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TitleBest Practice in Problem Gambling Services
LanguageEnglish
File Size767.3 KB
Total Pages114
Table of Contents
                            About the Research Team
Acknowledgements
Table of Contents
Executive Summary
	Purpose and Method
	Service Models
	Treatment Outcome Studies
	Gambler’s Help Counselling Practice
	Services other than Gambler’s Help
	Innovative Practice
	Recommendations
Chapter 1Introduction
	Project Background
	Report Structure
	Overview of Project Methodology
	A model of influences on gambling behaviours and outcomes
		Propensity to Gamble
		Gambling Products
		Gambling Uptake
		Protective and Risk Factors for Gambling Propensity,  Uptake and Consequences
Chapter 2Problem Gambling Intervention Models
	Introduction
	Community-Based Models
	Hospital Inpatient and Outpatient Models
	Self-Help Models
	Group Therapy Models
	Family-Oriented Treatment Models
	Miscellaneous Models
	Conclusion
Chapter 3Conceptualising and Measuring Therapeutic Effectiveness
	Introduction
	Measuring Therapeutic Effect or Process?
	Factors Contributing to Treatment Effects
Chapter 4 Treatment Outcome Studies
	Introduction
	Methodological Issues in Defining and Measuring Problem Gambling Program Treatment Outcomes
		Sample Selection
		Treatment Objectives
		Treatment Outcome Criteria
		Attribution of Treatment Effects
		Valid and Reliable Measures
		Definition of Success on Discharge
		Definition of Lapse and Relapse and Relationship to Treatment Failure
		Post-treatment Follow-up Intervals
	Treatment Approaches and Outcomes
		Psychoanalytic Formulations
		Self-help Organisations
		Behavioural Treatments
		Controlled Gambling
		Cognitive Therapy
		Multimodal Therapies
		Pharmacological Approaches
		Other Treatments
	Conclusions on ‘Best Practice’ from Reported Stud
Chapter 5Problem Gambling Services in Victoria
	Introduction
	Method
	The Victorian Gambler’s Help Program
		Introduction
		Existing Research on Treatment Practices and Inte
		Key Findings on Counselling Outcomes and the Counselling Process
		Key Findings on Counselling Outcomes and Client, Counsellor and Agency Characteristics
		Overview of Current Counselling Practice in Gambl
		Differential Diagnosis and Treatment
		Measuring Success and Ensuring Quality in Practice
	‘Best practice’ by Providers of Services other th
		Introduction
		Overview of Current Practice in Services other than Gambler's Help
	‘Best practice’: The Client’s Perspective
		Propensity to Gamble
		Causes of Problem Gambling
		What Clients Would Do to Protect Problem Gamblers
		Features of a Good Problem Gambling Service
		Service Elements Found to be Unhelpful
		Abstinence or Control
	Conclusions on ‘Best Practice’ in Victoria’s Pr
Chapter 6Studies in Innovation
	Introduction
	Single Session Consultations
	Online Counselling
	Theory Building from Clinical Practice: Developin
	The Free Yourself Program
		Free Yourself Participant Perspective
	Conclusions on Innovative Practice
Chapter 7Conclusion and Recommendations
	Introduction
	Service Models
	Treatment Outcomes
	Problem Gambling Services
	Innovative Practice
References
Appendices
	Appendix 1Interviews Conducted
	Appendix 2Gambler’s Help Sites
                        
Document Text Contents
Page 1

GRP REPORT NO. 3



Best Practice in
Problem Gambling Services




Prepared for the Gambling Research Panel by
Melbourne Enterprise International





Funded by the Victorian Government

through the Community Support Fund




June 2003


ISBN 0 9751191 0 9

Page 2

About the Research Team


Professor Alun Jackson is Professor of Social Work at the University of Melbourne, an
Honorary Senior Research Fellow at the Murdoch Children’s Research Institute, and is Co-
Director of the University of Melbourne/La Trobe University Problem Gambling Research
Program. Professor Jackson has also published widely in gambling and has been involved in,
and led, a series of large-scale gambling research projects for a variety of government bodies.
Professor Jackson is an international authority on the design and management of human
service programs.

Professor Shane Thomas is Professor in the School of Public Health, La Trobe University,
and at the time the study was conducted, was Director of Research at the Australian Institute
for Primary Care, La Trobe University and is Co-Director of the University of Melbourne/La
Trobe University Problem Gambling Research Program. Professor Thomas has published
widely in gambling and has been involved in, and led, a series of large-scale gambling
research projects for a variety of government bodies. He is an international authority in
research and evaluation methodology and in particular the development and validation of
measurement tools.

Professor Alex Blaszczynski is Professor of Clinical Psychology and a Director of the
Gambling Research Unit at the University of Sydney. He is an international authority in
gambling research with a strong international profile. He was the chairman of the Working
Party for the Australian Psychological Society and a committee member of the Australian
Medical Association’s position papers on problem gambling. Professor Blaszczynski is a
founding member of the Australian National Council for Problem Gambling, and the National
Association for Gambling Studies, and was a foundation director of the Australian Institute of
Gambling Studies. He has extensive links with international academics researching various
aspects of gambling and is on the Advisory Board, International Centre for the Study,
Treatment and Prevention of Youth Gambling Problems, McGill University, Canada.






Acknowledgements
We wish to thank the Gambling Research Panel Chair and members at the time that this study
was conducted, Associate Professor Linda Hancock, Associate Professor Chris Chamberlain
and Mr Peter Laver and the Panel's Secretariat. We also wish to thank Liz Kearney, Catherine
Stoove, and Kerryn Jackson for their work on the project, organising consultations, conducting
some interviews and conducting some analyses: Gambler’s Help Southern and Free Yourself
for their generous assistance in the client interviews; and staff of Melbourne University Private
for their efficient management of the project.

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Best Practice in Problem Gambling Services

One of the triennial grants provided by the Community Support Fund was for the implementation of a
Problem Gambling Services Strategy (PGSS). The Victorian government implemented and
developed the strategy from 1993, through a range of proposals by the Department of Human
Services including the establishment of:

• Problem gambling counselling services, including problem gambling counselling services that
are integrated with financial counselling services; and

• A range of counselling and support services that address family issues that may arise as a result
of problematic gambling, through the establishment of state-wide family skills and regional family
resource centres.

The strategy comprised a number of important and interrelated components including counselling
services for those affected by problem gambling activity located in generalist agencies; gaming
liaison and community education officers in each Department of Human Services region; a range of
community education initiatives and media campaigns; a free, 24-hour telephone counselling and
referral service; and a social research and evaluation program to provide information regarding
problem gambling in the community and inform appropriate service responses.

Developments in the service model in recent years have seen a re-branding of the original
BreakEven Problem Gambling Counselling Service as Gambler’s Help and the G-Line telephone
counselling service as Gambler’s Helpline. Financial counselling was integrated into the Problem
Gambling Services Strategy in 2000–2002, while discretionary funds were introduced in 1999–2000
and fully implemented by 2000–2001.

Existing Research on Treatment Practices and Intervention Outcomes of the Gambler’s
Help Counsellors
The Victorian program has been subject to the most thorough review of any Australian program to
date, through the Longitudinal Evaluation project noted in the introduction to this chapter. Data noted
here were obtained from two sources in that study: interviews with 51 of the available 52 counsellors
(98 per cent) and a Clinical Practice Evaluation (CPE) involving questionnaire data returned from 43
counsellors (83 per cent) (Jackson, Thomas, Thomason, Borrell, Crisp, Ho, Holt & Smith, 2000). Of
17 questions put to counsellors, three are relevant for the purpose of the present analysis. The
following open-ended questions were examined:

• Describe the theoretical orientation of your counselling practice;
• Describe what you understand to be the cause(s) of ‘problem gambling’;
• Please provide specific examples of the techniques and strategies you use when counselling

clients (e.g. reflective listening, imaginal desensitisation, free association, role-playing).

The survey of Gambler’s Help program counselling practice and theories in use revealed that a
broad range of theoretical perspectives underpin the delivery of the Victorian problem gambling
program. Counsellors incorporate a variety of therapeutic strategies and theoretical perspectives to
inform their counselling practice with problem gamblers. The majority of the 15 agencies represented
(of a possible 18 at the time, i.e. 83 per cent) by counsellor responses to the CPE questionnaire
adopted an eclectic approach to counselling. This is consistent, as noted previously, with current
trends in counselling and psychotherapy. Although a number of agencies did not specifically use the
term ‘eclectic’, they described a spectrum of perspectives that informed their counselling practice
with problem gamblers:

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Best Practice in Problem Gambling Services

• Among the most influential contributions to counselling practice was cognitive behavioural
therapy (CBT), mentioned by the majority of Gambler’s Help agencies as a major component of
their theoretical framework;

• The client-centred approach based on humanist psychology was also a major focus of
counselling practice;

• Motivational approaches (particularly those informed by Prochaska and DiClemente, 1998) in
terms of assessing the client’s readiness to change, and systems theory are part of the
theoretical framework of some Gambler’s Help host agencies;

• Solution-focused therapy, narrative therapy and psychodynamic therapy were also mentioned by
a number of Gambler’s Help program providers;

• Among the less common contributions to counselling practice were chaos theory, attachment
theory and feminist theory.

Counsellors’ perceptions of the causes of problem gambling behaviour were reviewed in order to
gain an understanding of the beliefs that influence the theoretical orientation and practice of
treatment. Many Gambler’s Help counsellors pointed out that the issue of aetiology is particularly
complex. There were some difficulties in reviewing counsellors’ responses to this question as many
offered possible causes of problem gambling, while others took a more philosophical approach,
questioning the causal relationship between gambling activity and problematic behaviour. Despite
this, counsellors provided a variety of possible causes of problem gambling behaviour:

• A number of counsellors responded that problem gambling is a way of managing problems in
one’s life, such as depression and stress;

• Similarly, gambling was thought to be an escape from problems, and possibly the result of
boredom and loneliness;

• A number of counsellors also mentioned grief and loss issues as underlying causes of
problematic gambling;

• It was also suggested that problem gambling behaviour is the result of attempts to chase losses,
the desire for a particular social image, the result of gambling industry promotion, and
social/familial factors.

In response to the question, ‘Please provide specific examples of the techniques and strategies you
use when counselling clients’, Gambler’s Help counsellors described a wide range of techniques. It
was not uncommon for counsellors within the same agency to use very different techniques, with
perhaps only a few strategies being utilised by more than one person. Table 3 shows the most
common therapeutic techniques and strategies employed by Victorian Gambler’s Help counsellors.

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Page 113

Best Practice in Problem Gambling Services — Appendices

Appendix 3
Abbreviated Draft Problem Gambling Service Standards
The following represent the sorts of standards that might be appropriate for a service such as
Gambler’s Help with some indicative questions that might determine compliance.

Staff involved in the delivery of problem gambling services should have appropriate qualifications
and experience to deliver effective services.

To evaluate the extent of compliance with this standard an agency would determine what the
evidence was that staff held recognised qualifications relevant to the provision of problem gambling
services and that staff engaged in a recognised ongoing program of professional
development/continuing education.

A systematic and comprehensive intake procedure should be used for all counselling service clients.

To evaluate the extent of compliance with this standard an agency would determine what the
evidence was that appropriate service and demographic data were collected and recorded using an
accepted coding scheme and records system and that clients were provided with appropriate
information about the range of services offered, other relevant services and referral options and
complaints procedures?

Effective evidence based counselling interventions should be selected and provided on the basis of
an individual assessment of client need.

To evaluate the extent of compliance with this standard there are a number of relevant indicators. An
agency would determine what the evidence was that:

• A recognised method of assessment had been used to assess the nature and extent of the
gambling related problems and the results recorded using an accepted coding scheme and
records system;

• A recognised method of intervention had been selected based upon the best available evidence
targeted at the identified profile of gambling and gambling related problems identified for the
client;

• The selected intervention had been applied according to the initial and subsequent assessments
of client need so as to provide the most effective client outcomes;

• A recognised discharge and disengagement protocol had been implemented for all clients.
Effective evidence based Community Partnership and Education interventions should be selected
and provided on the basis of an assessment of community need.

To evaluate the extent of compliance with this standard, an agency would need to determine that:

• A recognised method of systematic needs assessment had been used to assess the client and
Community Partnership and Education needs in problem gambling;

• A recognised method of education program design (based upon the best available evidence,
targeted at the identified profile of gambling and gambling related problems identified for the
client and the community) had been used to develop the Community Partnership and Education
program;

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Best Practice in Problem Gambling Services — Appendices

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• The Community Partnership and Education program had been applied according to the need
assessment of the client and the community so as to provide the most effective outcomes.

Source: Renhard, R., Thomas, S., Jackson, A.C. (2003) Self-audit Protocol for Problem Gambling Service
Standards, Melbourne: Australian Institute for Primary Care

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