©2008 the gppc initiative1 the future of gambling patient placement gppc

©2008 The GPPC Initiative 1

The Future of Gambling Patient Placement

GPPC


The GPPC Initiative

• The GPPC Team– Denise F. Quirk, M.A.– Janelle Baclayon, A.S.– Paula Chung, A.A.– Lynne J. Daus, M.A.– Colin Hodgen, M.A.– George E. Howell, M.A.– Dianne Springborn,

M.A.

• Advisory Members– Rena Nora, M.D.– Ken Winters,

Ph.D.


Gambling Patient Placement

• How do we determine patient placement?– Accurately– Reliably– Consistently

• How do we link screening & assessment?

• How do we track adjustment in LOC?• How can we harvest significant data?


So What’s the Problem?

• Lack of mutually agreed-upon criteria

• Lack of evidence basis• Lack of continuity• Lack of outcome tracking


So What’s the Point?

• The GPPC suggests ways to identify and link best practices in placement

• The GPPC suggests ways to link:– Screening– Assessment– Optimum placement– Effective treatment– Continuity of Care


The GPPC

• Compatible with ASAM PPC-2R and DSM

• Structures the patient placement process

• Guides assessment & treatment planning

• Links screening to assessment• Tracks movement in biopsychosocial

treatment dimensions• Provides documentation of effective

treatment


The Game Plan

• DHHS Grant from Revolving Account• Design, develop, disseminate the

GPPC• Refine based on practitioner

feedback• Produce the GPPC Manual• Train the workforce• Track pertinent data


The Timeline

• Develop and distribute the GPPC• Conduct Focus-Groups to refine the

GPPC• Collect completed GPPCs• Build the database• Analyze and incorporate the data• Publish the GPPC Manual


Phased Deployment of the GPPC

• All CPGCs and CPGC-Interns in NV• NV practitioners otherwise qualified

to diagnose Pathological Gambling• Leverage existing expertise for input

and referral (i.e., “Bridge-Building”)


The GPPC Toolkit

• The GPPC Form• The Working Aid• Level of Severity rating scale• Level of Care rating scale• Diagnostic criteria• Screening tools• Examples


The GPPC Form• Demographics• Dimensional Criteria with Severity Level• Driving Dimensions• Vulnerabilities/Strengths• Suicidality/Threat to Self & Others• Assessment Instruments & Results• Reports Made / Consents Given• Disposition/Follow-up/Appt/Reinterview• Provisional Tx Plan & Discharge Criteria


Dimensional Criteria

1. Frequency/Intensity/Duration of the Disorder

2. Biomedical Conditions / Complications3. Cognitive/Behavioral/Emotional

Conditions4. Readiness to Change5. History/Potential of

Relapse/Continued Problem6. Recovery/Living Environment

Adapted from ASAM PPC-2R (2001)


Severity Scale

9 – Significant Impediment to Treatment

5 – Moderate Symptoms

1 – No significant impairmentor distress


Our Working Hypothesis

• 3 or more Dimensions rated High (7-9)– May suggest Residential or Inpatient care

• 2 Dimensions rated High– May suggest Intensive Outpatient care

• Any Dimension rated High– May suggest Outpatient care

• Levels of care have varying levels of intensity based on severity


We Get the Client’s Drift

Duration

Recurrence

Intensity

Financial impact

Type


Dimension 1Pri/Cur

D1) FREQUENCY/INTENSITY/DURATION OF DISORDER

(DRIFT; Date/Amount last gambled; Urgency Co-occurring or Concurrent disorder; ATOD use; Big Win/Loss)

D Duration – How LongR Recurrence - How OftenI Intensity - How MuchF Financial Impact – How DeepT Type(s) of gambling – How Played


Dimension 2

D2) BIOMEDICAL CONDITIONS/COMPLICATIONS:

Prior/Current Dx / Tx / Meds

(Compliant?; Stable?; Satisfactory?)Vegetative symptoms (SAWES)Hx of accident/injury/surgeryHx of head trauma


Dimension 3

D3) COGNITIVE/BEHAVIORAL/EMOTIONAL CONDITIONS:

Prior/Current Mental Health Dx / Tx / Meds (Compliant?; Stable?; Satisfactory?)

Prior/Current ATOD use and/or Tx Prior/Current VEPS abuse Prior/Current Suicidal Ideation/Attempt

and/or family history; threat potential Hx of arrests/charges/incarceration


Dimension 4

D4) READINESS TO CHANGE:

Internal/external motivation to change and/or sustain change

Awareness of harmful effects Goals Self-help Stage of Change


Dimension 5

D5) HISTORY/POTENTIAL OF RELAPSE or CONTINUED PROBLEM:

Progression Prior/current ATOD/Behavioral abstinence/relapse Pressing events Triggers Relapse prevention skills/experience Intervention needs


Dimension 6

D6) RECOVERY/LIVING ENVIRONMENT:

EmploymentHousingTransportationCohabitantsFamily/Friends; Social constellationATOD/Behavioral environment


Focus Areas

• DRIVING DIMENSIONS:– For this phase of treatment– Any remarkable presentation


Focus Areas

• VULNERABILITIES/STRENGTHS:– Risk & Protective factors– Pending arrest/eviction/repossession – Threats, destabilizing factors– Spirituality, support groups– Other counseling– Individual Initiative


Focus Areas

• SUICIDALITY; THREAT TO SELF/OTHERS:– Ideation/statement/attempt– Inhibitors– PLAID PALS Screen


Administrative

• ASSESSMENT INSTRUMENTS USED:Prior/recent instruments used to

determine/adjust diagnosis or LOC

• REPORTS MADE:– External reports requested/required– Point of contact (Client release required)


Administrative

• PROVISIONAL TREATMENT PLAN & DISCHARGE/TRANSITION CRITERIA– Recommended treatment approach– Goals at each LOC– Transition to subsequent LOC– Aftercare


Administrative

• DISPOSITION / FOLLOW-UP / APPOINTMENT / RE-INTERVIEW:– Determination and disposition of report– Follow-up required/made– Next scheduled appointment – Continuation or re-interview required

• ADDITIONAL INFORMATION:– Interviewer identification/credentials– Date/location of interview


GPPCContact, Information &

Assistance• www.TheGPPC.com• 1.877.979.4774

(1.877.979.GPPC)• (775) 284.7234• (775) 284.5336 fax

http://www.thegppc.com/


We’re Here

• Assistance• Consultation• Collaboration• Referral• Training• Outreach


The Future of Gambling Patient Placement

©2008 the gppc initiative1 the future of gambling patient placement gppc

Documents

gppc initiative2008

gppc toolkitthe gppc

gppc manualtrain

gppc manual2008

placementthe gppc

gambling patient placementhow

screening assessment

asam ppc