Best practice in problem gambling services

Abstract

The purpose of the project was to: Analyse recent overseas and Australian research on successful problem gambling interventions; Consider a range of dimensions of service provision; Identify how services measure their own performance and achievements against these measures; Gain insight into the reasons for problem gambling, the reasons for contact with various types of services, take-up of various interventions, and perceptions of service effectiveness; Gain insight into service provision for third parties affected by problem gambling; Identify innovative, effective and culturally sensitive models of service delivery. In conducting this research a number of activities were undertaken, including: Analysis of the literature relating to research on gambling service provision with a primary emphasis on sites and models of service delivery; Analysis of the literature relating to research on problem gambling treatment effectiveness as well as literature relating to treatment effectiveness more generally, with which to contextualise the problem gambling treatment literature; Consultations with researchers; Group and individual interviews with Gambler's Help service co-ordinators and individual and group interviews with gambling counsellors; Group interviews with Department of Human Services Head Office and regional staff responsible for Gambler's Help liaison; Focus group interviews with service users of both a 'self-help' program and Gambler's Help; Analysis of the Problem Gambling Research Program's data bank on counsellors who completed two questionnaires — the Counsellor Task Analysis (Problem Gambling) Questionnaire, and the Clinical Practice Evaluation Counsellor Questionnaire); Analysis of the Problem Gambling Research Program's data bank on client outcome data; Trend analysis of reported outcomes of counselling as detailed in the Client and Services Analysis Reports published by the Victorian Department of Human Services Interviews with managers and counsellors from a range of agencies providing services that may be accessed by people with gambling problems themselves, or accessed by those impacted upon by another person's gambling behaviour. In order to contextualise findings on interventions presented in the report, two models are introduced: A model of influences on gambling behaviours and outcomes; and A model of inputs and outputs in relation to interventions. A number of key methodological issues in the definition and measurement of treatment outcomes of problem gambling programs compromised them as guides to 'best practice' such as poorly delineated selection criteria and procedures for the inclusion of gamblers into treatment programs; The implications of our review for service design are that services may be treatment-specific or multi-modal in orientation, but that interventions should be theory-driven, evidence-based and targeted. The review of Gambler's Help program counselling practice and theories in use revealed that a broad range of theoretical perspectives underpin the delivery of the Victorian problem gambling program. Counsellors incorporate a variety of therapeutic strategies and theoretical perspectives to inform their counselling practice with problem gamblers, with the majority of counsellors adopting an eclectic approach to counselling. For services other than Gambler's Help, the key review finding is that there is a negligible amount of gambling-related service provision by this sector, despite anecdotal evidence to the contrary. There is a paucity of information available on service provision to people with gambling-related problems, and therefore almost no information on outcomes achieved. A number of innovative practices in problem gambling services, both within the Gambler's Help program and in the services other than Gambler's Help sector, were briefly reviewed on the basis that they represent types of practice not covered in the review of practice models. They may or may not represent 'best practice' — none have undergone rigorous evaluation. Recommendations are made that they be so evaluated. In order to establish a better evidence base to inform service design and funding decisions, better outcome measures need to be developed and incorporated into routine outcome reporting by funded agencies.

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