a problem gambling telephone intervention program for the chinese community
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A Problem Gambling Telephone Intervention Program for the
Chinese CommunityInitial 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 Francisco’s 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 Helpline1-888-968-7888
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 - Overview8 sessions telephone counselingLicensed providersUtilizes self-help workbookLinked to helpline servicesCantonese, Mandarin (English, Spanish – BDA) Follow-up/ evaluation componentGoal:
Provide time-limited, telephone treatment to non-English Provide time-limited, telephone treatment to non-English PG and Affected IndividualsPG and Affected Individuals
transition to outpatient face-to-face
Who’s Eligible for PGTI Services?
Gamblers must meet the following criteria:a. Must be 18 years or older; andb. Meet at least one of the diagnostic criteria for Pathological Gambling
described in the Diagnostic and Statistical Manual-IV (DSM-IV); orc. 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; andb. Affected individual(s) must report an adverse psychiatric or physical
impact experienced due to ongoing problem or pathological gambling behaviors.
Players Involved in PGTIOffice 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: 1-888-968-7888 will refer clients to the PGTI Program.
Bensinger & Dupond Associates: 1-800-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 UCLA’s 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
70%
30%
EnrolledNo Show
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 SessionsBlock 1 Block 2
Client ID 1 & 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
WYT0001 x
DT1968 x
DC1955 x
EW1957 x
AC1955 x
WH1967 x
FY???? x
As of 2/11/2011
Overall Life Satisfaction
0102030405060708090
Intake
Sessi
on 3
Sessi
on 4
Sessi
on 5
Sessi
on 6
Sessi
on 7
Sessi
on 8
Sessi
on 9
Sessi
on 10
Sessi
on 11
Sessi
on 12
Sessi
on 13
Sessi
on 14
WYT0001
DT1968
DC1955
Urge/Craving to Gamble
Perceived Control over Gambling
Impact of Gambling
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
Intake
Sessi
on 3
Sessi
on 4
Sessi
on 5
Sessi
on 6
Sessi
on 7
Sessi
on 8
Sessi
on 9
Sessi
on 10
Sessi
on 11
Sessi
on 12
Sessi
on 13
Sessi
on 14
WYT0001
DT1968
DC1955
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
• Client’s 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
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• Consumer’s linguistic and other needs pose challenges
to transition• Paperwork challenges – (in-language is helpful, and
personal assistance helpful)
Next Steps
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 Coalition1208 Mason Street
San Francisco, CA 94108Chinese Helpline: 1-888-968-7888
http://www.nicoschc.org
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