adrian scarfe – head of clinical services at gamcare alison wilson – senior research associate...

Adrian Scarfe – Head of Clinical Services at GamCare

Alison Wilson – Senior Research Associate at Lancaster University

Offender ProblemOffender Problem Gambling Reduction ProgrammeGambling Reduction Programme

““Good organisational reasons for Good organisational reasons for programme success and failure”programme success and failure”

The course of events inside….The course of events inside….

Partnership: GamCare & Lancaster University UKFunded by RIGT (Responsibility in Gambling Trust)18 month screening, treatment & evaluation study (2007-2009)2 pilot sites – North West (Risley/male pop’n) & South (hopefully Holloway/female pop’n)

What is OffGam?What is OffGam?

1. The OffGam process: Good organisational reasons for overall programme success & failure

2. Organisational Impacts on the Intervention Programme

Presentation FormatPresentation Format

Swift Programme Overview…Swift Programme Overview…a) Fundingb) Finding a partner(s)c) Ethics

The Main Programme:The Main Programme:- Piloted questionnaire & prisoner focus group (7)

The prevalence Study (201)The prevalence Study (201)- Identifying Volunteers (27)- Pre Screening for Intervention (10)- Pre Screening for Controls (17/27)

The Intervention (10 → 7)The Intervention (10 → 7)- Post Screening Intervention (7)- Post Screening for Controls (3)- Intervention Evaluation- Tracking Process (incomplete)

NRC process holding up 2nd site

Can we evidence…

the prevalence of gambling?

a link to crime?

the need for intervention?

Programme PrinciplesProgramme Principles

Salient Points of evidence:

Averaging a 64% response rate (315)

5.4% considered their current offence was linked to gambling

12% of those who answered linked gambling to past offending (21% of gambling cohort)

52% of prisoners knew of 1> prisoners with a gambling problem

Abstainers why? Minimising risk of involvement in gambling activities & avoiding consequences – Ethics picked up on this issue!

Problem Gambling & Top Line FindingsProblem Gambling & Top Line FindingsPrevalence in Prison (Pilot Results N=201)

→100%.

(Williams, et al, 2005) 1/3 of criminal offenders meet criteria for ‘problem or pathological gambling’. This is the highest rate yet found in any population. OffGam supports this finding…(28%)

The prevalence rate of ‘gambling’ within this prison population (approx 57%) appears lower than in the general population (71% as per BGPS, 2007: so more prisoners are abstaining). Problem and/or pathological gamblers also appear to be disproportionately represented among prison populations… All of which are patterns reflected in Williams et al, 2005 Global Review on Gambling & Problem Gambling in Forensic Populations.

International – vs. – OffGamInternational – vs. – OffGam

Lack of screening & specialised provision of help in correctional facilities (Williams et al, 2005)

…OffGam confirms this.

Current (male) prison population approx 78,690*- 10% (PG) = 7,869 - ⅓ of male prisoners (28%:PG & Pathological) = 22,033- (28% - female population:4,510 = 1,263)

13% (27 No.) volunteered for intervention: - Wave 1 began Dec 2008 (N=201)

Prison Population Projections 2008–2015 *Ministry of Justice Statistics bulletin (June 2008)http://www.justice.gov.uk/publications/prisonpopulation.htm

Moving towards evidence of need…Moving towards evidence of need…

http://www.justice.gov.uk/publications/prisonpopulation.htm

http://www.justice.gov.uk/publications/prisonpopulation.htm

Consider that…

In general, research appears to be conducted in vulnerable populations so why is it that the prison population is more commonly neglected (e.g. BGPS, 2007)?

…”Facing the HMP challenge”?

Research in Vulnerable PopulationsResearch in Vulnerable Populations

What are the challenges?What are the challenges?From our experience to date, there are various challenges that may reduce both opportunity and frequency of research carried out in [UK] prisons – it is these factors that may also influence the degree of programme success or failure!

ORGANISATION

The Organisational StoryThe Organisational StoryR

egim

e & C

ultu

re

Engaging Management/Staff

Accommodation

Remote Programme Management

Perceptions & Experience

Alison Wilson

Genuine understanding expressed about programme needs for decent accommodation but by delivery time simply didn't have it (ETS overrun)! No compensation for move (terrible repercussions - THE KEY for the remote spare room). Many times programme [could] not be prioritised due to regime & work pressures. Lack of importance placed on us means men may establish perception of 1. not being valued (green beverages) and 2. if HMP doesn't value it "then why should I"?

Alison Wilson

+: Prior HMP experience enabled us to navigate the regime & negotiate change(s) to overcome problems & protect programme but the reality is that the regime and the culture permeate every aspect of organisational story; it's also very personality driven (who is a 'can do's').ACU are also central to everything - the hub! If you haven't got them on board things become very frustrating! At the mercy of key contacts.

Alison Wilson

Physically remote but process was connected through partnership. Knowledge of prison systems helped negotiating problems. Prescreen: ACU directed 3 men to us (1/2 men didn't know they had to go & 1 waited 2 hrs due to ACU releasing him at 7:30am - very pissed off - had to chase up other 6. Postscreen took place in 2 stages due to lack of interest - no one was talking to them! Due to changes in 'champions' & preference/style of doing things (facilitator vs do-er), psychology organised but we had to fit in [naturally] with workloads & priorities but approach vastly reduced our presence & contact with men.

Alison Wilson

3 Stage Process - 3 champions all pivotal to rollout! (Eileen - route to Gov; Monica - wing Gov facilitator deeply connected to wing/staff; Jenefer(psych) - at ground level connected to regime/coordination training & prisoners but we lost links at other levels, which compromised OffGam by the loss of authority at these levels that otherwise allowed us to negotiate/navigate the system - we had to fit in, which wasn't always realistic & carried consquences for our connectedness with prisoners (6:30am start/lack of presence at end due to 'fitting in' with Jen).

Alison Wilson

Trained staff (substance use etc) starkly different in approach to OffGam than those not; very pesimistic about likely return rate (based on previous questionnaire responses); observing unsuccessful programmes/surveys; little training or interest in encouraging men (this can impact on partnership success). Staff negative towards to new programmes demonstrates to men that it's not valued by HMP therefore not worth doing!

The Population StoryThe Population Story

Recruitment

Engagement

Motivation

Dropout Rates

Tracking

Prisoner Support

Humanistic Approach

Alison Wilson

Alison Wilson12/05/2009Ease of engagement (prev study) due to understanding impact of other research at HMP; adopting a humanistic approach; planning; engagement of staff & prisoner reps; offering thanks & beverages; offering time; demonstrating appreciation... Personal approach was central to engaging men & acheiving an excellent response to the prevalence study (engaged that well, nearly got invited to gamlbe at the lunch table).

Alison Wilson

Canvassing throughout all stages of the process (e.g. prev study, screening & intervention). There are ethical restrictions using incentives BUT we provided drinks as thanks, which was appreciated & an good way of engaging with men & gaining feedback/expressions of interest.Our view towards 'what's in it for them': support; something different to do; help family with gambling issues; GAMBLING MOT etc.

Alison Wilson

Humanistic/face2face: initial humour giving out questionnaires re lunch trays, papers; popular were info packs (coloured pens/envelopes); prisoners returned with completed questionnaires & to talk; good response through face2face working; provided intervention info. Using key contact(s); repts etc; screening; maintaining contact; valued prisoners; answering questions; queiries & addressing concerns etc.

Alison Wilson

Excellent source of support: Recruited very helpful focus group for pilot questionnaire; briefed reps at mtgs re OffGam & engouraged canvassing on wings but formal attempts to engage here was more of a flop until we got 'inside' HMP. Personal approach on wing/during jobs got key prisoners volunteering to read programme materials; supporting prevalancence study; helping during refreshments (this was a challenge - disappearing stock).

Alison Wilson

7/10 volunteered for the intervention group; 17 for 2 control groups that whittled down to small handful. Dropouts: illness; parole impacts; loss of interest; delays; transfers; sentence completion. Low no. of controls rendered 2nd intervention group impossible. A further intervention group would have involved re-advertising, recruiting & screening new cohort of volunteers & controls all achieved in tight turn around - not cost effective. Adrian can say more.

Alison Wilson

Men consented to tracking post intervention/screen; todate only a handful are contactable; HMP now inform us that they haven't insisted on acquiring participant's contact details prior to release. Most men have been released. iffficult to persist with this despite earlier agreements that this would be done - back to regime; priorities; & loss of focus & interest etc. At end of the programme working remotely has drawbacks - hard to maintain staff 'interest'.

Alison Wilson

Our 'humanistic & hands-on-approach' with OffGam was central to pulling contacts together, lifting partnership off the ground, motivating staff & especially engaging prisoners to the extent that we did (impact of prevalence study experience) and finally reaching completion in this prison.

Complex & cross cutting environmental factors:

- Identifying a problem is a problem - Problem exposure at an organisational level- Risk exposure at a population level (e.g. vulnerable women)- Current treatment capacity (e.g. IDTS)- Funding?- Perceptions of bigger issues (e.g. homelessness)- Have we got the ‘basics’ in place before tackling something else?

- Co-morbidity (Proponent hesitancy e.g. gambling, crime & substance use)- Media attention (Governor hesitancy, fear of failure & causing elements of

doubt about the institutions abilities – also reflected in Williams, 2005)

Environmental Factors Environmental Factors Impacting Impacting

on Researchon Research

What does it take?What does it take?PartnershipRealisticInnovativeSignificantOptimistic NegotiationStructure

Alison Wilson

wilsona14/05/2009Without a 'partnership' the programme will likely produce poor outcomes. The rollout has been challenging but it has been a valuable 'joint venture' made possible by both sides by a collaborative hands-on-approach at every level.

Alison Wilson

wilsona14/05/2009Aims and objectives have to be realistic overall & at each stage of the process. Important to avoid complex ideas & increasing already high workloads of prison staff (researchers managed the prevalence study with staff assistance). We were keen to do it!

Alison Wilson

wilsona14/05/2009Research needs to 'offer' something innovative & new to the prison service - GAMBLING IS AN UP & COMING ISSUE WITH CURRENTLY POOR RECOGNITION & SERVICE PROVISION - & incentive to participants - OUR OFFER OF TIME, THE INVOLVEMENT (PS/INT) & BENEFITS OF OFFGAM - demonstrating that prisoners are valued & important to the process of research - ethics won't allow incentives - harder work!

Alison Wilson

wilsona14/05/2009The research should be significantly meaningful & understandable i.e. trying to bring about a positive transformation (raising the profile of gambling) - enough that the programme aims, objectives & processes can be clearly conveyed to all (top down process). If it's not, then ask why are you doing it (prisons should not be test beds for poor research - it is an abuse of both institution and population).

Alison Wilson

wilsona14/05/2009Confidence to be assertive and proactive to enable resolution of problems. Easy to focus on the problems & become bogged down! But, it is key to take a step back, retain optimism towards the overall picture, & ensure principle focus is not lost in the myriad of risks & challenges to completion.

Alison Wilson

wilsona14/05/2009Secure establishments are not flexible or readily compliant to research needs (must fulfill own aims) so it is therefore important to have negotiation/navigational skills; the ability to 'adapt' research, planning & implementation of programme at every point at little notice.

Alison Wilson

wilsona14/05/2009Ensure a robust research struture is in place to support the entire rollout process. Also key to have an equally good knowledge of the prison 'infrastructure' (communication lines, contacts, access & internal network) to increase ease of navigation through the system - the programme hangs on this!

Midway thoughtsMidway thoughts……Encourage, inform & facilitate thinking…

Managing the organisational impacts…

Alison Wilson

The presentation has highlighted some of the complexities, challenges & experiences that we hope might help facilitate your thinking around future prison research. Some of the challenges we faced may also explain to why there is so little research conducted with this population - IT IS COMPLEX & TIME CONSUMING TO GET IT RIGHT.The biggest influence on OffGam was the organisation that markedly impacted our work.

Organisational Impacts Organisational Impacts During the Intervention During the Intervention

ProgrammeProgramme

Now over to Adrian to talk more about the impacts during the ‘intervention’….the second

phase of our programme!

wilsona

Remember to explain the reasons for 'intervention' and that our remit was not to deliver treatment, which is an ethical issue in itself!

Organisational Impacts on Organisational Impacts on InterventionIntervention ProgrammeProgramme

Delivery and direction of intervention programme

Motivation and engagement in the programme

Group process

Outcomes of intervention programme

DeliveryDelivery andand D Directionirection

Delays and regime effects, together with maintaining overall integrity of workbook structure and content, meant normal requirements for group intervention formulation not available at time of roll-out

“Why this particular group member presents with these particular problems and behaviour at this particular time?”

Imperative that emphasis placed on successfully engaging group members to prevent loss of interest and possible detachment from learning process

MotivationMotivation

A way of engaging the group without pissing them off

Lack of immediacy with some group members

Only 2 of 7 had answered “yes” to pre-screen question “Do you gamble in prison?”

“I don’t know why I’m here”

Absence of immediate pre-occupation, urges and drives (together with element of self-protection) made maintaining motivation difficult in some cases

Important to avoid trying to force the immediacy

EngagementEngagementDifferent levels of engagement within the group

More dominant and vocal tended to deter quieter

Exacerbated by low group number (7)

Regime effects:

- potential impacts on parole and release

- role gambling plays in prison life

Related to personal histories and pathology

PathologiesPathologies

Vulnerability when contemplating and confronted with different ways of thinking and behaving

Rigid and inflexible ‘all-or-nothing’ absolutist thinking

Evidence of damaged and split sense of self

Defended self perpetuating an illusion of functioning without needs and admitting only gratification

Accumulation of under-developed and unattended needs subject to sudden eruption

Group Process (1)Group Process (1)

Danger of too strongly challenging or confronting such thinking (or interpreting individual comments as avoidance or resistance)

Escalation of confusion and frustration

Feeling of being overwhelmed, shamed and belittled

Dire consequences in a prison setting

Intensification of absolutist way of thinking

Evasive withdrawal from the group and programme

Group Process (2)Group Process (2)

Purposely provide flexibility in the programme to maintain an optimal level of frustration

Manage thoughts and feelings stated in the moment

Enable group members not to feel overwhelmed or shamed while frustration being experienced

Remain engaged in the programme

Prison officers familiar with participating prisoners passed over key information about how men were feeling on the programme and what issues were emerging

Evaluation and OutcomesEvaluation and Outcomes

Aim of programme to provide interventions for progress and change in attitude

Organisational issues did impact but motivation and engagement levels were good and sustained enabling group process to create an environment for change

Post programme outcomes were positive

Considerable reduction in individual and collective pre-and post-screen scores

Healthy and complimentary group evaluation comments about all three main components of the programme i.e. the instructor, group process and workbook

ThankThank you for listening…you for listening…Adrian Scarfe

GamCareHead of Clinical Services - UK

Telephone: 020 7801 7008Email: [email protected]

Professor Corinne May-ChahalJill AndersonAlison Wilson

Applied Social Science DepartmentBowland College, North Lancaster University Bailrigg Lancaster LA1 4YT UK

Telephone : 01524 594105Email: [email protected]

Email: [email protected] web page:

http://www.assure-evaluation.org.uk/

mailto:[email protected]





adrian scarfe – head of clinical services at gamcare alison wilson – senior research associate...

Documents

gambling problem gambling

prevalence of gambling

pathological gambling

linked gambling

gambling activities

gambling cohort

gambling problem abstainers

prevalence rate of gambling