Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services

Lived Experience Performance to Reduce Stigma, Enhance Understanding of Gambling Harm and Change Attitudes and Behaviours of Professionals and Community Members

Gamblers and their family members or friends (affected others) can experience stigma and shame due to gambling which can result in a reluctance to seek timely support. However, gamblers and affected others access intersecting health services and talk to friends or family, thereby providing opportunities for early intervention. Three sides of the coin is a group of storytellers with lived experience of gambling harm who use dramatic performance to share personal stories to enhance the understanding of gambling-related harm in allied professions and the broader community. They do this to encourage attitude and behaviour change so that gamblers and affected others receive empathy and support during encounters with these groups. A mixed-methods study was used to explore whether these performances were successful in increasing understanding and changing attitudes and behaviour of allied professionals and the community in the short and longer-term. Data collected immediately post-performance revealed that performances increased understanding of gambling, and improved attitudes and behavioural intent of audience members in relation to gamblers and affected others. Professionals also reported an increased willingness and confidence to discuss gambling harm with clients. Follow-up data demonstrated potential longer-term impact, with respondents continuing to report more positive attitudes towards those affected by gambling harm and professionals being confident to explore gambling issues in their clients and provide appropriate referrals. These finding demonstrate that performance based on lived experience can be a powerful education tool, encouraging deep connection to the issue, resulting in a nuanced understanding and sustained attitudinal and behavioural change.

The Practice and Feasibility of Screening, Treatment, and Referral for Gaming Problems in Gambling, Alcohol and Other Drugs, and Youth Services

Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive approach to identifying people at risk of addiction, but its feasibility for gaming disorder is unknown. This study surveyed 88 clinicians from gambling, alcohol and other drugs, and youth services in New Zealand. Results indicated that the most frequent GD screening method was an unstructured interview (61%), but 74% stated they would use a standardized tool if available. Responsivity to the detection of GD was an immediate intervention (84%), and rates of referral were low (28%). Around 50% of clinicians indicated high confidence in administering motivational approaches and relapse prevention. There was strong support for screening training (85%), treatment guidelines (88%), self-help materials (92%), and access to internet-delivered CBT that could be used in conjunction with other treatment (84%). Clinicians appear motivated and willing to implement SBIRT for GD but report lacking necessary training and resources, including access to screening tools and treatment guidelines.

Gambling and Gambling Problem Perception Questionnaire as a tool to evaluate professionals’ attitudes towards problem gamblers and training programmes in Japan

Aim: To develop and measure the psychometric properties of the Gambling and Gambling Problem Perception Questionnaire (GGPPQ); a scale to evaluate professionals’ attitudes towards people with problem gambling in the Japanese context. Data collection: We held 12 workshops in Japan targeted at mental health professionals who consult people with gambling problems. Participants completed the survey before the workshop. Some were also asked to complete the survey after the workshop to measure workshop influence. Setting: Public and private healthcare facilities in all 47 prefectures of Japan. Participants: Medical doctors, nurses, social workers, clinical psychologists, and other professionals working in the aforementioned facilities ( n = 653, response rate = 98.5%). Measurements: licence; knowledge about gambling and gambling problems (questionnaire); self-rating of knowledge and general confidence for helping problem gamblers; years of practice; frequency of working with clients; experience in attending workshops; overall satisfaction with the workshop. Results: A five-factor structure extracted by exploratory factor analysis showed a good fit by confirmatory factor analysis (CFI = .973, TLI = .967, RMSEA = .060, AIC = 28913.6, BIC = 29110.8). The GGPPQ showed good internal consistency and good concurrent validity with participants’ self-rating of their knowledge, general confidence, frequency of working with clients who have gambling problems, and experience in attending workshops. The workshop had a positive influence on participants’ attitudes. Japan's unique gambling industry and lack of training opportunities on problem gambling were assumed to have influenced the psychometric properties of the measurement tool. Conclusion: The GGPPQ is a valid tool to measure the attitudes of healthcare professionals towards people with gambling problems, as well as workshop effectiveness in Japan.

Should screening for risk of gambling-related harm be undertaken in health, care and support settings? A systematic review of the international evidence

Background

Gambling-related harm is an increasing recognised problem internationally. Recent years have seen an explosion in opportunities to gamble, both in person and online. Health and other care settings have the potential to act as screening sites to identify and support gamblers who may be at high risk of experiencing gambling-related harm. This study aimed to identify interventions to screen for risk of gambling-related harm in the general population which may be delivered in health, care and support settings.

Methods

Systematic review. Searches of key databases and grey sources since 2012 were undertaken in October 2019. Electronic database searches generated a total of 5826 unique hits. Nine studies published 2013–2019, along with thirteen grey literature documents met our eligibility criteria. The criteria were setting (health, care and support settings), participants (any attendee in help, care and support settings), interventions (screening to identify risk of harm from gambling behaviours) and outcome measures (gambling behaviours, service use).

Results

Three papers evaluating screening interventions delivered in general practice (repeat visits and written advice), mental health service (the use of screening tools to identify risk of harm), and substance abuse treatment (intensive outpatient treatment for substance use disorders or methadone maintenance) indicated evidence of potential effectiveness. Six papers supported the feasibility and acceptability of delivering interventions in various settings. Grey literature reports described the implementation of interventions such as training materials, and transfer of interventions developed for substance abuse populations by practitioners.

Conclusions

Health, care and support services offer potentially important contexts in which to identify and offer support to people who are at risk of gambling related harm. Screening interventions appear feasible and acceptable in a range of community and healthcare settings for those at risk of gambling harm. Evaluation of effectiveness and cost-effectiveness of screening in these populations should therefore be prioritised.

Screening for Gambling Disorder in VA Primary Care Behavioral Health: A Pilot Study

The current pilot study assessed the prevalence of at-risk/problem gambling using the Brief Biosocial Gambling Screen (BBGS) among a sample of U.S. military veterans seeking mental health treatment services in a primary care medical setting at a Veterans Affairs (VA) hospital in the Northeast. Out of the 260 veterans screened, 85 veterans (32.7%) reported gambling behaviors within the past 12 months. No significant differences were found between gambling and non-gambling veterans on demographics, medical, or mental health conditions collected in the study. Among veteran past-year gamblers, five veterans (5.9%) screened positive for at-risk/problem gambling. The estimated prevalence of problem gambling was 1.9% among veterans screened in a primary care behavioral health clinic. Results suggest that self-disclosure of problem gambling among veterans, as well as outreach efforts by VA health care providers, could serve to increase veterans' participation in treatment services for problem gambling. Larger, well-powered studies that examine the utility of the BBGS for detecting problem gambling among military populations are needed.

An Examination of Clinician Responses to Problem Gambling in Community Mental Health Services

Gambling problems commonly co-occur with other mental health problems. However, screening for problem gambling (PG) rarely takes place within mental health treatment settings. The aim of the current study was to examine the way in which mental health clinicians respond to PG issues. Participants (n = 281) were recruited from a range of mental health services in Victoria, Australia. The majority of clinicians reported that at least some of their caseload was affected by gambling problems. Clinicians displayed moderate levels of knowledge about the reciprocal impact of gambling problems and mental health but had limited knowledge of screening tools to detect PG. Whilst 77% reported that they screened for PG, only 16% did so “often” or “always” and few expressed confidence in their ability to treat PG. However, only 12.5% reported receiving previous training in PG, and those that had, reported higher levels of knowledge about gambling in the context of mental illness, more positive attitudes about responding to gambling issues, and more confidence in detecting/screening for PG. In conclusion, the findings highlight the need to upskill mental health clinicians so they can better identify and manage PG and point towards opportunities for enhanced integrated working with gambling services.

Factors related to screening for problem gambling among healthcare and social service providers in Ontario, Canada: A concept mapping study

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.

The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis

Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy in detecting both problem and at-risk gambling: Brief Problem Gambling Screen (BPGS-2), NODS-CLiP, Problem Gambling Severity Index-Short Form (PGSI-SF), NODS-PERC, and NODS-CLiP2. Of these, the NODS-CLiP and NODS-PERC have the largest volume of diagnostic data. The Lie/Bet Questionnaire and One-Item Screen are also promising shorter options. Because these conclusions are drawn from a relatively limited evidence base, future studies evaluating the diagnostic accuracy of existing brief instruments across settings, age groups, and timeframes are needed.