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