Oregon Problem Gambling Services

1. ADDICTIONS AND MENTAL HEALTH
Problem Gambling Services
WELCOME
Problem Gambling All Providers
Meeting
Hosted by Problem Gambling Service Staff
June 12, 2014
GotoMeeting Webinar
We will begin in a few moments…….

2. 2
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3. Agenda Items
• State Updates (10 minutes)
• Client Finding Outreach Strategic Plan (10 minutes)
• Presentation from Oregon Lottery on Helpline new look
and feel (20 minutes)
• Presentation from Problem Gambling Student Research
Grant: Does the Presence of a Casino Impact
Community Youth Gambling Behaviors? (20 minutes)
• Presentation on data: Who’s using special programs?
(15 minutes)
• Use of Aftercare and billing codes (5 minutes)
• Questions and Answers (10 minutes)
3

4. State Updates
• Staff Updates-
• Treatment Site Reviews
• Prevention Meet and Greets
• Regional Trainings
• Fall Oregon PGS Conference- Newport, OR
4

5. State Updates
Staff Update
 Roxann Jones, new PGS Prevention Coordinator
 The AMH PGS Unit is now fully staffed!
5

6. State Updates
Treatment Site Reviews: Simon Williams, PGS Treatment Compliance
Specialist
 Make sure final assessments are completed timely, and in the chart,
and the service plan addresses the final treatment timeline
component in the plan.
 Even though OARs remove the discharge summary from the
treatment chart, the chart needs to have this information included in
the documentation.
6

7. State Updates
Prevention Meet and Greets, Roxann Jones, PGS Prevention
Coordinator
 Hopes to meet with most of the prevention coordinators at the
regional trainings coming up this summer; otherwise, will make a
point to meet via phone calls, and in person as well.
7

8. Regional Trainings
• 6 trainings this summer (Albany, Tillamook, Baker City, Bend, Grants Pass
and Portland area)
• 6 hours (lunch provided) 9:00 am to 3:00 pm
• Purpose:
– Strengthen local outreach plans/efforts
– Strengthen the relationship and collaboration between local treatment
services providers, local prevention specialist and agency executives,
along with state staff
– Help to develop regional collegiality among treatment providers and
prevention specialists.
– Spark excitement, motivation and networking
• Encouraging PGS prevention and treatment providers, along with their
program managers to make these trainings a priority regarding
attendance.
• If you need a registration and/or subsidy form, email Patricia at
patricia.alderson@state.or.us
8

9. Fall OR PGS Conference
• Slated for October 9 &10, 2014
• Hallmark Resort, Newport, Oregon
• Keith Whyte, National Council, will be the featured speaker, as well
as Jeff Marotta, talking about problem gambling, online gambling, as
well as the past, present, and the future regarding this subject.
• Save the Date came out in an email to everyone; please mark your
calendars
• A registration form and information will be coming out a couple
months prior to the conference.
9

10. PGS Strategic Plan for
Client Finding Outreach
• 2014-16
– Client Finding Outreach Webinars-Completed
– Regional Trainings-In Process
– Development of statewide method for collecting and measuring
outcomes
– New and updated outreach materials (brochures, canned presentations,
etc.)
– Hire consultant to provide PGS outreach technical assistance and
development of outreach plan.
– Add language to prevention contract stipulating a percentage of funds
must be designated to outreach efforts.
– Development of PGS 5- year Strategic Plan to improve and support
program structure
10

11. Helpline Web Page Redesign
• Presented by
Shad Barnes
Online Marketing Manager
Oregon Lottery
shad.barnes@state.or.us
503-540-1082
11

12. “Replacing destructive thoughts
with hope filled optimistic ones
bring peaceful and confidence
producing circumstances.”
12

13. 13
WHY CHANGE?
• All efforts should lead back to the goal of engaging with more at risk
individuals and families affected by problem gambling.
• Reach the at risk audience in a more effective, more relevant
manner.
• Create a consistent look and feel that is pleasing to the eye, easy to
read and commensurate with current media trends.
• Improve the capture and collection system to best capitalize on
advertising and marketing campaigns.
• Above all, this process is about helping more people in need.

14. 14
CURRENT TRADITIONAL
• Brochures
• Posters
• Terminal
Stickers

15. 15
CURRENT SITE

16. 16
WHAT ARE USERS DOING?

17. 17
RECAP
• Current designs are dated.
• Images convey sadness.
• Dark color schemes.
• Long copy.
• No hierarchy, what should the reader do.
• Where is the call to action? Where is the hope in
recovery?
• Is this a web address or a phone number?

18. 18
THE MESSAGE – WHAT TO SAY?
• Everything should convey a feeling of hope.
• Messages should lead to phone calls.
• Open, friendly, trustworthy, sensitive, non-
judgmental.
• Emphasize that treatment is FREE and
EFFECTIVE.
• Should use imagery and mention of Oregon and
Oregonians whenever possible.

19. 19
BRANDING RECOMMENDATION
In thinking about the “name” we want this to be bigger than a phone
service. While the telephone is still the best way to connect, calling it a
helpline feels too small in scale.
OREGON PROBLEM GAMBLING NETWORK
www.oregonproblemgamblingnetwork.org
www.oregonpgn.org
We will likely purchase additional domains.

20. 20
BRANDING RECOMMENDATION
IMAGERY
The images should
convey a sense of hope,
helpfulness, happiness
and inclusion.
People should be from all
walks of life, genders,
ages, ethnicities, races
and should never display
a look of despair or pain.
Basically everyday people
who make the viewer feel
like they made a life
decision to be healthy and
are better for it.
When possible, scenes
should be Oregon-based.
COLOR SCHEME
Colors should be neutral to
put emphasis on the
images. Light, Inviting
Combinations
FONTS

21. 21
BRANDING RECOMMENDATION

22. WEB DESIGN RECOMMENDATION
NOT THE ACTUAL LOOK – JUST A GUIDELINE

23. 23
WEB DESIGN RECOMMENDATION
NOT THE ACTUAL LOOK – JUST A GUIDELINE

24. 24
WEB DESIGN INTERIOR
HIGHLIGHTS
• Informational
• Video
• Minimal Copy
• Image Heavy
• Interactive
• Search Engine
Optimized content
• Content Management
System – Update your
own informationNOT THE ACTUAL LOOK – JUST A GUIDELINE

25. 25
OREGON PARTNERSHIP
FOR PROBLEM GAMBLERS
All attribution goes to the Oregon
Partnership for Problem Gamblers. It will
include all the organizations that cooperate
to provide this valuable service to
Oregonians. Never any direct attribution to
the Oregon Lottery, or any other specific
organization.

26. 26
We are nearly final with logo development
and color palettes. We also have received a
statement of work from our digital agency
that is going to help with some of the design
work, and recently hired a creative agency
to help create our next TV commercial. We
plan to present first drafts in July and
hopefully be final with re-branding by late
August if not sooner.
NEXT STEPS

27. Youth Gambling and its Association
with Casino Proximity
Ashley Reynolds
27

28. Casino Proximity and its Association
with Youth gambling
This study sought to determine if casino proximity is associated with
youth gambling and its frequency. The 2012 Arizona Youth Survey
was used (n = 66,127), analyzed using ordinary logistic regression and
ordered logistic regression models. This study may aid prevention
efforts in problem gambling since early-onset gambling was found to be
a significant risk factor of at-risk gambling in adolescents (Winters,
Stinchfield, Botzet, & Anderson, 2002), and adults with severe
gambling problems are likely to have begun gambling at an earlier age
(Volberg, Gupta, Griffiths, Olason, & Delfabbro, 2010).
In order to prevent problem gambling, in either youth or adults,
consideration is important to identify factors that contribute to early-
onset gambling and its frequency.
28

29. Background
• Adolescent gambling a problem in the United
States.
• Gambling frequency associated with alcohol,
tobacco, and marijuana use (Volberg, Hedberg, &
Moore, 2008).
• Problem gambling in youth associated with drug
and alcohol use, poor seatbelt use, violence, and
risky sexual activity (Volberg, Gupta, Griffiths,
Ólason, & Delfabbro, 2010)
29

30. Background
• The estimated prevalence of youth gambling
indicates that it should be addressed
30

31. Volberg et al. (2008)
• Oregon youth survey (n=1,555)
• 63% of adolescents have gambled at least one
point in their lives
• 13% gambled on monthly basis
• 3% gambled on weekly basis
31

32. Welte, Barnes, Tidwell, & Hoffman (2009)
• National survey of youth (n=2,274)
• 68% gambled within past year
• 11% more than twice per week
32

33. Winters, Stinchfield, Botzet, & Anderson
(2002)
• Prospective cohort study of 305 adolescents over 8
years in MN
• Rates of prior-year gambling found to be consistently
high for each year
• Rates of regular gambling around 20%
• Rates of problem gambling ranged from 2.3 to 4.3%
33

34. Role of Casinos in Adolescent Gambling
• Some adolescents able to get past age
restrictions and gamble (Welte et al., 2009;
Fabiansson, 2006).
• Fabiansson (2006) found that in one of Australia’s
largest casinos approximately 700 underage
individuals are caught each month
34

35. Casino Advertisements
• Casinos may influence youth gambling by making
gambling appear “cool”
• Casino advertisements effect youth (McMullen &
Miller, 2010; McMullan, Miller, & Perrier, 2012).
• From ads, gambling has cultural capital
35

36. Casino Proximity and Gambling
• Adult studies found positive link between proximity
and gambling
• A correlation between casino proximity and
participation in casino games/casino expenditure
(Sévigny et al., 2008)
• Participating in casino slots and table games more
frequent in students attending university near a
casino (Adams et al., 2007)
36

37. Casino Proximity and Youth Gambling
• No studies have addressed the effect of a nearby
casino on youth gambling behaviors
• Living near a casino may be positively correlated
with lifetime gambling and frequency
• Proximity may make casinos more accessible to
youth, if they desire to sneak-in.
- Findings of adult proximity studies
demonstrate the importance of less travel time
37

38. Casino Proximity and Youth Gambling
• Youth near a casino may be more exposed to
casino advertisements.
• Youth near a casino may be exposed to a social
environment that approves of gambling.
• Fabiansson (2006) found that in rural areas with
casinos, parents are encouraged to bring their
families to casinos for activities
• Youth may see family visit casinos
38

39. Casino Proximity and Youth Gambling
• Exposure to casinos at an early age may cause
adolescents to think that gambling is cool
• May lead youth to gamble
- Friend and family approval a predictor of
gambling among youth (Moore and Ohtsuka,
1999; Larimer and Neighbors, 2003)
39

40. Purpose of Study
• To determine the prevalence of gambling and
gambling by frequency
• If casino proximity is associated with lifetime
gambling
• If casino proximity is associated with gambling
frequency
• All types of gambling examined
40

41. Significance of Study
• If association between early-onset gambling and
casino proximity, interventions preventing problem
gambling may target adolescents near casinos
• Casinos may:
- Provide resources to local schools for
prevention and treatment programs
- Advertise responsibly
41

42. Significance
• To prevent problem gambling in adolescents and
adults, we should consider early-onset gambling and
its frequency.
• Adults with severe gambling problems are likely to
have begun gambling at an earlier age (Volberg et al.,
2010).
• Early-onset gambling a significant risk factor of at-risk
and problem gambling in adolescents (Winters et al.,
2002)
42

43. 2012 Arizona Youth Survey
• Measures prevalence and frequency of substance
abuse among 8th, 10th, and 12th graders
• Assesses risk and protective factors.
• One of the few statewide youth behavioral surveys
examining gambling and whose state has casinos
43

44. AYS
• Conducted every 2 years by the Arizona Criminal
Justice Commission
• Conducted for 21 years
• Ideal since many casinos in Arizona open before
2012
• Casinos scattered throughout state
- 21 casinos located in 17 towns
44

45. Participant Recruitment and Informed
Consent
• Consent needed from schools, parents, and
students
• All 15 counties participated
• 349 schools participated
- Public and charter schools
• 62,817 8th, 10th, and 12th grade participants
45

46. Data Collection
• Collected anonymously
• Collected between January and April 2012
• Teachers read scrip to students to ensure anonymity and reduce
response bias
• Questionnaire was pretested
• After completion, mailed to Bach Harrison L.L.C.
- Bach Harrison provided technical assistance
46

47. Data Use Agreement and Management
• IRB approval not needed
• Agreement granted by Arizona Criminal Justice
Commission
• SPSS file sent in February, 2014
• SPSS file converted to STATA 12
• Recoded variables
47

48. Predictor Variable- Casino Proximity
• Measured by whether the participant lived in a zip-
code that is in a town that has a casino(s)
• Dichotomous variable
• Casino must have been open before January 2012
48

49. Outcome Variables
• Lifetime gambling and gambling frequency
• Determined using same question on AYS
49

50. Outcome Variables
• How often have you done the following for money, possessions, or
anything of value:
a. Played a slot machine, poker machine or other gambling
machine?
b. Played the lottery or scratch off tickets?
c. Bet on sports?
d. Played cards
e. Bought a raffle ticket?
f. Played bingo?
g. Gambled on the internet?
h. Played a dice game?
i. Bet on a game of personal skill such as pool or a video
game?
j. Bet on a horse or other
50

51. Outcome
• Responses are:
- Almost every day
- Once or twice a week
- Once or twice a month
- At least once in the past 12 months
- Before, but not in the past 12 months
- Never
51

52. Lifetime Gambling and Frequency
• Lifetime gambling defined by whether an
adolescent ever gambled, regardless of activity
• Frequency defined by how often an adolescent
gambled, regardless of activity.
• For each participant, frequency was the highest
frequency marked
52

53. Variables adjusted for
• Grade
• Sex
• Race
• Rural vs. urban status
• Alcohol and drug use
• Smoking status
• Parental living situation
• Whether one skipped school
53

54. Descriptive Statistics
• Characteristics determined by calculating
frequency distributions for each variable
• Prevalence calculated for lifetime gambling
• Prevalence calculated for each gambling
frequency
•
54

55. Inferential Statistics
• Logistic regression used to determine if proximity is associated with
lifetime gambling
• Multinomial logistic regression used to determine if proximity is
associated with gambling frequency
– Base level: ‘never gambled’
• Determined both adjusted and unadjusted associations
• Model diagnostics and outlier detection
• Assessed for proximity, gender, and grade interactions
• Criteria of α=.05
55

56. Descriptive Analyses
• Mean age was 15.2 years (SD=1.7)
• 50.5% female, 49.5% male
• 46% in 8th grade, 30% in 10th grade, and 24% in
12th grade
• Approx. 25.9% lived near at least one casino
56

57. Gambling Prevalence
N Percentage
Lifetime Gambling
(n=60,891)
No
Yes
17020
43871
27.95%
72.05%
Gambling frequency (n=60,891;
Never
Before, but not in the past 12
months
At least once in the past 12
months
Once or twice a month
Once or twice a week
Almost every day
17020
9048
17141
10015
4180
3487
27.95%
14.86%
28.15%
16.45%
6.86%
5.73%
57

58. Logistic Regression
• Univariate analyses first conducted
• Casino proximity not a predictor of lifetime
gambling (p=.21; OR=.97)
• After adjusting for important covariates, grade
level an effect modifier between proximity and
lifetime gambling (p=.009)
58

59. Logistic Regression
• Relationship only significant among eighth graders
59
Main effect model Final model with interactions
Variable OR (95% CI) P-value OR (95% CI) P-value
Effect of grade for
proximity
8th grade
Far
Proximate
10th grade
Far
Proximate
12th grade
Far
Proximate
Referent
1.11
(1.02,1.20)
Referent
1.04 (.85, 1.14)
Referent
.95 (.86, 1.04)
.009

60. Multinomial Logistic Regression
60
Never- at least once in the past 12
months
Variable RRR (95% CI) P-value
Effect of grade for
proximity
8th grade
Far
Proximate
10th grade
Far
Proximate
12th grade
Far
Proximate
Referent
1.14 (1.01, 1.29)
Referent
1.22 (1.06, 1.40)
Referent
.94 (.81, 1.08)
.04

61. Predicting Monthly Gambling
61
Never-once or twice a month
Variable RRR (95% CI) P-value
Effect of grade for proximity
8th grade
Far
Proximate
10th grade
Far
Proximate
12th grade
Far
Proximate
Referent
1.13 (.98, 1.31)
Referent
.94 (.77, 1.13)
Referent
.83 (.67, 1.03)
.004

62. Predicting Weekly Gambling
62
Never- once or twice a week
Variable RRR (95% CI) P-value
Effect of grade for
proximity
8th grade
Far
Proximate
10th grade
Far
Proximate
12th grade
Far
Proximate
Referent
1.05 (.85, 1.31)
Referent
.97 (.71, 1.34)
Referent
.55 (.36, .82)
.008

63. Predicting Daily Gambling
Never-almost every day
Variable RRR (95% CI) P-value
Effect of grade for
proximity
8th grade
Far
Proximate
10th grade
Far
Proximate
12th grade
Far
Proximate
Referent
1.12 (.87, 1.44)
Referent
1.09 (.76, 1.57)
Referent
.59 (.35, 1.00)
.027
63

64. Summary
• 8th graders near a casino 10% more likely to
report ever gambling compared to those far from a
casino
• 8th graders near a casino were 14% more likely to
have gambled in the past year.
• 10th graders near a casino were 22% more likely
to have gambled in the past year.
• 12th graders near a casino were 45% less likely to
gamble weekly and 41% less likely to gamble
daily.
64

65. Discussion
• Must be careful not to generalize grade*proximity interactions
• Past findings that lifetime gambling and frequency may
positively correlate with grade level (Volberg et al., 2008;
Carlson & Moore, 1998; Shapira et al., 2002; Wallisch; 1993).
• Contrary to our findings and rationale
– Grade negatively correlated with lifetime gambling
– Grade negatively correlated with gambling
frequency
65

66. Limitations of Study
• Unable to control for depression, a family history of gambling, and if
one has recently moved
• Measurement of casino proximity: if an adolescent resides in a zip-
code that belongs to a casino town
• Defining proximity as within a specific distance
may be more reliable
• However, such data not collected by the AYS
• Adams et al. (2007) based proximity on if the
casino was visible in the immediate or local
community, also a subjective measure
66

67. Limitations
• May not be representative of Arizona
- Pima County comprised of 14% students
statewide and only 8% of the sample (Harrison,
2012)
- Exclusion of youth living near a casino: Pima
county includes Tucson (home to three casinos)
- Uneven grade distribution: 46% in 8th grade, 30%
in 10th grade, and 24% in 12th grade
- Possible exclusion of older youth who gamble
67

68. Limitations
• Results may not be generalizable
• Only AZ youth surveyed
• Other regions gambling is more or less mature
• All 21 AZ casinos open at least 10 years
• Need to consider adaptation hypothesis (Shaffer,
2005)
68

69. Generalizability
• All AZ casino towns range from having 1-3 casinos
- Need to consider casino heavy
communities such as Las Vegas and Atlantic
City
• States differ in types of gambling available
• Types may influence youth gambling rates
• Studies need to be repeated in other regions
69

70. Strengths
• Study is first of its kind
• Large dataset (n = 62,603)
• Easy to detect any statistical differences
• Large enough group near a casino
70

71. Implications
• Findings may be of comfort because proximity not
positively associated with higher frequencies
• Frequency associated with severity (Shinogle, Norris,
Park, Volberg, Haynes, & Stokan, 2011)
• Should be concerned that proximity was positively
associated with prior-year gambling (among 8th and
10th graders) and lifetime gambling (among 8th
graders)
71

72. Implications
• Some individuals in the population gamble less
frequently and yet gamble more heavily (Abbott,
2001; Abbott, Volberg, & Rönnberg, 2004).
• One may only need initial experience
• Interventions be implemented
• Casinos provide resources for prevention and
treatment for local communities
• Socially responsible advertising
72

73. Future Studies
• Address relationship between casino proximity
and problem gambling in youth
• Address relationship between youth casino
proximity and gambling problems later in life
• Current studies have only examined adult
casino proximity and problem gambling.
73

74. Who’s using special programs?
Presented by Tom Moore, Phd
Herbert and Louis, LLC
74

75. Minimal Intervention Program (SAFE; GEAR)
• Purpose: fill the gap in available treatment for individuals who
did not meet full diagnostic criteria for pathological gamblers
and to provide services to pathological gamblers who could not
attend brick and mortar programs. Home-based with workbook
and phone consultation.
 9/2001 – 6/2007 (Cascadia: n = 185)
 7/2007 - present (Emergence: n = 340)
 Older (p < .01) than TAU: 53.5 years compared to 46.9 years
 More likely (p < .01) to have 1st gambled older: 31.1 years
compared to 24.4 years
 Slightly more likely to be female
 Slightly more likely to have higher DSM Score: 8.2 to 7.7
 For enrollment call the Helpline!
75

76. Respite Care
 Purpose: Short term stabilization with referral from TAU with
intent for follow-up/continuing care at the referring agency.
(Some gaps in funding years)
 9/2001 – 5/2009 (Columbia County: n = 83)
 9/2001 – current (Josephine/Options for Southern Oregon: n =
104)
 More likely female; divorced
 (Small sample last five years)
 For admission contact PGS & Options
76

77. Residential Care
 Purpose: Provide acute stabilization and intense residential care for high
risk patients. Must be referred by a TAU outpatient program with the
intention for follow-up continuing care at the referring agency following
residential treatment
 7/06 – 6/09 (Cascadia: n = 237)
 7/09 – Present (Bridgeway: n = 291)
 No difference in age or gender with TAU
 Significantly more (p < .01) DSM Criteria Endorsed: 9.2 vs. 7.7
 Significantly more likely (p< .01) for younger first gambling experience:
18.3 years vs. 24.4 years
 More likely to be single-never married, homeless, higher gambling debt,
increased suicidality than TAU
 ALOS: 34.3 days
 For admission/logistics contact Bridgeway Recovery
77

78. Aftercare and Billing Codes
• Aftercare: Automatic one year after case closing with H&L.
– G2100 for group; H2027 for individual
• Consolidated document can be found on PGS web page at:
http://www.oregon.gov/oha/amh/gambling/BILLING%20CODES%20
012214.pdf.
• Flex Code
– ‘FLEX’ Submit in normal format
– Comes from agency’s AD81 funds
– Keep detailed records on site for possible audit
78

79. PG Flex Funds
• PG flex funds must be used for Problem Gambling
Services.
• Funds can be used for PG wraparound type services,
such as travel expenses for assisting client to residential
treatment, etc.
• Fund can also be used for supporting PG staff’s
workforce development needs (i.e., trainings, etc.).
• If you are a subcontractor for a county, you may need to
contact the county for use of funds approval, outside the
scope of treatment, outreach and prevention.
79

80. Questions
80

81. Contacts
• Greta Coe, Problem Gambling Services Manager
– Greta.l.coe@state.or.us; 503-945-6187
• Simon Williams, Problem Gambling Treatment Specialist
– Simon.o.williams@state.or.us; 503-945-6555
• Roxann Jones, Problem Gambling Prevention Specialist
Roxann.r.jones@state.or.us; 503-947-5548
• Patricia Alderson, Problem Gambling Administrative Support
– Patricia.alderson@state.or.us; 503-945-9710
81

82. Final Notes:
• Power point, minutes and CEU
certificates will be emailed to you next
week.
Thanks for your participation in this
webinar, and for the work that you do
every day!
82

83. 83