A Problem Gambling Telephone Intervention Program for the Chinese Community

1. A Problem Gambling Telephone Intervention Program for the Chinese Community Initial Successes, Challenges and Lessons Learned

2. About NICOS NICOS Chinese Health Coalition is a public-private-community partnership of more than 30 health and human service organizations. The mission of NICOS is to enhance the health and well-being of San Francisco’s Chinese community.

3. Background • Chinese Community Health Study • (NICOS/ Four Winds, 1997) • Telephone Survey of 1,808 Chinese American adults in San Francisco • Purpose: Health profile • 70% identified gambling as a problem

4. NICOS – PG Programs • Chinese Community Problem Gambling Project (CCPGP) • Chinese Statewide Problem Gambling Helpline • Problem Gambling Technical Assistance and Training Project (PGTAT) • Problem Gambling Telephone Intervention (PGTI)

5. Gambling Helpline 1-888-968-7888 Information & Literature GA or Gam-Anon Inpatient Outpatient Telephone Counseling Refer to Resources Refer to Services Case Coordinator (NICOS) Sends Reg. Packet to Client Receives Signed Consent Chinese Community Problem Gambling Helpline NICOS Chinese Health Coalition Assigns Case to Appropriate Provider NICOS PGTI Providers UGSP / OPG Approved Provider Schedules Intake Session & Subsequent Sessions w/Client UGSP / Office of Problem Gambling Submits Client Data via DMS Administrative Tasks

6. Project Overview

7. PGTI - Overview • 8 sessions telephone counseling • Licensed providers • Utilizes self-help workbook • Linked to helpline services • Cantonese, Mandarin (English, Spanish – BDA) • Follow-up/ evaluation component • Goal: • Provide time-limited, telephone treatment to non-English PG and Affected Individuals • transition to outpatient face-to-face

8. Who’s Eligible for PGTI Services? Gamblers must meet the following criteria: • Must be 18 years or older; and • Meet at least one of the diagnostic criteria for Pathological Gambling described in the Diagnostic and Statistical Manual-IV (DSM-IV); or • Receive approval from OPG for services on a case-by-case basis. Affected individual(s) (including but not limited to: spouses, domestic partners, cohabitants, family members, work or school colleagues, or neighbors) of pathological/problem gamblers must meet the following criteria: • The affected person is 18 years or older; and • Affected individual(s) must report an adverse psychiatric or physical impact experienced due to ongoing problem or pathological gambling behaviors.

9. Players Involved in PGTI Office of Problem Gambling: Overall oversight of the CPGTSP – including PGTI. Reimburses providers and its subcontractors. UCLA Gambling Studies Program: Clinical and research oversight – including the design of tools for treatment and data collection. Bensinger & Dupond Associates: 1-800-GAMBLER will refer clients to the PGTI Program. BDA Richmond Area Multi-Services: 1-888-968-7888 will refer clients to the PGTI Program. NICOS: Subcontractor to administer the Chinese/Asian Language PGTI Program. NICOS’ PGTI Providers will provide telephone-based counseling services to problem gamblers and affected individuals.

10. Provider Qualifications • Licensed in California to engage in the practice of mental health (MD, PhD, PsyD, LCSW, MFT, etc.) • License must be current and in good standing and possess no violations or pending actions • Completion of Phase I Provider Training (30 hours) • Completion of NICOS’ language assessment certification • Current and viable professional malpractice insurance*** • Clinical office policies must be HIPAA compliant; and • Access to a personal computer, with high-speed Internet access

11. Cultural & Linguistic Adaptations • Translated client consent forms (Release of Info., Rights & Responsibilities, Telephone Follow-up, Revoke Consent, Client Handbook, etc.) • Providers • Providers utilize UCLA’s Chinese-translated Freedom from Gambling handbook • In the process of developing treatment module for affected individuals • NICOS and providers offer linguistic/cultural support to clients to navigate PGTI program

12. Program Accomplishments

13. NICOS PGTI Program Provider Overview • Developed program policies & procedures manual • Developed training curriculum (incl. how to work with clients on the phone) • 8 providers trained – Nov. 3, 2010 through 2011 • Currently 5 active providers, 1 pending • English, Cantonese, Mandarin, Taiwanese, Vietnamese, Teo-Chow

14. Percentage of PGTI Enrollment Referral from Helpline n = 10

15. NICOS PGTI Program Client Overview • 7 clients enrolled to date • 4 gamblers & 3 affected individuals • Average NODS score = 7.33 out of 10 • Chinese ethnicity(100%) • Cantonese (57%), Mandarin (43%) • Speaks English: Very Well (17%); Well (17%); Not Well (50%); Not Well At All (17%) • Full Time Employed (100%)

16. Number of Treatment Sessions As of 2/11/2011

17. Overall Life Satisfaction

18. Urge/Craving to Gamble

19. Perceived Control over Gambling

20. Impact of Gambling

21. Challenges

22. Challenges for the PGTI Program • Telemedicine is a relatively new mode of psychotherapy delivery, esp. for PG • Both must work to eliminate distractions not found in conventional therapeutic settings

23. Challenges for the PGTI Program • Telemedicine is a relatively new mode of psychotherapy delivery, esp. for PG • Both the consumer and the provider must adapt to a new therapeutic interaction, incl. the absence of visual/facial cues, etc.

24. Challenges for the PGTI Program • Community stigma towards mental health and professional help • Qualitative research in Chinese community shows that many equate MH with insanity and do not believe in seeking help • Reticence of seeking outside help for PG, unless/until situation is exacerbated by large debts • Chinese PGs may not seek help until problems have progressed to greater degree of severity

25. Challenges for the PGTI Program • Client’s linguistic & cultural needs, and socioeconomic status poses challenges for transition • Several clients are uninsured, and holding multiple low-end jobs, making out-of-pocket therapeutic expenses difficult • Limited linguistically specific resources

26. Challenges • Cultural acceptance • Immigration-related issues • Environmental prevalence • Target marketing

27. Lessons Learned

28. Lessons Learned • Telephone treatment poses fewer barriers for consumers to access • Client urgency for immediate provision of services • Preliminary data shows PGTI program to be promising • Telemedicine requires specialized psychotherapeutic approach • Consumer’s linguistic and other needs pose challenges to transition • Paperwork challenges – (in-language is helpful, and personal assistance helpful)

29. Next Steps

30. Next Steps • Engage Chinese media in promoting program (e.g.,  press conference or press release, TV/ radio interviews, etc.) • Develop webinar trainings for providers • Adapt NICOS’ successful affected individual treatment module for the PGTI program • Investigate possibilities of integrating existing PGTAT curriculum on Asian Americans into PGTI training curriculum

31. THANK YOU!!!NICOS Chinese Health Coalition1208 Mason StreetSan Francisco, CA 94108Chinese Helpline: 1-888-968-7888http://www.nicoschc.org