg. 2. 13 Turning Point, 2009, Caller Profile in Gambling Helpline Tasmania Annual Report 2008/09, pg. 10. 14 DHHS, Client Type in Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007, pg. 1. Page 13 of 69

A. Background and overview of the services Barriers to help-seeking A number of barriers were identified that prevent gamblers from seeking help or accessing gambling services. The ACT Gambling and Racing Commission offers the following insights. Perceived shame and the stigma associated with problem gambling have been major barriers to seeking help for gambling problems. On an individual basis, gamblers described the shame associated with not being able to control their own actions and being weak-willed. The stigma associated with counselling appears to be a significant barrier which discouraged many self-identified problem gamblers from seeking help from a counselling service. Counselling was perceived by some to imply personal weakness. Common themes expressed by both gamblers and their families were the need for personal rapport between the counsellor and client, and for a more personal approach to their specific problems. Several expressed the view that counsellors lacked a practical understanding of the problem or that proposed solutions were unrealistic. In addition, families often felt excluded from the helping process and experienced difficulties in locating help for the family member who was experiencing gambling problems, as well as for themselves. 15 This same study concluded that people seek help due to significant financial or relationship stresses. Self-identified gamblers were more likely to seek help due to financial stresses while family members cited both financial and relationship stresses. Blaszczynski et al assert that most problem gamblers enter treatment due to a crisis such as debt, depression or feeling suicidal. 16 While the stigma attached to problem gambling seems to be the key reason that people do not seek assistance, another reason for problem gamblers not seeking help (despite wanting help) was that they believed they could solve the problem by themselves. Embarrassment/shyness was similarly reported as a further reason by problem gamblers. 17 It is these barriers to help-seeking that are responsible for the low proportion of problem gamblers who access professional treatment. A changing world The Gambling Support Program anticipates changes in the gambling world. 2010 saw a decline in EGM expenditure and an associated marginal decline in the take-up of counselling services; The reforms centred around mandatory pre-commitment suggested in the Productivity Commission Report into Gambling 2010 are now the subject of political discussion and action; and Online gambling is a looming issue. However, there are always new recruits to the gambling world, and a percentage of these will always use gambling as a form of self-medication or a mode of escaping from overwhelming issues. Page 14 of 69 15 ACT Gambling and Racing Commission, October 2004, Help-Seeking by Problem Gamblers, Friends and Families: A Focus on Gender and Cultural Groups. 16 Blaszczynski, Walker, Sagris & Dickerson, 1999, Psychological aspects of gambling behaviour: An APS position paper. Australian Psychologist, vol 34: 1, pp. 4-16. 17 Department of Justice, Victoria, 2009, A Study of Gambling in Victoria Problem Gambling from a Public Health Perspective Fact Sheet 15: Help Seeking Behaviour.

B. Review of operations B. Review of operations The scope of the operational review is to: (i) Undertake an appraisal of the Gambling Helpline Tasmania based on an evaluation of the current services and a comparison with other gambling and non-gambling Helpline services. Areas for consideration include: (a) existing contractual specifications requirements (see Appendix 2 for a copy of the current service contract); (b) client outcomes; and (c) best practice evidence of effectiveness. (ii) Make recommendations on future direct service delivery adjustments or re-modelling, if indicated. Areas for consideration include: (a) eliminating real or perceived barriers for future clients to access service delivery; and (b) positioning of the Helpline in an integrated service response which meets a range of diverse clients needs along the continuum of gambling behaviours which may include: risk awareness; emergency support; financial advice; legal advice; and counselling. Page 15 of 69

B. Review of operations Services available to those affected by gambling There are currently a number of services available to consumers to receive information and advice about problem gambling. Break Even network The Break Even network is a community-based service that is funded through the Community Support Levy and provides programs to people who are affected by gambling, including people who gamble, their families and friends. The programs delivered include face-to-face counselling and are located in major centres around Tasmania. In Tasmania, Anglicare is contracted to provide face-to-face counselling in major centres around the State and to respond to the referrals from the Gambling Helpline Tasmania. Anglicare works closely with Relationships Australia to provide this service. In 08-09 the Break Even service received 421 new client contacts, compared with 385 in 07-08 and 350 in 06-07. 18 Gambling Helpline 1800 858 858 The Gambling Helpline Tasmania is a free crisis counselling and referral service that is available to all Tasmanians. Qualified counsellors are available on the Helpline 24-hours a day, 365 days a year. The Helpline number was changed in August 2009 (previously 1800 000 973). The old number is still operable and will continue to be so for at least another two years. The Helpline can provide direct crisis counselling, ongoing support, and accurate and appropriate information (verbal written or online), as well as assistance in referring on to one of the Break Even network services at a local level (Anglicare or Relationships Australia). The Helpline is not only for gamblers, but also for those affected by someone's gambling such as family and friends. Although the service is free to access from a landline, access from a mobile phone would incur an additional cost to the caller. Currently inbound calls, those initiated by the caller, are the only mechanism for people to be able to speak with a counsellor through the Helpline. The current service delivery is provided by Turning Point. This includes the Gambling Helpline (1800 858 858) and Gambling Help Online (www.gamblinghelponline.org.au). Turning Point is based in Victoria and has been contracted to provide the service under an agreement with the Tasmanian State Government since July 2007. A review of the Gambling Helpline Tasmania s current service standards provided by Turning Point was undertaken as part of this review. Turning Point has an extensive training program that all Helpline staff must undertake. A comprehensive set of policies and protocols exist to guide the staff in handling even the most complicated situations. The contractor's documentation and clinical supervision appears to be adequate to provide the service. While the reporting format from Turning Point appears to not be as detailed as reports provided by the previous contractor, the content of the reports meets the contractual agreement. Page 16 of 69 18 Data from Break Even Annual Reports.

B. Review of operations Service take-up In 2008/09, the Gambling Helpline Tasmania received a total of 479 calls involving a gambling presentation or concern. 19 This compares to 536 in 2007/08. 20 A graph depicting clinical calls to the Helpline for the period July 2006 to August 2010 is provided below. 21 Gambling Helpline Tasmania Clinical Calls Per Month July 2006 to August 2010 90 80 70 Repeat Callers First Time Callers 27 Calls 60 50 40 30 20 10 7 5 11 4 7 12 2 33 31 3 4 28 28 30 22 24 25 27 24 26 26 24 19 20 14 16 14 Jan-08 Dec-07 Nov-07 Oct-07 Sep-07 Aug-07 Jul-07 Jun-07 May-07 Apr-07 Mar-07 Feb-07 Jan-07 Dec-06 Nov-06 Oct-06 Sep-06 Aug-06 Jul-06 1 1 1 5 2 2 2 3 6 7 11 26 19 44 44 41 35 15 59 51 14 18 12 4 3 38 36 33 35 26 7 4 51 45 3 2 6 1 40 1 26 29 27 17 1 18 5 45 42 37 9 7 4 5 2 1 3 4 5 30 34 36 24 18 23 26 23 28 27 31 1 8 Jun-09 May-09 Apr-09 Mar-09 Feb-09 Jan-09 Dec-08 Nov-08 Oct-08 Sep-08 Aug-08 Aug-10 Jul-10 Jun-10 May-10 Apr-10 Mar-10 Feb-10 Jan-10 Dec-09 Nov-09 Oct-09 Sep-09 Aug-09 Jul-09 0 Jul-08 Jun-08 May-08 Apr-08 Mar-08 Feb-08 Month 19 Turning Point, 2009, Gambling Helpline Tasmania Annual Report 2008/09, pg. 4. 20 Turning Point, 2008, Gambling Helpline Tasmania Annual Report 2007/08, pg. 4. 21 Derived from data provided in annual reports from Turning Point and McKesson. Page 17 of 69

Referral pathway and flow of referrals B. Review of operations The referral pathway for the Helpline is illustrated on the next page. The referral pathway for the Quitline is also provided for comparison. When a client contacts the Gambling Helpline Tasmania for either information, advice or a counselling service, the client is also offered face-to-face counselling through referral to the Break Even program. This referral process can be by direct patch (facilitated or warm referral) or the phone number of their closest Break Even service is given to the client to make contact themselves. In late 2009 and early 2010 the performance of the Helpline became uneven in terms of flow of referrals to the services and even in the flow of calls themselves. The face-to-face counsellors at Anglicare and Relationships Australia noticed the change and expressed their concern. The table below provides details. Break Even Service Referrals Helpline to face-to-face counselling Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Direct transfer Total Referrals 3 7 2 2 2 5 31 27 20 15 24 22 Turning Point, the current operator, has not been able to explain why this variation came about. Recent flows have been in line with the long-term pattern. While the Helpline provides clients with the local counselling contacts and considers this action a referral, the number of clients who actually follow through and seek out face-to-face counselling has always been much lower. Page 18 of 69

B. Review of operations Gambling Helpline Tasmania calls, responses and referrals Call to Gambling Helpline Tasmania 24/7 Brief intervention responses Assessment Counselling Information Referral(s) Gambling Helpline Tasmania referral process Standard referral request Facilitated Facilitated referral referral request request or warm(attempts referral. to Attempts link caller to link with caller with face-to-face - counselling) Facilitated referral not offered (e.g. caller unable to provide Informed informed consent) Live transfer request (business hours only) Referral follow- up request (24/7) Email or answering Machine machine message Call transferred successfully Call transfer unsuccessful Standard referral Information information provided Referral follow-up accepted Email or answering machine message Page 19 of 69

Quitline caller flowchart for comparison B. Review of operations Person calls Quitline 13 7848 (13 QUIT) Call answered by telecentre staff Caller may request information Quit pack only Quit pack order taken by telecentre staff Population data is collected (gender, age, postcode, indigenous Indigenous status) Caller is asked again if they would like to speak to an advisor adviser Caller transferred to a Quitline advisor adviser Standard Quit pack A Quit pack can also be tailored to suit a caller s specific needs (i.e. pregnant, youth, mental health etc) Call- back service Prompt call Offered on quit Quit date or in in one week to see if further help is required Page 20 of 69

B. Review of operations Service complaints Most services that deal with people are not without criticisms or complaints, and the Gambling Helpline Tasmania is no different. Two complaints were received by the Gambling Support Program in 2008 and five in 2009. These complaints were detailed in writing by the face-to-face counsellors and emailed to the Gambling Support Program Coordinator to follow up. All complaints were investigated and the outcome responded back to the person who provided the complaint. While any type of complaint can be of concern, there are generally two sides to a story and the replies from the helpline coordinator responding to the emails suggest this. Gambling Helpline Tasmania complaints Year Complaint Details and Response 2008 (2) 1 Response by a counsellor to a caller who had breached their self-exclusion notice was What do you want me to do about it? (or words to that effect). Response from Turning Point The Helpline prioritises addressing all complaints received around service delivery. The standard procedure undertaken is to firstly request IT to complete a search of call records based on the date and time of the call. This allows the service to identify the counsellor involved in the contact so that appropriate follow up can be completed. In conjunction with this, the program coordinator or a senior member of the gambling team reviews the feedback received against Helpline protocols to ensure that counsellors have access to accurate information and are delivering the service as outlined in the protocols. When the counsellor has been identified their supervisor is contacted who then follows up with the counsellor to discuss the feedback and to address any professional development issues. Other senior staff members are informed of any necessary changes in protocols in response to feedback. In this case the counsellor involved was identified and the selfexclusion protocol was reviewed. 2 Caller (Relationships Australia Tasmania representative) was hoping to speak to someone from Gambling and Betting Addiction (GABA) after calling them and being transferred through to the Gambling Helpline and the counsellor did not know who they were (GABA) or what was going on. This is perhaps not surprising: GABA ceased as a Break Even service provider in 2007, but had provided a phone answering message which referred callers onto the Break Even services via the Helpline number. Response from Turning Point Unfortunately this complaint was received following the closure of GABA. In response to this closure, all Helpline resources including the electronic database which is our primary resource used with callers were updated. 2009 (5) 1 Caller was waiting on the line for five minutes and then hung up as no one answered the phone. This caller just heard a recorded message stating that the counsellors were busy. Response from Turning Point The contract stipulates that 70% of telephone contacts be responded to within 45 seconds. Whilst the Helpline endeavours to both meet and exceed this benchmark, there are occasions when the service is unable to respond within this timeframe. Such occasions are generally characterised by unusually high call demand or unforeseen circumstances. Page 21 of 69

To date, we have been able to consistently meet the figure of 70%. B. Review of operations 2 Client reported that the counsellor had an accent and was unable to answer a question regarding third party exclusions in Tasmania, and that they felt unheard. Response from Turning Point On this occasion a follow up was completed with the counsellor involved. The follow up entailed: Counsellor spoken with by Helpline supervisor in regard to feedback received and to ascertain counsellor s experience of the call. The session was used to identify areas for retraining as well as providing an opportunity for the counsellor involved to be debriefed. Follow up conducted by gambling program coordinator. The counsellor involved in this case had extensive experience in both face-to-face and telephone gambling counselling with a particular emphasis on culturally and linguistically divers clients. A strength of the service is that we offer bilingual counsellors and occasionally people find speaking to a person with an accent disruptive, particularly if they are feeling stressed and are seeking a particular outcome. If this occurs there is always the opportunity for the client to speak with a different counsellor. 3. Counsellor not helpful. The client called again the next day to complain to the same counsellor and found it hard to get information out of her. She was not very communicative. Response from Turning Point This complaint was addressed in the supervision session and the program coordinator follow up was outlined in complaint two (2009). 4. Client at risk of relapse and was told that he did not have a gambling problem, but rather a mental problem and to get off the line. Counsellor hung up on him after a few minutes. Response from Turning Point See complaint five, as the response is the same. 5. Same client as described in 4 called again two days later and said they received the same treatment and were hung up on. Response from Turning Point Follow up was conducted to ascertain the circumstances of these two final complaints. The second counsellor recalled that the caller had presented aggressively and had not wanted to respond to key assessment questions. She also recalled that the caller had disconnected the call. Once again a supervision session was conducted with the counsellor to identify areas for further development as well as providing her with support around how to work with callers with complex presentations. Following discussion with Kath Heading and the Helpline senior clinician, a case management plan was discussed and implemented to address the needs of this complex caller. No complaints have been received since this contact. 2010 (to end September) No complaints. Page 22 of 69

Mystery shopping B. Review of operations As part of this review of the Helpline, it was important to experience the service provided and therefore the Helpline was mystery shopped on three occasions. Below is a brief overview of the mystery shopping conducted. Scenario 1: Parent whose son is concerned about his friend s gambling behaviour. Expectations call to be answered promptly and discussion around how son feels about his friend s behaviour. Positives friendly approach, knowledge displayed about strategies, and information available. Negatives call was placed on hold for around three minutes before being answered. Scenario 2: Male gambler who didn t think he had a problem until he went onto the www.gamblinghelponline.org.au website and completed the risk assessment. He received a high risk response and is now concerned. Expectations discussion around online questions and results in detail to confirm or ease concerns about being at high risk. Positives friendly approach, knowledge displayed about strategies, and referral services available. Counsellor provided the phone number of Anglicare s Break Even program but not the freecall number. Negatives counsellor controlled the conversation, which did not allow much input from the caller into the conversation. Scenario 3: Woman who has just found out about her partner s gambling problem and wants to know what she can do about it. Expectations what can be done to help partner; advice on how to deal with the situation. Positives very knowledgeable, friendly, understanding, sympathetic and a kind voice. Negatives did not know the counsellor s name. Page 23 of 69

Turning Point s credentials B. Review of operations Responsibility for the provision of the Gambling Helpline Tasmania service was transferred to Turning Point in July 2007 following a competitive tendering process. The HealthLink arm of Turning Point is experienced and well qualified to operate the Helpline. HealthLink also operates the state-wide Gambling Helpline services for Victoria, Queensland and the Northern Territory (in conjunction with Amity Community Services) and provides a range of intersectorial Helpline and online services in areas including alcohol, drugs and mental health. Key HealthLink services and programs Gambling Helpline services Gambler s Help Line (Victoria) Gambling Helpline (Queensland) Gambling Helpline (Tasmania) Gambling Helpline (Northern Territory) Online counselling and support services CounsellingOnline (national) Just Ask Us (national) Australian Online Gambling Counselling and Support Program in development Alcohol and drug Helpline services DirectLine (Victoria) Drug Diversion Line (Victoria) Disposal Helpline (Victoria) Family Drug Helpline (Victoria) Youth Substance Abuse Service (YSAS) Line (Victoria) Alcohol and Drug Information Service (ADIS) (Tasmania) ADIS (Northern Territory) Professional consultation services Drug and Alcohol Clinical Advisory Service (DACAS) (Victoria) DACAS (Tasmania) DACAS (Northern Territory) Consultancy and project based services Page 24 of 69

Summary of client outcomes and Helpline effectiveness Volume The volume of calls to the Helpline has been maintained, with a slight decrease in recent times that corresponds to a falling off in EGM revenue. See pages 9-10. B. Review of operations Quality Turning Point HealthLink assumed responsibility for the provision of the Gambling Helpline Tasmania in July 2007. From commencement to date, a total of seven complaints have been received. Turning Point responded promptly and positively in all cases. While the mystery shopping conducted as part of this review identified some minor issues, the overall experience was positive, and counsellors came across as knowledgeable, friendly and understanding. Access and timelines The contract with Turning Point stipulates that 70% of telephone contacts be responded to within 45 seconds. While there are occasions of high demand or other unforeseen circumstances, this figure has been met consistently. The Helpline also operates 24/7. A call-back service to mobiles would further improve access, through minimising the high costs associated with mobile calls. Client outcomes It was beyond the scope of this review to conduct a random audit of Helpline clients. There are no outcome measures built into the Helpline contract, as there are for therapeutic counselling. Page 25 of 69

New complementary service Gambling Help Online Gambling Help Online www.gamblinghelponline.org.au B. Review of operations Gambling Help Online was launched nationally in October 2009 and is an initiative of the Ministerial Council on Gambling (MCG). It is funded as part of an agreement between all State and Territory governments and the Australian government. This online service aims to complement and increase the range of services available in responding to problem gambling issues. It provides all Australians with an opportunity to access counselling and information services when they are unable or reluctant to access face-to-face services provided in each jurisdiction. Informed by extensive research and expert advice, Gambling Help Online is a world first to provide: 24/7 availability of live and email counselling and support services; availability of professional counsellors with expertise in problem gambling and online services; integration with state based 24/7 telephone services and face-to-face counselling; and the provision of extensive website content, information and web links for additional help and information. MCG envisaged that the web-based environment would appeal to and encourage more people to access the information and professional services which are available to prevent and respond to problem gambling. Gambling Help Online is a program operated by Turning Point Alcohol and Drug Centre in Victoria. It is an online service providing a number of self-help resources as well as online counselling. This service is free and available to gamblers and those affected by someone s gambling. From when it was first launched in August 2009 through to December 2009, the service received 4209 visitors. While most of these visitors were from Australia (3030), a number were identified from the United States, United Kingdom and Russia. The highest number of Australian visitors originated from Victoria (35.9%) followed by New South Wales (28.9%), Queensland (16.3%), South Australia (7.1%), ACT (4.2%), Tasmania (4.4%), Western Australia (2.9%) and the Northern Territory (0.1%). Tasmania has approximately 2.3% of the total Australian population, so the Tasmanian uptake of Gambling Help Online (accounting for 4.4% of the Australian visitors) is statistically relevant. At this stage we are not clear of what impact, if any, this is having on calls to the telephone helpline. The publicity for the online service is included in our advertising in the Yellow Pages, on brochures, posters and promotional material generally. Page 26 of 69

B. Review of operations Recommendations Call-back facility There is currently no call-back facility available to Tasmanian callers to the Gambling Helpline Tasmania. Gamblers may benefit from a call-back program similar to that which the Quitline (helpline for smokers) offers to its clients, where there would be a benefit to the client in receiving ongoing contact with a counsellor to offer support and encouragement during the initial stages of making changes. Discussions with Simone Rodda, the manager of the gambling helplines at Turning Point, have identified some difficulties with this model, including the following: (i) Gamblers tend to be very difficult to catch if the call is not responded to immediately. The Gambling Helpline s number appears as blocked and callers often don t answer as they are avoiding creditors etc. (ii) Most gamblers want an immediate response, and we know that Tasmanian clients often will not wait for more than 30 seconds for a response. (iii) All the information systems are based around PABX data, which means there is not the capacity to manipulate calls in and answered, talk time etc. Calls out can not be captured with the same model. Ongoing telephone counselling The Ready to Change (RTC) program is one that should be investigated further for availability to Gambling Helpline Tasmania clients. RTC is a service enhancement associated with the Gambler s Helpline Victoria program, which commenced on 1 January 2008. The RTC program provides flexible and free ongoing telephone counselling for eligible callers. The service aims to provide counselling for people experiencing barriers to accessing face-to-face counselling. The caller first completes an assessment, formulates treatment goals and negotiates the number of sessions (normally 4-6). A workbook is provided to support the change process. Sessions are conducted at scheduled appointment times. Appointments can be made during normal business hours, evenings, and late at night for shift workers. Currently a caller s personal details, other than general statistics (gender, suburb, age etc), are not kept. This means that if a client wanted to contact the Helpline service again for ongoing support, they may need to explain the situation each time they called. If the RTC program was adopted in Tasmania, then the counsellors will need to request more information from the client, which the client may or may not be willing to provide. At the moment, callers are: dealing with qualified counsellors; given as long on the phone as they wish to explore whatever they wish; and able to call back and be identified as a returning client (if they call back on the same number). There is provision in the current Service Agreement that the Gambling Helpline Tasmania provides sessional telephone counselling. Implementation is underway. Page 27 of 69

Access to the Helpline service B. Review of operations Access to the Helpline service is currently available free from any landline or payphone. Access from a mobile phone would attract an additional cost to the caller. However, as many people have mobile phones, and may not want to call from a landline for privacy reasons, consideration should be given to a text 4 help service where a client can send a text message to the Helpline service then receive a call back from a counsellor, thus keeping access costs to a minimum for the client. Mystery shopping Monitoring of the Gambling Helpline Tasmania by way of mystery shopping is not currently undertaken and, as part of a quality assurance measure, should be conducted on a quarterly basis. The results can then be fed back to the Helpline contractor. There is currently only minimal data that is able to be collected from callers to the Helpline by Turning Point. These include gender, suburb, age, employment status, country of birth, cultural identity and language spoken at home. On the three occasions that the Helpline was mystery shopped as part of this review, the caller was not asked a number of these. It is important that, wherever possible, callers are asked these questions to gauge who is utilising the Helpline service. Advertising Although this review was not about advertising strategies, it should be noted that the online Yellow Pages advertisement still used the old Helpline number (1800 000 973) until recently. While the old number is still operable for at least another two years, it should be updated to make sure it is consistent with other media. [GSP had great difficulty in getting Sensis to fix the problem. However the new phone number was eventually incorporated in October 2010.] One comment made in the stakeholder discussion was that in the Gambling Helpline Tasmania television advertisement the phone number is quite small and does not stay on the screen long enough for people to note it down. Page 28 of 69

C. Communications review C. Communications review (i) The scope of the communications review is to: Undertake an appraisal of the Gambling Helpline Tasmania promotion aimed at Tasmanians affected by gambling. Areas for consideration should include: (a) access considerations (importance of telephone access for regional clients and for those reluctant to attend face-to-face counselling); (b) stage of change considerations (where are most callers on the stage of change? How should the promotion assist the client to move further towards taking action to change problematic behaviour?) (c) scope of messages (are different messages needed for different segments, e.g. gamblers compared to those affected by the gambler? The Helpline offers information through to counselling. Should these messages be integrated or split?); (d) positioning of messages (the Helpline has been viewed by GSP as the logical point to start an enquiry about problem gambling, hence the number is prominent in current publicity. The Gambling Help Online, launched in 2009, now provides an alternative starting point and quality self-help as well. Face-to-face counselling remains highly important too.) (e) effectiveness of messages (are the slogans and information the best for the job?); (f) channels of communication; and (g) strategies for cost effective marketing (how best to choose between the many options). (ii) Consider how other States promote their gambling helplines, and how helplines are promoted generally. (iii) Make recommendations on future promotion and budgets based on the considerations above. This section of the report is divided into four sections: 1. The communication challenge 2. An overview of the promotional vehicles currently used to get the message of the Gambling Helpline Tasmania to the target audiences 3. A survey of the target audiences, their perceived needs and drivers 4. Conclusions and recommendations. Page 29 of 69

1. The communication challenge C. Communications review One of the major barriers to people affected by problem gambling seeking help is the stigma attached to the phrase gambling addiction. In some ways it is similar to the stigma around mental illness in the middle of the twentieth century. This stigma has been consistently mentioned as a considerable impediment to seeking help and merits serious consideration in forming any promotional approach. The Productivity Commission acknowledges the challenge involved: Only a small proportion of people experiencing problems with their gambling seek professional help... Most clients of help services have either hit rock bottom or are coming close. Social stigma associated with having a problem, denial of a problem or believing they can handle it themselves, are the main reasons why gamblers do not seek professional help. 22 Also, from personal investigation, it seems clear to this reviewer that the venues are of vital importance. In fact, there is a strong argument that the venue has to be the prime focus of distribution of gambling help information. For example, the typical problem gambler who has reached the help-seeking stage needs to have instant and secure access to useful relevant information on where to get help right now. The logical focus for this intervention has to be the venue, where they spend increasing amounts of time. In addition, the information must be easy to access, be anonymous, and be safe. One factor influencing this thought was an extended visit to the Hobart casino on a fine Sunday afternoon, which contrasted with another to a major downtown hotel during a mid-week lunchtime. The casino itself seemed to be a major barrier to accessing timely information about getting help. There was no evidence to this investigator that the casino had made anything more than a desultory effort to make it at all easy for someone affected by problem gambling to find out where to call right now. In both of the darkened gaming rooms, the machines had no reference to the Gambling Helpline or its number. There were no posters on the walls, and no brochures on the spaces between machines that mentioned the Helpline. The only Gambling Support Program brochures were in one of the two main rooms the Riverview Room did not have any. The brochures on view were in one location, beside just one of the two cashier windows, not the other. And the only brochure was the Low-risk gambling one. The Need to take a break from gambling? brochure was nowhere to be found in the casino. On a search for other supportive material, the only other location where there were any brochures was in the two-tiered display area of 36 different promotional brochures next to the Service Desk on the upper floor. There was one bunch of brochures competing with the other 35. There is a notice about the Gambling Helpline on the back of the stalls in the men s toilets not on the main door into the toilets. You had to be in the privacy of the stall to see the notice about getting help. (It is understood that plans are in hand to trial a system similar to the Victorian one where carry out cards will be attached to the back of all the toilet entrance doors in a few venues, not just on the back of toilet stall doors. This seems like a positive and useful trial, and will be followed with interest.) Of the other three notices on walls (the small square black notices) one was beside the phone on the ground floor, away from the Gaming Room. Another was well placed between two ATMs on the ground floor. There was none anywhere near the three ATMs on the upper floor. Page 30 of 69 22 Productivity Commission 2010, Gambling, Report no. 50, Canberra, Section 7.2

C. Communications review In marked contrast, a visit to a popular downtown pub showed lots of brochures easily available, Helpline numbers on the front of the EGMs, and this was three weeks after Gambling Awareness Week coasters with the GA message and table cards spread generously and obviously across the venue. It is not the purpose of this report to question the commitment of venues to the cause of preventing or mitigating problem gambling and its effects. But if the casino is a location where a significant number of problems arise, then the casino may have to be encouraged to become more effective in enabling its patrons to make more informed choices about their options while at the venue. Making the information about the Helpline more available would seem to be a minimum if they are serious about addressing problem gambling. It may also be that different venues will require different approaches. What works in downtown hotels may not be appropriate for the casinos, for one reason or another. And what works in the city may not be suitable for some regional venues. 2. Promotional vehicles currently in use to promote gambling services and the Helpline Unlike Victoria, where for the past four years the Helpline has been the primary focus of all campaigns to promote services around problem gambling, Tasmania has a broader approach and focus of services. Although the Gambling Helpline Tasmania number does appear on all promotional material, it is not the primary vehicle for attracting problem gamblers, except where there is limited space, such as in TV and bus advertisements, where the Helpline and the Gambling Help Online website are highlighted. Where there is space, the full list of services phone, online and in person is featured with access details. This strategy will be discussed later in the report. Here are the main vehicles where the Helpline is featured: (i) TV and press advertisements the recent campaign has been well received. In a recent survey of nearly 400 participants in Glenorchy, awareness of the existence of the Helpline was high 23. 79% of respondents were aware of services for problem gambling. 70% of all respondents recalled seeing advertisements to do with responsible gambling and 90% of these people saw these advertisements on television. Television advertisements were successful in raising awareness of gambling support services availability for approximately half of the sample. When participants were asked about their perception of the main message of the commercials (see below), the majority interpreted a useful message (e.g. people hide their gambling; there is help available; people should gamble responsibly; or gambling has negative consequences). Page 31 of 69 23 The Evaluation of Responsible Gambling Messages and Promotion Glenorchy LGA 2010 conducted in March/April 2010 by the Gambling Support Program, DHHS

C. Communications review Perception of the main message of The Mask TV advertisement 24 100 90 88 29% 80 Number of respondents 70 60 50 40 54 18% 44 14% 37 13% 40 13% 30 20 10 21 7% 4 1% 5 1% 4 1% 10 3% 0 1. Mask/shame/people hide their gambling 2. There is help/hope/get help 3. Raising awareness to extent of problem/addiction 4. Anyone can be a gambler 5. Gambling has negative consequences/destroys lives/families 6. Don t gamble/gamble responsibly 7. Don t know/don t remember/didn t take much notice 8. Message was confusing 9. It s about gambling in general 10. Participant response unclear The focus of the ad campaign is on people not telling the truth to themselves and others about their gambling. It is based on two ads: the first is partly about getting help, while the second tells a positive story about actually getting help. While the Helpline number is featured as the primary contact point, it appears mainly at the end of the ad. One criticism has been that the Helpline number is only on screen for what seems a short time it s on for two seconds which may be too short a time for anyone who is not quick with figures to get it. However, the Glenorchy survey figures show a contrasting possibility, as this local government area is likely to get a lot of its information from TV, and shows a high awareness of the Helpline service. The press ads complement and support the TV campaign as part of a comprehensive mass media umbrella campaign to increase awareness among the most at risk demographics. Page 32 of 69 24 Gambling Support Program, DHHS. (Sept, 2010). Report: Evaluation of Responsible Gambling Messages and Promotion: Glenorchy LGA. Hobart, TAS.

C. Communications review (ii) Brochures the Gambling Support Program has two current DL size brochures: Need to take a break from gambling? and Low-risk gambling. These are colourful, well produced and professional brochures that catch the eye. The Helpline number is in the middle of the back page, which has a list of all the options of Where to go to get support and assistance. (iii) Local newsletters or health bulletins gambling a pilot initiative was set up to target local communities, with the first distributed in Glenorchy. Following its success, others based on it have been launched in Devonport, George Town and the West Coast. These are all meeting with considerable success and support in their areas, which all have significant numbers of people affected by problem gambling. (iv) Long Odds another innovation has been to produce a series of illustrated comics in magazine format, based on gambling scenarios. Recently 2000 of these have been distributed in public areas across Tasmania. It is still too early to determine their success in increasing awareness of the Helpline or other services. (v) Venue posters and notices the Tasmanian Gambling Industry Group Code of Practice aims to ensure venues are committed to the provision of responsible gambling practices and products in a safe and comfortable environment. This code aims to ensure that responsible gambling brochures are available in venues and that information regarding the Break Even services is displayed via signage. Such notices vary from having the Helpline number displayed (prominently or otherwise) on the EGM itself, on the wall of the venue, or on the back of toilet doors etc. to providing notices about easy and discreet access to brochures or other take away material. As we ll see later, the venues have a crucial role to play if there is to be a significant increase in the take-up of any Break Even services. (vi) Take away reminder cards, drink coasters etc Gambling Awareness Week in May 2010 featured colourful and striking tent cards as well as coasters based on the current TV campaign. These were considered highly successful in the venues in which they were used. They featured the Helpline number prominently. They could be easily and discreetly slipped into a pocket or purse for later contact with help services. People affected by problem gambling often take up to a few years after picking up a card or brochure to do anything about getting help. Page 33 of 69

(vii) C. Communications review Online services: gamblinghelponline.org.au this is a national initiative providing 24/7 self help and an immediate response via online counselling or chat to anyone concerned with a gambling issue. [A discussion paper on the draft Responsible Gambling Mandatory Code of Practice for Tasmania was released by the Tasmanian Gaming Commission in November 2010. This seeks to further strengthen responsible gambling practices and build on harm minimisation measures. It is expected that the new Code will be implemented from September 2011.] Page 34 of 69

C. Communications review Who are these promotional vehicles intended to influence? Approximately 30% of problem gamblers as measured in the prevalence studies make contact with the Break Even services in any one year. Statistics suggest that about 70% of Tasmanians who are affected by problem gambling never contact any support service. While at first glance this low take-up of support services may seem unacceptable, it needs to be seen in the context of the cycle of change. As hinted in (vii) above, awareness of the existence of a problem and of the availability of help does not mean that help will be sought anytime soon. The critical factor seems to be where exactly the problem gambler sits on the cycle of change. At this point in time, there is no clear-cut route to increasing this take-up number. Cycle of change 25 Page 35 of 69 25 Prochaska and DiClement, Six Stages of Change, from Miller, Rollnick, 1991

Time horizon C. Communications review Break Even services client data shows that 2740 clients registered with the Break Even counselling services between 1 July 2000 and 30 June 2007 26. The client session database includes the question: How long has gambling been causing a problem for the client? In the period, there were 1396 responses recorded to the question providing the following detail: N=1396 Time horizon 600 500 445 Number of clients 400 300 200 136 246 266 239 100 21 43 0 Less than 3 months 3 to 6 months 6 to 12 months 1 to 2 years 2 to 6 years 6 to 10 years Over 10 years Period of time 3. Survey of the target audiences Korn and Shaffer s gambling continuum 27 Korn and Shaffer s gambling continuum provides an excellent starting point for looking at the issues around problem gambling. Page 36 of 69 26 DHHS, Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007, pg. 1 27 Productivity Commission, 1999, Enquiry Report into Australia s Gambling Industries

C. Communications review Problem gamblers come from all levels of society, and from all across the adult age range. However, the Social and Economic Impact Study into Gambling in Tasmania 2008 (SEIS) shows clearly that the majority come from a particular demographic that of the lower socio-economic areas. The study found an association between communities that are more disadvantaged on the SEIFA index and the regional concentration of gaming machines and player loss. 28 The study found an association between high per capita player loss but lower median income. Player loss appears to be the most significant influence on the number of the Gambling Helpline Tasmania callers from a region. EGMs earn higher per capita revenue in disadvantaged areas, while revenue per machine generally falls as the level of disadvantage declines. This pattern is found in regions in other States. By the SEIFA Index, Tasmanian LGAs with the greatest level of disadvantage are Brighton 871 and George Town 895 The map shows the ten most disadvantaged LGAs. 29 By overlaying the LGAs in the illustrations we can isolate four areas which are at risk with gambling, and at risk generally. However it should be remembered that the analysis is by LGA, not towns. In some LGAs the relative affluence of one town or locality can balance or mask a disadvantaged locality. In Tasmania at the current time, the primary involvement of problem gamblers is with EGMs the pokies. While other gambling attractions have their ardent followers, some of whom are problem 28 The Socio-Economic Index for Areas (SEIFA) is a suite of four summary measures that have been created from 2006 Census information. The indexes can be used to explore different aspects of socio-economic conditions by geographic areas. 2039.0-Information Paper: An Introduction to Socio-Economic Indexes for Areas (SEIFA), 2006 29 ABS. 2033.0.55.001-Socio-economic Indexes for Areas (SEIFA), Data Cube only, 2006. Page 37 of 69

C. Communications review gamblers, they pale into insignificance before the overwhelming number of problem gamblers whose problem is exclusively (or nearly so) tied to their addiction to playing the pokies. Therefore, for the purpose of this report, and on the principle of the 80/20 rule, the entire focus will be on the EGMs and the fallout from their use and abuse. Online gambling, racing, lotto and other forms of gambling will not be addressed in any meaningful way, even though they form some of the attractions for some problem gamblers. The prevalence study undertaken as part of the Social and Economic Impact of Gambling in Tasmania (SEIS) found that according to the CPGI, 0.54% of the adult population are problem gamblers, with an additional 0.86% at moderate risk. 30 [GSP also considers that recent research into escapism and gambling is critical to the understanding of problem gambling. Recent research undertaken by Thomas et al finds that the accessibility and social experience provided by EGM venues makes them highly appealing as a means of escape. 31 According to Thomas et al, EGM gambling is used by gamblers to cognitively and physically avoid life s problems. Any promotional material or message aimed at the Tasmanian problem gambler should incorporate these insights to maximise its potential effectiveness.] While all problem gamblers are individuals, and have their own demons and drivers, it might be useful to posit a typical problem gambler by way of illustration. Here s one typical scenario of a Break Even male client. Tony s in his forties and lives alone in a lower socio-economic suburb. He left school at 15 and he s earning less than $20,000 a year. He made a call to the Helpline and discussed his problems with a counsellor on the phone for 30 minutes or so. This helped reinforce the measures he had started taking to control his gambling he had been gambling for four years. At this stage he didn t feel the need to get face to face counselling, nor to call back the Helpline for more assistance. It was several months before he took their advice and came to Break Even. His counsellor said that what finally drove him to Break Even was that he couldn t pay the rent. On the one hand, negative issues from gambling encourage change. On the other, problem gamblers don t want to stop. Looking at the cycle of change, taking action will require considerable effort and involve facing up to the situation. In one sense the scenario is not typical. The distribution of problem gamblers is almost equal between male and female, but statistics show that it is mostly women who seek help. This alerts us to the fact that females seek help for their own problem gambling and for the gambling of others. Page 38 of 69 30 South Australian Centre for Economic Studies, 2008, Social and Economic Impact Study into Gambling in Tasmania 2008, vol. 2, pg. 56. 31 See Thomas, A. Allen, F. & Phillips, J. 2009, Electronic Gaming Machine Gambling: Measuring Motivation, in Journal of Gambling Studies, vol 25, pp. 343-355 and Thomas, A. Sullivan G. & Allen, F. 2008, A theoretical model of EGM problem gambling: More than a cognitive escape, in Addiction, vol. 100, pp. 33-45.

Primary target audiences C. Communications review Break Even client data shows that of the 2740 clients registered with the Break Even counselling services between 1 July 2000 and 30 June 2007, EGM gambling is the major issue, particularly in hotels and clubs 32. The client session database includes the question: What forms of gambling are causing problems? In the period, there were 2789 responses (with multiple responses allowed) recorded to the question providing the following detail: Forms of gambling 33 Form of gambling Number Percentage of respondents who noted this form of gambling as causing a problem Gaming machines hotel/club 1407 76.1% Gaming machines casino 757 40.9% TAB/races 283 15.3% Keno 141 7.6% Casino gaming tables 111 6.0% Lotteries/XLotto/Powerball 39 2.1% Card games 19 1.0% Raffles/Bingo 15 0.8% Other 17 0.9% From this, it is clear that EGM gambling is the major issue, particularly in hotels and clubs. It follows that the primary target audience for any efforts to reduce problem gambling is an EGM player who is a regular patron of a hotel. This gambling patron could be on a pension, retired or elderly, a man or a woman, and often single. While a majority of problem gamblers fit this profile, a minority are well educated, affluent and in a steady job. This reinforces recent research which points to an increase in the retreat to gambling as an escape from personal daily pressures. It should also be noted that online gambling is now a real issue. At this stage, there are very few online problem gamblers appearing in the counselling services. Placement of advertising online will be of more importance as online gambling becomes more popular, and it is anticipated that it will. The build up of sports betting gambling promotion, and online gambling promotion on Facebook is particularly worrying. [GSP has suggested to Treasury that comprehensive questions around online gambling should be considered for the next Social and Economic Impact Study.] Promotional efforts aimed at getting these different people to become more aware of the Helpline and increase the chances of them actually calling it need to be closely tied to the reality of their daily lives, their education levels, and their existing beliefs and attitudes about themselves and their gambling. 32 DHHS, Forms of Gambling in Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007, pg. 2. 33 DHHS, Forms of Gambling in Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007, pg. 2. Page 39 of 69

Young people C. Communications review Surveys suggest that young people who are exposed to a gambling problem are not likely to do anything about it in the short term. The Operations Manager of the Gambling Helpline was of the opinion that young people consider themselves invincible and rarely call helplines or local services. This conclusion is borne out by studies about young people s takeup of other services, for example around depression. ABS statistics highlight that intentional self-harm is the major cause of death in Australia for young people aged between 15 and 24. 34 It is not a coincidence that suicide is the main cause of death in young men in Australia, even though strenuous efforts are being made to encourage them to seek help early. Tasmanian prevalence studies show that combined moderate risk and problem gamblers amongst 18-24 year olds in Tasmania make up 34% of combined moderate risk and problem gamblers in Tasmania. 35 Similarly, the SEIS found that young people were significantly more likely to be in the moderate risk and problem gambling categories, with 2.28% of young people aged 18 to 29 falling into this category. 36 Source of referrals to the Helpline As shown in the graph on page 11 of this report, the most commonly cited source of referral to the Helpline was information provided in telephone books and/or other directories (35.1%). Thirty-nine callers reported sourcing gambling referral information from a venue notice/poster (13.7 %) and information provided by family and friends was reported in 37 contacts (13%). It is important to note that directories/phone books accounted for more than a third of all referrals to the Helpline. Even when people may be uncertain of the name of gambling services, they know they can find the contact details in the phone book. The source of referrals to the Helpline varies quite significantly to the source of referrals to the Break Even services. From 1 July 2000 to 30 June 2007, 2740 clients registered with the Break Even Services Network. The client session database includes the question: How was the client referred to this service? In the period, there were 2254 responses recorded to the question providing the following detail: Page 40 of 69 34 ABS, 3303.0, March, 2010, Causes of Death Australia, 2008. 35 Roy Morgan Research, 2006, Profile of at risk and problem gamblers CPGI, in The Fourth Study into the Extent and Impact of Gambling in Tasmania with Particular Reference to Problem Gambling. 36 South Australian Centre for Economic Studies, 2008, Social and Economic Impact Study into Gambling in Tasmania 2008, vol. 2, pg. 59.

C. Communications review Referral source to Break Even counselling (not including Helpline) 37 Referral source Total % Family/friend/neighbour 384 17.0% Gambling Helpline 350 15.5% Brochure/phone book/other media Other (including celebrant, cultural organisation and other) 257 11.4% 242 10.7% GABA* 220 9.8% Anglicare 153 6.8% Community organisation 143 6.3% Another BE client 98 4.3% BE advertising (including TV, radio, print, etc) 95 4.2% Health practitioner 94 4.2% Other government agency 63 2.8% Financial counsellor 58 2.6% Legal representative 45 2.0% Relationships Australia 35 1.6% Employer 15 0.7% Educator 2 0.1% *GABA (Gambling and Betting Addiction) ceased operating in 2007. The most significant source of referrals was from family/friend/neighbour, accounting for 17% of the total. The Gambling Helpline supplied 15.5% of the total. Page 41 of 69 37 DHHS, Referral Source in Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007, pg. 3.

4. Conclusions and recommendations C. Communications review Messages for those most at risk The main focus of problem gambling intervention should be on the people most at risk. These may be characterised as less well off than the average, and not well educated. They are mostly in specific geographic localities, which are often in the lower socio-economic bracket. Therefore these people will be most likely to be influenced by promotional material which reflects them directly, their view of themselves, and seems to talk to them personally in language and images they can identify with. The messages need to be simple without in any way talking down to people who are otherwise competent and they need to offer simple and practical ways to address what they see as their problem. The messages also need to be in tune with the person s own stage of change where the person is right now in their thinking. When I see the TV ad come on the screen I leave the room, was a comment relayed by a counsellor, who added: They call the Helpline or some local agency when they are ready to do something. This backs up the problem of the stigma attached to problem gambling: People don t want to talk about it, and reinforces the Victorian experience of the length of time between picking up a card and doing anything with it. Consistency in Strategy and Branding The simple message must be consistent across the entire strategy. The brochures, ad programs, posters and carry cards must all be consistent, to make the message easier to absorb and believe. Therefore, this report suggests that a change to the strategy might be considered, following in the steps of the Victorian campaign some four years ago, which was initially doubted but is now totally accepted. The suggested change is to make the Gambling Helpline number the primary focus of all promotional activity in all media without exception, and to encourage closer cooperation between Turning Point and Break Even to ensure that Helpline counsellors promote local and personal Break Even services as a regular priority. Here is the logic: most people who take action on problem gambling first make a phone call to someone. They may have been inspired by a friend, by their own state of change, or by an external stimulus such as an ad, a carry card, a coaster, a poster or a brochure. Some will go to the local Anglicare or Relationships Australia because they know or have heard of someone. Most will go to the Helpline if they see it clearly as the first port of call, the first and most logical option. In that regard, the recognition factor for the name Break Even does not seem to be high, in spite of this brand being in use for almost a decade. A change of wording to something like Gamblers Help or similar might be a valuable change of brand name. The important thing is to have high recognition and simplicity for the target audiences so as not to get in the way of their taking action if they are in any way affected by problem gambling. Main brochures The Low Risk Gambling brochure put out by GSP features images that are mostly of young, middle class people, cheerful in most cases. This may not now reflect the sort of people who are in the majority of being at risk from EGM gambling. Therefore it is suggested that the brochures may not now be as effective as they might have been. Page 42 of 69

C. Communications review Also, since the casino did not have on view even one copy of the Need to take a break from gambling? brochure (which suggests it is too strong meat for the casino, also suggesting it might be valuable in that context for younger patrons) it could be useful to revisit this brochure and make the message more simple with images closer to the reality of the people most at risk who might be influenced by it. (The next question would be how to get the brochure into their hands at the casino ) In that regard, it might have been an off day for the casino when this reviewer visited, as the casino is said to usually be supportive of the distribution of literature promoting responsible gambling. One other suggestion was to consider what other frontline services people affected by gambling might be influenced by places where they might pick up a brochure such as taxis, country markets, libraries, local cafés, schools etc. Positioning the Helpline as the initial point of contact The next campaign of TV advertisements might follow the idea of targeting the less educated with a simple message to call the Helpline, which is open 24/7, and where there is always someone to talk to. (Perhaps there is a need to involve the Helpline people more in dialogue with the providers of counselling services in Tasmania, to increase the incidence of warm referrals. For historical reasons, there may be a communications deficit at the moment between these two vital players.) If the Helpline was at the pointy end of all campaigns from coasters and cards to brochures and TV ads the incidence of calling the Helpline should increase, and the referrals to on the ground counselling services should also increase. As one counsellor remarked: Having the Gambling Helpline number everywhere would be really helpful. In Victoria, it seems the most recent ad campaign was not as successful as previous ones in attracting callers to their Helpline. Apparently the campaign was also the first that did not highlight the Helpline number with a simple message, such as an earlier one which led to a big increase in referrals: Do you wonder where your partner is? In gambling, just as in all areas where people with problems have to decide what to do about them, nothing happens until the person involved arrives at a stage of change where they see the problem is truly theirs. Until then, it s not them. An ad agency creative director once asked this reviewer if he had ever seen ads about bed wetting. When the answer was in the negative, the director said: There are lots of them, but you don t have kids, so you never see them. Education experts say that until something new is internalised, it rarely leads to action. Accessing those at risk in the community The pilot newsletters health bulletins seem to have hit a solid note in the communities they are in. They seem to say the right things to the right people in the right way. They should be supported and extended to other communities. The only change might be to make the Helpline a more prominent part of the overall message, without downgrading the Break Even face to face services. Integration of service delivery There is a case to have a better integration of face-to-face counselling and the Helpline, so that the Helpline could be a really practical link into face-to-face counselling. This could include block bookings handled by Helpline, rather like travel agents who make all the bookings for you at one time. Page 43 of 69

C. Communications review So it is worth considering whether over time the referrals to Break Even would increase if the Helpline and the Break Even services got together to map out a strategy and working consensus on that basis. The benefits could be both to clients and to Break Even. Venue considerations While the following comment is outside the strict focus of this review, it should be pointed out that the difference in venues is stark, and so are the consequences that flow from this difference. The hotels in general are not very big, with a small staff who can get to know the patrons over time. This makes it more likely that they will take some interest in the patrons personally, and be aware of possible problems arising in their behaviour. For all their faults, the hotels retain a human scale in their interactions. In the casino one can see a large number of individuals in darkened rooms, where the only focus is the machine, and the human connections are limited to the professional and relatively impersonal staff, who are many, and who change constantly. This is not to say the casino or its people are at fault it is simply the nature of the venue, its size and its set up, all of which combine to reduce to a minimum any possibility of true interaction between players and staff. Counsellor: At the local hotel, the barperson knows you you can go to them. And Gambling is a presenting issue for lots of other stuff. Some people want bigger venues and huge rooms where they can zone out from other issues in their lives. They can feel safe with the professionally friendly staff who don t know them, and they can be a lot more anonymous. Advertising in public conveniences In Victoria, one intervention which has been widely praised and which has resulted in a significant increase in calls to the Helpline is the simple expedient of being able to take a carry card from behind toilet doors in venues. This is the best was the comment. (These cards are not just on the back of W.C. doors as in the casino, but on the main door leading out of the toilet, where a patron can easily take a card out and put it away for a later date.) The Helpline supervisor said: Sometimes they hold on to the card for a year before they call. When they re ready for change, they have the card with them. That s the important thing. In Victoria, according to the data: Take it cards from behind toilet doors were the main source of referrals for the local service number as well as Helpline. The upcoming trial of such Convenience Advertising in Tasmania will be interesting to follow. Page 44 of 69

Summary of conclusions C. Communications review There are no easy answers to why the Tasmanian Helpline is not called more often, nor why there are not more referrals from the Helpline to face-to-face counselling services. Some face-to-face counsellors have reported comments from clients that they didn t feel well supported when they called the Helpline, and that they got odd reactions from the Helpline service. This may suggest that closer formal ties between all services could be useful in making the referral route more effective. It is important to point out that the relationship between all the services is excellent, and this suggestion is merely that there may be structural elements that could be improved. However, it seems that the message itself is confusing for the people whom the Gambling Support Program wants to influence. One way forward could be to simplify the messages and the strategy, and to make the Helpline the primary focus of the next promotion stage. Easily available and more direct take away vehicles at all venues, with a simple message that there is someone to talk to anonymously at no cost at all times of the day or night would be useful. They would encourage more people to have a memory aid available for the time when their stage of change is at the point where they are ready to act. If the casino is the venue of choice for a significant number of people affected by gambling, then it will need to be much more involved in strategies to provide its patrons with a genuine level of information and support, rather than the token level at present. That direction, along with an even more comprehensive liaison between Turning Point people and other Break Even people, could well see a marginal but real improvement to the service, and an increase in the take-up of all gambling support services. Page 45 of 69

References References ABS, 3303.0, March, 2010, Causes of Death Australia, 2008. ABS. 2033.0.55.001-Socio-economic Indexes for Areas (SEIFA), Data Cube only, 2006 ACT Gambling and Racing Commission, October 2004, Help-Seeking by Problem Gamblers, Friends and Families: A Focus on Gender and Cultural Groups. Blaszczynski, A., Walker, M., Sagris, A., & Dickerson, M. 1999, Psychological aspects of gambling behaviour: An APS position paper. Australian Psychologist, vol 34: 1, pp. 4-16. Department of Justice, Victoria, 2009, A Study of Gambling in Victoria Problem Gambling from a Public Health Perspective Fact Sheet 15: Help Seeking Behaviour. DHHS, 2007, Break Even Gambling Services Client Information Fact Sheet July 2000 June 2007. DHHS, Prevalence Study Fact Sheet 1: Group Classifications, based on material from the Social and Economic Impact Study into Gambling in Tasmania 2008. Published by the Gambling Support Program, DHHS. DHHS, Prevalence Study Fact Sheet 5: Adverse consequences of problem gambling, help seeking knowledge and behaviour, based on material from the Social and Economic Impact Study into Gambling in Tasmania 2008. Published by the Gambling Support Program, DHHS. Gambling Support Program, DHHS. Sept, 2010, Report: Evaluation of Responsible Gambling Messages and Promotion: Glenorchy LGA. Hobart, TAS. Miller, C.L., Wakefield, M., & Roberts, L. 2003, Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign, in Tobacco Control, vol. 12. pp. 53-58. Productivity Commission, 1999, Enquiry Report into Australia s Gambling Industries. Productivity Commission Report into Gambling 2010 no. 50, Canberra. Roy Morgan Research, 2006, Profile of at risk and problem gamblers CPGI, in The Fourth Study into the Extent and Impact of Gambling in Tasmania with Particular Reference to Problem Gambling. Shandley, K. & Moore, S., 2008, Evaluation of Gambler s Helpline: A Consumer Perspective, in International Gambling Studies, vol. 8, no. 3, pp. 315-330. South Australian Centre for Economic Studies, 2008, Social and Economic Impact Study into Gambling in Tasmania 2008. vols. 1 & 2. Tasmanian Gambling Industry Group Code of Practice Thomas, A. Sullivan G. & Allen, F. 2008, A theoretical model of EGM problem gambling: More than a cognitive escape, in Addiction, vol. 100, pp. 33-45. Thomas, A. Allen, F. & Phillips, J. 2009, Electronic Gaming Machine Gambling: Measuring Motivation, in Journal of Gambling Studies, vol 25, pp. 343-355. Turning Point, 2008, Gambling Helpline Tasmania Annual Report 2007/08. Turning Point, 2009, Gambling Helpline Tasmania Annual Report 2009/09. Page 46 of 69

Appendices 6. Request from Treasury to undertake a review of the Helpline 7. Service Agreement with Gambling Helpline Tasmania and the Crown 8. Project Brief Review of operations 9. Project Brief Review of promotion 10. Stakeholder discussion

APPENDIX 1 References Letter from the Treasurer to Minister Lin Thorp requesting a review of the Helpline. Page 48 of 69

Appendices APPENDIX 2 From the current Agreement with Gambling Helpline Tasmania and the Crown Schedule 1 Department s Requirements The services to be provided are the delivery of the Gambling Helpline Tasmania service, as part of Break Even Services Network, by providing counselling and related services to Clients by Appropriately Qualified Counselors, in the following manner: 1. General Service Description 1.1 The Contractor will deliver the following services which will be known and marketed as Gambling Helpline Tasmania. (a) (b) (c) (d) (e) (f) (g) (h) (i) Page 49 of 69 The Contractor will provide a seven day a week, 24 hour gambling helpline response to Clients, as detailed in this Agreement. Each and every Contact will be received, and responded to, by Appropriately Qualified Counsellors. These services will include: a 24 hour, seven days per week, telephone information, counselling, and referral service; a 24 hour, seven days per week, web based support service which will include e- counselling, information, self-help, and confidential chat room services; and the receipt of up to a total of 900 Contacts (including both telephone and web based Contacts) per annum, and if more than 900 Contacts are received in any one year then the Contractor may contact the Department to ask that the response time in clause 3.1(d)(i) be reviewed, and if subsequently agreed to in writing by both parties, can then be amended. The Contractor will receive telephone based Contacts via the specified 1 800 (or any other) helpline number ( Helpline Number ), as directed by the Department from time to time, on behalf of the Department; The Contractor will pay all costs associated with the Helpline Number; The Helpline Number will be operated in accordance with any and all written directions received from the Department; Gambling Helpline Tasmania will deliver services to persons from non-english speaking backgrounds and Aboriginal and Torres Straight Islanders to the satisfaction of the Department. To meet the requirements detailed in Item 1.1(f) in this Schedule, Gambling Helpline Tasmania must have access, and utilise when required to effectively and professionally deliver services, to a recognised telephone interpreter service which will be available 24 hours a day, seven days per week. Gambling Helpline Tasmania services will be provided free of charge to all Clients. The Contractor acknowledges that Gambling Helpline Tasmania will be the main point of contact for Clients within the wider Break Even Services Network, and that referrals of

References Clients to the most appropriate service or services available within the Break Even Services Network is critical to the successful delivery of services under this Agreement. Referrals include but are not limited to services that include: face to face gambling, legal, financial, mental health, and drug and alcohol counselling services. 2. Service Requirements 2.1 Legal The Contractor will comply with all relevant laws in addition to Legislative Requirements including, but not limited, to: (a) (b) (c) (d) client confidentiality; grievance or complaints mechanisms; anti-discrimination; and support for children of Clients in accordance with the Tasmanian Children, Young Persons and Their Families Act 1997 as amended from time to time. 2.2 Security (a) (b) The Contractor will provide the service from secure premises suitable for confidential telephone, email and chat-room counselling, and warrants that all Appropriately Qualified Counsellors will abide by all security requirements as directed by the Contractor; The Contractor s premises will be kept secure to ensure that any unauthorised person cannot access Client records. 2.3 Identifying and Promoting the Service (a) The Contractor will have in place the means to identify all calls to the Helpline Number as calls originating in Tasmania, and in answering such calls will initially identify themselves as The Gambling Helpline Tasmania prior to providing services under this Agreement. (For the avoidance of doubt, the Department will ensure continued listing of the Gambling Helpline Tasmania telephone number in all appropriate sections of Telstra s Tasmanian regional telephone books in both the White and Yellow Pages, including the Internet listing for the service.) 3. Service Capacity, Standards And Protocols 3.1 Staffing (a) (b) (c) Supervision of Appropriately Qualified Counsellors will be provided by appointed supervisors who must possess completed and relevant qualifications in psychology, psychiatry or a related tertiary qualification ( Supervisors ). Supervisors will have specialised training and experience in problem gambling counselling and supervision. Supervisors will provide professional supervision and debriefing for all Appropriately Qualified Counsellors. Page 50 of 69

Appendices (d) (e) (f) The Contractor warrants that at all times there will be a sufficient number of Appropriately Qualified Counsellors to receive and respond to all Contacts according to the following response rate indicators: (i) (ii) 70% of telephone Contacts will be responded to within 45 seconds; and agreed performance measures and targets for web based Contacts will be developed, and mutually agreed to in writing, and then implemented over the course of the Agreement. These web based response rate indicators will be based on the service activity level of the web based service during the first year of the Agreement. The Contractor warrants that all of its staff, agents, volunteers, contractors and subcontractors ( staff ) are made aware of and will comply with all the terms of this Agreement. Staff employed by the Contractor will comply with the Contractor s Policy and Procedures requirements (as amended from time to time) and, in particular, will uphold professional standards regarding privacy and confidentiality issues. 3.2 Telephone based services 3.2.1 The Contractor will provide Gambling Helpline Tasmania Clients, who make Contact by calling the Helpline Number, with the following services according to each Client s needs when and wherever appropriate: (a) telephone problem gambling counselling including subsequent sessional telephone, email or chat-room counselling; (b) immediate crisis counselling; (c) risk assessment, psychosocial assessment and any other relevant assessment; (d) a hot referral service, whereby an Appropriately Qualified Counsellor connects the caller to an appropriate face-to-face counselling provider via a three-way conferencing facility (the said facility must be available during business hours for Appropriately Qualified Counsellors); and (e) case managed counselling. 3.2.2 The Contractor will: (a) use and promote the Helpline Number as a toll-free number to all Clients of the Gambling Helpline Tasmania service; (b) only use the Helpline Number for receiving Contacts; (c) have at all times the technological capacity and infrastructure in place to receive and respond to Contacts in accordance with the response rate indicators detailed in this Contract ( response rate indicators ), which includes but is not limited to having in place efficiently working telephones and lines. (d) have a call management system that records and reports on the number (and duration) of all Contacts answered; and (e) be able to redirect calls as required to key referral agencies, including but not limited to Break Even Services Network providers and interpreters for people experiencing language difficulties, including the ability to facilitate three-way conferencing with these agencies and providers when required. Page 51 of 69

References 3.3 Web-based services 3.3.1 The Contractor will provide Gambling Helpline Tasmania Clients, who makes Contact by the Internet with the following services according to each Client s needs when and wherever appropriate: (a) counselling via email including subsequent sessional email, telephone or chat-room counselling; (b) immediate crisis counselling; (c) risk assessment, psychosocial assessment and other relevant assessment; (d) connection with an appropriate face-to-face counselling provider, with three-way conferencing where necessary; and (e) case managed counselling where appropriate. 3.3.2 In addition the Contractor will: (a) use and promote an internet access page promoting access to self-help, e-mail and chatroom counselling and phone counselling; (b) ensure the continued provision of Internet pages which will be dedicated for the delivery of Gambling Helpline Tasmania services ( Website ) to Clients, and the latter pages must not be used for any other purpose; (c) have the technological capacity to handle enquiries from and services to Clients in accordance with response rate indicators, including but not limited to efficiently working data lines with appropriate bandwidth, computer terminals with appropriate software; (d) have the means to record and report on the number of and (where applicable) duration of all and every email, chat-room activity and referrals received and the responses given; (e) have the means to record and report on the number of hits to the Website and the Website s key components including the use of interactive pages; (f) have access to interpreters to assist with the counselling of people experiencing English language difficulties; and (g) work in collaboration with, and respond to all directions issued by, the Department to make available internet based self-help information (the Contractor acknowledges that the Department will at its own discretion prepare, source or recommend a set of suitable static and/or interactive self help material). 3.4 Protocols 3.4.1 The Contractor will write and produce protocols for all counselling services delivered under this Agreement. All counselling will be delivered in accordance with these protocols. 3.4.2 The protocols must include: (a) a written protocol for telephone, email and chat-room answering procedures, consistent with this Agreement, and the Contractor will deliver copies of all such protocols (including any and all reviews) within 10 Business Days of the Contractor having them available for use in delivering services under this Agreement; Page 52 of 69 (b) a written description of the counselling practices and intended outcomes of those

practices, consistent with the terms of this Agreement; Appendices (c) a written protocol for reporting child protection/abuse information. 3.4.3 The protocols will be provided by the Contractor to the Department prior to the implementation of the service, or at a latter dated agreed to in writing by the Delegate. 3.5 Data Collection 3.5.1 The Contractor agrees to record client information and activity as defined by the new National Data Dictionary, as provided by the Department. This is expected to occur in the latter part of 2007. In the interim, the contractor will collect and report on data using the interim dataset implemented in July 2007. In the event that implementation of the National Data Dictionary is delayed, it is agreed that further adjustments to the interim dataset may be required by the Department. 3.5.2 The information collected in accordance with 3.5.1 And 3.5.2 will be used by the Contractor in client case management, in managing the service and in reporting to the Department. 3.6 Other client service standards All Gambling Helpline Tasmania Clients will: (a) be given sufficient time and assistance to clearly articulate their issues or problems; (b) be assured of confidentiality in discussing their issues or problems; (c) have the opportunity to explore options for dealing with their issues or problems; (d) receive counselling and/or information relevant to their issues or problems; (e) have arrangements made, if necessary, with language-specific interpreter services able to assist speakers of that language with gambling related problems; (f) where appropriate receive from an Appropriately Qualified Counsellor a telephone or emailed assessment of the extent of their issues or problems; (g) be referred or connected to an appropriate alternative counselling provider where appropriate and possible; (h) be encouraged to call or make email or chat-room Contact again where appropriate; (i) where appropriate and possible, be asked to provide their name and contact details with an assurance that personal identifying information will be kept confidential; (j) be sent current and relevant information where desired by the Client; and (k) receive (if required) a response in accordance with established protocols addressing the situation where in the reasonable opinion of the Appropriately Qualified Counsellor the Client s-or another person s-life or well being may be at risk (such situations may involve, but is not limited to, domestic violence, criminal intent, child abuse and suicide ideation). 4. Referrals 4.1 The Contractor will accept a range of referrals 4.1.1 The Contractor will accept referrals from the other Break Even Services Network providers for the purposes of: Page 53 of 69 (a) providing the Client with sessional telephone, email or chat-room counselling or other services as detailed in this Schedule.

References (b) providing a follow-up call after a Client has left a Break Even Services Network provider, where that Client has agreed to a follow up call within an agreed time frame (typically but not necessarily three months in length). 4.1.2 The Contractor will accept referrals from Break Even Services Network providers. All such referrals will be received, accepted and responded to in accordance with all protocols developed between the Contractor and Break Even Services Network providers. 4.2 The Contractor will provide a range of referrals 4.2.1 The Contractor will provide booking or referral to other providers in the Break Even Services Network located throughout Tasmania. Contact details of Break Even Services Network providers will be accessed by the Contractor via the Tasmanian Referral Register. 4.2.2 The Contractor will provide, as required in delivering services, referral to providers listed in the Tasmanian Referral Register. 4.2.3 Clients who require on-going assistance and/or counselling will as required be referred to providers listed in the Tasmanian Referral Register. This may include, but not be limited to, referral on psychological, psychiatric, legal and/or financial grounds. 4.3 Register of Referral Providers 4.3.1 The Contractor will work cooperatively with the Department on the required content of the Tasmanian Referral Register (including keeping it up to date). 4.3.2 The Contractor will develop and circulate to all providers in the Tasmanian Referral Register (and any other providers and organisations to whom referrals are made) a protocol for referrals to clarify the organisation's role and operations and its procedures for referrals from and to Gambling Helpline Tasmania. 4.3.3 The Contractor and Department will monitor the outcome of referrals, by receiving feedback and statistics from the Break Even Services Network. 4.3.4 The Contractor will maintain regular contact with Break Even Services Network providers and other organisations to whom callers may be referred throughout Tasmania, including but not limited to services for persons from non-english speaking backgrounds, Aboriginals and Torres Strait Islanders and the hearing impaired. 4.3.5 The Contractor will seek and record suggestions from Break Even Services Network providers for the improvement of referral practices, and make such records available to the Department as and when requested. 5. Printed material 5.1 Where appropriate, the Contractor will mail material to Clients. Such material will include information on problem gambling issues, management and treatments. 5.2 The Contractor will work with the Department to ensure suitable material is available. The Department will prepare or source agreed printed material. 5.3 No material will be mailed to Clients unless it is first approved of in writing by the Delegate. Page 54 of 69

Appendices 6. Coordination of Service 6.1 Client Outcomes Information and Evaluation 6.1.1 Service quality will be monitored by the Department through the monthly, quarterly and annual reports submitted to the Department as detailed under Item 7 of this Schedule. 6.1.2 The Department will conduct a comprehensive evaluation of services delivered under this Agreement prior to expiry of the Term. The Department will inform the Contractor as to when this evaluation will occur and what services will be evaluated. The Contractor will work in collaboration with the Department in this evaluation. 6.2 Communications 6.2.1 The Contractor will ensure that services are not adversely affected by increase demand for services under this Agreement in response to : (a) the Department promoting the service from time to time; and (b) events which may have service implications. 6.2.2 The Contractor will identify a representative who will be the main contact between the Department and the Contractor ( representative ), and inform the Department immediately of any changes regarding a change in the representative. 6.2.3 The Department will ensure that the representative is informed of, and involved fully in, the regular meetings between the other Break Even Services Network providers and the Department. There will be at least six meetings per year, as determined by the Department. The Contractor will participate and contribute to these meetings. 6.2.4 In addition to all reporting requirements under this Agreement, the Contractor will inform the Department about any issues which may threaten the integrity or quality of services under this Agreement. 7. Reporting Requirements 7.1 General 7.1.1 Data is to be collected on all Contacts and services delivered under this Agreement to the Department s satisfaction. 7.1.2 The Contractor will collect data on all Contacts from Clients and report monthly and quarterly to the Delegate. 7.1.3 All reports will be provided to the Department in electronic form in a Microsoft Office compatible format. 7.1.4 Statistical data will be collected on all Contacts in a database designed for this purpose. The database will allow the exporting of records (excluding client-identifying data) in a Microsoft Office compatible format. 7.1.5 Subject to the professional discretion of the Appropriately Qualified Counsellors, data for each Contact will be sought and recorded. The data items to be collected are listed in the Data Dictionary. Page 55 of 69

References 7.1.6 In addition, the counsellors will record all case notes as required for case management. Data will also be collected to assist with further Contacts, debriefing and qualitative analysis of Contacts. 7.2 Monthly Reporting 7.2.1 The Contractor will report and provide data to the Department in writing via emailed reports for each and every month, within 10 Business Days of each month concluding. 7.2.2 The Contractor will work with the Department to develop an agreed monthly reporting template during the first three months of this Agreement. 7.2.3 The template will include, but not be limited to, the following information and data in the following manner: (a) a narrative report giving an overview of service delivery for the month, including commentary on the numbers and types of Contacts, counselling, monthly target response rate indicators, and also covering any operational issues; (b) phone-based activity will be delineated from web-based activity; (c) the report will distinguish between new Clients (who are accessing Gambling Helpline Tasmania for the first time) and existing Clients (who have previously accessed Gambling Helpline Tasmania); (d) a listing of referrals made to, and received from Break Even Services Network providers and other organisations; and (e) a listing of hits to key pages of the website. 7.2.4 All monthly reports must satisfy the Department. 7.3 Quarterly Reporting 7.3.1 The Contractor will report to the Department in writing via emailed reports, within 10 Business Days of the end of each calendar quarter, an analytic report, based on the monthly reporting requirements, on service delivery over the quarter (with monthly breakdowns). 7.3.2 In addition the quarterly reports will detail: Page 56 of 69 (a) a description and review of service delivery over the quarter; (b) an analysis of referrals to other agencies; (c) any recommendations proposed for Departmental consideration copies of any proposed changes to protocols; (d) identified details on any complaints received and the outcome of the complaints handling procedures; (e) quarterly and monthly trend tables and charts on all non-identifying Client data collected on Contacts, cross-tabulated by sex and type of caller; (f) in the key area of Client telephone calls, a statistical report of activity by days of the month to highlight varying activity by time of day, and day of week and month; (g) Aggregate service data, including response times, duration of all Contacts, and the number of abandoned Contacts and whether the Contact is essentially for information, counselling or referral; (h) all Client activities for the quarter, showing demographic and other field data as detailed in the Data Dictionary for new Clients.

Appendices 7.3.3 The Contractor will work with the Department to develop other reports as required. 7.3.4 All quarterly reports must satisfy the Department. 7.4 Annual Reporting Within four weeks following the end of each and every financial year the Contractor will provide the following: (a) a comprehensive report on Gambling Helpline Tasmania services delivery over the financial year, modelled on the monthly and quarterly reports; (b) a detailed report on training and courses completed by the Appropriately Qualified Counsellors and Supervisors; and (c) the Contractor s annual report including fully audited financial statements. Page 57 of 69

APPENDIX 3 References Project Brief Review of Operations Reform Implementation Unit Gambling Helpline Tasmania Review of Operations 2010 PROJECT BRIEF Department of Health and Human Services Page 58 of 69

Appendices Title: Gambling Helpline Tasmania - Review of Operations Objective: The Gambling Support Program seeks a qualified and experienced professional to review the operation of the GHT and make recommendations on future service delivery based on current and future needs as well as linkages with other Break Even services. Promotion of the GHT will be addressed in a separate review. Background Context: The Gambling Support Program (GSP) is located within the Reform Implementation Unit of the Department of Human and Health Services. The Gaming Control Act 1993 specifies that a percentage of the gross profit of gaming machines in hotels and clubs be directed into a Community Support Levy (CSL). Section 151 of the Act requires the Treasurer to distribute the funds in three ways: 1. 25% is directed to grants for sporting and recreation clubs; 2. 25% is directed to grants for charitable organisations; and 3. 50% is for the provision of : - Research into gambling; and - Services for the prevention of compulsive gambling; and - Treatment or rehabilitation of compulsive gamblers; and - Community education concerning gambling; and - Other health services. DHHS addresses the social impact of gambling through programs funded by components 2 and 3. Department of Economic Development (Sport and Recreation Unit) administers programs funded by component 1. Gambling Support Program (GSP), within DHHS, administers: o A Service Agreement with Anglicare Tasmania, working in partnership with Relationships Australia Tasmania, to provide counselling, financial counselling and group support for anyone adversely affected by gambling; Page 59 of 69

References o Contracts with Eastern Health s Turning Point Drug and Alcohol Centre to provide the 24/7 Gambling Helpline Tasmania service and the Gambling Help Online service. These are separate contracts, with the Gambling Help Online being a nationally arranged contract to which Tasmania is a signatory. These services comprise the Break Even services. The standards for the Gambling Helpline service are contained in the contract, attached. In addition, GSP administers: o Two Charitable Organisations Grants Rounds. A Small Grants round has just closed, $330,000 (incl GST) will be expended on grants of up to $12,000 value. A Health and Wellbeing grants round is planned to be offered within the next two months, expending more than $1m on grants of up to $90,000 with and a project duration up to three years. o Research to complement key state and national studies; and o Community Education to address prevention of problem gambling and to promote services for those adversely affected by gambling. Output(s): The scope of the operational review is to: 1. Undertake an appraisal of the Gambling Helpline Tasmania based on an evaluation of the current services and a comparison with other gambling and non-gambling Helpline services. Areas for consideration include: (a) existing contractual specifications requirements (see Attachment 1 for a copy of the current service contract); (b) client outcomes; and (c) best practice evidence of effectiveness. 2. Make recommendations on future direct service delivery adjustments or re-modelling, if indicated. Areas for consideration include: (a) eliminating real or perceived barriers for future clients to access service delivery; and (b) positioning of the Helpline in an integrated service response which meets a range of diverse clients needs along the continuum of gambling behaviours which may include: risk awareness; emergency support; financial advice; legal advice; and counselling. Page 60 of 69

Appendices How will the success of the project be measured: 1. A report complete with executive summary on the current service delivery to Tasmanians against best practice client outcomes; and 2. This report to be provided on time. Budget: $5000 Project Manager: Gavin Miller Coordinator, Gambling Support Program Resources: GSP will provide access to data, support and materials for the review. GSP will facilitate access to key stakeholders, community sector, and gambling clients and inter jurisdictional liaisons. GSP will provide working space for the reviewer if required. Reporting Requirements: Assumptions and Constraints: The Report is to be submitted to the Project Manager by 31 May 2010. 1. The request for the review came from the Treasurer, and the report will be provided to the Treasurer via the Minister for Human Services. 2. GSP will provide documentation, reports and research as required. 3. GSP will arrange access and an introduction to Simone Rodda, Gambling Programs Coordinator at Turning Point, the operator of the Helpline. 4. GSP can assist with report editing and proofing. Major Risks & Minimisation Strategies: 1. Gambling Support Services evaluation is highly political. The consultant will need to have credibility in provision, management and evaluation of helpline services. 2. The Helpline has recently been criticised by the Break Even counselling service for the deterioration of the number of referrals from the Helpline to the face-to-face counselling service. A solution to this difficulty, if it is a real difficulty, might be integration of the Helpline with the Break Even face-to-face service. The seriousness of the criticism should be explored. Strategies to best link the Helpline with the other services to be examined. Page 61 of 69 3. The Helpline is operated out of Victoria and the possibility of having a Tasmanian service is often raised.

References This should be considered in strategic options. 4. This review is taking place against a broader reform agenda aimed at reducing problem gambling on electronic gaming machines. This is being driven by the Productivity Commission, the Greens stated election policy on gambling, DHHS and the Tasmanian Gaming Commission. GSP will brief the consultant on these issues, allowing the consultant to provide any strategic recommendations in a suitable timeframe and context. Issues Management: As the consultant will be working with the GSP, any issues raised can be rapidly addressed. ATTACHMENT Current Agreement with Gambling Helpline Tasmania and the Crown Page 62 of 69

APPENDIX 4 Appendices Project Brief Review of Promotion Reform Implementation Unit Gambling Helpline Tasmania Review of Promotion 2010 PROJECT BRIEF Page 63 of 69 Department of Health and Human Services