Breakout Session Notes

Prevention

What aspects of Prevention are important when we think of problem gambling?

• Education ~ consequences, risk factors
• Awareness
• Target groups ~ age, culture
• Social issues
• Advertising
• Availability
• Types of gambling ~ casino, internet (better training to address/recognize)
• Help line
• Training counselors
• Define the risk of problem gambling
• Identify risks/protective factors related to problem gambling
• Research evidence based programs related to problem gambling
• What laws are related to underage gambling?  Is it against the law for kids to be in Texas Hold’em restaurants?
• Start prevention education early
• Stigma
• Programs/Services
• Education       

                  Potential gamblers
                  Teenagers (adolescents, ages 12-24)
                  Parents
                  Far reaching/outreach
                  Professionals
                  Judicial system
                  School counseling staff
                  CPS
                  Aging population/APS

• Make gambling a part of the assessment
• Social/Environment
• Availability
• Policies

What are our Prevention priorities today?  Where and how does problem gambling fit?

• Seek advice/help from national resources (National Council on Problem Gambling)
• Advertising – all medias
• Work together with medical profession
• Financial institutions
• Remove ATMs from casinos

What are our Prevention priorities today?  Where and how does problem gambling fit? Continued…

• Identify enabling behaviors
• Identify alternative recreation (youth & elderly)

• Schools
• Look at commonalities with other risk factors for substance abuse prevention
• Develop PSAs to counter pro-gambling advertising
• Priority to use evidence based data and programs
• Substance abuse / Underage drinking
• Consider problem gambling in current risk factor model (another “problem behavior”
• EES
• CFS
• Working with casinos to identify need for services
• Working with clients on budgeting/financial boundaries
• Identifying common risk factors/needs assessment
• Counter-advertising
• Collaboration – National, State to State, local, community.

 What people, organizations, systems and professional groups should be at the table?

Who should conduct the training?

• Someone with experience and success
• “Kansas grown” based on experts
• Recovering individuals
• Local (service coaches)
• Bankers (financial)
• Increased number of certified gambling counselors
• GA group

How could the training needs of providers in rural and frontier areas be addressed?

• Technology ~ video conferencing                                         
• Travel
• Sharing information ~ What is available?
• Incentives to serve ~ tuition, etc.
• Address poverty issue
• Established reimbursement program
• Assess greatest need
• Informed choices
• Border issues ~ who pays?

How could the training needs of providers in rural and frontier areas be addressed? Continued…

• Staff assessment
• Study results provided to state

With what existing systems can we partner in the effort and what would their roles be (e.g. Addiction Treatment Transfer Center (ATTC), community colleges)?

• KAAB
• National council NCADD
• Mental health counselors
• Problem gambling coalition
• Racing and Gaming Commission
• Fellow agencies
• Prevention from within
• Interfaith counsels, community colleges
• Medical community, clinics
• High schools
• Technology – WIKI, internet
• Mid-America (ATTC
• ATTC training of the trainers ~ web and in person

Research and Evaluation

What kind of research should be done and for what purpose?

• All people with addiction resist treatment.
• Core addiction treatment can be used and augmented for gambling addicts.
• Is there another addiction involved?  Prevalence of co-occuring disorder.
• Distinction between evaluation and research.  Typically:

            Research = prevalence studies
                               enrollment/discharge data in treatment

• Montreal – Research methodology – 7 year longitudinal study of community

      (where casino was going in)

• “Pure” research is expensive
• Research grant program to take the state toward a “best practice” standard.
• Role of clinical research with clinical trials with medication – med center, self-

      help network, WSU, etc.

• How high a priority is it to put dollars into research?
• Pick one community r/t whole state.
• Dodge City – good choice.  Establish baseline and log longitudinal study.
• SRS could provide dollars by prioritizing research and making grants available.
• Leverage Federal funds.
• Setting up state-wide RFP/grant system.  Would bring in academic community.

      No national institute in gambling.

• What are pathways to recovery from gambling addiction?  There is a small

      amount of these studies.

• Consider student research grants (small amounts – big results)
• How do we evaluate these research grants (see Bill language)

Themes:     Lots of support for grant based research – not all pre-defined.
                  Socio-economic impact on one community like Dodge City.

What treatment outcomes would be important to measure for this population?

• Successful completion of treatment.
• Define success.  Treatment complete vs. lower gambling or zero gambling.
• Abstinence vs. harm reduction.
• Measuring quality of life components

                  Family
                  Employment
                  Finances

• Currently no standardized tracking.  We use NOMS.
• Treatment complexion is different for people and programs.
• Many pathways to recovery.
• Addiction vs. abuse definition.

What treatment outcomes would be important to measure for this population? Continued…

• Promising practices.  States vary widely.  Some only GA or some with inpatient/outpatient.  Mostly funding goes to outpatient – combo individual/group.  On average, 20 sessions.
• What types of gambler benefits from what type of treatment.  Based on typologies r/t progression.
• Need theoretical model (to classify).

                  Extensive assessment
                  Drives treatment decisions

• Do we need to bring (or does Kansas have) gambling addiction experts?

Themes:     Don’t just look at outcome measures, look at several harm reduction vs.                              abstinence for outcomes.

                  Importance of follow- up evaluation.
           
What data should SRS collect to evaluate regarding problem gambling services?

• Start with baseline – Dodge City

                  Prevention
                  Treatment
                  Community impact
                  Community based survey before, during and after.

• No systematic way to collect information on gambling, i.e. police reports, accident rate on route, other related incidences.  CTL is exception.
• Race and ethnicity.  Cultural awareness/attitudes
• Gender
• Demographics in general.  Epidemiological.
• How to evaluate impact.  ID sub populations early.
• To what extent do problem gamblers turn to others outside treatment/recovery system for help?
• Interview community leaders etc. as part of survey/initial data and on-going.
• Can we piggy  back on existing A&D infrastructure for research/evaluation?  KCPC.  Interface with A&D system.
• Mental Health Center intakes.  AIMS data.  Lets not reinvent the wheel.
• Interface with providers who are collecting data.  All of group.  Specify in grants.

Themes:     Programs and community data.
                  Gather much descriptive data about gambler entering treatment.
                  Not reinvent the wheel.
                  Use existing infrastructure.

Public Awareness and Marketing

On what should a public awareness campaign focus?

• What the problem is…and what it is not.
• Results of problem gambling.  Impact on the family.
• Where to go to get help.
• High risk factors that lead to the problem.
• Look at populations – Aging, youth, etc.  Not just one group.  Have target audiences.
• Education to break the stereotypes.  Everyone is at risk.
• Use data to educate.
• Prevention efforts.
• Available treatment options.
• Design the message appropriately – succinct – so the message is branded and doesn’t lose focus.
• Approach it using strategic marketing strategies.
• Benefits to a community for having gambling.
• Delineate gambling vs problem gambling – gamble responsibly.
• Appeal to consumers rather than making it a political statement.
• Signs and symptoms of problem gambling and who to call for help (helpline).
• Focus on those family members (and others) affected and signs and symptoms that others can identify.
• A separate campaign for self-exclusion.
• Create a cohesive brand – one number to call, one website for gaming information – a coalition of all interested parties.

What types of advertising, marketing, and promotion might be especially effective?

• Billboards furnishing help line and website.
• Radio
• Anonymous information on websites.
• Television commercials.
• Regional Prevention Centers working with coalitions.
• Bathroom stall advertising.
• Direct mailing.
• Coupons – message about responsible gaming.
• Public utilities – flyers.
• Newspaper advertising.
• Curriculum in schools.
• Faith-based.
• High profile spokesperson – or “real” spokespersons.
• Look for someone like Michael Vick to say “I lost it all.”
• Counselor training.

What types of advertising, marketing, and promotion might be especially effective? Continued…

• Educate people about side-effects of medication.
• A brand!
• Make materials available – logos, PSAs, etc.

What sub-populations should be targeted and by whom?

Sub-population	By whom?
50+ to Retirees	AARP
Youth	Schools, On-line gambling, Hip Hop radio stations, Sports talk radio
College students	Orientation
Those already addicted
Geographical Areas	Resource Directories, Phone books
Families
Caregivers – Parents (includes exploitation)
Professionals – Physicians	Medical Schools, Conferences, Continuing Education
Financial Institutions – Housing Refinancing
General	Legal System
Other Ethnicities

Highlights:

• A brand – organized, cohesive, consistent effort.  Simple and memorable effort.
• Recognizing many sub-populations.  Crafting messages to diverse audience.
• Define what problem gambling is and what it is not.

Crisis Intervention and Helpline Services

How will we assure there are no “wrong” doors for problem gamblers or affected others seeking services?

• Advertise.
• Phone calls from phone book > Awareness.
• Clear broad-based, wide spread information.
• Standard screening into regular screening.
• Target awareness by all access points.  Addictionizing.  Need specific knowledge for this issue.  Competency of providing the service.  Point person needs to be informed/qualified with crisis intervention experience.
• Need Master’s level for point person.  Casino…training as a “natural Helper”.  Non Professional.
• Learn more about “process addiction”.  Adequate funding for quality hiring for “point person” who’s accessible and knowledgeable of resources across the state.
• Collaborate with 911, Law Enforcement, Hospital ER, First Responders, Cosmotoligists, Clergy, Bartenders.

What services should a helpline offer?

• What percentage come from gambler?  Average 3-5 minute conversations.  Engagement.
• Provide excellent resource to Mental Health and community.  Phone number, information, location of caller, family.
• Gambler’s mindset.  Won’t admit problem, narsistic, 12 steps for GA are different.
• Need process training and treatment.
• Engagement skills must be stronger.
• More training and qualified for each addiction type.
• Treatment on demand and the system to log the information.
• On call counselors across the state.
• Implement access standards, triage and tracking of information.
• Shared knowledge per person – Database.
• Helpline is the beginning of case coordination.
• Follow up for the caller and check with caller later.  Call helpline with feedback.
• Crisis and treatment on demand (24 hour access to treatment).

Where and how can we most effectively implement problem gambling assessment and referral programs within community contact points?

• Standard questions in all assessments.
• Training of persons asking screening questins.
• Next step if “yes”
• Tool like SASSI for gambling addiction

Where and how can we most effectively implement problem gambling assessment and referral programs within community contact points? Continued…

• Community contacts developed.  Banks, Credit Unions, Doctor offices.
• Know where GA meetings are being held.  Help non-GA get to meeting.
• Curriculum to include core competency for providers and legitimize this treatment.
• Become a part of what AAPS requires.  Credentials include specific education.
• Degrees, Doctor, Nurses, Social Workers, Psychologists, Etc.
• Use helpline as consultation point for community and providers.  Community resource.

Treatment

What levels of care are essential for problem gamblers?

• Base it on what research says.
• Work equity.  Community service.  Give back.
• Crisis services.
• One on one care.
• Group
• Family
• Residential
• Couple
• Intensive out patient
• Case management
• DBT – Dialetical Behavioral Treatment
• Medication management
• Financial
• Aftercare
• Immediate intervention
• Support groups
• Dual diagnosis
• Legal consultation
• Recovery house/Oxford houses
• Housing – gambling shelters
• Assessment services
• Services for children
• Transportation
• Payees

How should the client fee structure be set up?

• Income based.
• Progressive.  As the person goes through treatment, they pay more.
• Ability to pay.
• Client being responsible for a portion.
• Individualized treatment with individualized fee structure.
• If no fee – it would be for family members.
• Completion responsibility.
• No cost at all to gambler or family.  State pays all.

Who should be eligible to provide SRS supported problem gambling treatment?  Include any discussion about provider training or certification requirements.

• Certified speciality for program gambling.
• Trained to work with problem gamblers.
• Determine an oversight structure for monitoring counselors.
• Ongoing C.E.U.s offered locally.
• University courses need to be developed and offered.
• Core competencies i.e. personality disorders, social anxiety, crisis intervention, suicide.
• Decompression therapy (debriefing)
• Special populations – casino vs. internet vs. stock market.  Youth vs. elderly.
• Not so narrow it excludes SA treatment professional.
• Why must you be CADC II or III?
• Standards for non-mental health providers (credit counselors to be able to provide services.)

What should the provider reimbursement structure look like?

• Fee for service with no limit.
• Fees based on qualifications.
• Standard fee for each service.
• Fee based on outcomes.
• Fee schedule based on percentage of Medicaid.
• Incentive the fee schedule to encourage providers to come into the field.
• Appropriate pay for the intensity of service.
• Incentives for treatment retention – can’t keep them coming.
• Formulamatic – fee payment for referrals to out of state providers.
• Flex fund to pay rent/utilities with stipulation the person stays in treatment.

Themes:

• Need for specialized training.
• Knowledge of community supports.
• Need to be paid for services.
• Cooperation between entities.
• Incentives for clients.
• Communication and creativity.