OffGam

1. OffGam Offender ProblemGambling Reduction Programme Adrian Scarfe – Head of Clinical Services at GamCare Alison Wilson – Senior Research Associate at Lancaster University

2. “Good organisational reasons for programme success and failure” The course of events inside….

3. What is OffGam? • Partnership: GamCare & Lancaster University UK • Funded 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)

4. Presentation Format The OffGam process: Good organisational reasons for overall programme success & failure 2. Organisational Impacts on the Intervention Programme

5. Swift Programme Overview… NRC process holding up 2nd site a) Funding b) Finding a partner(s) c) Ethics The Main Programme: - Piloted questionnaire & prisoner focus group (7) The prevalence Study (201) - Identifying Volunteers (27) - Pre Screening for Intervention (10) - Pre Screening for Controls (17/27) The Intervention (10 → 7) - Post Screening Intervention (7) - Post Screening for Controls (3) - Intervention Evaluation - Tracking Process (incomplete)

6. Programme Principles • Can we evidence… • the prevalence of gambling? • a link to crime? • the need for intervention?

7. Problem Gambling & Top Line Findings Prevalence in Prison (Pilot Results N=201) • 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! →100%.

8. International – vs. – OffGam • (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.

9. Moving towards evidence of need… • 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

10. Research in Vulnerable Populations • 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”?

11. 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

12. The Organisational Story Engaging Management/Staff Regime & Culture Accommodation Remote Programme Management Perceptions & Experience

13. The Population Story Recruitment Tracking Motivation Humanistic Approach Dropout Rates Engagement Prisoner Support

14. Environmental Factors Impacting on Research • 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)

15. What does it take? Partnership Realistic Innovative Significant Optimistic Negotiation Structure

16. Midway thoughts… Encourage, inform & facilitate thinking… Managing the organisational impacts…

17. Organisational Impacts During the Intervention Programme Now over to Adrian to talk more about the impacts during the ‘intervention’….the second phase of our programme!

18. Organisational Impacts on InterventionProgramme • Delivery and direction of intervention programme • Motivation and engagement in the programme • Group process • Outcomes of intervention programme

19. Deliveryand Direction • 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

20. Motivation • 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

21. Engagement • Different 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

22. Pathologies • 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

23. 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

24. 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

25. Evaluation 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

26. Thankyou for listening… Adrian Scarfe GamCare Head of Clinical Services - UK Telephone: 020 7801 7008 Email: adrian@gamcare.org.uk Professor Corinne May-Chahal Jill Anderson Alison Wilson Applied Social Science Department Bowland College, North Lancaster University Bailrigg Lancaster LA1 4YT UK Telephone : 01524 594105 Email: c.may-chahal@lancaster.ac.uk Email: a.k.wilson@lancaster.ac.uk ASSURE web page: http://www.assure-evaluation.org.uk/