oregon health authority problem gambling services gbirt & … · 2020. 6. 27. · oha pgs gbirt...

Oregon Health Authority

Problem Gambling Services

GBIRT & Referral Pathways

Implementation Toolkit

Ver1. October 2018

OHA PGS GBIRT & REFERRAL PATHWAYS IMPLEMENTATION TOOLKIT

A Community Outreach Model for Problem Gambling Programs

Principle #1: At risk groups and gatekeepers must be specifically identified.

Principle #2: Outreach efforts to at risk groups and gatekeepers must be regular.

Principle #3: Outreach efforts to at risk groups and gatekeepers must be repetitive.

Principle #4: Outreach efforts to at risk groups is best done by peer mentors.

Principle #5: Create a detailed plan and stick to it.

Phase #1 Within the Agency

A. Provide Gambling Informed Training to all staff – utilize GBIRT modela. Front deskb. Physical Health Providers (if part of agency services)c. Mental Health Providersd. Addiction Treatment Providers

B. Establish clear processes for screening and referral to treatmentC. Conduct ongoing trainings on a regular schedule

a. Refreshersb. New Employee Training

D. Outreach Education presentations to at risk clients and patients served by the agencya. Regularly scheduledb. Conducted by peers if possible

Phase #2 Outside Healthcare, Addiction and Mental Health Service Providers in the Community

A. Provide Gambling Informed Training to all staff – utilize GBIRT modela. Front deskb. Physical Health Providers (if part of agency services)c. Mental Health Providers

B. Establish clear processes for screening and referral to treatmentC. Conduct ongoing trainings on a regular schedule

a. Refreshersb. New Employee Training

D. Outreach Education presentations to at risk clients and patients served by the agencya. Regularly scheduledb. Conducted by Peers if possible

OHA PGS GBIRT & REFERRAL PATHWAYS IMPLEMENTATION TOOLKIT Phase #3 Criminal Justice System

A. Identify available groups within community a. Judges and Courts – Including Treatment Courts b. District Attorneys c. Defense Attorneys d. Parole and Probation Officers e. Jails

B. Provide Gambling Informed Training to all staff – utilize GBIRT model C. Establish clear processes for screening and referral to treatment D. Conduct ongoing trainings on a regular schedule

a. Refreshers b. New Employee Training

E. Outreach Education presentations to at risk offenders at P&P and Jails a. Regularly scheduled b. Conducted by Peers if possible

Phase #4 Community Gatekeepers (Potentially high frequency of contact with Problem Gamblers)

A. Identify non-clinical gatekeepers a. Bankruptcy Attorneys b. DV/IPV agencies c. Senior Services Agencies d. Lottery Retailers e. Casinos f. Veteran’s Services g. Others?

B. Provide Gambling Informed Training to all staff – utilize GBIRT model C. Establish clear processes for screening and referral to treatment D. Conduct ongoing trainings on a regular schedule

a. Refreshers b. New Employee Training

E. Ongoing regular contact (eg. newsletter, electronic newsletter, email, phone calls)


1. In Reach to Problem Gambling Treatment programs’other agency programs.

2. Out Reach to Other MH and SUD programs in thecommunity.

3. Out Reach to Community Corrections and TreatmentCourts.

4. Out Reach to Community Organizations in contactwith High Risk Groups.

PG Program

A: Organizations & Agencies

B: At Risk Groups

1 2 3 4


Presentation Structure Overview

When organizing a GBIRT presentation or a presentation to at risk groups, a presentation structure that has an experiential component, data tailored to a specific audience, and structured outcomes have optimal traction.

OHA PGS recommends the following structure for presentations:

I. An Experiential Component. Exercises that engage the audience in theemotional experience of gambling are strongly suggested.

II. Establishing Problem and Prevalence. Utilize data that illustrates howproblem gambling impacts individuals, families and communities.

III. Audience specific content. Utilize data and anecdotal information toillustrate how your specific audience is impacted by problem gambling.

IV. Screening Tool/Self assessment: Working with tools for staff on how toscreen. Working with at risk populations on self assessment

V. Intervention/Psychoeducation. Working with staff audience on usingthe brief intervention. Working with at risk populations using the briefintervention.

VI. Referral to treatment/treatment availability. Working with staff onprocess to refer to your program – both clinically and operationally.Working with at risk populations with process to access treatment.

Structuring and Implementing a Strategic Outreach Plan

I. Create team outreach meeting that meets regularly (All Staff Bill 50A ateach meeting. Monthly 50A billing can not be more than 10% of monthlyfunding).a. Initially bi-weeklyb. Then monthlyc. Utilize forms in this toolkit to:

i. Identify tasks for staff membersii. Create Referral Partner Agreements (Bill 50B/50PB)

II. Plan Phase #’s 2 through 4a. Utilize separate Referral Partner Agreement Form to identify specifics

for each referral source.


b. Utilize separate training/presentation planning form for each referralsource.

Setting Up Presentations: Preliminary Tasks

Before designing and implementing trainings and presentations,your program will need to arrange the dates and times for the trainings. This will involved discussions with the decision makers involved with the group your program intends to present to. This discussion will be somewhat of a "mini" presentation, as it will be important for the decision makers to understand the need for the trainings.

The main sticking points are:1) Gambling is a problem, and here's how and why.2) People dealing with gambling issues often do not come forward (how and

why). Training can provide people with what is needed to get into appropriate services.

3) Trainings for clinical staff can provide free CEU's.


Index of Forms

Form 1A: IMPLEMENTING GBIRT WITHIN AGENCIES: STAFF TRAINING

(Bill 50C/50CP)

Form 1B: AGENCY IN REACH TO AT RISK POPULATIONS (Bill 50D/50DP)

Form 2A: IMPLEMENTING GBIRT WITHIN ALLIED AGENCIES: STAFF TRAINING (Bill 50C/50CP)

Form 2B: OUT REACH TO AT RISK POPULATIONS IN ALLIED AGENCIES (Bill 50D/50DP)

Form 3A: IMPLEMENTING GBIRT WITHIN CORRECTIONS AGENCIES AND PROGRAMMING: STAFF TRAINING (Bill 50C/50CP)

Form 3B: OUT REACH TO AT RISK POPULATIONS IN CORRECTIONS SETTINGS (Bill 50D/50DP)

Form 4A: IMPLEMENTING GBIRT WITHIN COMMUNITY AGENCIES AND PROGRAMMING: STAFF TRAINING (Bill 50C/50CP)

Form 4B: OUT REACH TO AT RISK POPULATIONS IN COMMUNITY SETTINGS (Bill 50D/50DP)

Problem Gambling Services Partner Agreement (Bill 50B/50BP)


Form 1A: IMPLEMENTING GBIRT WITHIN AGENCIES: STAFF TRAINING

GBIRT training materials reviewed

Presenter(s) Identified

Name(s) of Presenters: _______________________________

MHACCBO approved CEU’s can be offered to staff provided training structure from OHA PGS is followed. To get CEU’s: (1) Contact OHA PGS prior to training with date, time and location of training. (2) Provide OHA PGS with sign and sign out sheets from the training. (3) Provide OHA PGS with outline of training.

Discussion with decision makers: program managers in SUD’s and/or MH program.

Date and Time for initial training set. (Allow 90 to 120 minutes)

Training Structure

PART I: Experiential

Experiential exercises identified

Materials/props assembled

PART II: Establishing Problem & Prevalence of Gambling Disorder

Specific Content Added and Updated

PART III: Audience Specific Content

Content addressing issues relevant to SUD’s and MH Tx Staff

PART IV: Screening Tool

Integration of screening tool into agency assessment process

Recommendations prepared

Screening tool prepared

PART V: Brief Intervention

Process for integrating Brief Intervention into Practice

Opportunities for role play in training


Brief Intervention Cards Ordered (bill to PG Flex Funds)

PART VI: Referral to Treatment

Process for staff to refer to PG treatment identified

Training material developed

Specific training content incorporated into training

Frequency of GBIRT Trainings

NOTES:


Form 1B: AGENCY IN REACH TO AT RISK POPULATIONS

At Risk Treatment Groups Identified

SUD’s Groups MH Groups



Discussion with decision makers.

Program Managers/Clinical Supervisors

Length of Presentation

Frequency of Presentation (regular and repetitive)

Group Facilitators



Date and time for presentation set

Presentation Structure







Content addressing issues relevant to SUD’s and MH Clients

PART IV: Intervention/Psychoeducation

Integrate Brief Intervention from GBIRT into presentation

PART V: Treatment Availablity

Information about accessing treatment


Form 2A: IMPLEMENTING GBIRT WITHIN ALLIED AGENCIES: STAFF TRAINING




ACCBO approved CEU’s can be offered to staff provided training structure from OHA PGS is followed. To get CEU’s: (1) Contact OHA PGS prior to training with date, time and location of training. (2) Provide OHA with sign and sign out sheets from the training.

Discussion with decision makers: program managers in SUD’s and/or MH program.


Training Structure







Content addressing issues relevant to SUD’s and MH Tx Staff














NOTES:


Form 2B: OUT REACH TO AT RISK POPULATIONS IN ALLIED AGENCIES


SUD’s Groups MH Groups




Program Managers/Clinical Supervisors



Group Facilitators











Content addressing issues relevant to SUD’s and MH Clients






Form 3A: IMPLEMENTING GBIRT WITHIN CORRECTIONS AGENCIES AND PROGRAMMING: STAFF TRAINING




Discussion with decision makers. (Use one form per group.)

Parole & Probation Managers/Supervisors

Treatment Court Coordinators

Attorneys

Judges


Training Structure







Content addressing issues relevant to corrections population














NOTES:


Form 3B: OUT REACH TO AT RISK POPULATIONS IN CORRECTIONS SETTINGS


Parole & Probation Prison Population Jail Population




Program Managers/Supervisors



Group Facilitators/Jail Advocates/Case Managers/Counselors











Content addressing issues relevant to corrections population




Information about accessing GEAR, GRIP or Treatment Program


Form 4A: IMPLEMENTING GBIRT WITHIN COMMUNITY AGENCIES AND PROGRAMMING: STAFF TRAINING




Identification of Gatekeepers (check those that apply for your program efforts)

DHS Senior Services Hospital Systems/ER’s

Physicians Defense Attorneys Other:

Discussion with decision makers (Can encounter to 50 codes)

Date and Time for trainings set. (Allow 90 to 120 minutes)

Training Structure







Content addressing issues relevant to population being presented to














NOTES:


Form 4B: OUT REACH TO AT RISK POPULATIONS IN COMMUNITY SETTINGS

At Risk Treatment Groups Identified (Utilize community settings identified from form 4A)




Managers/Supervisors











Content addressing issues relevant to population






Problem Gambling Services Partner Agreement

Name of Problem Gambling Program:

Agency/Program Contact:

Name of Community Partner Organization

Agency/Program Contact:

Frequency of presentations to at risk groups:

Frequency of staff trainings:

Type of follow up contact and frequency (check all that apply):

Phone Calls Emails Promotional materials

Frequency Frequency Frequency

Meetings

Frequency

Referral Pathway


Notes:


GBIRT Brief Intervention

(Recommended: Print business cards with program contact on one side, brief intervention on the other side. Distribute cards to gatekeepers and high risk groups)

Substance addicted brains are hard wired to become addicted to gambling.

Gambling machines are designed and engineered to keep you playing.

If you gamble, stick to time and money limits – Play Responsibly.

Gambling is entertainment. Never play to win. Remember, the House Always Wins!


GBIRT Screen

Gatekeeper Question: “Most people gamble. In the last year about how many times did you play slot machines or video poker, or poker for money, or buy a lottery ticket or a scratch-off, or bet on a sports event, play Keno or bingo, or play craps for money or play blackjack for money or go to a casino or play the stock market or do any other sort of betting or gambling?”

Question does not need to be asked verbatim. However, normalizing gambling and naming several ways that people gamble is key.

If answer is five or more times per year, proceed to step 1. If answer is less than five times per year, do Brief Intervention and complete screen.

Step 1:

During the past year . . .

1. Have you tried to hide how much you have gambled from your family or friends?

2. Have you had to ask other people for money to help deal with financial problems that had been caused by gambling?

3. Have you ever felt restless, on edge or irritable when trying to stop or cut down on gambling?

If one or more questions in step 1 are endorsed positively – “yes”, proceed to step 2. If answer to all three questions is “no”, do Brief Intervention and complete screen.

Step 2:

During the past year . . .

4. Have you tried to cut down or stop your gambling?

5. Have you increased your bet or how much you would spend, in order to feel the same kind of excitement as before?

6. Did you think about gambling even when you were not doing it? (Remembering past gambling experiences, or planning future gambling?)

OHA PGS GBIRT & REFERRAL PATHWAYS IMPLEMENTATION TOOLKIT 7. Did you go to gamble when you were feeling down, stressed, angry or bored?

8. Did you ever try to win back the money that you had recently lost?

9. Has your gambling caused problems in your relationships or with work?

If four or more questions in step 2 are endorsed positively – “yes”, conduct referral to treatment. If answer to five or more questions is “no”, do Brief Intervention and complete screen.

NOTE: In Oregon, endorsing one criteria makes one eligible for treatment. So referral to treatment can be performed if any of the nine questions is endorsed.

oregon health authority problem gambling services gbirt & … · 2020. 6. 27. · oha pgs gbirt...

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