CA’s: Pathways/NorthCare Network, Northern Michigan Substance Abuse Services and Western U.P. Substance Abuse Services
Contacts: Donna Kitrick, Director of Pathways/NorthCare Network; dkitrick@up-pathways.org,
In partnership, the Northern Michigan Substance Abuse Services, Pathways/NorthCare Network and the Western UP Substance Abuse Services offer this proposal for gambling treatment and prevention services throughout their forty-five county catchment area in northern Michigan and the Upper Peninsula. Approximately 552,000 of adult residents of NMSAS’ region and another 300,000 in the Upper Peninsula live within 50 miles of a casino. In the U.P., besides the Michigan Casinos available, there are another 3-4 casinos within 40 miles on the Michigan-Wisconsin border! Throughout the entire proposed service area, most residents live within 50 miles of a casino. The national Gambling Impact and Behavior Study (GIBS) found that the presence of a casino within 50 miles was associated with double the rate of pathological gambling (Gerstein et al., 1999). It would appear that the rates for at-risk and problem gamblers would reflect the same prevalence within the presence of a casino within 50 miles. This same study also indicated that some forms of gambling, such as electronic gaming and casino table games have a stronger association with problem gambling than other popular forms of gambling. This would suggest that in the NMSAS region, a conservative estimate of the number of adults expected to meet DSM IV criteria for pathological gambling could approach 18,000 individuals. Of this total, more than 16,500 reside within 50 miles of a casino. Of equal concern, the data also suggests that an additional 25,000 adult residents in the region may meet the criteria for problem gambling. “The Upper Peninsula has higher rates of problem gambling than statewide. Current rates of 2.5% as compared to 3.2% statewide and lifetime rates are at 5.1% compared to 4.9% statewide.”
(UP Problem Gambling Task Force).
The GIBS found that approximately 3% of the population of pathological gamblers would seek treatment services if available. In the NMSAS region and the U.P., current access to certified gambling counselors is extremely low. Based on the NSO list of certified gambling counselors, there are 4 clinicians in the region and 2 or 3 that are current in the Upper Peninsula. Only 2 of the 4 clinicians are employed with providers within the NMSAS Provider Network. All of the U.P. clinicians are employed in a contract substance abuse program. Thus it would prove to be cost effective utilizing the existing CA contract structure. Lack of available services is compounded by the fact that systematic efforts to identify and refer pathological gamblers and problem gamblers have not occurred within the NMSAS region or the U.P. Barriers such as gas prices and distances to travel to the services are obvious and a reality. Finally, the GIBS indicate that “at risk” and problem gamblers are responsive to prevention efforts, specifically public awareness and education campaigns. Evidenced-based prevention programming will guarantee positive results. This proposal seeks to:
►Create a systematic screening and referral service for problem and pathological gambling in venues in which individuals with these conditions are likely to be seen.
►Significantly expand the availability of treatment services for problem and pathological gambling through training of clinical staff within the current NMSAS, WUPSAS and Pathways/NorthCare Network provider panels to meet NSO Provider Network credentialing standards.
►Implement “Facilitated Support” groups for those in early recovery from pathological or problem gambling.
►Utilize recognized prevention education strategies to reach “at risk” individuals which will include a major media event project that will cover both northern Michigan and the Upper Peninsula. Also included in the prevention portion of this proposal is a joint awareness raising project targeting key stakeholders, using evidence-based or best practice environmental strategies.
Screening and Identification of pathological gamblers
Beginning with courts that fall within a 50 mile travel distance to casinos, we will ask that they become engaged in the systematic use of the National Opinion Research Center (NORC) Diagnostic and Statistical Manual (DSM) Screen for Gambling Problems (NODS) and application of the information to make appropriate referrals for treatment. Support for the courts will include training on the use of the NODS, referral system and treatment resources, ongoing consultation and nominal reimbursement for utilization of the screening tool. The project will secondarily target credit counseling agencies, Senior Citizen Centers, DHS, banks and lending agencies and other appropriate organizations. The NODS will be incorporated into the CA Access Center screenings and treatment provider assessments. This proposal includes training on use of the NODS, reimbursement for utilization of the screening tool and information on the treatment resources available.
Treatment Capacity
NMSAS, PW/NorthCare Network and WUPSAS will work together to secure appropriate training to expand access to gambling treatment services. We propose to train 30 to 35 clinicians in the first year of the project with an option to train an additional 30 in the second and third year based on need.
Utilizing our established contracting system, payment methodologies and data collection and reporting systems is not only cost effective but will also enable us to quickly implement the expanded services for pathological and problem gamblers. Building capacity for treatment providers, and our community members as well as identifying those in need of our services is the priority.
Prevention Education
NMSAS, PW/NorthCare Network and WUPSAS will work together to identify and purchase a single evidence-base or best practice public awareness and education media campaign targeting at-risk and problem gamblers, including those impacted by internet gambling. Contact has been made with Central CAPT’s Tracey Johnson for assistance in investigating what is available. It would be more cost effective to collaborate on a media event than to do them individually, especially since the UP share TV and many broadcasting entities and one TV station is shared by the NMSAS and PW/NorthCare Network region. We will coordinate our efforts to raise awareness in those sectors, both private and public, which are negatively impacted by the chronic and addicted gambler. An educational and environmental awareness project will focus on Senior Citizen Centers, youth serving organizations, Dept. of Human Service’s clients, banking institutions and Credit Counselor organizations and also through the use of community Town Hall meetings which focus only on gambling disorders and addiction. Also, as part of the annual U.P. High School Youth Conference held at Northern Michigan University in the fall, two breakout sessions on problem gambling will be offered. That breakout session will be complemented by one on how to manage finances facilitated by our local MSU Cooperative Extension staff.
Harbor Hall, Inc., Catholic Human Services, Addiction Treatment Services, Munson Hospital, Catholic Social Services, Addiction Solutions, Ten Sixteen Recovery Network are providers ready and willing in the NMSAS region. In the U.P., there is Catholic Charities, Great Lakes Recovery Centers, Bell Hospital Behavioral Health Services, Marquette General Behavioral Health Services, Public Health of Delta and Menominee Counties and the LMAS District Health Department, Community Substance Abuse Services, Anne Gregor, Ph.D., Phoenix House, Psychology Associates, Second Chance Services and Superior Psychological Services. The providers have been identified based on their interest, strategic geographic locations and staff education backgrounds. Each has expressed the strongly perceived need for the referenced services and has tentatively committed staff time for organization and implementation of the project. As previously indicated, each provider will utilize the NODs at the time of screening, assessment or intake (as appropriate) and the Substance Abuse Access Systems will utilize NODs at every client screening.
Specification of major project milestones and deliverables including a project time/time will be part of the collaborative effort. Getting clinical staff trained and certified is a high priority; developing and implementing a media and awareness project would be the next priority with the expectation that a well planned and effective media/awareness event will identify people in need of gambling treatment. A media and awareness project could have an immediate impact and would allow programs to jump on-board quickly.
See Attachment: Timeline
Barriers:
●The Cost of implementation of NODs; Courts and other institutions continue to be challenged to add more functions within current and existing revenues. We seek to recognize the partnership and participation of the courts by providing a nominal reimbursement for the administration of the NODs at possibly $5 per screening.
●Provider cost associated with training by NSO of Detroit; Substance abuse services providers are reimbursed on a “fee for service” basis. Training of counselors is very costly as they are not generating revenue during the training time. We seek to overcome this barrier by reimbursing service providers for the cost of taking therapy staff “off line” for the necessary 30 hour training course.
●Access to payment through NSO of Detroit; the few providers from the NMSAS and UP region that are part of the provider panel report significant challenges in working with NSO. We are intent on overcoming that barrier by creating a gambling service payment structure that will operate through the CA and its current contract, reporting and payment systems. Gambling service providers will be encouraged to enroll on the NSO Provider Panel, but will not be required to do so. This effort will supplement the current activities of the NSO and should also result in increased participation on the NSO Provider Panel.
Although the entire geographic area served by NMSAS and the Upper Peninsula CA’s (45 counties) will benefit from this project, the screening and treatment efforts will focus on those areas that fall within the 50-mile radius of existing casinos. This represents 23 counties within the NMSAS region and in the eastern U.P., each of the 8 counties in the NorthCare Network also have at least one or more casinos. The western U.P. has 2 of their 7 counties affected by casinos. In the central and western U.P., there are another 3-4 casinos located in Wisconsin, less than 40 miles from the Michigan border! We believe that a systematic screening and referral will readily increase the number of clients seeking treatment services for pathological gambling problems. We estimate that approximately 1,000 clients in the NMSAS region could seek services and an additional 500 from the U.P. could seek services once they are fully operational. We project that 250 clients will be provided treatment services based on the limitation of resources. We have also projected that approximately 300 clients per year will be served by facilitated support groups. Additionally, we expect our geographic specific, evidenced-based/best practice prevention education efforts will reach the audience at risk for and who are already problem gamblers. We would estimate at that to be around 30,000 to 50,000 on an annual basis including the residents of the U.P.
Monitoring of treatment services will take place within the established CA contracting system, annual Site Reviews and required audits, etc. Client satisfaction surveys will also be utilized as will data drawn from the CareNet system in order to monitor the work that is being done. We will look at the provider, the number of clients served, length of stay and reason for discharge. Measuring treatment completion will be automatic.
Training and technical assistance will be provided upon request. Training the clinical staff will take place to assure that we meet all necessary requirements per this request. Evaluation of the media campaign will be incorporated into the media design. Specific prevention demographic activity will be entered into the SUDPUDS as appropriate. All CAs will provide staff to plan and implement the media and awareness event which will reach the entire northern part of the state.
Budget justification:
●The bulk of the request is time limited (media, counselor training, etc.)
●We will work with the tribes to develop funding streams for screening and treatment.
●We will encourage providers to enroll as NSO providers.
●We will approach DCH as necessary for small amounts of funding that may be available from the same source.
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