July 11, 2012
National Conference on Problem Gambling
Presenter:
Jennifer Clegg, LSW, MSW, NCGC-II, OCPS-II
Recovery Resources
3950 Chester Ave.
Cleveland, OH 44114
216-923-4021
[email protected]
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
1
 1950’s




early 1960’s
Scare 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


Just Say No
MADD
 Mid

mid1980’s
Develop curricula providing effective education
and alternative activities and trainings
1980’s - mid 1990’s
Research based curricula and peer prevention
programs


SADD
DARE
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2
 Mid


1990’s - Today
The gap between research and application are
gradually bridged
Evidences 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
Common Types of
Gambling Among
Teens
Cards
 Sports Bets
 Games of Skill (like
betting each other in
hoops, pool)
 Bingo
Source: Carlson & Moore, 1998
Video/Arcade
Games
Lottery
 Internet
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3
This image cannot currently be display ed.
FAMILY
COMMUNITY
Work
Secrecy/withdrawal
Unexplained
Tardiness
debts/cash
Missing school
Missing money
Stealing
Increased anxiety
Mood swings
Substance use
Criminal activity
Theft/Robbery
Embezzlement
Drug dealing
Shoplifting
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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 University
11
 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
4
 What




prevention model do you follow?
Public Health Model
Environmental Management
Youth Empowerment and development
Social ecological theory
13
Agent
Host
Environment
14
15
5
 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.
Services 2009
DMHAS Problem Gambling
17
 We
know that high
risk behaviors tend to
cluster and gambling
appears to fit within a
risk behavior matrix
sexual
behavior
smoking
delinquency High Risk
violent
Behaviors behavior
drug
use
gambling
(Marotta, J, 2007)
18
6
 Create
awareness of gambling attitudes &
behaviors;
 Increase protective factors;
DMHAS Problem Gambling Services 2009
19
Our Approach:
Uses CSAP Prevention Strategies
Information Dissemination
Prevention Education
Alternative Activities
Community-Based Processes
Problem
Identification/Referral
Research shows
that it takes
ongoing efforts
in all 6 areas for
prevention to
really work
Environmental Approaches
(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
7
 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
leadership and peer helper groups
 Parenting and family management classes
 Educations sessions for youth groups
 Groups for children of addicts
 Peer
24
8
 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
and adult leadership activities
 Community drop in centers
 Mentoring programs
 Youth
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
9
 Community
and volunteer training
planning
 Multi agency collaboration and coordination
 Accessing services and funding
 Community team building
 Systematic
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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/ageinappropriate 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
10
 Employee
assistance programs
assistance programs
 DUI education programs
 Student
31
 Individual





Peer
Family
School/work
Community
Society/environmental
32
USE
MULTIPLE STRATEGIES
OVER MULTIPLE DOMAIN
33
11
 37.9%
- non-gamblers
Social gamblers
 7.8% at risk gambler’s
 49.3%


9.5% males
1.6%females
 5%


Probable pathological gamblers
11.7%males
4.9% 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
12
 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
SOCIAL GAMBLING
PROBLEM GAMBLING
Occasional gambler.
Frequent, or spends
more time gambling.
Sticks to limits of
money to play with.
Plays with $ that is
needed or borrowed.
Hopes to win but
expects to lose.
Can take it or
leave it.
Expects to win;
keeps playing to
win back losses.
Is revolved around
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 behavior


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.
39
13
 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, Scouts
or 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
14
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)
43
How do we know if our needs assessment data is valid?
Next-
First-
Stare at
the black
"+" in the
center.
What color
dots do
you see?
What color
are the
moving
dots now?
Lastly- Keep staring at the black "+" in the center of the picture.
What happens to moving dots now?
44
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?
45
15
Hy p o Ha p p y Vall e y
“We have a problem, but we don’t care!”
Gamblingtown, USA
“We have a problem, but we don’t care.”
HIGH
LOW
PERCEPTION
OF
PROBLEM
PERMISSIVE
ATTITUDES
YOUTH
ACCESS
SUPPOR T
FOR ATOD
PREVENTION
COMMUNI TY
COMMITMENT
(Adapted from CSAP Strategic Planning Framework)
Poised For Action
“We ha
a probl but
, we
“We have
a problem,
but we don’t know what to do!”
don’t know what to do.”
HI GH
LOW
PERCEPTION
OF
PROBLEM
PERMI SSIV E
ATTI TUDES
YOUTH
ACCESS
SUPPORT
FOR ATOD
PREVENTION
COMMU NI TY
COMM I TMENT
(Adapted from CSAP Strategic Planning Framework)
Utopia
“No
highhigh
support
and
“Noproblem,
problem,
support
commitment”
and commitment.”
HI GH
LOW
PERCEPTION
OF
PROBLEM
PERMI SSIV E
ATTI TUDES
YOUTH
ACCESS
SUPPORT
FOR ATOD
PREVENTION
COMMU NI TY
COMM I TMENT
(Adapted from CSAP Strategic Planning Framework)
16
Increase Awareness
Change in Attitude
Change in Behavior
(Adapted from CSAP Strategic Planning Framework)
49
50
Types and levels of resources needed to
address identified needs including:
• Human resources
• Technical resources
• Management and Evaluation
resources
• Financial resources
(Adapted from CSAP Strategic Planning Framework)
17
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)
52
 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
of required outcome data
 Review of policy, program, and practice
effectiveness
 Development of recommendations for quality
improvement
 Collection
(Adapted from CSAP Strategic Planning Framework)
54
18
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
55
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)
56
 Structures
 Champion
and formal linkages
and leadership actions
 Resources
 Administrative
policies and procedures
 Expertise
 Ownership
among stakeholders
57
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



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
58
 Why
invent the wheel?
spent many years learning what works
and what doesn’t in substance abuse
prevention, let’s adapt it to gambling
prevention
 We
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20