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

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 Franciscos Chinese community.

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

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)

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

Project Overview

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 Provide time-limited, telephone treatment to non-English PG and Affected Individuals transition to outpatient face-to-face

Whos Eligible for PGTI Services? Gamblers must meet the following criteria: a.Must be 18 years or older; and b.Meet at least one of the diagnostic criteria for Pathological Gambling described in the Diagnostic and Statistical Manual-IV (DSM-IV); or c.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: a.The affected person is 18 years or older; and b.Affected individual(s) must report an adverse psychiatric or physical impact experienced due to ongoing problem or pathological gambling behaviors.

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. Richmond Area Multi-Services: will refer clients to the PGTI Program. Bensinger & Dupond Associates: GAMBLER will refer clients to the PGTI Program. NICOS PGTI Providers will provide telephone-based counseling services to problem gamblers and affected individuals. NICOS: Subcontractor to administer the Chinese/Asian Language PGTI Program.

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

Cultural & Linguistic Adaptations Translated client consent forms (Release of Info., Rights & Responsibilities, Telephone Follow-up, Revoke Consent, Client Handbook, etc.) Providers Providers utilize UCLAs 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

Program Accomplishments

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

Percentage of PGTI Enrollment Referral from Helpline n = 10

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%)

Number of Treatment Sessions Block 1Block 2 Client ID 1 & WYT0001x DT1968x DC1955x EW1957x AC1955x WH1967x FY????x As of 2/11/2011

Overall Life Satisfaction

Urge/Craving to Gamble

Perceived Control over Gambling

Impact of Gambling

Challenges

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

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.

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

Challenges for the PGTI Program Clients 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

Challenges Cultural acceptance Immigration-related issues Environmental prevalence Target marketing

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 Consumers linguistic and other needs pose challenges to transition Paperwork challenges – (in-language is helpful, and personal assistance helpful)

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

THANK YOU!!! NICOS Chinese Health Coalition 1208 Mason Street San Francisco, CA Chinese Helpline: