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					  HELPING WOMEN
   WHO GAMBLE:
  Views of Ontario
  Service providers



      Report of Study Results
           Joan M. Brewster, PhD
with Roberta Boughton M Ed, CGC (Consultant)


                July 2002
                  The authors thank the

         Ministry of Health and Long-Term Care
                 Problem Gambling Unit
                   Addiction Programs

                  for funding this project

      Research findings, results, interpretations and
conclusions expressed in this report are those solely of the
  authors and are not necessarily those of the Ministry.
                             TABLE OF CONTENTS
List of Tables                                         iii

EXECUTIVE SUMMARY                                      v

Background and Literature Review                       1
      Role of Service Providers                        1
      Needs of Service Providers                       2

Method                                                 2
     Sampling                                          2
     Limitations of the Sample                         3
     Survey Instrument                                 3
     Survey Method                                     4

Results and Discussion                                 4
       Responses                                       4
       Data Analysis                                   4

Respondent Characteristics                             5
      Demographics                                     5
      Respondent Training, Occupation, and Education   5
      Work Setting                                     7
      Proximity to Gambling and Treatment Facilities   9
      Respondents’ Personal Behaviour                  11
      Respondent Characteristics: Summary              12

Respondents’ Gambling-Related Practice                 13
      Practice Activity and Treatment of Gamblers      13
      Treatment Approaches                             15
      Gambling-Related Practice: Summary               17

Client Characteristics                                 18
       Games Clients Play                              19
       Client Characteristics: Summary                 19

Perception of Service Needs of Women Gamblers          20
      Information Needs                                20
      Gambling-Related Services for Women Gamblers     21
      Gambling Service Delivery                        22
      Non-Gambling Services for Women Gamblers         23
      Services for Specific Groups of Women            24
      Other Needs of Women Gamblers                    25
      Summary of Perceived Service Needs of Women      26
              Gamblers




                                                             i
Barriers to Treatment-Seeking                               27
       Perceived Barriers                                   27
       Location of Gambling treatment services              28
       Summary of Barriers to Treatment                     29

Perceived Concurrent Problems of Women Gamblers             30
       Summary of Concurrent Problems of Women Gamblers31

Service Provider Needs                                      32
       Information on Gambling-Related Topics               32
       Training Needs                                       33
       Changes in Work Environment                          34
       Summary of Service provider Needs                    35

Preventing Gambling Problems                                36
      Summary of Prevention of Gambling Problems            38

Conclusions                                                 38

REFERENCES                                                  40

Appendix 1: Advisory Board members                          41




                                                                 ii
                                    LIST OF TABLES

Table 1. Demographic characteristics of respondents – page 5

Table 2: Respondent Training, Occupation, and Education – page 6

Table 3: Respondents’ Work Setting – page 8

Table 4: Proximity of Employment to Gambling Facilities and Treatment Programs – page
       9

Table 5: Respondents’ Personal Smoking, Drinking & Gambling Behaviour – page 11

Table 6: Respondents’ Practice Activity & Treatment of Gamblers – page 14

Table 7: Respondents’ approach to treatment of gambling problems and problems with
       alcohol and other drugs – page 16

Table 8: Characteristics of Respondents’ Clients – page 18

Table 9: Ranking of Games most commonly played by Clients – page 19

Table 10: Perceived importance of information services for increasing help-seeking by
       women gamblers – page 20

Table 11: Perceived importance of gambling-related services for increasing help-seeking by
       women gamblers – page 21

Table 12: Perceived importance of aspects of gambling-related service delivery for
       increasing help-seeking by women gamblers – page 22

Table 13: Perceived importance of non-gambling-related services for increasing help-
       seeking by women gamblers – page 23

Table 14: Perceived importance of services for specific groups of women for increasing
       help-seeking by women gamblers – page 24

Table 15: Perceived importance of other services for women gamblers for increasing help-
       seeking – page 25

Table 16: Perceived importance of barriers to treatment seeking by women gamblers –
       page 28

Table 17: Location of gambling treatment services perceived as encouraging or
       discouraging to treatment-seeking by women gamblers – page 29




                                                                                         iii
Table 18: Perceived frequency of need to address concurrent issues with female gamblers –
       page 31

Table 19: Perceived helpfulness to Service Providers of additional information on
       gambling-related topics – page 32

Table 20: Perceived helpfulness to Service Providers of additional training and skills – page
       34

Table 21: Perceived helpfulness to Service Providers of changes in their work environment
       – page 35

Table 22: Perceived importance of measures to prevent gambling problems among women
       – page 37




                                                                                           iv
                                 EXECUTIVE SUMMARY

                           HELPING WOMEN WHO GAMBLE:
                            Views of Ontario Service Providers

Both professional gambling counsellors and other Service Providers (SPs) come into contact
with women who gamble. Each has an important role to play in detecting, referring, and
providing service to women who have problems with their gambling. Despite the importance of
these roles, little is known about the SPs’ preparation for, or the context within, which they
perform them. In addition, their perception of the needs of female gamblers has not been
studied.

The current survey’s purpose was to obtain the perspective of SPs on the adequacy of current
services available to women who gamble, and the service needs of women gamblers. An
additional purpose was to explore the training, information, and other needs of the providers
themselves to help them better serve Ontario women who gamble. This study is complementary
to, but separate from, the survey “Voices of Women who Gamble in Ontario,” carried out by
Roberta Boughton, who surveyed women who have gambling problems.

Method & Response

A mailed questionnaire was sent to all SPs (N = 137) who deal with gamblers in the Ontario
Designated Gambling Treatment System, and to a sample of SPs (N = 127) working in other
settings throughout Ontario where women gamblers are among their clients (Non-Designated
SPs). The questionnaire asked about professional education and practice, needs of women
gamblers, SPs’ needs to help them better serve women gamblers, and prevention of gambling
problems, as well as demographic questions. A response rate of 72% was achieved among
Designated SPs, and 66% among Non-Designated SPs.

Respondent Characteristics and Practice

Of the 99 Designated SP respondents, 35% were gambling counsellors and 54% were Addiction
counsellors. Among Non-Designated SPs, 25% were social workers, 17% were addiction
counsellors, 14% were financial counsellors, and 10% were physicians. The remainder was from
other occupations. Reflecting the sampling procedure, Designated SPs were more likely than
Non-Designated SPs to work as gambling counsellors, to have received gambling-related
education, and to work in the Designated Gambling Treatment System. Designated SPs see
more gambling clients and are more likely to treat gambling problems themselves (93%) than are
the Non-Designated SPs (47%). They are also more familiar with standard gambling screening
tools, and are more likely to endorse flexible treatment goals (69%) than are Non-Designated
SPs (38%), who are more likely to endorse abstinence as the treatment goal (35% vs. 14% for
Designated SPs).




                                                                                             v
Client Characteristics

All respondents report that just under half of their clients who gamble are women. The games
most commonly played by the women are bingo, casino slots, lottery/scratch, and Nevada/Break
Open, consistent with the findings of the related study of women gamblers themselves.

Perceived Needs of Women Gamblers

All respondents agree that information about what constitutes gambling, and what constitutes
problem gambling, should be widely available to the Ontario public and to women who gamble.
Looking at service needs, there is a clearly perceived need for women-specific services and
programs for women who gamble. In addition, aspects of service delivery such as female
counsellors, counsellors specifically trained to deal with women gamblers, and flexible delivery
of services were perceived as important by more than 90% of respondents. Concurrent, non-
gambling needs of women such as family counselling, counselling regarding abuse, financial
counselling, employment counselling and addiction services were perceived as important by
almost all respondents. For most service needs, Designated SPs were more likely to perceive
current levels of delivery as adequate than were Non-Designated SPs, possibly reflecting
Designated SPs increased proximity to and knowledge of what is currently available.
Nonetheless, for almost all services, only a minority of all SPs perceived current service delivery
to be adequate.

The majority of all respondents perceived as important other service needs of women gamblers:
child care at treatment agencies; transportation; temporary financial help; food and shelter;
employment; affordable housing. In contrast, fewer than 25% perceived these services to be
currently adequate. SPs also identified as important the specialised or modified services for
special populations of women: youth, seniors, aboriginal and ethnic groups, lesbians, women in
the correctional system, and those with co-occurring problems.

Barriers to Treatment-Seeking

As perceived by the respondent SPs, the major barriers to help-seeking by female gamblers are
the women’s perceptions of gambling and of themselves: not perceiving themselves as gamblers,
denial or minimization of problems, perception that their gambling is not a problem, shame and
stigma. To encourage women who gamble to seek treatment, most respondents endorsed the
provision of gambling-related services and other services for women gamblers, in a wide variety
of locations including women’s centres, community health centres, Aboriginal centres, and credit
counselling offices.




                                                                                                 vi
Concurrent Problems of Women Gamblers

Among possible issues co-occurring with gambling problems, those identified by respondents as
most frequent included stress, depression/anxiety, and self-esteem, reflecting those identified by
the women themselves in the related “Voices of Women” study.

Service Provider Needs

The great majority of all respondent SPs reported a desire for more information on almost every
topic suggested, including basic information about women’s gambling, women-specific
gambling programs, and non-gambling services and programs for women. Designated SPs were
more likely than Non-Designated SPs to report that training on a variety of gambling-specific
issues would be helpful. Responses of Non-Designated SPs indicated a desire to know more
about currently available services and how to access them for their clients. In addition,
Designated SPs are more likely than Non-Designated SPs to desire more support for working
with women gamblers within their work environment, including management support and more
time devoted to gambling, and a more women-friendly environment in their agencies.

Preventing Gambling Problems

The majority of SPs expressed support for a wide variety of options presented to prevent
gambling problems among women. These include widely available information about gambling
problems and gambling-related services, measures in casinos and other gambling venues to
prevent excessive spending, and reduction of gambling opportunities. Community based
preventive measures endorsed by a majority of respondents include affordable housing,
accessible education, and better employment opportunities.

Conclusions

The survey of Ontario Service Providers is consistent with the “Voices of Women who Gamble
in Ontario” in identifying as important the need for more women-specific services for women
who gamble, along with support and programs addressing other life areas for these women. In
addition, the respondent SPs strongly endorse increased availability of information about
gambling, what constitutes gambling problems, and what services are available to help women
who develop such problems.

For themselves, the respondent SPs express a strong desire for more information about women’s
gambling, how to treat women who gamble, and what services are currently available for women
gamblers. They also want administrative and environmental support for dealing with women
who gamble.

The current study is the first to examine the perceptions of Ontario Service Providers about the
needs of women gamblers and their own information and support needs in providing care to
these women. The findings of the survey provide a basis for policy and programming directions,
as well as for future research on how best to help women who develop problems with gambling.



                                                                                                vii
viii
                            HELPING WOMEN WHO GAMBLE:
                             Views of Ontario Service Providers

This report describes the results of a survey of those who provide services to Ontario women
who gamble.1 It is complementary to, but separate from, the survey “Voices of Women who
Gamble in Ontario” (Boughton & Brewster, 2002). The present survey’s purpose was to obtain
the perspective of the Service Providers (SPs) on the adequacy of current services available to
women who gamble, and the service needs of women gamblers. An additional purpose was to
explore the training, information, and other needs of the providers themselves to help them better
serve Ontario women who gamble.


Background and Literature Review

Role of Service Providers

Professional gambling counsellors are in frequent contact with problem gamblers, and have a
clinical sense of the needs of women gamblers. The Ontario Designated Gambling Treatment
System comprises about 50 agencies, which also offer assessment or help for problems with
alcohol and other drugs. These agencies receive funding from the Ministry of Health and Long-
Term Care for a counsellor to specifically deal with gambling problems. This counselling may
be carried out by one or more individuals in the agency. This system provides Ontarians with
gambling treatment services distributed throughout the province.

There is increasing recognition of the role of physicians, psychologists, social workers, financial
counsellors, and other service providers in detecting, referring, and providing service to those
who have problems with gambling. A recent survey of Ontario households found that
respondents, if they were to seek help for a gambling problem, would turn to, in order, family
members, gambling counsellors, friends, family doctors, social workers-psychologists-
psychiatrists, and religious counsellors (Wiebe et al., 2001). Those with severe problems were
least likely to turn to professionals (other than family or friends) for help, suggesting that
professionals are in a ideal position to detect and intervene when problems are less severe.
Recent literature has stressed the importance of a wide variety of professionals in addressing
gambling problems: physicians (Korn, 2000; Pasternak et al., 1999; Westphal et al., 2000); social
workers (Straussner, 2001); addiction counsellors (Langenbucher, 2001); psychologists (Drebing
et al., 2001); employee assistance program (EAP) counsellors (Lesieur, 1989).




1
 This study was funded by the Substance Abuse Bureau of the Ministry of Health and Long
Term Care.


                                                                                                 1
Needs of Service Providers

There have been several surveys of professionals who provide services to gamblers, both
gambling counsellors and other professionals and service providers. However, none has
specifically addressed their perception of the needs of women who gamble.

Lesieur (1989) surveyed EAP program counsellors and found that most had identified problem
gamblers and referred them elsewhere for treatment. Christensen and colleagues (2001) reported
similar findings in a survey of a mixed group of professionals. A survey of Veterans Health
Administration psychologists found that they were not aware of gambling problems and had little
experience with them (Drebing et al., 2001). All of these surveys found that the respondents
needed basic and detailed education in dealing with gambling problems. Also, all had very low
response rates.

One Canadian study examined resource needs of Canadian physicians in dealing with substance
use and gambling problems and concluded that current resources for physicians are inadequate
and not well disseminated (Rowan & Galasso, 2000). The findings were based on a survey of
Executive Directors of medically-affiliated organizations, interviews with key informants, and
focus groups, rather than a survey of practitioners. The authors conclude that Canadian
physicians need training to deal with gambling and substance abuse problems.

A survey of gambling counsellors in the Ontario Designated Gambling Treatment System was
carried out in 1999, to identify the gambling-related training needs of this group (Birchmore-
Timney et al., 1999). The areas in which respondents were most likely to want additional
training were: new developments in research and treatment of problem gamblers; working with
specific groups of gamblers such as youth, elderly, men, women, Aboriginals; solution-focussed
approaches to treatment; managing gambling clients in crisis.

None of the studies mentioned above asked about Service Provider needs specific to dealing with
women who have gambling problems, and none have asked SPs about their perceptions of the
needs of women gamblers. This research gap was addressed by the current study.


Method

Sampling

1. Designated Gambling Treatment System Service Providers: The director of each agency in
   the Designated Gambling Treatment System was telephoned by the study Research Assistant
   and asked to identify the person or persons in the agency who treat problem gamblers. In
   most of the Designated treatment agencies, all of the staff who counsel patients were
   identified as treating, or possibly treating, problem gamblers. All individuals identified in
   this way (N = 137) comprised the Designated Service Provider sample, the entire population
   of gambling counsellors within the Designated Treatment System.




                                                                                                 2
2. Non-Designated Treatment Service Providers: Professionals and SPs who are likely to come
   into contact with women who gamble, but who do not work within the Designated Gambling
   Treatment System, were identified to participate in the study through professional contacts
   and members of the Advisory Board for the “Voices of Women who Gamble” study (See
   Appendix 1). Professions targeted were addiction counsellors, financial counsellors, nurses,
   physicians, and social workers working in mental health, addiction, or financial counselling
   agencies. Additional individuals who have an interest in treating gamblers and who were
   known to investigators or members of the study Advisory Board were identified. An attempt
   was made to obtain names of people in different types of agencies and in all seven Ontario
   health regions. The study Research Assistant telephoned those who had been identified as
   potential participants to solicit their agreement to take part in the study. Those who agreed
   (N = 127) became the Non-Designated Service Provider sample.

Limitations of the Sample

As the survey was sent to every person working in the Designated Gambling Treatment System
who might possibly treat women who gamble, the Designated “sample” is the entire population
and is fully representative of the views of this group. The Non-Designated sample was generated
by a snowball contact technique, with initial contacts made with people who were known to the
investigators and the Advisory Board. This sample contained a small number of individuals in
each of several different occupations, and was not intended to be representative of any
occupational group. Rather, the sample included people whose work was likely to bring them
into contact with women who have gambling problems, and who had sufficient interest in
gambling issues to agree to complete the survey. It is not possible to say that the Non-
Designated group represents all health professionals and service providers in Ontario.

Survey Instrument

A questionnaire was developed, taking into account previous studies and the concurrent study of
the needs of women gamblers, “Voices of Women who Gamble in Ontario.” A draft
questionnaire was pre-tested with 13 service providers in the Designated Gambling Treatment
System and in other client service settings to verify the questionnaire wording, content, and
applicability to various work settings. Members of the Provincial Advisory Board also provided
feedback on the draft questionnaire. The questionnaire was finalized taking into account all
feedback.

The areas covered in the questionnaire were: professional practice; education; gambling-related
service needs of women; Service Provider needs; non-gambling needs of women gamblers;
prevention of gambling problems; demographic and other questions about SPs. The
questionnaire, cover letter, and other survey materials were translated into French.

Survey Method

Questionnaires were mailed to the sample participants in May, 2001. Those who were known by
the investigators to be Francophone were sent the materials in French. Every participant was
offered the opportunity to request a questionnaire in the language (English or French) other than



                                                                                                  3
the one originally sent. The questionnaires were mailed together with a cover letter explaining
the study and a postage-paid return envelope. A label on the return envelope identified
respondents so that their names could be removed from the mailing list for reminders.
Respondents also could indicate on this label whether they wanted to receive a summary of the
results of the study. When received, questionnaires were removed from the envelopes, which
were discarded after the label information was recorded. The questionnaires were completely
anonymous and without identifiers. Several weeks after the initial questionnaire mailing,
reminder letters, with a new questionnaire and postage-paid return envelope, were mailed to all
those who had not yet returned the questionnaire. The survey method was approved by the
Ethics Review Committee of the Ontario Centre for Addiction and Mental Health.


Results and Discussion

Responses

From the Designated SP sample, 99 completed questionnaires were received, for a response rate
of 72%. Of these 99 questionnaires, seven were completed in French. In the Non-Designated
group, 84 completed questionnaires were received for a response rate of 66%. Of these 84
questionnaires, one was completed in French. As several months elapsed between initial contact
with potential respondents and mailing of questionnaires, it is likely that some people had
moved. Incorrect addresses were not traced and response rates given are uncorrected,
representing a minimum response rate.

Data Analysis

Questionnaires were reviewed for inconsistencies and errors and entered into an SPSS database.
Data were analysed using SPSS version 8.0. For most variables, comparisons were made
between responses from the Designated and Non-Designated samples using t tests for continuous
data and Π2 for categorical variables. Questionnaires completed in English and French were
combined for the analysis.




                                                                                                  4
Respondent Characteristics

Demographics

Characteristics of respondents are summarized in Table 1. Respondents are predominantly
female (69% Designated; 77% Non-Designated), and all offer services to clients in English.
More than 40% of each group also offer service in French. The Non-Designated SPs are more
likely to offer services in other languages than are the Designated SPs, and are older on average,
than the Designated SPs.

Table 1. Demographic characteristics of respondents

                                                                           NON-DESIGNATED
                                                    DESIGNATED                   N = 84
                                                         N = 99             % of respondents
                                                    % of respondents
Respondent Gender
                                        Female              69                        77
                                          Male              31                        24
Language of service offered
                                       English           100                       100
                                       French             46                        43
                                       Other*             25                        44
                                                      MEAN (SD)                 MEAN (SD)
Age*                                                   42 (9.26)                 46 (9.22)
  Categories not mutually exclusive
* p < .05


Respondent Training, Occupation, and Education

Respondents’ professional training, occupation, and education are summarized in Table 2. For
the questions on professional training, occupation, and level of education, respondents were
instructed to choose one alternative but many chose more than one. Therefore, each alternative
was analysed as a separate variable, using 2 x 2 Π2.

As expected from the sampling procedure, most of the Designated SPs were trained in gambling,
alcohol & drugs, or both, or mental health counselling. The Non-Designated SPs were less likely
to be trained in gambling or alcohol and drugs, but were more likely to have been trained in
mental health counselling, medicine, financial counselling, or other areas. These differences are
reflected in the occupation of the respondents. Designated SPs are more likely to be gambling
counsellors or addiction counsellors, whereas Non-Designated SPs are more likely to be
financial counsellors, physicians, or other occupations. These other occupations include
employment counselling, law enforcement, parole officers, and psychotherapy. Consistent with
this variability in occupation, Non-Designated SPs are more likely to have either high school
education or less, or post-graduate education, than are the Designated SPs.


                                                                                                     5
In Continuing Education (CE), Designated SPs are more likely to have taken additional training
in gambling problems, but Non-Designated SPs are more likely to have been trained in women’s
issues. Overall, the level of pursuit of CE is high, with more than 70% of both groups having
taken training in drug & alcohol problems, mental health issues, social work issues, and
counselling skills. In almost all topic areas, less than one third of CE was specific to women.
This is puzzling when applied to women’s issues, but it is likely that most respondents did not
see the need to indicate that this topic was specific to women.

Table 2: Respondent Training, Occupation, and Education

                                                                                NON-
                                                    DESIGNATED             DESIGNATED
                                                         N = 99                 N = 84
                                                    % of respondents       % of respondents
Professional Training
                  Primarily Gambling-related*              6                       0
          Primarily Drug & Alcohol-Related**               39                      21
          Equally Gambling & Drug/Alcohol**                39                      0
               Mental Health or Counselling**              25                      49
                                       Medical*            1                       8
                                        Spiritual          3                       0
                                    Financial**            1                       18
                                        Other**            4                       17
Occupation
                       Gambling Counsellor**               35                      0
                       Addiction Counsellor**              54                      17
                                 Social Worker             16                      25
                                   Psychologist            0                       4
             Mental Health or other Counsellor             6                       8
                        Financial Counsellor**             1                       14
                                    Physician**            0                       10
                    Nurse or Nurse Practitioner            2                       6
                Spiritual or Pastoral counsellor           1                       0
                        Traditional Practitioner           1                       0
                                        Other**            5                       20




                                                                                              6
Table 2, continued …

                                                                                 NON-
                                                    DESIGNATED              DESIGNATED
                                                         N = 99                  N = 84
                                                    % of respondents        % of respondents
Level of Education
                         High School or Less*               2                       10
                              College Diploma               17                      19
                               Some university              13                      10
            University Degree – Undergraduate               44                      35
                        Post-Graduate Degree*               29                      45
                                        Other               9                       11
                                                              SPECIFIC                SPECIFIC
                                                                 TO                      TO
                                                              WOMEN                   WOMEN
Continuing Education
                           Gambling Problems**       97           32          55         11**
                      Drug & Alcohol Problems        96           38          89          27
                            Mental Health Issues     93           31          90          24
                    Social Work Problems/Issues      72           18          83          17
                                Financial Issues     41           9           35          4
                              Women’s Issues*        63           32          82          31
                              Counselling Skills     93           23          92          19
                               Aboriginal Issues     59           14          60          5*
                                          Other      58           7           65          2
  Categories not mutually exclusive
* p < .05; ** p < .01


Work Setting

Summaries of respondents’ work settings are given in Table 3. For questions on community
location and type of agency respondents were instructed to choose one alternative but many
chose more than one. Therefore, for these questions, each alternative was analysed as a separate
variable, using 2 x 2 Π2.

Designated SPs are more likely to practice in the North region, while Non-Designated SPs are
more likely to be located in Toronto than are Designated SPs. Consistent with this finding, Non-
Designated SPs were more likely to report working in an urban community, and less likely to be
in a rural community. Most (84% Designated; 74% Non-Designated) respondents’ practices
were located within 100 km of an Aboriginal reserve. As expected, almost all (96%) Designated
SPs reported being employed in a Designated gambling agency or a drug, alcohol, and gambling
treatment agency. While a few of the Non-Designated SPs are employed in drug and alcohol
treatment agencies, they are more likely to be employed in hospitals, private practice, women’s
and Aboriginal centres, financial agencies, and other employment settings.



                                                                                                7
Table 3: Respondents’ Work Setting

                                                                    NON-DESIGNATED
                                                 DESIGNATED               N = 84
                                                      N = 99         % of respondents
                                                 % of respondents
Ontario Health Region**
                                 South West            16                  16
                                Central West            7                  12
                                Central South           8                   7
                                     Toronto            3                  23
                                 Central East          10                  13
                                         East          10                  13
                                        North          45                  21
Community Location
                                     Urban**           31                  57
                             Rural/Urban Mix           42                  31
                                       Rural*          27                  13
                                      Isolated          7                   2
Aboriginal Reserve within 100 km                       84                  74
Type of agency where employed
              Designated Gambling Agency**             42                   0
        Drug, Alcohol, & Gambling Agency**             54                   8
           Drug & Alcohol Treatment Centre*             1                   7
                     Community Health Centre            0                   4
                        Mental Health Centre            2                   6
                                   Hospital**           0                   7
                            Private practice**          0                  12
                            Women’s Centre*             0                   6
                           Aboriginal Centre*           0                   6
                          Financial Agency**            1                  13
                                      Other**           1                  29
  Categories not mutually exclusive
* p < .05; ** p < .01




                                                                                    8
Proximity to Gambling and Treatment Facilities

Summaries of the proximity of respondents’ employment to gambling facilities and gambling
treatment programs are given in Table 4. A large majority (89% or more) of both groups of
respondents work within 100 km of bingo halls, lottery ticket outlets, hospital lotteries, and
church and other fund-raisers. Non-Designated SPs are more likely to be located near casinos,
race tracks, and unsanctioned gambling than are Designated SPs, possibly related to their relative
concentration in urban areas.

Clients of the respondents generally have easy access to a wide variety of gambling-related
treatment facilities. By definition, clients of Designated SPs have “easy access” to Designated
gambling treatment agencies (94%, vs. 76% for Non-Designated SPs) and to drug and alcohol
treatment centres. Clients of Non-Designated SPs are more likely to have access to GA meetings
and to Aboriginal counselling centres. Gambling and drug and alcohol treatment are less likely
to be offered in the agencies of the Non-Designated SPs, where individual private practitioners,
women’s centre services, and credit counselling are more likely to be offered. While more than
half of respondents reported that gambling clients have “easy access” to a women’s centre, only
5% of Non-Designated and no Designated SPs reported that there is a women’s centre in their
own agency.

Table 4: Proximity of Employment to Gambling Facilities and Treatment Programs

                                                                           NON-DESIGNATED
    TYPE OF GAMBLING FACILITY                      DESIGNATED                    N = 84
           (Within 100 km)                              N = 99              % of respondents
                                                   % of respondents
Casino**                                                  54                        76
Charity Casino                                            59                        73
Race Track**                                              64                        87
Bingo Hall                                                100                       100
Lottery Ticket Outlet                                     100                       100
Hospital Lotteries                                        89                        90
Church & Other Fund Raisers                               97                        95
Off-Track Betting                                         79                        82
Unsanctioned Gambling**                                   15                        38
Other                                                     45                        24




                                                                                                 9
Table 4, continued …

                             DESIGNATED            NON-DESIGNATED
                                 N = 99                   N = 84
                            % of respondents         % of respondents
        CLIENTS’          “EASY          OWN      “EASY           OWN
 “EASY ACCESS” TO:       ACCESS”        AGENCY   ACCESS”        AGENCY
Designated Gambling         94             64       76             8**
Treatment Agency**
Drug & Alcohol              93           50         87          18**
Treatment
Community Health            70           6          81           6
Centre
Mental Health Centre        75           9          78           1
Private Practitioners       60           0          74          12**
Women’s Centre              54           0          66           5*
Gamblers Anonymous          52           1          66           1
meetings**
Credit Counselling          72           3          87          12*
Aboriginal Counselling      63           3          82           2
Centre*
Other                       32           3          36           10
* p < .05; ** p < .01




                                                                         10
Respondents’ Personal Behaviour

Respondents were asked about their personal smoking, drinking, and gambling behaviours.
Results are given in Table 5. More than 65% of respondents were non-smokers and few
respondents drink more than once or twice per week. More than 70% of each group had not
sought help or support for personal problems. The majority of respondents reported gambling
less than once per month in the past year. Of those who gambled, the games played most
frequently were, in order, lottery/scratch, casino slots, and raffles. All other games were played
by fewer than 10% of the gamblers in each group. There were no significant differences in
reported personal behaviours between the Designated and Non-Designated SP respondents.

Table 5: Respondents’ Personal Smoking, Drinking & Gambling Behaviour

                                                                            NON-DESIGNATED
                                                    DESIGNATED                    N = 84
                                                         N = 99              % of respondents
                                                    % of respondents
Smoking in past year
                                     Not at all             75                        68
                                 Once or twice               3                         6
                                  Occasionally              10                         7
                                         Daily              13                        18
Drinking Alcohol in past year
                                  Not at all                25                        28
                             < once/month                   28                        17
                               < once/week                  23                        26
                       once or twice / week                 19                        18
                     > once or twice / week                  4                        11
                                       Daily                 1                         0
Ever had problems or sought support for:
                                  Gambling
                    Alcohol or other Drugs                   0                         1
                             Mental Health                   9                        13
                                      Other                  8                        12
                                       None                  5                         6
                                                            78                        71
Gambled in past year
                                    Not at all              22                        28
                              Once or Twice                 40                        33
                                < once/month                26                        27
                        Once or twice / month                6                         5
                               > twice/month                 5                         7




                                                                                                 11
Table 5, continued …

                                                     DESIGNATED            NON-DESIGNATED
                                                     % of gamblers           % of gamblers
Games Played
                                Lottery/Scratch             52                       52
                                 Nevada/Break               9                         4
                                          Bingo             4                         5
                                   Casino Slots             38                       27
                                  Casino Cards              5                         2
                                       Roulette             2                         4
                               Charity Casinos              0                         2
                                  Track Betting             2                         4
                                 Sports Betting             4                         2
                                 Private Games              3                         1
                                Internet Games              1                         0
                                         Raffles            22                       23
                                         Other`             1                         1
  Categories not mutually exclusive


Respondent Characteristics: Summary

The response rate of 72% in the Designated Group and 66% of Non-Designated SPs is sufficient
to provide reliable data. Respondents came from all areas of Ontario, but Designated SPs were
more likely to be from the North health region, while Non-Designated SPs were more likely to
be from Toronto. The respondents are an abstemious group, with smoking rates similar to the
general population, and 11% or fewer drinking more than once or twice per week. Only 12% or
fewer had gambled more than once or twice per month in the past year. Their favourite games
are lottery/scratch, casino slots, and raffles.

As expected, the majority of the Designated SPs were gambling counsellors or addiction
counsellors. While some of the Non-Designated SPs were addiction counsellors, they were more
likely to be social workers, financial counsellors, physicians, or other occupations than were the
Designated SPs. Training and education level reflected the occupations of each group. Almost
all of the Designated SPs were employed in Designated Gambling agencies or drug, alcohol, and
gambling agencies. Non-Designated SPs were employed in a wide variety of settings including
private practice, hospitals, financial agencies, Aboriginal centres, and mental health centres, as
well as drug and alcohol treatment centres. Correspondingly, Designated SPs were more likely
to report that their clients have “easy access” to a Designated gambling treatment agency, and
Non-Designated SPs more frequently reported that their clients have easy access to GA meetings
and Aboriginal counselling centres.

Both groups of SPs reported high levels of CE activity, indicating a thirst for knowledge among
these practitioners. Designated SPs were more likely to have taken CE training specifically
related to gambling.


                                                                                               12
Respondents’ Gambling-Related Practice

Practice Activity and Treatment of Gamblers

Summaries of the respondents’ professional practice are given in Table 6. For all categorical
variables in this table except “Where gamblers treated,” each alternative response was analysed
as a separate variable using 2 x 2 Π2.

Respondents of both groups spend about 60% of their time in client counselling and treatment.
In other activities, Designated SPs are more likely to spend time in outreach and public education
than are Non-Designated SPs, while the Non-Designated SPs are more likely to spend time in
administration. As expected, respondents in the Designated Gambling Treatment System were
are likely to treat gamblers themselves (58% + 35% combination of self & elsewhere), while
Non-Designated respondents were more likely to refer clients elsewhere to address gambling
problems (53% refer elsewhere). Non-Designated SPs frequently refer women who gamble to
Designated gambling treatment agencies and drug and alcohol treatment agencies, the locations
where Designated SPs are most likely to be employed. Other than these agencies, the most
common referral destinations are to Gamblers Anonymous, the Ontario Problem Gambling
Helpline, and mental health centres. Non-Designated SPs are significantly more likely to refer
women to Aboriginal counselling centres than are Designated SPs.

Only those respondents who treat gamblers themselves were asked to identify the dominant
treatment model they use in their work with these clients. They were instructed to choose only
one alternative, but many chose more than one, and alternatives were analysed separately using 2
x 2 Π2. Among Designated SPs, the Cognitive/Behavioural/Social Learning model was endorsed
by more than half of respondents. This was also chosen most frequently by Non-Designated
SPs, but, as this question was restricted to those who work with gamblers, fewer Non-Designated
SPs answered this question.

Only those who treat gamblers were asked about their use of standard gambling screening and
diagnostic instruments. Designated SPs were most familiar with standard screening instruments,
and more than 90% of respondents in this group had used the South Oaks Gambling Screen and
the DATIS required forms in the past year. Fewer than 10% of this group were not familiar with
each of the screening instruments named. The Non-Designated SPs were most likely to use the
DSM-IV criteria for diagnosing gambling problems, and 40% or more of them were not familiar
with all of the other named standard screening instruments.




                                                                                               13
Table 6: Respondents’ Practice Activity & Treatment of Gamblers

                                                                    NON-DESIGNATED
                                                 DESIGNATED              N = 84
                                                    N = 99
                                                  MEAN (SD)            MEAN (SD)
% Time in each activity
            Client counselling and treatment          58 (23)             61 (28)
            Administration & Management*              19 (16)             27 (24)
             Outreach & Public Education*             17 (15)             11 (14)
                                   Research            6 (8)               4 (5)
                    Teaching & Supervision            9 (11)              12 (11)
                                       Other          6 (11)              14 (27)
                                                 % of respondents    % of respondents
Where gamblers treated**
                                          Self         58                   5
                             Refer Elsewhere            7                  53
                           Both of the Above           35                  42
Past year, referred women who gamble
to :
                Designated Gambling Agency             39                  51
           Drug & Alcohol Treatment Agency             37                  49
                   Community Health Centre             18                  23
                        Mental Health Centre           43                  30
                         Private Practitioners         23                  16
                            Women’s Centre             34                  21
                  Ontario Gambling Helpline            42                  49
                       Gamblers Anonymous              62                  52
              Aboriginal Counselling Centre*           10                  27
                                         Other         20                   7




                                                                                    14
Table 6, continued …

                                                                         NON-DESIGNATED
                                                  DESIGNATED              % of those treating
                                                 % of those treating          gamblers
                                                     gamblers                   N = 29
                                                       N = 88
Dominant Treatment Model
   Cognitive/Behavioural/Social Learning**           55                         11
                 Motivational Interviewing           10                          4
                 Psycho-social/Educational            3                          1
        Brief time-limited Solution-focused           9                          4
                             Psychotherapy            1                          0
             Gamblers Anonymous/Disease               2                          6
                                      Other           5                          7
                                     DESIGNATED                   NON-DESIGNATED
                             % of those treating gamblers      % of those treating gamblers
USE OF STANDARDIZED                      KNOW      USED                    KNOW       USED
GAMBLING SCREENING            DON’T     OF, BUT WITHIN          DON’T      OF, BUT   WITHIN
                              KNOW       DON’T     PAST         KNOW       DON’T      PAST
        TOOLS                 OR USE      USE      YEAR         OR USE      USE       YEAR
                      SOGS**       1         5          94        48          14        38
     GA Twenty Questions**         4        54          42        41          31        28
         DSM – IV Criteria**       8        45          46        31          21        48
    DATIS Required forms**         1         7          92        56          28        16
                        Other     32         5          64        50           0        50
  Categories not mutually exclusive
* p < .05; ** p < .01


Treatment Approaches

Respondents were asked several questions about their approach to treatment of gambling
problems and treatment of problems with alcohol and other drugs, responses to which are
summarized in Table 7. While respondents were instructed to choose only one approach to
treatment, many chose more than one; each response was analyzed separately using 2 x 2 Π2.

Respondents from the Designated Gambling Treatment System were more likely to say that they
use flexible goals in gambling treatment, depending on client preference. Non-Designated SPs
are more likely to endorse abstinence as a goal of gambling treatment. Correspondingly, Non-
Designated SPs are more likely to see gambling problems, and problems with alcohol and drugs,
as addictive diseases, while Designated




                                                                                             15
SPs are more likely to see these problems as behaviours to be changed. The latter view is
consistent with flexible treatment goals, while the view of problems as a disease tends to be
associated with abstinence as the only acceptable treatment goal. Both groups believe that those
who have gambling problems should be treated separately from those who have problems with
alcohol and other drugs, or that only overlapping issues should be treated together. Less than 5%
of both groups of respondents would like to see these two groups of clients treated together.

Table 7: Respondents’ approach to treatment of gambling problems and problems with
alcohol and other drugs

                                                                          NON-DESIGNATED
                                                  DESIGNATED                    N = 84
                                                       N = 99              % of respondents
                                                  % of respondents
Treatment Goals
                              Abstinence**                 14                       35
       Occasional gambling with fixed limit*                0                        6
    Gambling with reduced financial harms –                11                       10
                             harm reduction
          Flexible goals depending on client               69                       38
                               preference**
                                       Other               4                         5
View of gambling problems
                        Addictive disease**                 9                       35
                      Mental health problem                 3                        6
                    Impulse control disorder               13                       11
                 Behaviour to be changed**                 33                       11
                            Coping strategy                22                       24
                           Criminal problem                 0                        0
                                       Other               13                        5
View of Alcohol and Drug Problems
                        Addictive disease**                21                       44
                      Mental health problem                 2                        5
                    Impulse control disorder                4                        2
                 Behaviour to be changed**                 24                        8
                            Coping strategy                27                       25
                          Criminal problem                  0                        0
                                       Other               12                        6
Treat gamblers with those who have drug
problems?
                                  Separately               43                       39
                                   Together                 4                        4
                 Overlapping issues together               48                       56
                                       Other                5                        1
  Categories not mutually exclusive
* p < .05; ** p < .01




                                                                                              16
Gambling-Related Practice: Summary

Respondents of both groups spend about 60% of their time in client counselling and treatment.
As expected, respondents in the Designated Gambling Treatment System are more likely to treat
women with gambling problems themselves, while Non-Designated respondents were more
likely to refer women elsewhere to address gambling problems. Among those who treat
gamblers themselves, the Cognitive/Behavioural/Social Learning approach to treatment was
endorsed by the majority of respondents. Designated SPs are very familiar with standard
gambling screening instruments, and more than 90% had used the SOGS and the DATIS
required forms in the past year. Non-Designated SPs were less familiar with gambling-specific
screening tools, and were more likely to have used the DSM-IV criteria.

Designated SPs are more likely to see gambling problems as a behaviour to be changed, and to
use flexible goals in treatment, than are the Non-Designated SPs, who are more likely to see
gambling problems as an addictive disease and to see abstinence as the best treatment goal. Both
groups believe that people with gambling problems should not be treated together with those
who have problems with alcohol and other drugs, except for overlapping issues.




                                                                                             17
Client Characteristics
Characteristics of respondents’ clients are summarized in Table 8. More than 90% of the clients
of both respondent groups speak English, with about 10% speaking French and/or other
languages. Non-Designated SPs report being more likely to see women clients, lesbian or gay
clients, and clients of low socioeconomic status than do Designated SPs. The clients of
Designated SPs are more likely to have gambling problems (23%; range 0 – 100%) than are
those of Non-Designated SPs (9%; range 0 – 50%). On average, just under half of clients who
gamble are women, reported by both groups. The average total number of women gamblers seen
in the past year by the Designated SPs is 17 (range = 0 – 120), significantly more than the
number seen by the Non-Designated SPs (8; range = 0 – 60).

Table 8: Characteristics of Respondents’ Clients

                                                                        NON-DESIGNATED
                                                   DESIGNATED                N = 84
                                                      N = 99
                                                    MEAN (SD)                MEAN (SD)
% Speak Each Language
                                      English           90 (17)                 93 (12)
                                       French           11 (16)                 9 (16)
                                         Other          13 (22)                 8 (11)
% of all (gambling & other) Clients in each
Group
                                   Women**              42 (18)                 56 (25)
                                       Men**            51 (19)                 40 (23)
                                       Seniors          10 (15)                 11 (14)
                                        Youth           17 (21)                 13 (11)
                                   Aboriginal           15 (19)                 17 (29)
                                   Immigrant             8 (16)                 9 (11)
                                        Ethnic          10 (16)                 13 (14)
                               Lesbian/Gay**             4 (4)                  10 (16)
                                  Low SES**             35 (24)                 53 (29)
                       Mentally Handicapped              5 (8)                   5 (6)
                         Other Special Needs            10 (18)                 12 (20)
% Clients who have Gambling Problems**
                                                        32 (37)                 9 (10)
% of Gambling Clients who are:
                                       Women            46 (25)                 48 (34)
                                         Men            45 (24)                 37 (28)
Past Year, Number of Gamblers seen:
                                    Women**             17 (24)                 8 (12)
                                      Men**             22 (35)                 8 (14)
  Categories not mutually exclusive
* p < .05; ** p < .01




                                                                                            18
Games Clients Play

Respondents who see clients who gamble were asked to rank the first three most common games
played by their female gambling clients. These games and their ranks are shown in Table 9. The
most popular game among the clients of the Designated SPs is Casino slots, closely followed by
Bingo, then Nevada/Break Open tickets and lottery/scratch tickets. Non-Designated SPs ranked
Bingo first followed by lottery/scratch, casino slots, and Nevada/Break Open. Other games were
not commonly played, except for Charity casino games by clients of Non-Designated SPs.
Frequencies of people choosing each game first, second, or third were compared between the two
respondent groups for each game separately, using 3 x 2 Π2, resulting in no significant
differences.

Table 9: Ranking of Games most commonly played by Female Clients (Number of
Respondents Indicating each Rank)

                                                                        NON-DESIGNATED
                                                    DESIGNATED
                                        RANK        1     2   3            1       2       3
                                Lottery/Scratch     7    15  25            7       8       7
                           Nevada/Break Open        6    17  19            2       7       5
                                          Bingo    25    31  11           16       8       3
                                   Casino Slots    34    14   7            6       5       5
                                  Casino Cards      2     3   4            2       3       4
                Roulette or other Casino games      0     1   1            0       0       1
                         Charity Casino Games       2     0   4            9       1       1
                                  Track Betting     0     0   0            0       1       1
                                 Private Games      0     1   0            0       0       0
                                 Internet games     0     0   1            0       0       0
                                         Raffles    0     0   0            0       0       1
                                          Other     2     1   2            0       0       0



Client Characteristics: Summary

As expected, the Designated SPs see more clients with gambling problems than do the Non-
Designated SPs. Both groups report that just under half of their clients who gamble are women.
The top four games most commonly played by the female clients of both groups of respondents
are Bingo, casino slots, lottery/scratch, and Nevada/Break Open. This corresponds to the most
commonly reported games played by the women in the “Voices of Women who Gamble in
Ontario” survey (Boughton & Brewster, 2002).




                                                                                            19
Perception of Service Needs of Women Gamblers

Respondents were asked to indicate the importance of the need for each of a list of services or
resources in increasing help-seeking by women gamblers. That is, how important would each
service or resource be in encouraging women who have problems with gambling to seek help?
The importance of each item was rated on a four-point scale ranging from “Extremely
Important” to “Not at all Important.” For this report, “Extremely Important” and “Somewhat
Important” responses were combined into a single “Important” category. Respondents were also
asked to indicate whether, in their opinion, the indicated service or resource is currently
adequately available.

Information Needs

The perceived importance of various types of information for increasing help-seeking by women
gamblers is summarized in Table 10. More than 90% of all respondents think that increased
information to the public, to gamblers, and to service providers is important in increasing help-
seeking among women gamblers. One quarter or less of all respondents think that such
information is adequate at the present time, with Non-Designated SPs being more likely than
Designated SPs to see current information as not adequate.

Table 10: Perceived importance of information services for increasing help-seeking by
women gamblers. % of respondents selecting “Extremely” or “Somewhat” important.

                                                  DESIGNATED             NON-DESIGNATED
                                                     N = 99                   N = 84
    INFORMATION SERVICE                            %          %           %               %
                                               IMPORTANT   ADEQUATE   IMPORTANT       ADEQUATE
                                                             NOW                        NOW
Public awareness of gambling problems             97          25            99           13*
Public awareness of games that constitute         92          24            96           5**
         gambling
Public awareness of what constitutes problem      100         25            98            5**
         gambling
Information to women gamblers about               100         17            98             6*
         services available
Service providers’ awareness of women’s           98          18            96             8
         gambling
* p < .05; ** p < .01




                                                                                                20
Gambling-Related Services for Women Gamblers

Perceptions of the importance of gambling-related services for women in increasing help-seeking
by women gamblers are summarized in Table 11. More than 80% of all respondents think that
women’s help-seeking would be increased by women-specific assessment & referral, outpatient
counselling, day treatment programs, women-specific gambling therapy programs, GA programs
for women only, and self-help manuals for women gamblers. Fewer respondents report that
interactive internet services and residential or inpatient programs are important. Less than 10%
of respondents think that residential programs, day treatment programs, GA groups for women
only, and self-help manuals are currently adequately available. Non-Designated SPs are less
likely than Designated SPs to perceive that women-specific assessment & referral, outpatient
counselling, and women-specific gambling therapy groups are adequately available now,
although only 11% of Designated SPs say that women-specific gambling therapy groups are
currently adequate.


Table 11: Perceived importance of gambling-related services for increasing help-seeking by
women gamblers. % of respondents selecting “Extremely” or “Somewhat” important.

                                             DESIGNATED                NON-DESIGNATED
      GAMBLING-RELATED                          N = 99                      N = 84
          SERVICE                            %            %              %               %
                                         IMPORTANT     ADEQUATE      IMPORTANT       ADEQUATE
                                                         NOW                           NOW
Women-specific assessment & referral         87           23               94           7**
Outpatient counselling                       99           57               96           21**
Residential or inpatient programs            82            6               73            5
Day treatment programs for women             87            5               91            4
Women-specific gambling therapy groups       89           11               93           6**
Gamblers Anonymous groups for women          81            0               85            0
         only
Self-help manuals                            88             4              81             0
Interactive internet services                69             3              70             2
* p < .05; ** p < .01




                                                                                              21
Gambling Service Delivery

Table 12 summarizes the perceptions of respondents regarding the importance of various aspects
of the gambling service delivery process in increasing help-seeking by female gamblers. More
than 90% of both groups believe it is important to have female counsellors, counsellors
specifically trained to deal with the needs of women, flexible hours of service, proximity of
services, services available in women’s own language, reduced waiting times for service,
flexibility of treatment goals, and a 24-hour crisis hot line. Telephone counselling was judged to
be important by 89% of Non-Designated SPs and 91% of Designated SPs. Fewer than 70% of
both groups perceive home visits to be important in increasing treatment-seeking by women
gamblers.

Designated SPs are more likely than Non-Designated SPs to perceive every aspect of gambling
service delivery as currently adequate. However, even among this group, only female
counsellors and flexibility of treatment goals are perceived as currently adequate by half or more
of the respondents. Every aspect of service delivery was seen as currently adequate by fewer
than 20% of Non-Designated SPs.

Table 12: Perceived importance of aspects of gambling-related service delivery for
increasing help-seeking by women gamblers. % of respondents selecting “Extremely” or
“Somewhat” important.

                                                   DESIGNATED            NON-DESIGNATED
       GAMBLING SERVICE                               N = 99                  N = 84
          DELIVERY                                  %          %           %               %
                                                IMPORTANT   ADEQUATE   IMPORTANT       ADEQUATE
                                                              NOW                        NOW
Female counsellors                                 90          60            91           19**
Counsellors trained specifically to deal with      97          34            92           7**
          women gamblers
Telephone counselling                              91          40            89            6**
Flexible hours of operation of services            97          42            94            5**
Proximity of services                              99          36            95            10**
Service available in women’s own language          95          15            93            2**
Reduced waiting time for services
Flexibility of treatment goals                     96          49            95            6**
Home visits                                        99          54            95            7**
Telephone referral hotline                         63          11            68            1**
24-hour crisis hot line                            93          46            91            13**
                                                   96          44            93            13**
* p < .05; ** p < .01




                                                                                                  22
Non-Gambling Services for Women Gamblers

Perception of importance of services not directly related to gambling in increasing help-seeking
by women gamblers are summarized in Table 13. More than 90% of all respondents believe that
it is important to offer family counselling, counselling for abused women, women’s mental
health centres, financial counselling, employment counselling, and culturally-specific services to
women gamblers. Leisure activities resources are seen as less important by Non-Designated
SPs, and pastoral counselling is selected by fewer, albeit more than 75%, members of both
groups. Again, perceptions of current adequacy of these resources lags behind their perceived
importance for both groups and all resources. Non-Designated SPs are less likely than
Designated SPs to perceive that family counselling, counselling for abused women, women’s
mental health services, and addiction services are currently adequately available. However only
family counselling, counselling for abused women, and addiction services are perceived as
currently adequate by more than half of Designated SPs.

Table 13: Perceived importance of non-gambling-related services for increasing help-
seeking by women gamblers. % of respondents selecting “Extremely” or “Somewhat”
important.

                                              DESIGNATED                 NON-DESIGNATED
                                                 N = 99                       N = 84
   NON-GAMBLING SERVICE                       %             %              %               %
                                          IMPORTANT      ADEQUATE      IMPORTANT       ADEQUATE
                                                           NOW                           NOW
Family counselling                            99            52              100           27**
Counselling for abused women                  97            64              100           39**
Women’s mental health services                99            41               99           24*
Financial counselling                         98            34              100            33
Employment counselling                        94            32               97            29
Addiction services                            98            60              100           35**
Culturally-specific services                  93            21               90            14
Resource centre for leisure activities*       89            15               76            12
Grief counselling                             92            42               85            29
Pastoral counselling                          80            39               78            39
* p < .05; ** p < .01




                                                                                                23
Services for Specific Groups of Women

Table 14 summarizes respondents’ perception of the importance of services for specific groups
of women in increasing treatment-seeking by women gamblers. More than 80% of both groups
of respondents perceive it to be important to provide services for young women, senior women,
Aboriginal women, ethnic women, lesbians, women in the correctional system, physically
disabled women, women of low socioeconomic status, women with low literacy skills, and
women with mental health problems. Perception of the current adequacy of provision of these
services is low overall, with every service perceived as adequate by less than half of both groups.
As with other categories of women’s service needs, Non-Designated SPs are significantly less
likely than Designated SPs to perceive that the current level of service is adequate for all groups
except women in the correctional system, where fewer than 20% of respondents in both groups
believe that current services are adequate.

Table 14: Perceived importance of services for specific groups of women for increasing
help-seeking by women gamblers. % of respondents selecting “Extremely” or “Somewhat”
important.

                                              DESIGNATED                  NON-DESIGNATED
                                                 N = 99                        N = 84
        SERVICES FOR …                       %              %               %               %
                                         IMPORTANT       ADEQUATE       IMPORTANT       ADEQUATE
                                                           NOW                            NOW
Young women                                    87           40               93            12**
Senior women                                   96           41               94            11**
Aboriginal women                               92           26               96            12*
Ethnic women                                   84           17               91            2**
Lesbians                                       80           25               84            7**
Women in the correctional system               89           18               92             8
Physically disabled women                      88           23               92            6**
Women of low SES                               93           30               95            5**
Women with low literacy skills                 92           26               95            7**
Women with mental health problems              96           34               92            12**
* p < .05; ** p < .01




                                                                                                24
Other Needs of Women Gamblers

Table 15 summarizes the perceived importance for increasing help-seeking by women gamblers
of services not included in other categories above. These include non-treatment supports for
women and such items as transportation to services and other social services. More than 80% of
respondents in both groups say that it is important for women gamblers seeking help to have
child care services at treatment agencies, transportation to services, home phones, food and
shelter, employment, affordable housing, social services, and help with household budgeting.
Fewer than 70% of both groups feel that internet information is important. There is no
significant difference between the two groups of SPs. While all of these services are judged to
be important, there is agreement that they are not currently adequately provided. Fewer than one
quarter of respondents in both groups feel that any of these services are currently adequate.

Table 15: Perceived importance of other services for women gamblers for increasing help-
seeking. % of respondents selecting “Extremely” or “Somewhat” important.

                                               DESIGNATED               NON-DESIGNATED
  OTHER SERVICE NEEDS OF                          N = 99                     N = 84
    WOMEN GAMBLERS                              %          %              %             %
                                            IMPORTANT   ADEQUATE      IMPORTANT      ADEQUATE
                                                          NOW                          NOW
Child care services at treatment agencies      93           3              93            0
Transportation to services                     90           7              89            5
Temporary financial help                       82           5              78            5
Telephone at home                              90           7              84            4
Food and shelter                               95          17              95           10
Employment                                     89           5              96           10
Affordable housing                             96           9              94            5
Social services                                94          22              94           16
Internet information                           69           5              63            6
Household budgeting                            98          13              92           11
Other needs                                    88           0              63            1




                                                                                              25
Summary of Perceived Service Needs of Women Gamblers

Information Needs: More than 90% of all respondents reported that all listed types of
information are important to support help-seeking by women who gamble, and one quarter or
less of all respondents report that currently available information is adequate. Service providers
clearly support increased information about gambling and treatment services provided to the
general public and to women gamblers.

Gambling-Related Service Needs: More than 80% of all respondents think women’s help-
seeking would be increased by women-specific assessment & referral, outpatient counselling,
day treatment programs, women-specific gambling therapy programs, GA programs for women
only, and self-help manuals for women gamblers. Except for outpatient counselling, which is
perceived as currently adequate by more than half of the Designated SPs, gambling-related
services are perceived as currently adequate by fewer than one quarter of all respondents.
Overall, a need for women-specific services is identified as a priority for increasing help-seeking
among women gamblers.

Gambling Service Delivery Needs: More than 90% of both groups believe it is important to
have female counsellors, counsellors specifically trained to deal with the needs of women,
flexible hours of service, proximity of services, services available in women’s own language,
reduced waiting times for service, flexibility of treatment goals, and a 24-hour crisis hot line.
The only aspects of gambling service delivery seen as currently adequate by half or more of
Designated (only) SPs were availability of female counsellors and flexibility of treatment goals.
Again, the emphasis is on services designed specifically to meet the needs of women. The
perceived inadequacy of current services such as reduced waiting times, a telephone referral
hotline, and a crisis hotline reflects the lack of knowledge of service providers about the current
services available in the Gambling Treatment System.

Non-Gambling-Related Service Needs for Women Gamblers: More than 90% of all
respondents believe that it is important to offer family counselling, counselling for abused
women, women’s mental health centres, financial counselling, employment counselling, and
culturally-specific services to women gamblers. Those seen as currently adequate by fewer than
half of Designated SPs are women’s mental health services, financial counselling, and culturally
specific services. Grief counselling and pastoral counselling were also seen as important, and
not currently adequately provided. Where services are judged not to be currently adequate, this
may reflect SPs’ lack of knowledge about the service, or how to access it, as well as inadequate
service.

Services for Specific Groups of Women: More than 80% of both groups of respondents
perceive it to be important to provide services for young women, senior women, Aboriginal
women, ethnic women, lesbians, women in the correctional system, physically disabled women,
women of low socioeconomic status, women with low literacy skills, and women with mental
health problems. Perception of the current adequacy of provision of these services is low
overall, with every service perceived as adequate by less than half of both groups. Again, while
this low level of judged adequacy may reflect the actual situation, it also may be due to lack of
knowledge among the service providers of available services. Service needs for these groups of



                                                                                                  26
women are not necessarily gambling-specific, but may be related to other needs. For example,
low literacy women may require literacy training or low-literacy self-help materials and ethnic
women may require services in their own language or in a culturally-compatible group.

Other Needs of Women Gamblers: More than 80% of respondents in both groups report that it
is important for women gamblers seeking help to have child care services at treatment agencies,
transportation to services, home phones, food and shelter, employment, affordable housing,
social services, and help with household budgeting. For every service, fewer than one quarter of
respondents in both groups feel that they are currently adequate. Services that help women to
change their lives and address aspects other than gambling are seen as important for encouraging
women to seek help for their gambling problems.

Designated vs. Non-Designated Service Providers: For each of the categories of needs of
women gamblers listed above, respondents in both groups were in agreement that the indicated
needs are important in encouraging women who have problems with gambling to seek help.
Also, most respondents in both groups perceived that the current level of provision of the
services is not adequate. However, for many of the listed gambling-related needs, significantly
fewer of the Non-Designated SPs perceived the current level of service to be adequate than did
the Designated SPs. A lower level of awareness of services among Non-Designated SPs might
reflect the reality of their practice in settings outside the Designated Gambling Treatment
System, or it might be due to a lack of awareness of services that are actually provided by
Designated SPs.


Barriers to Treatment-Seeking

Perceived Barriers

Respondents were asked to rate the importance of a list of possible barriers to treatment seeking
or treatment access by women who have problems with gambling. Table 16 shows the
percentage of each respondent group that perceives each listed barrier as “Extremely” or
“Somewhat” Important. More than 80% of both groups of respondents perceive as important
those barriers that deal with women’s perception of gambling problems or perception of
themselves: women not perceiving themselves as gamblers, denial or minimization of gambling
problems, perception that the primary problem is financial, women not being ready to change,
and fear of shame and stigma. Barriers concerned with the gambling treatment system itself are
more likely to be perceived as important by Non-Designated SPs than by the Designated SPs
who work within that system. These barriers include: treatment system not meeting women’s
needs; treatment incompatible with culture of client; language barriers; illiteracy; concern about
requirements for total abstinence; lack of treatment goal options; lack of day care facilities; and
lack of temporary child care.




                                                                                                  27
Table 16: Perceived importance of barriers to treatment seeking by women gamblers. % of
respondents selecting “Extremely” or “Somewhat” important.

                                                                         NON-DESIGNATED
                    BARRIER                        DESIGNATED                  N = 84
                                                        N = 99            % of respondents
                                                   % of respondents
Women not perceiving self as gamblers                     88                       93
Denial or minimization of gambling problems               95                       98
Perception that problem is financial rather than          83
          gambling                                                                 88
Not ready to change                                       88                       95
Fear of shame and stigma                                  90                       91
Treatment system doesn’t meet women’s needs**             57                       78
Treatment incompatible with culture of client*            50                       69
Language barriers**                                       42                       67
Illiteracy**                                              42                       76
Concern about requirement for total abstinence**          51                       71
Lack of treatment goal options**                          38                       65
Lack of treatment approach options**                      42                       69
Lack of day care facilities*                              67                       82
Lack of temporary child care*                             69                       84
Concern about confidentiality                             53                       68
Concern about homophobia                                  32                       47
Other                                                     50                       40
* p < .05; ** p < .01



Location of Gambling treatment services

Respondents were asked to indicate whether the location of gambling treatment services would
be encouraging or discouraging to treatment-seeking by women gamblers. Table 17 shows the
percentage of respondents who chose each of the listed locations as “Very” or “Somewhat”
encouraging to women. More than 80% of both groups believe that it would encourage women
to locate gambling treatment in women’s centres, community health centres, and Aboriginal
centres. While 80% of Non-Designated SPs thought that locating services in gambling treatment
centres would be encouraging, this is significantly less than the proportion (94%) of Designated
SPs who think that their work setting is encouraging to women. Casinos were perceived as
encouraging by less than 40% of both groups, and hospitals were perceived as encouraging by
fewer than 60% of both groups.




                                                                                              28
Table 17: Location of gambling treatment services perceived as encouraging or
discouraging to treatment-seeking by women gamblers. % of respondents selecting “Very”
or “Somewhat” encouraging.

                                                                         NON-DESIGNATED
                 BARRIER                          DESIGNATED                   N = 84
                                                       N = 99             % of respondents
                                                  % of respondents
Gambling treatment centres**                             94                         80
Drug & Alcohol treatment centres                         73                         65
Women’s centres                                          94                         96
Mental health centres                                    69                         73
Community health centres                                 87                         91
Hospitals                                                55                         53
Community centres                                        75                         83
Aboriginal centres                                       94                         94
Private practice offices                                 71                         80
Credit counselling offices                               80                         79
Casinos                                                  36                         27
Elsewhere                                                67                         63
* p < .05; ** p < .01


Summary of Barriers to Treatment

Perceived Barriers: More than 80% of both groups of respondents perceive as important those
barriers that deal with women’s perception of gambling problems or perception of themselves:
not perceiving themselves as gamblers, denial or minimization of gambling problems, perception
that the primary problem is financial, women not being ready to change, and fear of shame and
stigma.

Barriers concerned with gambling treatment service delivery more likely to be perceived as
important by Non-Designated SPs than by the Designated SPs who work within the Designated
system. While these factors may represent real barriers to practice by SPs outside the gambling
treatment system, and indicate a need for increased information about available gambling
services to SPs outside the Designated system.

Location of Gambling Treatment Services: More than 80% of both groups of respondents
believe it would encourage women to seek help for gambling to locate treatment services in
women’s centres, community health centres, and Aboriginal centres. Almost as many responded
that locating services in credit counselling offices would also be helpful.




                                                                                              29
Perceived Concurrent Problems of Women Gamblers
Respondents were asked to indicate how frequently, in their experience, each of a list of
concurrent issues needs to be addressed when women have problems with gambling. For each
issue, frequency was estimated on a four-point scale from “Always or Almost Always” to
“Never.” For this report, responses of “Always or Almost Always” and “More than Half the
Time” were combined for a response of “Frequent.” The percentage of respondents indicating
that each issue needs to be addressed frequently is give in Table 18. Respondents were also
given the opportunity to indicate whether it would be helpful to them to receive more
information on each issue.

More than 90% of the respondents from the Designated Gambling Treatment System perceive
that the following concurrent issues frequently need to be addressed with women gamblers:
stress, depression/anxiety, self-esteem, guilt or shame, social relationships, intimate
relationships, and leisure time. A similarly high proportion of Non-Designated respondents
perceived that stress, depression/anxiety, and self-esteem frequently need to be addressed.
Significantly fewer Non-Designated respondents than Designated respondents perceived that the
concurrent issues of guilt or shame (still 90% among Non-Designated respondents), social
relationships, intimate relationships, and leisure time frequently needed to be addressed.
Concurrent issues perceived as frequently needing to be addressed by 80 – 90% of respondents
were: assertiveness, finances and budgeting, and credit counselling (Non-Designated only).

In general, respondents from the Designated Gambling Treatment system were more interested
in receiving further information on concurrent issues than were Non-Designated respondents, but
no more than 25% of either group expressed interest in receiving more information on any
concurrent issue to be addressed with women gamblers. This relative lack of interest in
information on concurrent issues may result from a perception that addressing these issues is not
the role of gambling treatment. The current emphasis in gambling treatment is on brief
behavioural therapies that directly address gambling. Clients are often referred elsewhere for
treatment of other issues.




                                                                                              30
Table 18: Perceived frequency of need to address concurrent issues with female gamblers.
% of respondents selecting “Always or Almost Always” or “More than Half the Time.”

                                              DESIGNATED                 NON-DESIGNATED
                                                 N = 99                       N = 84
       CONCURRENT ISSUE                                   % MORE                        % MORE
                                             %             INFO            %             INFO
                                          FREQUENT        DESIRED       FREQUENT        DESIRED
Drug & Alcohol problems                      68              8             75              7
Stress                                       98              13            96              10
Depression/Anxiety                           95              20            90             10*
Anger management                             62              15            68              7
Panic attacks                                59              17            62              6*
Assertiveness                                83              16            84              6*
Self-esteem                                  96              23            92             7**
Guilt or shame*                              98              24            90             7**
Coping with loss                             79              24            68             6**
Eating disorders and body image              42              20            49             5**
Spirituality                                 54              14            50              6
Finances & budgeting                         87              20            88             10*
Credit counselling                           78              14            86              7
Legal issues                                 51              20            59              7*
Social relationships**                       94              13            78              6
Intimate relationships**                     92              22            76             6**
Sexual behaviour                             43              17            45              6*
Sexual preference issues                     21              19            29             6**
Parenting                                    57              16            60             2**
Trauma/Abuse                                 74              25            70             6**
Employment issues                            53              12            65              8
Leisure time**                               95              15            73              7
Compulsive spending or shopping              66              25            74             11*
Crisis management                            79              16            79              11
Cognitive impairment or memory problems      36              18            46              8
Physical health problems
Other concurrent issues                       42             12              35             7
                                              67             6               70             0*
* p < .05; ** p < .01



Summary of Concurrent Problems of Women Gamblers

The concurrent issues for women gamblers perceived as most frequently occurring by the SPs
were stress, depression/anxiety, and self-esteem. These are consistent with the needs of women
identified in the accompanying “Voices of Women who Gamble in Ontario” study. Women
were most likely to identify stress and self-esteem as important issues, followed by leisure. Use
of leisure time was also identified as important by Designated SPs, who are familiar with the
needs of women gamblers.




                                                                                                 31
Service Provider Needs

Respondents were asked to rate the helpfulness to themselves, in their work with women
gamblers, of a variety of types of information, training, and changes in their work environment.
The helpfulness of each item was rated on a four-point scale ranging from “Extremely Helpful”
to “Not at all Helpful.” For this report, “Extremely Helpful” and “Somewhat Helpful” responses
were combined into a single “Helpful” category. Respondents were also asked to indicate
whether, in their opinion, the indicated information is currently adequately available.

Information on Gambling-Related Topics

The helpfulness to SPs of additional information on gambling related topics is summarized in
Table 19. At least 90% of both groups of respondents indicated that it would be helpful to have
additional information on prevalence and patterns of women’s gambling, characteristics of
women gamblers and their special needs, gambling-related cultural differences, and new
treatment models for gambling. Fewer (80%) Designated than Non-Designated SPs (96%) want
more information on gambling services in their area, and Non-Designated SPs are less interested
than Designated SPs in learning more about leisure alternatives. Except for current awareness of
gambling-related services in their area by 28% of Designated SPs, less than 15% of both groups
report that current information on any listed topic is adequate.

Table 19: Perceived helpfulness to Service Providers of additional information on
gambling-related topics. % of respondents selecting “Extremely” or “Somewhat” helpful.

                                             DESIGNATED                 NON-DESIGNATED
   INFORMATION ON                               N = 99                       N = 84
GAMBLING-RELATED TOPICS                                   %                              %
                                        % HELPFUL      ADEQUATE       % HELPFUL      ADEQUATE
                                                         NOW                           NOW
Prevalence of women’s gambling               90           12               95            2*
Patterns of women’s gambling                 99            8               98            2
Characteristics of women’s gambling          97           10               99            2*
Special needs of women gamblers              97            9               95            2
Services available in my area**              80           28               96           10**
Gambling-related cultural differences        90            6               90            2
New treatment models for gambling            97            7               94            2
Leisure alternatives**                       91            8               75            6
Other information                            83            2               50            4
* p < .05; ** p < .01




                                                                                              32
Training Needs

The perceived helpfulness to respondents of additional training in gambling-related skills is
summarized in Table 20. Despite their work with women gamblers, more than 60% of
Designated SPs endorsed every one of the suggested training topics. More than 90% of
Designated Gambling Treatment System SPs want additional training in outreach and marketing
to women gamblers, screening of women for gambling problems, assessment of female
gamblers, assessment tools specific to women gamblers, retaining women in treatment, cognitive
therapy approaches to gambling, solution-focused counselling, brief intervention techniques,
motivating clients to change, relapse prevention, group therapy, and a holistic approach to
counselling. In addition, except for the stages of change model, less than 40% of Designated SPs
thought that their current state of training in any of the suggested topics is adequate.

As would be expected from the relative lack of focus on gambling in their work, the Non-
Designated SPs were overall less likely than the Designated SPs to desire more gambling-related
training, significantly less so for training in outreach and marketing of gambling treatment to
women, assessment tools specific to women gamblers, retaining women in treatment, cognitive
therapy approaches to gambling, group therapy, holistic approach to counselling and culturally
sensitive training. However, while their scores were lower than those of the Designated
respondents, the Non-Designated respondents were desirous of further gambling-related training,
with a majority of respondents wanting training in every topic except inpatient approaches for
women gamblers. The Non-Designated SPs were less likely than the Designated SPs to perceive
that their current level of training is adequate for many of the topics, and 25% or less of the Non-
Designated group reported that they were adequately trained in any of the topics listed.




                                                                                                 33
Table 20: Perceived helpfulness to Service Providers of additional training and skills. % of
respondents selecting “Extremely” or “Somewhat” helpful.

                                                DESIGNATED             NON-DESIGNATED
   ADDITIONAL TRAINING IN                          N = 99                   N = 84
      THE FOLLOWING:                                        %                           %
                                             % HELPFUL   ADEQUATE     % HELPFUL      ADEQUATE
                                                           NOW                         NOW
Outreach and marketing gambling treatment       94           5             71            5
          to women**
Marketing gambling treatment in specific        65          4              51             2
          languages
Screening women for gambling problems           92          14             84             4*
Assessment of female gamblers                   94          29             86            2**
Assessment tools specific to women              94          5              81             2
          gamblers*
Diagnosis of problem gambling                   79          36             82            7**
Retaining women in treatment**                  94          12             73             11
Individual counselling skills                   89          39             82            25*
Cognitive therapy approaches to gambling**      96          37             82            14**
Solution-focused counselling
Stages of change model                          96          37             87            23*
Brief intervention techniques                   86          52             79            20**
Motivating clients to change behaviour          91          35             88            20*
Relapse prevention techniques                   99          37             94            18**
Group therapy skills*                           96          37             93            14**
Holistic approach to counselling**              91          19             77             23
Inpatient approaches for women gamblers         99          24             81             24
Culturally-relevant history of gambling         61          4              46             8
Culturally sensitive training*
Other training                                  65          5              64             7
                                                81          8              68             10
                                                90          1              56             4
* p < .05; ** p < .01



Changes in Work Environment

Table 21 summarizes the perceived helpfulness them of changes in their work environment to
help SPs serve the needs of women gamblers. Despite the fact that their employment includes
counselling of gamblers, 75% or more of Designated SPs reported that each of the list of changes
would be helpful to them. In particular, Designated SPs were significantly more likely than
Non-Designated SPs to want more of their time devoted to gambling and to want increased
management support for time spent with gamblers. Fewer that 50% of the Designated SPs
reported that these supports, and agency awareness of women’s gambling problems, are adequate
now. Nevertheless, this proportion is higher than the proportion of Non-Designated SPs who
report these measures are currently adequate. All of the Designated SPs, and 95% of Non-
Designated SPs would like more available materials to give to women gamblers, and less than
5% of both groups feel that such materials are currently adequate.




                                                                                                34
Table 21: Perceived helpfulness to Service Providers of changes in their work environment.
% of respondents selecting “Extremely” or “Somewhat” helpful.

                                               DESIGNATED               NON-DESIGNATED
        CHANGES IN WORK                           N = 99                     N = 84
         ENVIRONMENT                                       %                              %
                                            % HELPFUL   ADEQUATE       % HELPFUL      ADEQUATE
                                                          NOW                           NOW
More of your time devoted to gambling**        82          35               48           12**
More awareness in your agency of women’s
         gambling problems                     82            28             85            7**
Available materials to give to women
         gamblers*                             100           4              95             1
A more women-friendly environment in your
         agency                                77            59             62             49
Management support for time spent with
         gamblers*                             78            49             57            29**
Better referral networks
Other changes in work environment*              90           23             82             17
                                               100           1              50             4
* p < .05; ** p < .01



Summary of Service provider Needs

Information on Gambling-Related Topics: At least 90% of both groups of respondents
indicated that it would be helpful to have additional information on prevalence and patterns of
women’s gambling, characteristics of women gamblers and their special needs, gambling-related
cultural differences, and new treatment models for gambling. Fewer (80%) Designated than
Non-Designated SPs (96%) want more information on gambling services in their area. Except
for current awareness of gambling-related services in their area by 28% of Designated SPs, less
than 15% of both groups report that current information on any listed topic is adequate.

Training Needs: Despite their work with women gamblers, more than 60% of Designated SPs
endorsed every one of the suggested training topics, and more than 90% of Designated Gambling
Treatment System SPs want additional training in several of the gambling-related topics. In
addition, except for the stages of change model, less than 40% of Designated SPs thought that
their current state of training in any of the suggested topics is adequate.

The Non-Designated SPs were less likely than the Designated SPs to desire more gambling-
related training but, while the scores were lower than those of the Designated respondents, a
majority of respondents wanting training in every topic except inpatient approaches for women
gamblers. The Non-Designated SPs were less likely than the Designated SPs to perceive that
their current level of training is adequate for many of the topics, and 25% or less of the Non-
Designated group reported that they were adequately trained in any of the topics listed.

It may be surprising that SPs within the Designated Gambling Treatment System perceive their
current level of training on gambling-related topics to be inadequate in many areas, but much of



                                                                                                 35
their training may not have included information specific to women. This is consistent with the
finding regarding CE training, described above under “Respondent Characteristics.”

Changes in work environment: Designated SPs would like more of their time devoted to
working with gamblers, increased management support for time spent with gamblers, more
awareness within their agency of women’s gambling problems, and better referral networks.
Fewer that 50% of the Designated SPs reported that these supports are adequate now. All of the
Designated SPs, and 95% of Non-Designated SPs, would like more available materials to give to
women gamblers, and less than 5% of both groups report that such materials are currently
adequate.


Preventing Gambling Problems
Respondents were asked to indicate how important they thought each of a list of measures would
be in preventing gambling problems among women. The importance of each item was rated on a
four-point scale ranging from “Extremely Important” to “Not at all Important.” For this report,
“Extremely Important” and “Somewhat Important” responses were combined into a single
“Important” category. Responses are summarized in Table 22.

Possible measures to prevent women’s gambling problems can be divided roughly into two
groups, those directly related to gambling behaviour and gambling venues, and broader
community changes. The following measures to be taken at gambling venues were seen as
important by 80% or more of respondent SPs in both groups: remove ATMs from casinos,
eliminate “client cards” credit in casinos, more prominent help line numbers in casinos,
distribution of information about gambling problems and gambling-related services at gambling
venues. Designated SPs were significantly more likely to rate as important the following
measures: prominent clocks inside casinos, intervention by casino and other venue workers,
limitations on spending in casinos and other gambling venues. Possibly Designated SPs are
more aware of the possible effect of these measures, or the lack of them, on women’s gambling.
Other measures were also rated as important by a majority of respondents, and about half of each
group endorsed a ban of gambling in Ontario as a way of preventing women’s gambling
problems.
The following broader community changes were perceived as important to prevent women’s
gambling problems by 80% or more of both groups of SPs: information about gambling
problems available in different languages, education about what constitutes problem gambling,
stronger community connections, promotion of other leisure activities, better and affordable
educational opportunities, better employment opportunities.




                                                                                              36
Table 22: Perceived importance of measures to prevent gambling problems among women.
% of respondents selecting “Extremely” or “Somewhat” important.

  MEASURE TO PREVENT GAMBLING                                DESIGNATED         NON-DESIGNATED
           PROBLEMS                                               N = 99              N = 84
                                                             % of respondents    % of respondents
No advertising of gambling                                          61                 72
Fewer casinos                                                       73                 70
Prominent clocks inside casinos**                                   67                 43
Windows in casinos                                                  71                 60
Ban smoking in casinos and other gambling venues                    60                 70
Remove ATMs from casinos                                            92                 93
Eliminate “client cards” credit in casinos                          91                 93
Eliminate casino promotions to big spenders                         78                 72
Feedback to gamblers about money spent each day in the              90                 79
         casino
Intervention by casino or other venue workers**                     87                 68
Limitations on spending in casinos and other venues*                88                 75
More prominent help line numbers in casinos
Fewer bingo halls                                                   85                 82
Fewer lottery ticket outlets                                        68                 72
Fewer racetracks                                                    70                 69
Less use of gambling as a fund-raising technique                    59                 69
Information about gambling problems distributed at                  77                 86
         gambling venues                                            92                 86
Information about gambling-related services distributed at
         gambling venues                                            96                 91
Information about gambling problems available in
         different languages                                        95                 88
Less government involvement in gambling
Ban of gambling in Ontario                                          63                 72
More education about what constitutes gambling                      51                 47
More education about what constitutes problem gambling              92                 94
Legal crack-down on loan-sharking**                                 94                 98
Stronger community connections
Promotion of other leisure activities                               56                 76
Better and affordable educational opportunities                     90                 95
Better employment opportunities                                     95                 90
More affordable housing                                             81                 89
Other                                                               84                 86
                                                                    71                 79
                                                                    86                 43
* p < .05; ** p < .01




                                                                                               37
Summary of Prevention of Gambling Problems

Gambling-Related: The following measures for gambling venues were seen as important by
80% or more of respondents in both groups: remove ATMs from casinos, eliminate “client
cards” credit in casinos, more prominent help line numbers in casinos, information about
gambling problems and about gambling-related services distributed at gambling venues.
Designated SPs were significantly more likely to rate as important the following measures:
prominent clocks inside casinos, intervention by casino and other venue workers, limitations on
spending in casinos and other gambling venues. These preventive measures are consistent with
those identified by the women gamblers in the “Voices of Women who Gamble in Ontario”
study.

Other Prevention Measures: Among both groups of SPs, 80% or more perceived the following
to be important in prevention of gambling problems among women: information about gambling
problems available in different languages, education about what constitutes problem gambling,
stronger community connections, promotion of other leisure activities, better and affordable
educational opportunities, better employment opportunities.


Conclusions

The current study surveyed those who provide services to Ontario women who gamble, both
within and outside the Designated Gambling Treatment System. The views of these Service
Providers provide an important additional perspective to the “Voices of Women” (Boughton &
Brewster, 2002) as well as outlining the needs of the Service Providers themselves.

The important differences in responses between Service Providers who work in the Designated
Gambling Treatment System and those who work in other settings seem mostly due to familiarity
with services that are currently available for women who gamble. However, while differences
exist, Service Providers are united in calling for an increase in specialized services for women
who gamble, with an emphasis on women-specific services. They also point out the need for
services for women with concurrent mental health and social needs, and measures in casinos and
other gambling venues, and in society, to prevent the development of problems by women who
gamble. Information, service and concurrent needs identified by the Service Providers reflect
the priorities identified by the women in the related study “Voices of Women who Gamble in
Ontario” (Boughton & Brewster, 2002). The most important needs identified are for information
about gambling, gambling problems, and treatment services, for the general public, for women
and for the service providers themselves.

The Service Providers report that they need more education and training in most areas related to
women who gamble. Few respondents feel that their current level of training to work with
women gamblers is adequate. Those within the Designated Gambling Treatment System want
more time devoted to, and support for, work with women gamblers. The responses of the Non-
Designated SPs indicate that they need more information about services that are currently
available, and how to access these services for their clients, as well as additional training. A



                                                                                               38
consistently identified need is for materials suitable to give to women who gamble, both as self-
help and as an adjunct to therapy.

This study is an important step in identifying the needs of Ontario women who develop problems
with gambling, and of those who provide service to them. Findings indicate a need for increased
information to the public and to women who gamble, and increased education for Ontario service
providers. There is also a need to develop women-specific services and other supports for
women who gamble. Important steps can also be taken in preventing gambling problems among
women.




                                                                                                39
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Westphal, James R., Johnson, Lera Joyce, Stoghill, Stephanie, Stevens, Lee. Gambling in the
South: Implications for physicians. Southern Medical Journal, 2000(Sep), 93(9): 850-858.

Wiebe, Jamie, Single, Eric, Falkowski-Ham, Agata. Measuring gambling and problem gambling
in Ontario. Ottawa: Canadian Centre on Substance Abuse, December 4, 2001.




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Appendix 1

List of original Provincial Advisory Board Members in June 2000

Roberta Boughton *                  Principal Investigator
Joan Brewster*                      Consultant
Rosemary Barrett*                   Amethyst Women’s Addiction Centre
Sonia Maisonneuve                   Amethyst Women’s Addiction Centre
Darlene Barrett*                    Riverside Community Counselling
Peggy Davis*                        Lambton County Addiction Service
Angelique Lemay*                    Sioux General Hospital Addiction Treatment Clinic
Lisa Root                           Niagara Alcohol and Drug Assessment Services
Wendy Draper                        Pinewood Centre
Rosemary Hilbert*                   Alcohol, Drug & Gambling Assessment Services
Christine Glenn*                    Ontario Problem Gambling Helpline
Pamela Blake                        Clarke Institute of Psychiatry
Jane Scott*                         Lennox and Addington Addiction Services
Marie Brush                         Addiction Outreach Muskoka Parry Sound
Laurie Campbell*                    Credit Counselling Service of Toronto
Christine McKay*                    Centretown Community Health Centre
Marielle Cousineau                  North Cochrane Addiction Services

* Ongoing Board members as of Feb 2002

Cindy Jennings                      Niagara Alcohol and Drug Assessment Services
Claire Narbonne-Fortin              Francophone Consultant (CAMH – Sudbury)

Additional thanks to the following women for information on special populations of women.
Janine Robinson                      Problem Gambling Service CAMH
Linda Hobbs                          Problem Gambling Service CAMH
Pamela Rogers                       Donwood Institute




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