Evaluation Study on the Effectiveness of the Counselling and

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					Evaluation Study on the Effectiveness of the Counselling and Treatment Centers for Problem and Pathological Gamblers

Department of Applied Social Sciences The Hong Kong Polytechnic University 28 July 2006

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The Research Team
Prof. CHENG Chi-ho, Howard (Principal investigator),
Professor and Associate Head,

Dr. CHAN Ching-hai, Charles,
Associate Professor,

Dr. HO Kit-wan, Helen,
Assistant Professor,

Mrs. HUI LO Man-chun, Jenny,
Lecturer,

Dr. WONG Lai Kuen, Irene,
Instructor, Ms. LAM Yu Kiu, Rita (From October to December 2004), Research Associate, Mr. LEE Ka Man (from 1st January 2005 onwards), Research Associate,and

Ms. LUI Wai Sze,
Clinical Psychologist,

Dept. of Applied Social Sciences, Hong Kong Polytechnic University
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Objectives

a)

b)

c)

d)

a comprehensive review on adequacy and effectiveness of the services of the 2 Centres; examine the validity and usefulness of the screening tools adopted by the 2 Centres in assessing gambling-related problems; identity factors related to success or failure of services; and recommend to Govt. on longer term gambling treatment services.

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Findings: (1) Validation of Screening Tools


DSM-IV is a relatively reliable and valid tool that to be adopted for screening pathological gamblers:


screening & assessing the severity of gambling problems of service-seekers identifying pathological gamblers from service seekers.



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Findings: (2) Service Output (as at 31st Decembr 2005)
a. Hotline service and telephone enquiry were most welcomed and frequently used:
Caritas Addicted Gamblers Counselling Centre
Total number of telephone enquiries Average time spent on each enquiry 5,661

Tung Wah Even Centre
5,395

5 minutes

10 minutes

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b. Caseload (Level II cases – those screened as problem and/or pathological gamblers)
Caritas Addicted Gamblers Counselling Centre Total number of Level II cases 1,092 Tung Wah Even Centre

1,116

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c. Caseload (Level III cases - those who received psychiatric and/or residential treatment services) :
Caritas Addicted Gamblers Counselling Centre Total number of Level III cases 79 Tung Wah Even Centre 52

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d. Casework services for gamblers
Caritas Addicted Gamblers Counselling Centre
No. of telephone / hotline counselling 14,828

Tung Wah Even Centre
4,649

Average time used No. of individual counselling sessions for gamblers

2.0 minutes 4,479

12.7 minutes 4,595

Average time / session

1.2 hours

1.23 hours

No. of family counselling sessions for gamblers & significant others

1,720

619

Average time / session

1.3 hours

1.16 hours

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e. Case Services for Significant Others
Caritas Addicted Gamblers Counselling Centre
No. of telephone guidance / counselling Average time / call No. of individual counselling sessions for significant others Average time / session 4,556

Tung Wah Even Centre
1,076

3.2 minutes 178

17.7 minutes 1,222

1.8 hours

1 hours

No. of family counselling sessions for significant others & family members
Average time / session

47

490

1.5 hours

1.2 hours

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f. Group Work Services / Treatment Groups for Gamblers
Caritas Addicted Gamblers Counselling Centre No. of short-term group sessions on therapeutic intervention for gamblers Average time / group session No. of psycho-educational group sessions for gamblers Average time / group session No. of peer group counselling sessions Average time / group session No. of long-term (mutual-help) group sessions for gamblers Average time / group session 35 Tung Wah Even Centre 62

3 hours Nil

2 hours 78

N. A. Nil N. A. 146

1.2 hours 28 3 hours 109

2.5 hours

1.8 hours

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g. Group Work Services for Significant Others
Caritas Addicted Gamblers Counselling Centre Tung Wah Even Centre

No. of short-term group sessions on therapeutic intervention Average time / session No. of long-term mutual-help group sessions

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Nil

2.29 hours 27

N. A. 60

Average time / session
No. of psycho-educational group sessions Average time / session

2.9 hours
Nil N. A.

1.6 hours
10 1 hour

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h. Other Service Output
Caritas Addicted Gamblers Counselling Centre No. of staff training programmes Tung Wah Even Centre

38

118

Time used No. of supervision sessions

147.5 hours 222

625 hours 177

Time used

164.25 hours

264 hours

No. of educational programmes held for the public
No. of attendance Time used

39
3,149 82 hours

7
12,290 28 hours

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h. Other Service Output
Caritas Addicted Gamblers Counselling Centre Tung Wah Even Centre

No. of educational programmes held for primary and secondary schools No. of attendance Time used No. of educational programmes held for young people (15-24 age group) No. of attendance Time used

16

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4,421 29.92 hours 12

2,196 37 hours 15

632 25 hours

1,205 65 hours

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h. Other Service Output

Caritas Addicted Gamblers Counselling Centre

Tung Wah Even Centre

No. of training programmes for social workers

7

32

No. of attendance
Time used No. of training programmes for teachers No. of attendance Time used

162
45 hours 2 150 5.5 hours

895
52.5 hours 4 308 24 hours

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h. Other Service Output
Caritas Addicted Gamblers Counselling Centre Tung Wah Even Centre

No. of training programmes for other professionals No. of attendance Time used

12

30

631 68 hours

1,430 98 hours

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i. No. of Closed Cases (Level II cases) / Reasons for Closing
Reasons of closing case
Goal attained (successful cases) Caritas Addicted Gamblers Counselling Centre 507 (64.9%) Tung Wah Even Centre 543 (69.1%)

Lost contact
Missing appointment Lack of motivation Referred to other Centres Death of client Others Total

103 (13.2%)
Nil 168 (21.5%) Nil 3 (0.4%) Nil 781 (100.0%)

146 (18.6%)
32 (4.1%) 38 (4.8%) 3 (0.4%) 1 (0.1%) 23 (2.9%) 786 (100.0%)

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Findings: (3) Service Outcomes



The 2 Centres have been operating in the right direction, and are able to meet requirements of Service Agreement. Over 90% service users (gamblers & family members) were satisfied with the quality and quantity of services Close to 70% of the closed cases were successful cases.





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Findings: (3) Service Outcomes
The 2 Centres were:
• •

• •

•

providing appropriate & effective counselling & treatment services for gamblers & family members; facilitating the development of best practices & expertise in counselling & treatment services for gamblers; building up the requisite network for gambling treatment in Hong Kong; collecting required data and statistics which contribute to a better understanding of problem gambling; and reaching out to and educating the general public for prevention of problematic / pathological gambling.

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Findings: (3) Service Outcomes
Most significant service effectiveness:
1) 2)

3)

the ability to control desire to gamble; development of responsibility for own gambling behaviours and consequences; and improved social skills and family relationships.

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Findings: (3) Service Outcomes
After receiving services for 6 months, gambling behaviours of users had not deteriorated, and their perceived service by priority were,
1) 2) 3) 4)

better understanding of one’s own gambling behavior & consequences; more capable of controlling one’s desire for gambling; able to solve financial problems; and able to solve family problems. To conclude, outcome measurement reflected satisfactory cost-effectiveness of the services provided by the 2 Centres.

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Findings: (4) Users’ Profile / Level II P/P Gamblers

    



middle-aged male in their 30s and 50s with primary and junior secondary school education over 60% are working in the service sector over 80% have financial and debts problems over 60% have emotional problems about 50% are suffering from poor family and marital relationships

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Summary Remarks
1.

Literature revealed some gamblers dropped or cut down gambling without receiving service.
Causes of pathological gambling are complicated and are embedded in the culture, subculture, social systems and one’s psychological and social conditions. There is no single cure or the best model for treatment.

2.

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Summary Remarks

3.

Total abstinence of gambling addiction is very difficult. Positive treatment outcomes should be helping gamblers understand personal responsibility so that they can develop self control when engaging in gambling activities, and reduce the harm of gambling as far as possible.

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Summary Remarks

4.

Treatment methods: Cognitive-behavioural therapies which focus on altering cognitions and changing gambling behaviours are effective in casework services for pathological gamblers, and supplemented by treatment groups for gamblers and family members. The “case-in-group” approach is effective in treating local p/p gamblers and their families in HK.

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Summary Remarks
5.

Government has a responsibility, through law enactment and enforcement, to supervise the operations of gambling activities and keep them under control. On the other hand, the media also has the social responsibility to exercise restraint in disseminating gambling-related information. Prevention is better than cure. There is a need to develop a long term strategy in gambling prevention among young people.

6.

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Summary Remarks
7.

In developing a service delivery model, its feasibility, cost-effectiveness, sustainability, and financial support must be carefully considered. The need for service expansion is obvious, the research team supports with caution for a unlimited expansion of services in view of competing community needs. A careful and affordable expansion of treatment programmes for p/p gamblers is recommended.

8.

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Justification for Continuous Funding Support



 

Gambling, esp. social gambling, is perceived as a culturally acceptable form of entertainment in HK. About 80% of HK residents aged 15 - 64 report having gambled in the past year (A Study of HK People’s Participation in Gambling Activities, HKU, 2005), compared to 78 % in Gambling Prevalence Survey (HK PolyU, 2001). Development of internet gambling and telephone wagering. Rapid expansion of gambling industries in Asia, esp. in Macau with liberalization of gambling monopoly in 2001
Pathological gambling may become more widespread in Hong Kong.
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Justification of Continuous Funding Support


Findings of a HKU Study held the same views:

“While there is a modest increase in the estimated number of pathological gamblers in the society, as assessed using DSM-IV, the overall percentage share of p/p gamblers in the community has remained stable (around 5%). This points to a continued need to provide appropriate remedial service for p/p gamblers.”
(A Study of Hong Kong People’s Participation in Gambling Activities, Social Science Research Centre, The University of Hong Kong, Pg. 96).

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Recommendations


Support the 2 gambling treatment centres at the current service level for another 2 years up to 30 September, 2008. With the existing level of resource provision, the operating hours of the current hotline service could be considered to be extended to 24 hours on a pilot basis. The future development of and resource input to the treatment centres to be reviewed after commissioning another in-depth research to evaluate their costeffectiveness and demonstration of continuous service needs.
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



Recommendations


A community-based approach focusing on establishing capacity building among gamblers, potential gamblers and their families to be considered as an alternative treatment model. Consider to establish 2 small treatment centres with a smaller group of counsellors / social workers providing treatment services to p/p gamblers and their families in Kowloon and other areas.



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Recommendations


These two new treatment centres may consider using alternative treatment models and a community-based approach, to serve the needs of :


  

elderly gamblers (e.g. those involved frequently in group gambling in public housing estates); gamblers who belong to ethnic minorities; youth, especially secondary school students; and women, especially housewives aged between 30-60.

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Recommendations


The Ping Wo Fund may consider as appropriate applications from non-governmental organizations, schools and other community organizations to launch prevention and/or treatment programmes for p/p gamblers on a smaller scale. Service output and outcome indicators should be standardized for all gambling treatment centres.



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Recommendations: Standardization of Service Output Indicators
Service Output 1. Total no. of call 2. Total no. of calls taken 3. Total no. of new cases who receive Level 1 service 4. Total no. of new cases who receive Level 2/3 services 5. No. of clients who received Level 2/3 services Attainment level (per year) 8,000 5,000 2,000 500 700

6. No. of counselling and treatment sessions
7. No. of mutual support / self-help group sessions 8. No. of staff and professional training sessions 9. No. of participants attended the staff and professional training 10. No. of public education programmes 11. No. of participants attended the public education programmes

3,000
150 10 200 30 6,000

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Recommendations: Standardization of Service Outcome Indicators
Service Outcome Attainment level (per year)

1. % of cases achieving and maintaining complete abstinence for half a year upon termination of treatment (excluding social gambling)
2. % of cases showing increased ability of control, and ability to manage the emotional, cost and other factors leading to their gambling activities 3. % of cases with sustained and consistent use of structural support 4. % of cases closed with attainment of agreed goals in the case plan 5. % of cases with improvements in other aspects of clients’ life which are conducive to eliminating or reducing their gambling problems 6. % of positive feedback from users on achievement of programme objectives and effectiveness of programme

50%

65%

60% 70% 75%

90%

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Limitations of the Study


The first study on the effectiveness of the gambling services in Hong Kong, there is no local reference data for comparison. The cut-off date for data collection is 31.12.2005. Performance of the 2 Centres from 1.1.2006 to 30.9.2006 is not evaluated. Some users refused to participate in the study.







No longitudinal data to study changes, effects and sustainability over time.
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Acknowledgement


The research team is grateful to have this valuable opportunity to engage in a meaningful study. We have learned a lot and this study has developed a better understanding of pathological gambling in Hong Kong. The research team thanks for the support and assistance from the HAB, the Ping Wo Fund, Caritas and Tung Wah. We look forward to further collaboration with you all in working towards developing more effective services in the treatment of p/p gambling.







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Thank You

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