ADDICTIONS AND MENTAL HEALTH Problem Gambling Services

WELCOME

Problem Gambling All Providers Meeting

Hosted by Problem Gambling Service StaffJune 12, 2014

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Agenda Items• State Updates (10 minutes)• Client Finding Outreach Strategic Plan (10 minutes)• Presentation from Oregon Lottery on Helpline new look

and feel (20 minutes)• Presentation from Problem Gambling Student Research

Grant: Does the Presence of a Casino Impact Community Youth Gambling Behaviors? (20 minutes)

• Presentation on data: Who’s using special programs? (15 minutes)

• Use of Aftercare and billing codes (5 minutes)• Questions and Answers (10 minutes)

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State Updates• Staff Updates-

• Treatment Site Reviews

• Prevention Meet and Greets

• Regional Trainings

• Fall Oregon PGS Conference- Newport, OR

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State Updates

Staff Update

Roxann Jones, new PGS Prevention Coordinator The AMH PGS Unit is now fully staffed!

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State Updates

Treatment Site Reviews: Simon Williams, PGS Treatment Compliance Specialist

Make sure final assessments are completed timely, and in the chart, and the service plan addresses the final treatment timeline component in the plan.

Even though OARs remove the discharge summary from the treatment chart, the chart needs to have this information included in the documentation.

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State Updates

Prevention Meet and Greets, Roxann Jones, PGS Prevention Coordinator

Hopes to meet with most of the prevention coordinators at the regional trainings coming up this summer; otherwise, will make a point to meet via phone calls, and in person as well.

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Regional Trainings• 6 trainings this summer (Albany, Tillamook, Baker City, Bend, Grants Pass

and Portland area)• 6 hours (lunch provided) 9:00 am to 3:00 pm• Purpose:

– Strengthen local outreach plans/efforts– Strengthen the relationship and collaboration between local treatment

services providers, local prevention specialist and agency executives, along with state staff

– Help to develop regional collegiality among treatment providers and prevention specialists.

– Spark excitement, motivation and networking• Encouraging PGS prevention and treatment providers, along with their

program managers to make these trainings a priority regarding attendance.

• If you need a registration and/or subsidy form, email Patricia at patricia.alderson@state.or.us

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Fall OR PGS Conference

• Slated for October 9 &10, 2014• Hallmark Resort, Newport, Oregon• Keith Whyte, National Council, will be the featured speaker, as well

as Jeff Marotta, talking about problem gambling, online gambling, as well as the past, present, and the future regarding this subject.

• Save the Date came out in an email to everyone; please mark your calendars

• A registration form and information will be coming out a couple months prior to the conference.

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PGS Strategic Plan for Client Finding Outreach• 2014-16

– Client Finding Outreach Webinars-Completed– Regional Trainings-In Process– Development of statewide method for collecting and measuring

outcomes– New and updated outreach materials (brochures, canned presentations,

etc.)– Hire consultant to provide PGS outreach technical assistance and

development of outreach plan. – Add language to prevention contract stipulating a percentage of funds

must be designated to outreach efforts. – Development of PGS 5- year Strategic Plan to improve and support

program structure

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Helpline Web Page Redesign

• Presented by Shad Barnes Online Marketing ManagerOregon Lotteryshad.barnes@state.or.us503-540-1082

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“Replacing destructive thoughts with hope filled

optimistic ones bring peaceful and confidence

producing circumstances.”

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WHY CHANGE?• All efforts should lead back to the goal of engaging with

more at risk individuals and families affected by problem gambling.

• Reach the at risk audience in a more effective, more relevant manner.

• Create a consistent look and feel that is pleasing to the eye, easy to read and commensurate with current media trends.

• Improve the capture and collection system to best capitalize on advertising and marketing campaigns.

• Above all, this process is about helping more people in need.

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CURRENT TRADITIONAL

• Brochures• Posters• Terminal

Stickers

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CURRENT SITE

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WHAT ARE USERS DOING?

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RECAP

• Current designs are dated.• Images convey sadness.• Dark color schemes.• Long copy.• No hierarchy, what should the reader do.• Where is the call to action? Where is the hope in

recovery?• Is this a web address or a phone number?

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THE MESSAGE – WHAT TO SAY?

• Everything should convey a feeling of hope.• Messages should lead to phone calls.• Open, friendly, trustworthy, sensitive, non-

judgmental.• Emphasize that treatment is FREE and

EFFECTIVE.• Should use imagery and mention of Oregon and

Oregonians whenever possible.

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BRANDING RECOMMENDATION

In thinking about the “name” we want this to be bigger than a phone service. While the telephone is still the best way to connect, calling it a

helpline feels too small in scale.

OREGON PROBLEM GAMBLING NETWORK

www.oregonproblemgamblingnetwork.orgwww.oregonpgn.org

We will likely purchase additional domains.

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BRANDING RECOMMENDATIONIMAGERY

The images should convey a sense of hope, helpfulness, happiness and inclusion.

People should be from all walks of life, genders, ages, ethnicities, races and should never display a look of despair or pain. Basically everyday people who make the viewer feel like they made a life decision to be healthy and are better for it.

When possible, scenes should be Oregon-based.

COLOR SCHEMEColors should be neutral to put emphasis on the images. Light, Inviting Combinations

FONTS

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BRANDING RECOMMENDATION

WEB DESIGN RECOMMENDATION

NOT THE ACTUAL LOOK – JUST A GUIDELINE

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WEB DESIGN RECOMMENDATION

NOT THE ACTUAL LOOK – JUST A GUIDELINE

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WEB DESIGN INTERIORHIGHLIGHTS

• Informational• Video• Minimal Copy• Image Heavy• Interactive• Search Engine

Optimized content• Content Management

System – Update your own information

NOT THE ACTUAL LOOK – JUST A GUIDELINE

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OREGON PARTNERSHIP FOR PROBLEM GAMBLERS

All attribution goes to the Oregon Partnership for Problem Gamblers. It will include all the organizations that cooperate to provide this valuable service to Oregonians. Never any direct attribution to the Oregon Lottery, or any other specific organization.

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We are nearly final with logo development and color palettes. We also have received a statement of work from our digital agency that is going to help with some of the design work, and recently hired a creative agency to help create our next TV commercial. We plan to present first drafts in July and hopefully be final with re-branding by late August if not sooner.

NEXT STEPS

Youth Gambling and its Association with Casino Proximity

Ashley Reynolds

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Casino Proximity and its Association with Youth gamblingThis study sought to determine if casino proximity is associated with youth gambling and its frequency.  The 2012 Arizona Youth Survey was used  (n = 66,127), analyzed using ordinary logistic regression and ordered logistic regression models.  This study may aid prevention efforts in problem gambling since early-onset gambling was found to be a significant risk factor of at-risk gambling in adolescents (Winters, Stinchfield, Botzet, & Anderson, 2002), and adults with severe gambling problems are likely to have begun gambling at an earlier age (Volberg, Gupta, Griffiths, Olason, & Delfabbro, 2010). 

In order to prevent problem gambling, in either youth or adults, consideration is important to identify factors that contribute to early-onset gambling and its frequency. 

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Background• Adolescent gambling a problem in the United

States.

• Gambling frequency associated with alcohol, tobacco, and marijuana use (Volberg, Hedberg, & Moore, 2008).

• Problem gambling in youth associated with drug and alcohol use, poor seatbelt use, violence, and risky sexual activity (Volberg, Gupta, Griffiths, Ólason, & Delfabbro, 2010)

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Background

• The estimated prevalence of youth gambling indicates that it should be addressed

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Volberg et al. (2008)

• Oregon youth survey (n=1,555)

• 63% of adolescents have gambled at least one point in their lives

• 13% gambled on monthly basis

• 3% gambled on weekly basis

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Welte, Barnes, Tidwell, & Hoffman (2009)

• National survey of youth (n=2,274)

• 68% gambled within past year

• 11% more than twice per week

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Winters, Stinchfield, Botzet, & Anderson (2002) • Prospective cohort study of 305 adolescents over 8

years in MN

• Rates of prior-year gambling found to be consistently high for each year

• Rates of regular gambling around 20%

• Rates of problem gambling ranged from 2.3 to 4.3%

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Role of Casinos in Adolescent Gambling

• Some adolescents able to get past age restrictions and gamble (Welte et al., 2009; Fabiansson, 2006).

• Fabiansson (2006) found that in one of Australia’s largest casinos approximately 700 underage individuals are caught each month

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Casino Advertisements

• Casinos may influence youth gambling by making gambling appear “cool”

• Casino advertisements effect youth (McMullen & Miller, 2010; McMullan, Miller, & Perrier, 2012).

• From ads, gambling has cultural capital

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Casino Proximity and Gambling• Adult studies found positive link between proximity

and gambling

• A correlation between casino proximity and participation in casino games/casino expenditure (Sévigny et al., 2008)

• Participating in casino slots and table games more

frequent in students attending university near a casino (Adams et al., 2007)

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Casino Proximity and Youth Gambling• No studies have addressed the effect of a nearby

casino on youth gambling behaviors

• Living near a casino may be positively correlated with lifetime gambling and frequency

• Proximity may make casinos more accessible to youth, if they desire to sneak-in.

- Findings of adult proximity studies demonstrate the importance of less travel time

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Casino Proximity and Youth Gambling

• Youth near a casino may be more exposed to casino advertisements.

• Youth near a casino may be exposed to a social environment that approves of gambling.

• Fabiansson (2006) found that in rural areas with casinos, parents are encouraged to bring their families to casinos for activities

• Youth may see family visit casinos

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Casino Proximity and Youth Gambling

• Exposure to casinos at an early age may cause adolescents to think that gambling is cool

• May lead youth to gamble

- Friend and family approval a predictor of gambling among youth (Moore and Ohtsuka, 1999; Larimer and Neighbors, 2003)

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Purpose of Study

• To determine the prevalence of gambling and gambling by frequency

• If casino proximity is associated with lifetime gambling

• If casino proximity is associated with gambling frequency

• All types of gambling examined

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Significance of Study• If association between early-onset gambling and

casino proximity, interventions preventing problem gambling may target adolescents near casinos

• Casinos may: - Provide resources to local schools for prevention and treatment programs

- Advertise responsibly

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Significance

• To prevent problem gambling in adolescents and adults, we should consider early-onset gambling and its frequency.

• Adults with severe gambling problems are likely to have begun gambling at an earlier age (Volberg et al., 2010).

• Early-onset gambling a significant risk factor of at-risk and problem gambling in adolescents (Winters et al., 2002)

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2012 Arizona Youth Survey

• Measures prevalence and frequency of substance abuse among 8th, 10th, and 12th graders

• Assesses risk and protective factors.

• One of the few statewide youth behavioral surveys examining gambling and whose state has casinos

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AYS

• Conducted every 2 years by the Arizona Criminal Justice Commission

• Conducted for 21 years

• Ideal since many casinos in Arizona open before 2012

• Casinos scattered throughout state- 21 casinos located in 17 towns

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Participant Recruitment and Informed Consent • Consent needed from schools, parents, and

students

• All 15 counties participated

• 349 schools participated- Public and charter schools

• 62,817 8th, 10th, and 12th grade participants

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Data Collection• Collected anonymously

• Collected between January and April 2012

• Teachers read scrip to students to ensure anonymity and reduce response bias

• Questionnaire was pretested

• After completion, mailed to Bach Harrison L.L.C.

- Bach Harrison provided technical assistance

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Data Use Agreement and Management

• IRB approval not needed

• Agreement granted by Arizona Criminal Justice Commission

• SPSS file sent in February, 2014

• SPSS file converted to STATA 12

• Recoded variables

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Predictor Variable- Casino Proximity

• Measured by whether the participant lived in a zip-code that is in a town that has a casino(s)

• Dichotomous variable

• Casino must have been open before January 2012

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Outcome Variables

• Lifetime gambling and gambling frequency

• Determined using same question on AYS

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Outcome Variables• How often have you done the following for money, possessions, or

anything of value:

a. Played a slot machine, poker machine or other gambling machine?

b. Played the lottery or scratch off tickets?c. Bet on sports?d. Played cardse. Bought a raffle ticket?f. Played bingo?g. Gambled on the internet?h. Played a dice game?i. Bet on a game of personal skill such as pool or a video

game?j. Bet on a horse or other

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Outcome

• Responses are:- Almost every day- Once or twice a week- Once or twice a month- At least once in the past 12 months

- Before, but not in the past 12 months - Never

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Lifetime Gambling and Frequency

• Lifetime gambling defined by whether an adolescent ever gambled, regardless of activity

• Frequency defined by how often an adolescent gambled, regardless of activity.

• For each participant, frequency was the highest frequency marked

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Variables adjusted for• Grade• Sex• Race• Rural vs. urban status• Alcohol and drug use• Smoking status• Parental living situation• Whether one skipped school

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Descriptive Statistics• Characteristics determined by calculating

frequency distributions for each variable

• Prevalence calculated for lifetime gambling

• Prevalence calculated for each gambling frequency

•

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Inferential Statistics• Logistic regression used to determine if proximity is associated with

lifetime gambling

• Multinomial logistic regression used to determine if proximity is associated with gambling frequency – Base level: ‘never gambled’

• Determined both adjusted and unadjusted associations

• Model diagnostics and outlier detection

• Assessed for proximity, gender, and grade interactions

• Criteria of α=.05

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Descriptive Analyses

• Mean age was 15.2 years (SD=1.7)

• 50.5% female, 49.5% male

• 46% in 8th grade, 30% in 10th grade, and 24% in 12th grade

• Approx. 25.9% lived near at least one casino

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Gambling Prevalence  N PercentageLifetime Gambling (n=60,891) No Yes

 

1702043871

 

27.95%72.05%

Gambling frequency (n=60,891; Never Before, but not in the past 12 months At least once in the past 12 months Once or twice a month Once or twice a week Almost every day

 17020 9048

17141

10015 4180 3487

 27.95%14.86%

28.15%

16.45% 6.86% 5.73%

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Logistic Regression

• Univariate analyses first conducted

• Casino proximity not a predictor of lifetime gambling (p=.21; OR=.97)

• After adjusting for important covariates, grade level an effect modifier between proximity and lifetime gambling (p=.009)

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Logistic Regression• Relationship only significant among eighth graders

  Main effect model Final model with interactionsVariable OR (95% CI) P-value OR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate

    

    Referent1.11 (1.02,1.20) Referent1.04 (.85, 1.14) Referent.95 (.86, 1.04)

.009  

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Multinomial Logistic Regression  Never- at least once in the past 12

monthsVariable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate

  

Referent1.14 (1.01, 1.29) Referent1.22 (1.06, 1.40) Referent.94 (.81, 1.08)

.04

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Predicting Monthly Gambling  Never-once or twice a month

Variable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate

  

Referent1.13 (.98, 1.31) Referent.94 (.77, 1.13) Referent.83 (.67, 1.03)

.004

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Predicting Weekly Gambling   Never- once or twice a week

Variable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate

  

Referent1.05 (.85, 1.31) Referent.97 (.71, 1.34) Referent.55 (.36, .82)

.008

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Predicting Daily Gambling  Never-almost every dayVariable RRR (95% CI) P-value Effect of grade for proximity 8th grade Far Proximate 10th grade Far Proximate 12th grade Far Proximate

  

Referent1.12 (.87, 1.44) Referent1.09 (.76, 1.57) Referent.59 (.35, 1.00)

.027

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Summary • 8th graders near a casino 10% more likely to report

ever gambling compared to those far from a casino

• 8th graders near a casino were 14% more likely to have gambled in the past year.

• 10th graders near a casino were 22% more likely to have gambled in the past year.

• 12th graders near a casino were 45% less likely to gamble weekly and 41% less likely to gamble daily.

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Discussion• Must be careful not to generalize grade*proximity interactions

• Past findings that lifetime gambling and frequency may positively correlate with grade level (Volberg et al., 2008; Carlson & Moore, 1998; Shapira et al., 2002; Wallisch; 1993).

• Contrary to our findings and rationale

– Grade negatively correlated with lifetime gambling

– Grade negatively correlated with gambling frequency

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Limitations of Study• Unable to control for depression, a family history of gambling, and if

one has recently moved

• Measurement of casino proximity: if an adolescent resides in a zip-code that belongs to a casino town

• Defining proximity as within a specific distance may be more reliable

• However, such data not collected by the AYS

• Adams et al. (2007) based proximity on if the casino was visible in the immediate or local community, also a subjective measure

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Limitations• May not be representative of Arizona

- Pima County comprised of 14% students statewide and only 8% of the sample (Harrison, 2012)

- Exclusion of youth living near a casino: Pima county includes Tucson (home to three casinos)

- Uneven grade distribution: 46% in 8th grade, 30% in 10th grade, and 24% in 12th grade

- Possible exclusion of older youth who gamble

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Limitations

• Results may not be generalizable

• Only AZ youth surveyed

• Other regions gambling is more or less mature

• All 21 AZ casinos open at least 10 years

• Need to consider adaptation hypothesis (Shaffer, 2005)

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Generalizability• All AZ casino towns range from having 1-3 casinos - Need to consider casino heavy communities such as Las Vegas and Atlantic City

• States differ in types of gambling available

• Types may influence youth gambling rates

• Studies need to be repeated in other regions

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Strengths

• Study is first of its kind

• Large dataset (n = 62,603)

• Easy to detect any statistical differences

• Large enough group near a casino

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Implications

• Findings may be of comfort because proximity not positively associated with higher frequencies

• Frequency associated with severity (Shinogle, Norris, Park, Volberg, Haynes, & Stokan, 2011)

• Should be concerned that proximity was positively associated with prior-year gambling (among 8th and 10th graders) and lifetime gambling (among 8th graders)

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Implications

• Some individuals in the population gamble less frequently and yet gamble more heavily (Abbott, 2001; Abbott, Volberg, & Rönnberg, 2004).

• One may only need initial experience

• Interventions be implemented

• Casinos provide resources for prevention and treatment for local communities

• Socially responsible advertising

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Future Studies

• Address relationship between casino proximity and problem gambling in youth

• Address relationship between youth casino proximity and gambling problems later in life

• Current studies have only examined adult casino proximity and problem gambling.

Who’s using special programs?

Presented by Tom Moore, PhdHerbert and Louis, LLC

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Minimal Intervention Program (SAFE; GEAR) • Purpose: fill the gap in available treatment for individuals who

did not meet full diagnostic criteria for pathological gamblers and to provide services to pathological gamblers who could not attend brick and mortar programs. Home-based with workbook and phone consultation.

9/2001 – 6/2007 (Cascadia: n = 185)

7/2007 - present (Emergence: n = 340)

Older (p < .01) than TAU: 53.5 years compared to 46.9 years

More likely (p < .01) to have 1st gambled older: 31.1 years compared to 24.4 years

Slightly more likely to be female

Slightly more likely to have higher DSM Score: 8.2 to 7.7

For enrollment call the Helpline!

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Respite Care

Purpose: Short term stabilization with referral from TAU with intent for follow-up/continuing care at the referring agency. (Some gaps in funding years)

9/2001 – 5/2009 (Columbia County: n = 83)

9/2001 – current (Josephine/Options for Southern Oregon: n = 104)

More likely female; divorced

(Small sample last five years)

For admission contact PGS & Options

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Residential Care Purpose: Provide acute stabilization and intense residential care for high

risk patients. Must be referred by a TAU outpatient program with the intention for follow-up continuing care at the referring agency following residential treatment

7/06 – 6/09 (Cascadia: n = 237)

7/09 – Present (Bridgeway: n = 291)

No difference in age or gender with TAU

Significantly more (p < .01) DSM Criteria Endorsed: 9.2 vs. 7.7

Significantly more likely (p< .01) for younger first gambling experience: 18.3 years vs. 24.4 years

More likely to be single-never married, homeless, higher gambling debt, increased suicidality than TAU

ALOS: 34.3 days

For admission/logistics contact Bridgeway Recovery

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Aftercare and Billing Codes

• Aftercare: Automatic one year after case closing with H&L. – G2100 for group; H2027 for individual

• Consolidated document can be found on PGS web page at: http://www.oregon.gov/oha/amh/gambling/BILLING%20CODES%20012214.pdf.

• Flex Code– ‘FLEX’ Submit in normal format– Comes from agency’s AD81 funds– Keep detailed records on site for possible audit

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PG Flex Funds • PG flex funds must be used for Problem Gambling

Services.

• Funds can be used for PG wraparound type services, such as travel expenses for assisting client to residential treatment, etc.

• Fund can also be used for supporting PG staff’s workforce development needs (i.e., trainings, etc.).

• If you are a subcontractor for a county, you may need to contact the county for use of funds approval, outside the scope of treatment, outreach and prevention.

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Questions

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Contacts

• Greta Coe, Problem Gambling Services Manager– Greta.l.coe@state.or.us; 503-945-6187

• Simon Williams, Problem Gambling Treatment Specialist– Simon.o.williams@state.or.us; 503-945-6555

• Roxann Jones, Problem Gambling Prevention SpecialistRoxann.r.jones@state.or.us; 503-947-5548

• Patricia Alderson, Problem Gambling Administrative Support– Patricia.alderson@state.or.us; 503-945-9710

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Final Notes:

• Power point, minutes and CEU certificates will be emailed to you next week.

Thanks for your participation in this webinar, and for the work that you do

every day!

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