1. Prevention of Problem Gambling: What Every Preventionist Needs to Know Jim Wuelfing Owner and Principle Associate The New England Center Jim.Wuelfing@gmail.com Prevention and Recovery Conference Inspiration. Connection. Motivation. Oklahoma City, Oklahoma November, 2014

2. Never underestimate the power of a few committed people to change the world. Indeed, it is the only thing that ever has. Margaret Meade

3. About the Meaning and Challenges of Prevention

4. Prevention No progress has ever been made against any epidemic by treating only the casualties. We simply replace them with more.

5. Prevention Is an active process of changing conditions and fostering personal attributes that supports the well being of people.

6. Challenges and Principles of Prevention Planning Based prevention in tested theory, research and data Use a proven prevention planning model Using multiple strategies over multiple domains Use evidenced-based strategies Reduce risk and enhance protective factors Utilizing best practices

7. Based on Tested Theory, Research and Data What prevention models are you following? – Public health model – Environmental management – Youth empowerment and development – Social ecological theory What do you know about your population?

8. Quality and Accuracy of Data Luxury Car –Valid and reliable measures that allow you to observe outcomes over time (examples surveys) Sedan – Proxy measure that may or may not be valid indicators of outcomes of interest Compact Car – Qualitative data such as focus groups and people’s perception of the problem.

9. CSAP’s Strategic Planning Framework Assessment Capacity Building Planning Implementation Evaluation All under the umbrella of cultural competence and sustainability

10. Assessment Assessment involves using data to access: – Problem gambling and related problems (i.e. needs) which leads to recommendations for state and community priorities – Capacities and resources in existence to address the problems and gaps in capacities – Readiness of state and communities to act. (Adapted from CSAP Strategic Planning Framework)

11. Capacity Building Involves identifying types and levels of resources in the prevention system and enhancing those systems by: – Workforce development – Improving data-based systems – Increasing coordination – Building community resources. (Adapted from CSAP Strategic Planning Framework)

12. Planning Includes developing a comprehensive, logical and data driven plan to: – Address priority problems and issues – Decrease risk factors – Increase protective factors – Minimizes gaps in resources and capacity – Selects complementary strategies (multiple strategies over multiple domains. (Adapted from CSAP Strategic Planning Framework)

13. Implementation Involves: – Infrastructure development – Implementing evidenced-based strategies. (Adapted from CSAP Strategic Planning Framework)

14. Evaluation Involves: – Assessing technical assistance and training efforts needed – Policies and procedures needed to foster positive outcomes – Measuring positive change that occurred. (Adapted from CSAP Strategic Planning Framework)

15. Six Prevention Strategies [Center for Substance Abuse Prevention (CSAP)] Information Dissemination Prevention Education Alternative Activities Community-Based Processes Environmental Approaches Problem Identification and Referral

16. Information Dissemination Complementary to more intensive / interactive approaches Includes all types of passive education – Posters – PSAs (print, radio, TV) – pamphlets Choice air times Target audience Avoid authority figures & exhortations

17. Prevention Education Combine information, skills, protective factors Interactive, intense, with booster sessions Peer-led components Provide social skills training & practice Involve parents individually & with students

18. Alternatives May be more effective with high-risk youth Intense programs with variety Component of integrated comprehensive strategy Community service, mentoring, recreation, cultural activities

19. Community-Based Processes Utilize multi-agency activities & interagency coordination Clear purpose, appropriate planning, commitment to results Active participation by meeting members’ needs Leadership essential Appropriate roles for paid staff Implement proven effective strategies to achieve outcome-based goals Effectiveness based on strategies not structure

20. Environmental Approaches Individualized environment – Seek to socialize, instruct, guide, & counsel to increase their resistance to health risks Shared environment – Support healthy behavior, prevent risky behavior for all in the population Environmental strategies – Price interventions, minimum -purchase-age, deterrence, location & density, counter-ads

21. Problem Identification and Referral Estimate accurately people who justify intervention Ensures appropriate referral to meet needs Realize relationship between substance use, gambling and other health problems. Risk of exposure to other risk behaviors Brief interventions appear promising

22. PREVENTION DOMAINS Individual Peer Family School/work Community Society/environmental

23. MULTIPLE STRATEGIES OVER MULTIPLE DOMAINS

24. Questions to Consider in Selecting Strategies Who is the strategy targeting ? Why are you targeting this population and what data/information supports your targeting this group ? What factors is your strategy addressing ? Why do you feel this strategy will lead to a desired change? Is their any evidence that indicates that this strategy is effective ? What change due you want to occur in this group or population?

25. Effective* Innovative and/or Unproven Conditionally Effective* Promising* Of Interest* Insufficient Current Support* SAMHSA’s Emerging Evidence-Based Continuum * SAMHSA/NREPP effectiveness levels Little-to-No Evidence of Effectiveness Evidence of Effectiveness Based on Rigorous Evaluation New NREPP 2005+

26. Protective and Risk Factors

27. Protective factors – Factors that decrease the chances of someone (or a community) developing health and behavioral problems are called protective factors. Having multiple protective factors can override risk factors. Risk factors - Factors that increase the chances of someone developing health and behavior problems are called risk factors. Individuals, families and communities which possess these factors are considered at risk. Those that possess several are considered high risk.

28. PROTECTIVE FACTORS A relationship with a caring adult role model Having an opportunity to contribute and be seen as a resource Effectiveness in work, play and relationships Healthy expectations and a positive outlook Self-esteem and an internal locus of control Self-discipline Problem solving and critical thinking skills A sense of humor Family cohesion School/community connectedness

29. Protective Factors Family connectedness Designing school-based prevention programs that seek to develop student’s attachment, trust, and identification with larger groups (e.g., school clubs and sports teams, Scouts or Guides). YOUTH GAMBLING PROBLEMS: THE IDENTIFICATION OF RISK AND PROTECTIVE FACTORS:: Report to the Ontario Problem Gambling Research Centre: Laurie Dickson, M.A. Jeffrey L. Derevensky, Ph.D., Rina Gupta, Ph.D.

30. Risk Factors for Problem Gambling At-risk for a substance abuse problem Having a parent, sibling, relative, friend, or significant person with either a gambling problem or substance use problem Having or knowing peers with substance use problems is a risk correlate of youth problem gambling Anxiety High risk propensity Low perception of risk regarding problem gambling Early onset of gambling behaviour YOUTH GAMBLING PROBLEMS: THE IDENTIFICATION OF RISK AND PROTECTIVE FACTORS::Report to the Ontario Problem Gambling Research Centre: Laurie Dickson, M.A. Jeffrey L. Derevensky, Ph.D., Rina Gupta, Ph.D.

31. High Risk Categories Child of a compulsive gambler Belief that skill is involved An early big win Feeling that one must chase gambling loss with more gambling Early age of onset (8.5 years for pathological gamblers; 11.5 years for non-pathological gamblers) Large first bets Otherwise addicted

32. Characteristics of Low Risk Gambling For fun or recreation, never for financial gain Knowledge that over time nearly everyone loses Socially with family and friends, not alone Limited time – frequency and duration With predetermined limits for losses Acknowledging that knowing a lot does not make you a better gambler

33. Minimizing Your Risk Always bet with a predetermined amount of money to be lost Never borrow money to gamble Never gamble illegally Know your personal risk factors Know where to get help Be willing to help others

34. Three Consistent Messages The choice to abstain from gambling as a lifelong practice is a legitimate choice that many people make. We want you to be legally allowed to gamble before you do so and we do not want you to gamble illegally ever. If you still choose to gamble, we want you to know enough about gambling so that you can lower your risk of gambling problems.

35. Best Practices in Prevention Research and Conceptual Framework Accuracy, Efficacy and Credibility of Approach Needs Assessment Measurable Goals and Objectives Outcome and Process Evaluation Comprehensive Approach Integrates Overall Health Promotion Community Involvement and Ownership Long-Term Commitment Replicability

36. The Connection Between Prevention and Recovery Both are primarily concerned with wellness Both focus on both building personal recovery capital as well as community recovery capital There is much overlap in the skills used by preventionists and recovery support personnel Both support a holistic approach

37. Prevention of Problem Gambling on the National Level National Council on Problem Gambling NCPG) – Prevention Committee – Co-chairs: Julie Hynes (OR) julie.hynes@co.lane.or.us julie.hynes@co.lane.or.us Susan McLaughlin (CT) susan.mclaughlin@ct.govsusan.mclaughlin@ct.gov NCPG Annual Conference – July 10-11, 2014, Baltimore, MD

38. State Efforts Oklahoma Association on Problem and Compulsive Gambling (www.oapcg.org)www.oapcg.org – Wiley Harwell, Executive Director 405-801-3330 Other State Affiliates of NCPG – Go to www.ncpgambling.org and click “About Us” and then “State Affiliates”www.ncpgambling.org

39. Evidenced-based curriculum for the prevention of problem gambling among teens and young adults. Created by Robert Williams, Ph.D., Alberta Gaming Research Institute and Robert Wood, Ph.D., University of Lethbridge, Alberta Teaches young people to approach life as smart risk-takers, weighing the pros and cons of their actions to determine the odds of achieving positive results. Stacked Deck

40. Thank you.