SGTS

1. SGTS Statewide Gambling Therapy Service Alwin Chong, Peter Harvey, Sue Bertossa & Josh Wilson

2. Gambling in Indigenous communities engagement, consultation and assessment South Australia

3. overview SGTS programme background engagement of Aboriginal people in consultations modification of assessment & treatment the Australian Indigenous Problem Gambling Index (AIPGI) survey findings to date future work

4. SGTS context CBT based treatment for gambling disorder (now a mental health / addictive disorder in DSM5) exposure therapy to overcome the urge to gamble funded to treat around 400 clients a year…8-12 sessions in outpatient and inpatient facilities evidence of successful outcomes over many years of ongoing work

5. Community engagement SA Office for Problem Gambling CALD project project officer (PGSI study) Australian Institute of Aboriginal and Torres Strait Islander Studies Ceduna community survey project report

6. project background in 2007 SGTS was funded through the SA Office for Problem Gambling to increase access to treatment for Aboriginal people to 2007 only a few Aboriginal people had received support from the service in the previous 10 years in 2010 over 30 people were registered with the service

7. Alwin’s involvement

8. Early involvement background to the Ceduna project few Aboriginal people accessing help services need to improve access to treatment why / how involved the main issues for community engagement connections between gambling, tobacco and alcohol what we set out to achieve CBT and money management barriers

9. Early involvement working in a collaborative manner taking time to connect and explain regular visits to and contact with communities building trust and confidence identifying the ‘urge’ to gamble as central

10. Process Sue Bertossa’s role engaging local champions (Peter Miller) local workshops (art, discussion groups) introducing gambling issues in context recruitment of a project officer to expand the work and collect survey data (football clubs)

11. high proportion of Aboriginal residents • mixed living styles, township/homelands/remote • mixed groups, Kokatha, Wirangu, Mirning, Pitjantjatjara • initial resistance… • PG competing with many other needs and priorities eg alcohol abuse, family violence • discussions of PG confronting for workers/managers who are experiencing PG themselves work mainly in Ceduna to explore PG community surveys literature review and report leading to a focus on assessment and treatment approaches to suit Aboriginal people

12. Initial Ceduna street survey 1. 48 people interviewed about gambling more females (69%) 2. most popular forms of gambling 88% pokies, 28% race betting, 21% private card playing 3. chief motivations “excitement of winning” (37%) “needing to relax or escape” (28%) 4. gambling overwhelmingly associated with negative community impact ie… losses causing financial hardship, family conflict and break up gambling coming ahead of other responsibilities Aboriginal people are over-represented in gambling venues

13. Emerging themes Financial hardship “behind in bills”, “no food in cupboards”, “waste so much money, don’t realise it at the time” Personal responsibilities “I hate seeing my kids missing out”, “leaving my kids here, there and everywhere”, “kids standing outside pokie areas, waiting for parents”

14. Emerging themes family and cultural breakdown “I don’t see my Mum any more, can’t have a yarn with my sisters”, “arguments about money for pokies”, “ No families, no hunting”, “it’s killing people, taking their culture away” over-representation “Aboriginal people are the main people in the pokies, they starve then”, “Pokies is always 90% Aboriginal”, “The pokies is packed out with Aboriginal people” & “only white people win on pokies”

15. Community engagement art workshops series of community-developed posters, creating home-based messages community forums developing a platform for community discussion and recognition of problem gambling as a social health issue collaboration partnership with Indigenous-controlled health service

22. PGSI Project

23. PGSI process and outcomes survey modifications via consultations based on identified need for changes to wording testing and confirming suggested changes in a range of community settings run survey validity, internal reliability (Cronbach’s Alpha)

24. Examples of cultural Adaptation Q2 How often have you bet more than you could really afford to lose? Do you ever gamble more than you want to?

25. Example of simplification Q3 When you gambled, did you go back another day to try to win back the money you lost? After losing, do you return and try to win it back?

26. The new version meant that people identified more readily with the modified questions and were happy to complete the survey… • language more acceptable • key words relating more to the culture • images & scoring format connecting with Aboriginal people

27. Thinking about the past 12 months, please answer the following questions. Mark your answers with a circle or cross.

28. demographics

29. Type of gambling activity…

30. AIPGI scores modified APGSI

31. PGSI norm for SGTS SGTS sample of PGSI scores

32. AIPGI scale consistency

33. AIPGI modified questions • eigenvalues from a principal components analysis • eigenvalue ≅ amount of variance in the data accounted for or explained by the factor • Rules • retain factors for eigenvalues >1 • use scree plot to visualise components • check variance explained

34. original PGSI modified AIPGI

35. Cronbach’s Alpha (n = 9 questions of the scale) Standard PGSI Reliability Statistic: Cronbach's Alpha = 0.84 modified AIPGI Reliability Statistic: Cronbach's Alpha = 0.92

36. future work extend testing of the tool publish validation study wider community application further treatment adjustments exploring links between gambling & tobacco and alcohol use, anxiety and depression

37. project outcomes Bertossa S, Harvey PW, Smith D, Chong A. A Preliminary Adaptation of the Problem Gambling Severity Index for Australian Indigenous peoples: Internal Reliability and Construct Validity. ANZJPH. 2014;in submission. BertossaS, Harvey PW. Measuring problem gambling in Indigenous communities: An Australian response to the research dilemmas. Australian Aboriginal Studies. 2012;2:21-30. BertossaS, Miller P, Chong A, Harvey PW. Gambling in a remote Aboriginal setting – the good, the bad and the ugly. Aboriginal and Islander Health Worker Journal. 2010;34(4):10-3. Harvey PW, Bertossa S. Adapting Cognitive Behaviour Therapy for Indigenous Gamblers. In: McIntyre PE, editor. General Practice and Primary Health Care; July; Melbourne2009. Harvey PW, Bertossa S. Report to AIATSIS on outcomes of an investigation into the impact of gambling on Aboriginal communities. Adelaide2010.

38. Summary exemplar of Indigenous community engagement relevance of materials and approach of team consultation and validation re modifications testing of new tool validation of internal validity and structure model applied for the CTG tobacco intervention (gambling, tobacco and alcohol linkages) questions and discussion Thanks

39. www.sagamblingtherapy.com.au

40. SGTS Statewide Gambling Therapy Service