July 11, 2012National Conference on Problem Gambling

Presenter:Jennifer Clegg, LSW, MSW, NCGC-II, OCPS-II

Recovery Resources3950 Chester Ave.

Cleveland, OH 44114216-923-4021

Jclegg@recres.org

1

Prevention is an ordered set of steps along a continuum to promote individual, family and community health, prevent mental and behavioral disorders, support resilience and recovery and prevent relapse.

Prevention is prevention is prevention!

Common risk and protective factors exist for many addictions and mental health problems. Good prevention focuses on these common risk factors that can be altered

2

Resilience is built be developing assets in individual, families and communities through evidenced based health promotion and prevention strategies

Systems of prevention services work better than service silos

Baseline data, common assessment tools and outcomes are shared across service systems can promote accountability and effectiveness of prevention efforts

(The Guiding Principals of the Strategic Prevention Framework, SAMHSA)

3

1950’s- early 1960’sScare tactics

Mock crashes Recovery speakers Graphic pictures

Research indicated that these strategies are not effective

4

Late 1960’s to early 1970’s Information

Factual information “medicine show’s” Teaching what drugs are used and how they are

used

This strategies was found to be counter productive and actually glamorized drug use

5

1970’s- mid1980’sDevelop curricula providing effective

education and alternative activities and trainings Just Say No MADD

Mid 1980’s - mid 1990’sResearch based curricula and peer

prevention programs SADD DARE

6

Mid 1990’s - TodayThe gap between research and application

are gradually bridgedEvidences based curricula developed

Utilizing environmental approaches Comprehensive programming targeting many

domains, strategies evaluation of prevention programs, media campaigns and culturally sensitive programs

7

Adolescents today are the first generation of youth exposed to accessible and various types of gaming.

Gambling has become a new rite of passage

Typically 50-80% of teens reports gambling for money during their lifetime

8

Cards Cards

Sports BetsSports Bets Games of Skill Games of Skill (like (like betting each other in betting each other in hoops, pool)hoops, pool)

Video/Arcade Video/Arcade GamesGames

LotteryLottery

InternetInternet BingoBingo

Common Types Common Types of Gambling of Gambling

Among TeensAmong Teens

Source: Carlson & Moore, 1998

9

TardinessMissing school

StealingMood swings

Criminal activityTheft/RobberyEmbezzlement

Drug dealingShoplifting

Secrecy/withdrawalUnexplained debts/cashMissing moneyIncreased anxietySubstance use

FAMILYFAMILY COMMUNITYCOMMUNITY WorkWork

10

Can’t think of anything else but doing drugs

Need more and more to maintain a high

Will do drugs at any cost

Can’t stop even if they want to Lying and stealing to keep

using drugs Drugs help to escape life’s

problem, allows to forget Consequences:

Failing School Problems with

friends/family Risk of ending up in jail

• Can’t think of anything else but doing gambling

• Need to gamble more and more to maintain a high

• Will gamble at any cost• Can’t stop even if they want

to• Lying and stealing to keep

gambling• Gambling help to escape life’s

problem, allows to forget• Consequences:

– Failing School– Problems with

friends/family– Risk of ending up in jail

McGill University11

Students who gamble are more likely to participate in other risk behaviors

Gambling is one of many activities that carry risk and should be addressed as such in school and community prevention efforts

Casino nights in schools and other forms of gambling should be reconsidered.

Parents need to talk with their kids about gambling and gambling related consequences

12

What prevention model do you follow?Public Health ModelEnvironmental ManagementYouth Empowerment and developmentSocial ecological theory

13

Agent

EnvironmentHost

14

15

Universal Intervention refer to efforts focused on every eligible member of a community.

· Selective Intervention are more focused at a more systems domain where higher-risk subgroups are targeted

· Indicated intervention are prevention efforts targeted at individuals, for example those who show signs of developing problems.

16

Prevention is not just about “preventing” something from happening:

“ Prevention is a proactive process that promotes the well-being of people and empowers an individual, group, or community to create and reinforce healthy lifestyles and behaviors to meet the challenges, events and transitions of life.”

Prevention is building healthy people and healthy communities.

DMHAS Problem Gambling Services 2009

17

delinquency

sexualbehavior

smoking

violent behavior

druguse

gambling

High RiskBehaviors

We know that high risk behaviors tend to cluster and gambling appears to fit within a risk behavior matrix

(Marotta, J, 2007)18

Create awareness of gambling attitudes & behaviors;

Increase protective factors;

DMHAS Problem Gambling Services 2009

19

Information Dissemination

Prevention Education

Alternative Activities

Community-Based Processes

Problem Identification/Referral

Environmental Approaches

Our Approach: Uses CSAP Prevention Strategies

Research shows that it takes ongoing efforts in all 6 areas for prevention to really work

(Marotta, J, 2007)20

This strategy provides awareness and knowledge of the nature and extent of substance use, abuse, and addiction and their effects on individuals, families, and communities. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two. [Note: Information dissemination alone has not been shown to be effective at preventing substance abuse.]

21

Clearinghouses and other information resources centers

Resource directories Media campaigns Brochures PSA’s Speaking engagements Health fairs

22

This strategy involves two-way communication and is distinguished from the information dissemination strategy by the fact that interaction between the educator/ facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g., of media messages), and systematic judgment abilities.

23

Classroom or small group sessions Peer leadership and peer helper groups Parenting and family management

classes Educations sessions for youth groups Groups for children of addicts

24

This strategy provides for the participation of target populations in activities that exclude substance use. The assumption is that constructive and healthy activities offset the attraction to--or otherwise meet the needs usually filled by--alcohol and drugs and would, therefore, minimize or obviate resort to the latter. [Note: Alternative activities alone have not been shown to be effective at preventing substance abuse.]

25

Social and recreational activities Youth and adult leadership activities Community drop in centers Mentoring programs

26

This strategy aims to enhance the ability of the community to more effectively provide prevention and treatment services for substance abuse disorders. Activities in this strategy include organizing, planning, enhancing efficiency and effectiveness of services implementation, interagency collaboration, coalition building, and networking.

27

Community and volunteer training Systematic planning Multi agency collaboration and

coordination Accessing services and funding Community team building

28

Individualized environment Seek to socialize, instruct, guide, & counsel children to increase their resistance to health risks Shared environment Support healthy behavior, prevent risky behavior for all children Environmental strategies Price interventions, minimum -purchase-age, deterrence, location & density, counter-ads

29

This strategy aims at identification of those who have indulged in illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person is in need of treatment.

30

Employee assistance programs Student assistance programs DUI education programs

31

Individual Peer Family School/work Community Society/environmental

32

USE MULTIPLE STRATEGIES OVER MULTIPLE DOMAIN

33

37.9% - non-gamblers 49.3% Social gamblers 7.8% at risk gambler’s

9.5% males1.6%females

5% Probable pathological gamblers11.7%males4.9% females

Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D.

34

Similar to public health model of disease prevention: focus on decreasing risk and increasing protection

Risk factors predict addictive behaviors and protective factors can buffer risk factors

To prevent high risk behaviors, such as gambling or substance abuse, reduce risk factors and increase protective factors throughout a child’s life

35

Child of a compulsive gambler Belief that skill is involved An early big win Feeling that one must chase

gambling loss with more gambling Early age of onset Large first bets Otherwise addicted

36

Emotional difficulties Stress Distorted expectations about

winning Social pressure to gamble Risky gambling behavior Attention deficits Impulsivity Illusion of control over outcomes Addiction history

37

Plays with $ that is needed or borrowed.

Expects to win; keeps playing to win back losses.

Is revolved around

gambling.

Frequent, or spends more time

gambling.

Sticks to limits of money to play with.

Hopes to win butexpects to lose.

Can take it or leave it.

Occasional gambler.

PROBLEM GAMBLINGSOCIAL GAMBLING

38

At-risk for a substance abuse problem Having a parent, sibling, relative, friend, or

significant person with either a gambling problem or substance use problem

Having or knowing peers with substance use problems is a risk correlate of youth problem gambling

Anxiety High risk propensity Low perception of risk regarding problem

gambling Early onset of gambling behaviorYouth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem

Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D.

39

Family connectedness Designing school-based prevention programs

that seek to develop student’s attachment, trust, and identification with larger groups(e.g., school clubs and sports teams, Scoutsor Guides).

Youth Gambling Problems: The Identification of Risk and Protective Factors: Report to the Ontario Problem Gambling Research Centre” Laurie Dickenson, MA, Jeffery L. Derevensky, Ph.D., Rina Gupta, Ph.D.

40

41

Assessment Capacity Building Planning Implementation Evaluation All under the umbrella of cultural

competence and sustainability

42

43

What is Assessment? Assessment of high risk behavior and

related problems Assessment requires us to explore

rates and patterns of high risk behavior as well as related problems (consequences). Prevalence data Incidence data Consequence data

(Adapted from CSAP Strategic Planning Framework)

44

How do we know if our needs assessment data is valid?

Next- Stare at

the black "+" in the center.

What color are the moving

dots now?

First- What color

dots do you see?

Lastly- Keep staring at the black "+" in the center of the picture. What happens to moving dots now?

45

There really is no green dot, and the pink ones

really don't disappear.

What does this optical illusion have to do with conducting a

needs assessment?

49

Increase Awareness

Change in Attitude

Change in Behavior

(Adapted from CSAP Strategic Planning Framework)

50

(Adapted from CSAP Strategic Planning Framework)

Types and levels of resources needed to address identified needs including:

• Human resources• Technical resources • Management and Evaluation

resources• Financial resources

52

What is a Comprehensive Strategic Plan? A comprehensive, logical, and data

driven plan to address the problems identified in phase 1 using the capacity built or mobilized in phase 2

The plan includes Strategic Goals, Objectives, and Outcomes, as well as Logic Models and in some cases Action Plans

(Adapted from CSAP Strategic Planning Framework)

Taking action as guided by the Strategic Plan developed in phase 3

Developing detailed action plans for elements of your intervention

Developing a final detailed evaluation plan that includes process and outcome measurements and continual monitoring of implementation fidelity

(Adapted from CSAP Strategic Planning Framework)53

What does the Evaluation phase include?

Process evaluation Collection of required outcome data Review of policy, program, and practice

effectiveness Development of recommendations for

quality improvement

(Adapted from CSAP Strategic Planning Framework)54

55

Why cultural competence? To eliminate service and participation

disparities for people of diverse racial, ethnic, and linguistic populations

To consider culture, gender, ability levels, and sexual orientation in all aspects of the SPF

To improve the effectiveness and the quality of the programs, policies and practices chosen to achieve outcomes

56

Can be defined as “a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals and enable that system agency or those professionals

to work effectively in cross-cultural situations.”

(The Lewin Group, 2002)

57

Structures and formal linkages Champion and leadership actions Resources Administrative policies and procedures Expertise Ownership among stakeholders

58

Prevention is a continuum Prevention is prevention is prevention Successful prevention decreases risk

factors and enhances protective factors Prevention requires adoption of known

effective prevention practices within a framework that works

Why invent the wheel? We spent many years learning what

works and what doesn’t in substance abuse prevention, let’s adapt it to gambling prevention

59