Mandated client group project Rationale for the project Mandated - - PowerPoint PPT Presentation

Lee Palmer Gambler’s Help City and Inner North

Mandated client group project

Rationale for the project

Mandated clients present particular challenges to therapeutic counsellors:

• lack of client engagement and high rates of non-

attendance

• ineffective use of counsellor time and resources

following up unmotivated clients

• inconsistent service provision (number and

content of sessions, outcomes)

• difficulties aligning therapeutic- and compliance-

driven organisational cultures.

Groups are effective

• The benefits of a structured education program

delivered in the form of group work are well documented in the fields of – men’s behaviour change – offender rehabilitation – drug and alcohol programs – drink driving programs.

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Overview

• Developed early 2013 by experienced GH counsellors
• Two co-facilitators (safety, authority)
• Planned to run 3-4 times per year with 8-10 clients
• Neighbourhood Justice Centre offered venue
• Psychoeducational stance
• Content derived from current practice

– biopsychosocial model of gambling – motivational interviewing and CBT

• understanding and managing triggers
• cycle of change
• relapse prevention
• financial management strategies
• treatment options

Eligibility and screening

• Must speak and understand conversational English
• No unstable mental health conditions (e.g. active

psychosis) or current suicidality. Well-managed conditions ok. No current aggression.

• Must agree to Conditions of Attendance

– Arrive on time; attend all sessions; be sober; behave respectfully; no abusive or threatening behaviour; participate in the group; do tasks between sessions.

• Also open to non-mandated clients who prefer a group

educative format…

• …and clients who want to revoke a self-exclusion deed?

Summary of groups conducted

DATE (NO. SESSIONS) TOTAL REFERRED (M:F) ATTENDED ALL SESSIONS NO SHOW MISSED ONE SESSION DROPPED OUT CALD S-E DEED REVOCATION April 2013 (4) 6 (5:1) 4 1

• 1

5

• July 2013 (6)

8 (5:3) 5 1 2

• 4

1 Jan 2014 (5) 7 (6:1) 3 4

• 5

1 Aug 2014 (5) 8 (7:1) 2 2 3 1 7

• TOTAL

29 14 8 5 2 21 2

Evaluation

How much has this course helped you to think about your gambling? (n = 13)

Client feedback

Client feedback

Prefer group or individual tx? (n = 10)

• Group: 6
• Individual: 1
• No preference: 2
• Neither: 1 

Client comments

• “I feel very comfortable as I am able to open up

because everyone has my problem.”

• “It was fantastic. I had the opportunity to speak out and

not worry (about) someone laughing at you.”

• “It was a revelation. I truly enjoyed and learned a lot

from these group sessions. Meditation tools will surely help.”

• “I prefer group sessions because we learn from one

another.”

• “Felt embarrassed being in a group”

(also said sessions too long and too many)

Advantages of group for mandated clients

• Reduces isolation and destigmatises gambling
• Provides opportunities to learn new interpersonal skills
• Clients hear a range of perspectives from group members
• Clients can learn problem-solving skills
• Clients become more aware of their patterns by the

genuine feedback from others

• Clients give and receive peer support and validation
• Clients develop new capacities and become more

connected by helping others in the group.

Advantages for agency

• Onus on the client to attend, rather than the counsellor to

pursue and try to engage them– less counsellor frustration

• Benefits of peer support for isolated clients
• Opportunity for a more collaborative relationship between

counsellor and mandated clients

• Opportunities to obtain constructive feedback from

mandated clients

• More consistent service delivered
• Standard certificate of participation instead of individual letter
• More efficient?

Disadvantages

• Has taken a lot of time, mostly indirect
• Processes are complex and different from usual client work

(intake, assessment, communication with CCO)

• Unable to deliver regularly as intended

– operational constraints (tender, staffing) – declining referrals

• Waiting period for clients may be an issue
• No-shows and missed sessions still a concern
• Ongoing debate re content and standardisation
• Learning curve re co-facilitation skills

Going forward

• Continuing to review content and delivery options
• Continuing to evaluate experiences
• More and better publicity
• VRGF grant to manualize (standardize) the content

and procedures.