Maureen Fitzgerald
Editor, ATTC Network Coordinating Office and NIATx
Webinar 3 in the ATTC Network’s Problem Gambling Webinar series on Thursday, May 8, 2014, features Dr. Nancy Petry, who will be discussing changes to the DSM5 and how they'll affect treatment for problem gambling.
The webinar series a great lead-in to the 11th Annual Midwest Conference on Problem Gambling and Substance Abuse: Prevention, Treatment & Recovery in an Era of Change (June 25-27, 2014, Kansas City).
The Mid-America Addiction Technology Transfer Center sponsors this event in partnership with addiction treatment and problem gambling treatment programs from Iowa, Kansas, Missouri, Nebraska, and Oklahoma. The conference features national experts on problem gambling—the 2014 agenda includes Dr. H. Westley Clark and Dr. David-Mee Lee, among others—along with updates from the states on their problem gambling initiatives.
A few facts about Iowa: In 1986, Iowa was the first
state in the country to establish a state-funded gambling treatment program. A
portion of gambling profits from casinos and the state lottery were allocated
for problem gambling treatment. In 1987,
Iowa became the first state to offer 1-800-BETS
OFF, a free state-wide problem gambling helpline. That helpline receives
4,000 calls per year. Today, Iowa is home to 18 casinos licensed by the state’s
Racing and Gaming Commission, three tribal casinos, 2,400 lottery outlets,
3,350 social and charitable gaming licenses, along with many Internet and other
illegal gaming. Gambling is easily available in any one of the state’s 99
counties. IDPH contracts with 11 local treatment agencies to provide
problem gambling prevention, treatment and recovery support services in 11
service regions across the state.
NIATx has been widely used in Iowa's substance use treatment organizations; from 2005 to 2007, the state was party
of a CSAT-funded state/payer pilot project to test NIATx strategies to improve
access to and retention in substance abuse treatment. Iowa providers across the
state continued to participate in NIATx projects in subsequent years. A project
launched in 2009 applied NIATx change strategies to the state’s problem gambling
program. Bob Kerksieck, Health Facilities Surveyor IGTPP shared results of that
project at the 2013 Midwest Conference on Problem Gambling.
100 walk-through phone
calls: To get an idea of how Iowa’s funded gambling treatment programs were responding
to Bets Off Helpline referrals, Kerksieck, along with the project coach Janet
Zwick and Mark Vander Linden (then program manager for IGTPP), made more than
100 phone calls over a one-year period to the helpline, posing as problem
gamblers.
This exercise provided a wealth of information. “Many calls went well, but on the first
round, one-third of the calls didn’t get through to anyone at the program. Some
might have gone better. Some messages were never returned,” says Kerksieck. And for the majority of the cases, there was
no counselor available within two days of the call.
Eric Preuss, current program manager at IGTPP, recommends
that any agency interested in starting a NIATx change project start with the
phone-walk through. “The first phone call is especially critical for problem gamblers. Most problem gamblers present
as crisis callers, so engaging them on the phone when they’re seeking treatment
is critical.”
Based on the data gathered from the 100 phone walk-throughs
and other activities, the change team tested implementing a “warm handoff” from
the 1-800-BETS-Off helpline directly to treatment programs, for all calls made
from 8am to 8pm, Monday-Friday.
In a warm
phone hand-off, a caller gets connected directly to a counselor at a
treatment program. Instead of giving caller’s the phone number to call a local
treatment program, or transferring the caller and hanging up, the helpline
would transfer the caller and stay on the line, telling the program, “Hello, I
have Jane on the phone. She called about a gambling problem and would like to
talk to someone. Do you have a counselor available who can talk to him/her?”
“Before this change, 57% of callers asking for help were
actually connecting with a live person at a treatment agency,” says Kerksieck.
“After this change, that number increased to 83%.”
Adds Preuss, “We’re encouraging our programs to have a
counselor available to handle problem gambler crisis calls 24/7. We recommend
no waiting and no call-backs, and contracts now have a minimum requirement that
a qualified counselor responds to a helpline call within 90 minutes of the
initial call, 24 hours per day and 7 days per week.”
Preuss and his team continually evaluate the phone answering
processes. A recent NIATx change project took a look at calls that appeared to
be originating from outside the state of Iowa. These calls were automatically
forwarded to the national problem gambling helpline.
“We learned that many of those callers were actually Iowa
residents using mobile phone numbers with non-Iowa area codes,” says Preuss.
“We decided to unblock the out-of-state callers and then saw a 25% increase in
callers.” As part of a this change project, Helpline staff now ask callers to identify what state
they’re calling from, and if from Iowa, what county. “We can then refer people
who are calling from out of state to an appropriate resource in their area.
Kerksieck’s 2013 conference presentation also shared results
of a NIATx change project to reduce intake
paperwork. “In the first year of our NIATx problem gambling project, we
also took a look at the problem gambling screening tool our providers were
using. The most common screen at the time was a 20-question screen, which was
just too long to get substance abuse treatment programs to adopt,” says Kerksieck. After testing other screening tools, the
department selected the BBGS
screen, a three-question test that has been endorsed by researchers and the
National Center for Responsible Gaming (NCRG).
This resulted in a significant increase in problem gambling referrals from
substance abuse treatment programs that adopted the BBGS.
(Read how Substance Abuse Services Center (SASC) in Dubuque,
Iowa decreased
assessment paperwork and increased client admissions to gambling treatment
by 164%.)
A shorter screen was one of the changes that helped streamline
the intake process, says Preuss. “The net effect of the project reduced
paperwork at treatment programs from up to four hours for an intake to less
than one hour.” However, it appears that
some programs are increasing the amount of paperwork for an admission. “This would
be a prime area for a NIATx booster with programs,” he comments.
The Iowa programs are also encouraged to keep
time slots open the next day for problem gamblers who call the night
before. Some programs still have problematic waiting lists for both substance
abusers and problem gamblers. “Our NIATx
data informed us that this is more problematic for problem gamblers because
their referral is usually crisis-oriented and not forced by corrections,
employer, etc.” says Preuss. “If the crisis has passed, the client is more
likely to no-show.”
One of the most successful changes tested was offering the first four sessions free of charge.
“Our contracts
mandate programs offer a sliding fee schedule, but allow the programs to decide
how to set their sliding fee schedule,” says Kerksieck. “By the time you’ve got
the nerve to call a helpline, you’re usually in severe financial straits and
may balk at having to pay for those first sessions. We figured that these
people had already paid a huge down payment on their treatment, since their
gambling losses were in part funding our treatment programs.”
Kerksieck added, “All the programs that used this NIATx
change cycle got a significant bump up in both admissions and continuation by
offering the first four sessions free. One program reported a 300% increase in
admissions and one of the larger programs found that continuation (attending at
least 4 sessions in the first 30 days of treatment) increased from 57% to 100%.
”
Preuss and Kerksieck are optimistic that the DSM-5’s new definition of
problem gambling as an addictive disorder will increase awareness of problem
gambling as a co-morbid condition. They’ve also noted changes in Medicaid,
either due to the new definition or the ACA, leading to an increase in
reimbursements for problem gambling treatment outside of current state funding.
To find out more about how the DSM-5 changes for gambling
will affect treatment, attend Webinar
3 in the ATTC Network’s Problem Gambling webinar series, this Thursday, May 8.
Dr. Nancy Petry was a member of the American Psychiatric Association's
Substance Use Disorders Workgroup for the DSM-5, and she led the subcommittee
on behavioral addictions. In this webinar, she will outline the changes to
gambling diagnosis and describe their impact for other behavioral addictions.
She will also outline how the changes for gambling diagnosis are likely to
impact the assessment and treatment of gambling problems in years to come.
Preuss says that the potential increase in clients seeking treatment for
problem gambling underscores the need for the department and contracted
providers to continually examine their processes. “We ask for
regular feedback from providers on how their systems are working,” he comments.
“The NIATx tools are used by providers to continually monitor and improve
access to problem gambling treatment services ”
NIATx has been a “win-win” for
providers and those seeking problem gambling treatment services, concludes Preuss. “Integrating
the NIATx philosophy and tools into IGTPP has improved client access to care,
and has given us a foundation for continual process evaluation and improvement.
Every program wants to increase client admissions and continuation.”
For more information on the Iowa’s Office of Problem
Gambling Treatment and Prevention (IGTPP), contact:
Eric M. Preuss, MA, IAADC, CCS
Program Manager
Office of Problem Gambling Treatment and Prevention
Iowa Department of Public Health
Division of Behavioral Health
eric.preuss@idph.iowa.gov
Office of Problem Gambling Treatment and Prevention
Iowa Department of Public Health
Division of Behavioral Health
eric.preuss@idph.iowa.gov
Bob Kerksieck, LMSW, IAADC
Health Facilities Surveyor
Office of Problem Gambling Prevention and Treatment
Office of Problem Gambling Prevention and Treatment
Iowa Department of Public Health
Division of Behavioral Health
Robert.Kerksieck@idph.iowa.gov
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