PGF Services and The Salvation Army’s Oasis Service, with the support of University of Auckland and Deakin University in Australia, are piloting two new e-health products to promote help-seeking and to complement the delivery of their gambling harm counselling services.
One is an e-health self-assessment tool available on the websites of both organisations. The results of the simple questionnaire are available immediately to the person taking the test who then has the option of discussing their results with a counsellor if they choose to go further.
The second e-health product is a suite of e-health modules that tāngata whaiora can choose to complete while attending counselling. The self-help modules assist people who are working alongside a counsellor to regulate their gambling by identifying triggers. It also expands their access to resources and tools.
PGF Services National Director, Bridgitte Thornley says a substantial number of people who visit both organisations' websites do not go further and seek treatment.
“The stigma and shame around problem gambling means that people often try to manage their gambling addiction themselves. They want to hide their concerns from family and friends. The e-health self-assessment tool means they can confidently take that first important step in private, by themselves, to check if their gambling is still ok.”
In 2016, around 6000 gamblers sought face-to-face treatment although more than 80,000 people were identified as moderate risk or problem gamblers.).
“We hope this tool will attract a new cohort of tāngata whaiora” she says.
PGF Services and Oasis decided to expand their counselling intervention options to include e-health interventions, citing evidence that they appeal to gamblers and are effective at reducing gambling related harm [2,3].
They brought a team of experts together from New Zealand and Australia. The Australian member had developed a comprehensive and intensive iCBT suite of services called GamblingLess that has been subject to multiple clinical trials over the past 7 years.”
This team proposed embedding an e-health intervention programme within a stepped care model of counselling to reduce the high attrition rates of people completing e-health treatment programmes on their own.
Forty-seven people from different backgrounds, including consumers, counsellors, clinicians and health promotion experts, tested the tools. After the survey a co-design workshop with consumers and clinicians was held to incorporate the feedback into the customisation and protocols of the products and then into the final products.
The main benefits reported were increased access and the reduction of barriers to treatment. The main disadvantages were perceived to be the loss of face-to-face time and resources if clients moved to online resources only.
In terms of the online self-assessment, participants reported a preference for the intervention to be around 10 minutes in duration and that the self-assessment could be supported by email, chat, phone or face-to-face clinical support.
Participants reported that the blended counselling approach was feasible and that their preference was for partial blending leaving clinicians and counsellors autonomy to select intervention content at each episode of care.
The preferred duration of e-health treatment was around 30 minutes per week. It was expected that this approach will render the programme highly relevant and appropriate to both providers and clients.
The e-health self-assessment tool screens for gambling harm uses the Problem Gambling Severity Index and the gambling pathways model. It also covers confidence and motivation to change. The assessment takes about 10 minutes and at the end a personalised report is provided for the tangata whaiora.
Among other things the report compares the gambling behaviour of the tangata whaiora with that of others in New Zealand. It helps to identify their motivation for gambling and identifies some of their strengths.
At the end of the exercise tangata whaiora can save the report online or print a copy. They are offered the option of sharing their results with a gambling counsellor. If the latter option is chosen, they complete a short contact form and a counsellor will ring them within one working day.
Kaimahi in addictions services are encouraged to use this screen with tāngata whaiora who may be ambivalent about their gambling causing harm.
The new online platform developed by PGF Services and Oasis is modelled on a comprehensive and intensive iCBT suite of services called GamblingLess which has been running in Australia for the last seven years.
The comprehensive and intensive cognitive-behavioural program consists of activities to enhance motivation (e.g., negative consequences, values alignment, identification of triggers, goal setting); behaviour modification (e.g., limiting access to money, budgeting, problem solving, relaxation skills, pleasurable activities), cognitive restructuring (e.g., gambler's fallacy, illusion of control, positive expectancies, near misses) and relapse prevention (e.g., urge management, high risk situations, seemingly irrelevant decisions).
Activities are delivered with a combination of video, audio, interactive animations, and written activities. At the end of each module participants are asked questions relating to their gambling spend, are set treatment goals and there is also an option to leave a message that their counsellor can access and respond to.
For gambling harm counselling, advice and information please contact:
Dr Simone Rodda
1. Ministry of Health, Progress on Gambling Harm Reduction 2010 to 2017: Outcomes report – New Zealand Strategy to Prevent and Minimise Gambling Harm. 2018, Wellington, New Zealand: Ministry of Health.
2. Rodda, S.N., et al., Improved Outcomes Following a Single Session Web-Based Intervention for Problem Gambling. Journal of Gambling Studies, 2017. 33(1): p. 283-299.
3. Rodda, S.N., et al., Does SMS improve gambling outcomes over and above access to other e-mental health supports? A feasibility study. International Gambling Studies, 2018. 18(2): p. 343-357.
4. Gainsbury, S., N. Hing, and N. Suhonen, Professional Help-Seeking for Gambling Problems: Awareness, Barriers and Motivators for Treatment. Journal of Gambling Studies, 2014. 30(2): p. 503-519.