Substance Use Disorders and Problem Gambling Pilots

1. Substance Use Disorders and Problem Gambling Pilots Challenge and Success in Rural Settings

2. Project Partners

3. Environmental Scan • 45 rural Michigan Counties • 32,486 square miles (Detroit = 138) • 16 of Michigan’s 22 Casinos (2010) • 852,000 residents within 50 miles of a Casino

4. Environmental Scan • 6 Certified Gambling Counselors (not all active) • Gambling Impact and Behavior Study found pathological gambling rates twice as high for those living within 50 miles of a casino • Estimated 20,000+ meeting DSM IV criteria for pathological gambling

5. Baseline Service Data • # of calls to NSO from county residents (October 1, 2007-September 30, 2008) 883 • # of clients treated from service area (October 1, 2006-September 30, 2007) 36

6. Practical Barriers Distance Public transportation Fuel costs

7. Practical Barriers Weather Attitudes Denial

8. Practical Barriers • Resources Funding Counselor Training Identification and Referral

9. Project Objectives ►Create a systematic screening and referral service in venues in which individuals with these conditions are likely to be seen. ►Significantly expand the availability of treatment services to meet NSO Provider Network credentialing standards. ►Implement “Facilitated Support” groups for those in early recovery from pathological or problem gambling. ►Utilize recognized prevention education strategies to reach “at risk” individuals which will include a major media event project that will cover both northern Michigan and the Upper Peninsula.

10. Create a systematic screening and referral service for problem and pathological gambling in venues in which individuals with these conditions are likely to be seen • Courts engaged in the systematic use of the Screen for Gambling Problems (NODS) to make appropriate referrals for treatment. • Secondarily target credit counseling agencies, Senior Citizen Centers, DHS, banks and lending agencies and other appropriate organizations with education and awareness of the issue. • The NODS incorporated into the CA Access Center screenings and treatment provider assessments.

11. Outcome Courts and the SUD Treatment System were engaged and screened 2874 individuals using the NODS Eighty-eight people were identified as in need of treatment and referred (3%)

12. Expand the availability of treatment services for problem and pathological gambling • Propose to train 30 to 35 clinicians in the first year of the project with an option to train an additional 30 in the second and third year based on need. • Utilize our established contracting system, payment methodologies and data collection and reporting systems to quickly implement the expanded services for pathological and problem gamblers.

13. Outcome Trained 44 clinicians in the first year of the project The current provider network and the system for data collection, authorization and payment system was utilized. Procedures specific to this service were developed to streamline the process and remove barriers . First clients were served during the first month of the project.

14. Implement “Facilitated Support” groups for those in early recovery from pathological or problem gambling. • Not implemented during the first year of the grant

15. Utilize recognized prevention education strategies to reach “at risk” individuals which will include a major media event project Identify and purchase a single evidence-base or best practice public awareness and education media campaign targeting at-risk and problem gamblers, including those impacted by internet gambling.

16. Media Campaign-Television

17. Media Campaign- Radio

18. Outcome Neighborhood Service Organization reported a 20% increase in calls seeking information from the targeted area FY 2007 883 FY 2009 1057 (annualized from 11 months data)

19. Outcome Audience Reached with Media Campaign Newsprint – 154,900 Television - Over 1,660,000 “hits” Radio Spots - Undetermined

20. …So at the end of the year

21. We increased number of individuals entering treatment for problem/pathological gambling 67% Increase in the Number of Individuals Entering Treatment for Pathological Gambling FY 2007 – 36 FY 2009 - 60

22. What Worked? • Subsidizing agencies to send staff for training • Adding problem gambling addiction screening to Access Center and Treatment Providers • Providing modest incentive to the courts to conduct NODS • Reimbursing providers for outreach services • Creating a media message that was tailored to population in service area • Using existing infrastructure (billing, provider network, etc.)

23. What Worked? • Streamlining paperwork • Enlisting a referral source (courts) with capacity and authority to encourage follow through on referrals • Integrating substance use disorder treatment and pathological gambling treatment • Removing financial eligibility criteria • Payment for assistance to family members in person and over the phone

24. What Didn’t Work? • System for referrals through statewide 800 number • Making it a priority service for SUD providers including CA Access Center • Anticipated impact of outreach didn’t meet expectations

25. What We Learned • Need to have a “deeper” bench – staff turnover • Even small financial incentives matter • Opportunity to engage a person in treatment at the point of the first call and assuring a warm transfer to treatment is critical.

26. What We Learned • Very few calls to the 800 number resulted in an admission to treatment • CA needs to take lead in assuring ground work with referral sources is completed • Didn’t use our collective experience (CA partners, NSO and MDCH) to enhance outcomes • Takes longer to build infrastructure than planned-transformation in a system – Longer process

27. Future Ideas-Wish List • Telecounseling • Conduct an attitude survey of SUD providers regarding problem/pathological gambling • Continued funding • Target natural supports such as clergy • Improve working relationship and coordination between CA partners and with Neighborhood Service Organization and Michigan Department of Community Health

28. Questions?

29. Contact Information Pathways/Northcare Coordinating Agency Bob Mellin rmellin@up-pathways.org Northern Michigan Substance Abuse Services Sue Winter suewinter@nmsas.net