Community-designed screening tool aims to help GPs and community workers identify gambling harm and improve patient outcomes
1st September 2020
In NSW, 7.2 per cent of people who gamble are considered to be a moderate-risk or problem gambler according to the Problem Gambling Severity Index (PGSI).
Residents of Fairfield LGA lose $1.4 million to poker machines each day, more than any other LGA in NSW.
These alarming statistics have underpinned our Gambling Harm Screening and Referral Project led by the Fairfield City Health Alliance, a unique collaboration between SWSPHN, the South Western Sydney Local Health District and Fairfield City Council.
During the past 18 months, the project team led the co-design and piloting of a gambling harm screening model in the Fairfield LGA which aimed to:
- Improve identification of patients experiencing gambling harm
- Educate GPs and community workers about the issue of gambling harm
- Increase referrals to support services
Black Dog Institute-led CPD session for GPs, Problem Gambling and Mental Health Online Program for GPs - 23 September. Learn more
Community STaR is hosting a one-off webinar via Zoom to outline the results of the Screening for Gambling Harm pilot – 17 September. Learn more
Why was Fairfield chosen for the pilot project?
In 2019 the Fairfield City Health Alliance proposed the piloting of a community-designed screening tool to equip GPs and community workers with the resources and the tools to identify and assist patients access appropriate support services.
Fairfield LGA was chosen not only because of the prevalence of gambling harm in the city where $1.4 million is lost to poker machines each day, but because people from all walks of life are represented in its diversity of cultures, religions and social backgrounds.
What are the challenges to addressing gambling harm?
One of the greatest challenges to addressing gambling harm is that it is not part of the mainstream health system. Support services, referral and education information is largely provided outside the health system, via a separate stream of funding provided by levies on gambling products in NSW. This unfortunately contributes to a lack of knowledge about gambling harm, screening and referrals to support services particularly in primary care settings.
Unlike other lifestyle questionnaires or assessment tools GPs use to identify issues relating to domestic violence, mental health and alcohol and other drugs, gambling harm screening is not embedded in general practice.
How did the co-design process work?
The co-design process brought together more than 100 participants including GPs, community workers, psychologists and consumers. It included a workshop which attracted 39 stakeholders, an online survey which drew 73 responses, and interviews with 29 participants and two focus groups involving eight healthcare professionals.
What was developed through the co-design process?
The screening tool itself was chosen and adapted, bringing together the Problem Gambling Severity Index Short Form (PGSI Short Form) – which focuses on the individual engaging in gambling behaviour - and Concerned Others Gambling Screen (COGS) – which focuses on an individual experiencing harm as a result of another person’s gambling. The screening tool steps the practitioner through a series of questions, with responses weighted to produce an indicative screening outcome. Information packs were also provided to every participant with resources on the available support services and how to access them, and training materials including motivational interviewing techniques in the context of gambling.
A model for screening was also developed as part of the co-design process. The model recommends that all patients be screened to reduce stigma, ensuring of course that the screening is done in a safe environment at the beginning of an appointment. Ethics approvals stipulated that only those over the age of 18 may be screened in the pilot.
Who participated in the pilot project?
Healthcare providers in Fairfield LGA were invited to express their interest in implementing the screening model over 13 weeks during May to July. Participants included 10 community workers from a range of organisations and two GPs. More than 140 patients were screened during this period.
How did the pilot pivot in response to COVID-19?
The initial project called for face-to-face screening and, in the case of GPs, having the questions completed in the waiting room. The project moved online, acknowledging that many practitioners were moving to telehealth arrangements in response to the COVID-19 pandemic.
What were the results of the pilot project?
The levels of harm identified were higher than expected, with more than one in four of the 142 people screened experiencing some level of gambling harm across the continuum.
While financial harm was most often talked about given its measurability, individual harms also included relationship breakdown, deceitful behaviour, anxiety, stress, depression and in the most severe cases incarceration for fraud, embezzlement and stealing to support the habit.
Participants were interviewed at the conclusion of the pilot and were very positive about the project saying the screening tool was definitely successful in identifying gambling harm with many surprised at the prevalence of gambling harm in Fairfield LGA.
What happens now?
The project team is compiling a report for the Office of Responsible Gambling with the results and recommendation of the scalability acceptability of the screening tool. The report will go to the department at the end of this month (September). The team is also disseminating information about the screening tool and associated resources to GPs and community organisations.
SWSPHN is funding a Black Dog Institute-led CPD session for GPs, Problem Gambling and Mental Health Online Program for GPs, on Tuesday, 15 September. Unfortunately, this session is now full but an additional session funded by the NSW Ministry of Health has been added on Wednesday, 23 September from 6pm to 8pm. Register now.
Community STaR (outreach service of the Centre for Health Equity Training, Research and Evaluation) is also hosting a special one-off webinar via Zoom with Project Manager Nick McGhie presenting the results of the Screening for Gambling Harm pilot on Thursday, 17 September from 10.30am to 11.30am. To find out more and join
For more information about the Gambling Harm Screening and Referral Project, please email Integrated Health Coordinator Nick McGhie on email@example.com