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		Proceedings of the 19th annual conference on prevention, research, and treatment of problem gambling. June 23–25, 2005, in New Orleans, Louisiana. National Council on Problem Gambling, Washington, DC. Session II: Critical issues in problem gambling prevention, public health, and policy What is the role of problem gambling help line services? Presenter: Jeff Marotta (Introduction.) Loreen Rugle: I'd like to introduce Dr. Jeff Marotta. I have to say that he gets the humility award among all of the presenters. I think his is the briefest bio in the packet, not because he hasn't done much, but just as a sign of his humility. I'll embarrass him by saying that he's a previous winner of the student dissertation award for work on natural recovery, which was among the first work done in the field. The programs that he has developed for problem gambling in Oregon, I consider one of the models of using a public health approach to designing a whole range of interventions for problem gambling in state-funded programming. Jeff Marotta: Thank you Lori. And thanks to the council for inviting me here. And thank you all for being here at five o'clock. I have the task of defining the role of problem gambling help line services. And I was thinking, who am I to address this question? Shouldn't this be a question for the gambling help line? Let's give them a call right now. And let's find out from the people who answer the phone, what is their role? (Laughter.) We have a ring. Help Line Counselor: This is the Oregon Gambling Help Line. How can I help you? Jeff Marotta: This is Jeff Marotta. I'm at the National Conference on Problem Gambling, and I'm in a room with about two hundred people. Help Line Counselor: Oh boy. Jeff Marotta: And we wanted to ask you, what is the role of the help line? Help Line Counselor: The help line. What's our role? Most of the time, when people call this line, they are in crisis. Most of them have recognized that there's a loss of control. They're feeling pretty miserable. So this is a cry for help and we offer a referral service. That's our job. We try to get problem gamblers counseling and assistance, as close to their home as possible. We also are a crisis intervention team. We try to stabilize the person, and then encourage them to follow through with making a connection with an agency, so they can get free, confidential services. Jeff Marotta: Thank you very much. That was helpful and thanks for all the work that you do. (Applause.) Okay. You heard it from the expert. "What is the role of the help line?" You heard that the roles include crisis intervention, and facilitation into an appropriate level of care. I'm wondering if the help line counselor saw my slides. (Laughter.) There are other potential roles that are less apparent. Shortly after I moved to Oregon to administer the state's problem gambling services, I conducted a general assessment of the system. It became apparent that the system was not performing optimally. Because the help line was a vital piece of the system, I felt it was a logical focal point to begin system improvements. System data revealed that many more people were calling the help line than were getting into treatment. We were contracting help line services with an excellent firm staffed with mental health professionals. Help line counselors were well trained in crisis intervention but they were not problem gambling experts. We hypothesized this arrangement could have negatively impacted helpline performance in the following way; the counselor, not comfortable with the topic, may spend less time with the caller; the caller, not engaged by the counselor, may lose assurance in the system and motivation to follow-through with the referral. We have since restructured the Oregon Gambling Help Line and now contract with a gambling treatment agency for help line services. Certified problem gambling counselors staff the help line. With knowledgeable helpline counselors, the helpline can function beyond the traditional crisis intervention and referral roles to include a new role as the state's centralized information source on problem gambling. Callers get information from knowledgeable people about many things, including inquiries as to the winning lottery number. (Laughter.) A better example is the out-of-town callers looking for a GA meeting close to their hotel. They can call the help line and get that information. Another example is the concerned parent of a teen poker player who can call the helpline for information and advice on how to talk to their kid about risks. An often overlooked help line role is public relations. Help lines are usually one of the first services to enter jurisdictions. Their presence sends the message, "We are doing something to address this issue. If people come into problems with gambling, they can call this number, and they can get help." The public relations role can be expanded from a passive role to a more active one. A help line agency may actively promote community awareness through advocacy, coalition building, and working with state and local media. This public relations role is most evident in help lines operated by the state problem gambling councils. Case management is a role help lines traditionally have not played. This is a new role that we are trying out in Oregon to improve the conversion rate of help line caller to treatment enrollee. Instead of looking at that caller as a customer, the help line counselor is viewing callers as clients. Through a motivational interview process they listen, probe, and assist the caller to establish a solution-oriented plan. With the caller's consent, the help line counselor calls that client back to see if they followed through with their plan and continues to call until the client is engaged in the intervention of their choice. Let's look at this next slide. You heard from our help line counselor that his role is to handle crisis calls, to send people in a direction of treatment, and to facilitate entry into treatment. The top graph is composed of data provided by Nebraska and the bottom graph contains data from Oregon. Both graphs contain information on the number of calls to the help line and the number of new treatment enrollees. Both Oregon and Nebraska operate publicly funded gambling treatment systems. In Nebraska, we notice an inverse relationship between call volume and treatment enrollment. That is, as help line calls decreased, treatment enrollment increased. One interpretation of this finding is that the help line is not working. Another interpretation is that the help line worked extremely well. Without defining the roles and objectives of the service it is difficult to interpret these data. For example, if the role of the help line was to increase treatment utilization by kick-starting the system, it worked. That is, utilizing the help line, in conjunction with start-up media, to build up a client population large enough to generate a snowball effect. Word of mouth appears to be a primary vehicle delivering people to treatment in Nebraska. In Oregon we observe a positive relationship between call volume and treatment utilization. Why are the Nebraska data so different from the Oregon data? One confounding variable is diet. Nebraskans are obsessed with beef and Oregonians are obsessed with salmon. (Laughter.) The variable that more likely influenced the difference was help line advertising. During the time period this graph represents, Oregon invested $700,000 into promoting their help line number and in Nebraska the advertising budget was zero. Looking at call volume and treatment utilization data provides important information needed to manage and understand system performance. For example, if we observe help line volume increasing and treatment enrollment decreasing, that may indicate a treatment system at capacity. Are help lines efficacious? This topic has been debated in the literature on drug and alcohol help lines. A common argument against help lines is the finding that the proportion of callers that enroll in treatment is very small and most people in treatment did not arrive there through the use of a help line. Before we can determine if a help line is efficacious, we need to define the roles and objectives of that particular help line. After we determine what these roles are, we can then measure our progress in meeting the objectives. Multimethod evaluation procedures may include the measurement of call volume, treatment enrollment, public awareness, conversion rate of calls to treatment entry, user satisfaction, call time, length of call, and wait time. We need to look at the role of marketing. In Oregon, when TV ads were aired, call volume increased by 59 percent and treatment enrollments increased 39 percent. This is strong evidence that suggests good advertising combined with a good call line is effective in increasing care for people with gambling problems. Oregon is home to a relatively well-funded gambling treatment system. This allows Oregon to support its help line services with good referral options and good advertising. In jurisdictions that struggle for resources, there may be a greater importance to defining the different roles of their help line. Opportunities will be missed without expanding our thoughts about the roles help lines can assume. Different jurisdictions have different needs, so it starts with a needs and resource assessment. It is time for the developers of problem gambling help lines to expand beyond traditional help line roles and to look and think outside the box. As we assess help line roles over time, we need to evolve with the rest of the system. For example, the time may be near when help line providers also offer brief or minimal treatment interventions in order to target less severe problem gamblers or people who are not ready to enter traditional treatment. Another evolving role may be functioning as a centralized intake for jurisdictions with various levels of treatment. Perhaps we need to think of "help centers" as opposed to help lines with the growing importance of communicating through cyberspace. The time may be right to develop more of a Web presence, so that people seeking assistance can go to a site, gather information, and have the choice to interact with a counselor on a real-time basis. An Internet-based gambling help center may be particularly effective with the next generation of problem gambler growing up in the digital age of text messaging, instant messaging, and video conferencing. Furthermore, many problem gamblers may avoid calling a help line due to social anxiety, interpersonal discomfort, and feelings of guilt and shame, and may find a Web-based help center less intimidating. So what's the role of help lines? That is up to you. Go out and think! Think different! [End of session.] For correspondence: Jeffrey.j.marotta@state.or.us

		issue 15 — december 2005