Evaluation of Problem Gambling Public Health Services: An analysis of provider progress reports
Project Title: Evaluation and Clinical Audit of Problem Gambling Intervention and Public Health Services
Provider Number: 467589
Contract Numbers: 348109/00 and 01
FINAL REPORT
25 September 2015
Prepared for:
Ministry of Health
PO Box 5013
Wellington
Authors:
Dr Komathi Kolandai-Matchett
Dr Maria Bellringer
Dr Jason Landon
Professor Max Abbott
CONTENTS
1 Introduction 9
2 Method and analysis approach 9
2.1 Method overview 9
2.2 Analysis method 10
2.3 Reporting method 11
2.4 Limitations 12
3 Policy Development and Implementation (PGPH-01) 14
3.1 Identification of relevant organisations and relationship building 15
3.1.1 Stakeholder groups engaged and relationship development 16
3.1.2 Barriers and challenges to stakeholder engagement 20
3.2 Education and awareness raising 21
3.2.1 Workshops, presentations and education sessions 21
3.2.2 Development and distribution of awareness raising materials 23
3.2.3 Use of cultural approaches of relevance to Māori and Pacific communities 24
3.2.4 Organisation of special events 24
3.2.5 Special submission and position papers 25
3.3 Public policy development and implementation 25
3.3.1 Gambling (Gambling Harm Reduction) Amendment Bill 25
3.3.2 Gambling (Class 4 Net Proceeds) Regulations 2004 27
3.4 Class 4 (gaming machine) venue policies 27
3.4.1 Policy-related conversations and discussions 28
3.4.2 Encouraging community and stakeholder involvement in policy development 30
3.4.3 Resource development to support community involvement in policy development 34
3.4.4 Policy advocacy and awareness raising through the media 35
3.4.5 Supporting evidence-based policy development 36
3.4.6 Territorial Local Authority Class 4 gaming machine venue policies outcomes 37
3.4.7 Barriers and challenges to policy outcomes 39
3.4.8 Influencing council decisions in relation to individual gaming machine venues 40
3.5 Other policy outcomes 40
3.5.1 Racing Board (TAB) Venue Policy 40
3.5.2 Alcohol-related polices 40
3.6 Organisational / workplace gambling policies 41
3.6.1 Tools to support the development of organisational and workplace gambling policies 41
3.6.2 Encouraging organisational workplace gambling policies 42
3.6.3 Developing workplace problem gambling policies in providers’ own organisations 47
3.6.4 Inclusion of problem gambling in wider health-related policies 49
3.6.5 Challenges and barriers in developing workplace/organisational gambling policies 49
3.7 Policies on non-gambling fundraising 51
3.8 Social impact assessments of gambling harm 52
3.9 Other barriers and challenges 52
3.10 Success indicators: Policy Development and Implementation 54
3.11 Adapted Logic Model: Delivery of Policy Development and Implementation 55
4 Safe Gambling Environments (PGPH-02) 57
4.1 Providers’ knowledge development 58
4.2 Identification of relevant organisations and relationship building 58
4.3 Venue host responsibility measures and harm minimisation policies 61
4.3.1 Regular visits and discussions with appropriate parties 61
4.3.2 Provision of resources and advice to develop venue knowledge 62
4.3.3 Building venue staff knowledge through training 63
4.3.4 Responses to venues on host responsibility aspects 64
4.3.5 Information resources to support problem gamblers 65
4.3.6 Multi-venue exclusion support 67
4.4 Monitoring MVE implementation and regulation compliance 77
4.5 Collaboration between gambling venues and other organisations 78
4.6 Other activities to enable safer gambling environments 79
4.6.1 Delivery of brief interventions at pubs and clubs 79
4.6.2 Extension of “Safe Gambling Environments” to other gambling facilities 79
4.6.3 Ensuring safer gambling environments by influencing accessibility of gambling opportunities 81
4.6.4 Awareness raising activities for stakeholder groups 81
4.7 Success indicators: Safe Gambling Environments 83
4.8 Adapted Logic Model: Delivery of Safe Gambling Environments 85
5 Supportive Communities (PGPH-03) 86
5.1 Provider’s knowledge development 87
5.2 Identification of partner organisations and relationship building 87
5.3 Identification of community strengths and protective factors 89
5.4 Health promotion programmes to enhance community resilience 90
5.4.1 Working with the health sector stakeholder groups 90
5.4.2 Working with non-health stakeholder groups 92
5.5 Public discussion and debate on gambling harm and related issues 96
5.5.1 Providing space and avenues for public discussion and debate 96
5.5.2 Promoting discussions during presentations and workshops 98
5.5.3 Promoting discussions at local events and festivals 98
5.5.4 Promoting discussions on the ethical perspectives of gambling funds 99
5.6 Culturally appropriate resiliency building through community partnerships 103
5.6.1 Using Kaupapa Māori approaches 103
5.6.2 Establishing and supporting client groups and client-led initiatives 104
5.6.3 Supporting community groups working against gambling harms 106
5.6.4 Collaborating through sponsorship 107
5.6.5 Supporting community-led projects and initiatives 107
5.6.6 Supporting programmes for children and youth 108
5.6.7 Supporting health-focused community programmes 109
5.6.8 Challenges in working with communities 110
5.7 Access to evidence based information and education 110
5.7.1 Specially designed education programmes and awareness raising events on gambling harms 111
5.7.2 Providing evidential facts on gambling harms 112
5.8 Point of public contact for raising issues on harm minimisation approaches 114
5.9 Media and community initiates promoting social connectedness and positive leisure 115
5.9.1 Community initiatives that promote family/community connectedness 115
5.9.2 Community events that promote positive leisure and entertainment opportunities 115
5.10 Barriers and challenges 116
5.11 Other activities 117
5.11.1 Participation in the organisation of the international gambling conference 117
5.11.2 Increasing public awareness of providers’ intervention services 117
5.12 Success indicators: Supportive Communities 118
5.13 Adapted Logic Model: Delivery of Supportive Communities 118
6 Aware Communities (PGPH-04) 120
6.1 Providers’ knowledge development 121
6.2 Stakeholder engagement and relationship building 121
6.3 Public discussion and debate on gambling harm and related issues 122
6.3.1 Public fora 122
6.3.2 Media engagement 122
6.3.3 Encouraging community and client involvement in media coverage 128
6.4 Monitoring and responding to public media discussions 129
6.4.1 Tracking and responding to media coverage 129
6.4.2 Monitoring gambling advertising 129
6.4.3 Barriers to media responses 130
6.5 Community education and social marketing campaigns on gambling harm 130
6.5.1 Presentations and workshops for selected stakeholder groups 130
6.5.2 Education programmes for youth groups and schools 134
6.5.3 Information stalls and awareness raising activities at public events/festivals 135
6.5.4 Participation in community meetings 140
6.5.5 Community awareness bus tours 140
6.5.6 Awareness raising materials and information dissemination 141
6.5.7 Challenges in awareness raising 142
6.6 Develop awareness of gambling odds, risky gambling, and health and social risks 143
6.7 Community-led culturally relevant awareness campaigns 144
6.8 Alignment of activities with national social marketing campaign 147
6.9 Success indicators: Aware Communities 148
6.10 Adapted Logic Model: Delivery of Aware Communities 151
7 Effective Screening Environments (PGPH-05) 152
7.1 Providers’ knowledge development 153
7.2 Identification of relevant organisations and relationship building 153
7.3 Development of screening and referral practices in appropriate organisations 155
7.4 Facilitating relationships between organisations and intervention services 164
7.4.1 Increase awareness of availability of problem gambling intervention services 164
7.4.2 Develop relationships with stakeholder organisations to increase referrals 165
7.5 Brief screening at public events and premises of community support services 166
7.6 Barriers and Challenges 167
7.6.1 Lack of response to training offer 167
7.6.2 Lack of “holistic” screening practices uptake 167
7.6.3 Lack of interest among stakeholder organisations despite promotional efforts 167
7.6.4 Time constraints 168
7.6.5 Culture-related challenges 168
7.7 Success indicators: Effective Screening Environments 169
7.8 Adapted Logic Model: Delivery of Effective Screening Environments 169
8 References 171
9 Glossary 172
TABLE OF FIGURES
Figure 1: Expected timing pattern in work plan submissions 11
Figure 2: Preliminary Logic Model: Policy Development and Implementation 15
Figure 3: Stakeholder groups engaged with for delivering PGPH-01 16
Figure 4: Education and awareness raising 22
Figure 5: Policy advocacy through meetings and conversations 28
Figure 6: Supporting an ethnic community group in making policy submissions 34
Figure 7: Media engagement to raise awareness 36
Figure 8: Encouraging the involvement of Māori communities in policy development 38
Figure 9: Development of an organisational self-audit tool 42
Figure 10: Development of a workplace gambling policy 47
Figure 11: Development of an internal workplace gambling policy 48
Figure 12: Successful areas of policy outcomes 55
Figure 13: Adapted Logic Model: Policy Development and Implementation 56
Figure 14: Preliminary Logic Model: Safe Gambling Environments 57
Figure 15: Groups and organisations identified for PGPH02 58
Figure 16: Establishing a “symbiotic” relationship with venues 59
Figure 17: Activities to support gambling venues’ host responsibility and harm minimisation practices 61
Figure 18: Development of an information card in collaboration with gaming machine societies 67
Figure 19: Developing a multi-venue self-exclusion form in collaboration with stakeholders 69
Figure 20: MVE working party: Clarifying process and roles 71
Figure 21: Development of a digital photograph frame for MVE implementation 74
Figure 22: Venue audits to ensure compliance and provide feedback 77
Figure 23: Development of a problem gambling resource in collaboration with the gambling industry and stakeholder groups 79
Figure 24: Encouraging safer gambling within housie operators 80
Figure 25: Adapted Logic Model: Safe Gambling Environments 85
Figure 26: Preliminary Logic Model: Supportive Communities 86
Figure 27: Stakeholder sectors identified for PGPH-03 88
Figure 28: Supporting youth initiatives to enhance youth support as a protective factor 93
Figure 29: Pilot Māori art and culture activity to raise awareness of gambling harm 94
Figure 30: Community consultation in resource development 100
Figure 31: Establishment of a consumer voices action group 105
Figure 32: Youth education programme to enable informed discussions on gambling harm 111
Figure 33: Development of evidence-based promotional materials for problem gambling prevention 114
Figure 34: Adapted Logic Model: Supportive Communities 119
Figure 35: Preliminary Logic Model: Aware Communities 120
Figure 36: Youth awareness raising radio programme 124
Figure 37: Systematic approach to developing an organisational Facebook page 127
Figure 38: Provider-organised local event in line with the national Scribe With Us rap competition 138
Figure 39: Marae-based health promotion 145
Figure 40: Designing an awareness raising cultural performance 147
Figure 41: Adapted Logic Model: Aware Communities 151
Figure 42: Preliminary Logic Model: Effective Screening Environments 152
Figure 43: Stakeholder sectors identified for PGPH-05 154
Figure 44: Development of public health materials in relation to problem gambling-related domestic violence for the police 156
Figure 45: Approaching medical centres to screen for problem gambling 157
Figure 46: Development of a problem gambling harm minimisation programme for professionals 158
Figure 47: Encouraging screening practices among other community support and health services 160
Figure 48: The development of a screening and referral toolkit 163
Figure 49: Adapted Logic Model: Effective Screening Environments 170
LIST OF ABBREVIATIONS AND ACRONYMS
ABACUS / ABACUS Counselling, Training & Supervision LtdAOD / Alcohol and Other Drugs
DHB / District Health Board
DIA / Department of Internal Affairs (New Zealand)
GPs / General Practitioners (non-specialist physicians)
HPA / Health Promotion Agency (Crown entity established on 1 July 2012)
HSC / Health Sponsorship Council[1]
MOH / Ministry of Health (MOH)
MP / Member of Parliament
MVE / Multi Venue Exclusion
MVSE / Multi Venue Self Exclusion
PGPH / Problem Gambling Public Health
TAB / Totalisator Agency Board
TLA / Territorial Local Authority
WINZ / Work and Income New Zealand
1 Introduction
This report serves as a supplementary findings report to the final report, Evaluation and Clinical Audit of Problem Gambling Intervention and Public Health Services submitted to the Ministry of Health.
The objectives of Phase 2 of this evaluation included a desktop analysis of existing public health activity data (sets of six-monthly narrative reports submitted by 20 problem gambling public health service providers to the Ministry of Health) between the period July 2010 and June 2013. This report provides a summary of findings from a document analysis of these narrative reports. Chapters 3 to 7 provide an overview of the delivery of the five public health problem gambling service specifications as reported by the 20 contracted providers. A glossary of terms is provided at the end of this report.
2 Method and analysis approach
2.1 Method overview
The method used for this part of the evaluation, referred to as “document analysis”, has been described as an organised process of reviewing or evaluating sets of documents which when used in combination with other qualitative research methods offers a means of triangulation of data sources (Bowen, 2009). Documents typically used in evaluation include non-technical literature “that have been recorded without a researcher’s intervention” such as meeting minutes, background papers, correspondence records and reports among others (Bowen, 2009, p. 27).
As described above, the documents selected for this evaluation were sets of six-monthly narrative reports submitted to the Ministry of Health by 20 problem gambling public health (PGPH) service providers between July 2010 and June 2013. These narrative reports on the delivery of problem gambling public health services along with reports on intervention services is required as part of the service providers’ contracts with the Ministry.
Despite some limitations discussed in the section below, these narrative reports were a rich source of data that formed a key component of this evaluation. The five specific functions of documentary materials described by Bowen (2009, p. 29-30) were relevant to the current evaluation process as the six-monthly narrative reports offered:
1. Background information, historical insights and the context within which providers operated;
2. Historical data that informed the development of essential evaluation questions to be included in the surveys and focus group interviews;
3. Supplementary data which provided “valuable additions to a knowledge base” particularly in the form of best practice examples and a record of areas for improvement;
4. A way for “tracking change and development” over time through an analysis of progress reported on specific projects and activities; and
5. “A way to verify findings or corroborate evidence from other sources”. While contradictory findings would suggest the need for further investigation, “convergence of information from different sources” would result in greater reader “confidence in the trustworthiness (credibility) of the findings”.
Each service provider submitted up to six progress reports during the period of analysis, largely following the format described in the Ministry’s Service Specification document. PGPH service providers were required to report on specified details for five purchase units: Policy Development and Implementation (PGPH-01), Safe Gambling Environments (PGPH-02), Supportive Communities (PGPH-03), Aware Communities (PGPH-03) and Effective Screening Environments (PGPH-05). In addition to this “regular reporting on the delivery of problem gambling public health services” PGPH service providers were also requested to submit annual public health work plans using a specified template. “The Ministry’s intention [was] that this [would] be a useful tool for providers to align their key public health projects across the independent service lines of the problem gambling specification, and also demonstrate how the projects align with the Ministry’s Outcome Monitoring Framework” (Ministry of Health, 2010, p. 43).