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 . Page 3
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 TOTAL ATTENDED NO SHOW MISSED DROPPED CALD S-E DEED (NO. SESSIONS) REFERRED ALL ONE OUT REVOCATION (M:F) SESSIONS SESSION 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 - 0 5 1 Aug 2014 (5) 8 (7:1) 2 2 3 1 7 - TOTAL 29 14 8 5 2 21 2
Evaluation
Client feedback How much has this course helped you to think about your gambling? ( n = 13)
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.
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