Post on 19-Jan-2016
©2008 The GPPC Initiative 1
The Future of Gambling Patient Placement
GPPC
©2008 The GPPC Initiative 2
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.
©2008 The GPPC Initiative 3
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?
©2008 The GPPC Initiative 4
So What’s the Problem?
• Lack of mutually agreed-upon criteria
• Lack of evidence basis• Lack of continuity• Lack of outcome tracking
©2008 The GPPC Initiative 5
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
©2008 The GPPC Initiative 6
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
©2008 The GPPC Initiative 7
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
©2008 The GPPC Initiative 8
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
©2008 The GPPC Initiative 9
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”)
©2008 The GPPC Initiative 10
The GPPC Toolkit
• The GPPC Form• The Working Aid• Level of Severity rating scale• Level of Care rating scale• Diagnostic criteria• Screening tools• Examples
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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
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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)
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Severity Scale
9 – Significant Impediment to Treatment
5 – Moderate Symptoms
1 – No significant impairmentor distress
©2008 The GPPC Initiative 14
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
©2008 The GPPC Initiative 15
We Get the Client’s Drift
Duration
Recurrence
Intensity
Financial impact
Type
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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
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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
©2008 The GPPC Initiative 18
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
©2008 The GPPC Initiative 19
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
©2008 The GPPC Initiative 20
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
©2008 The GPPC Initiative 21
Dimension 6
D6) RECOVERY/LIVING ENVIRONMENT:
EmploymentHousingTransportationCohabitantsFamily/Friends; Social constellationATOD/Behavioral environment
©2008 The GPPC Initiative 22
Focus Areas
• DRIVING DIMENSIONS:– For this phase of treatment– Any remarkable presentation
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Focus Areas
• VULNERABILITIES/STRENGTHS:– Risk & Protective factors– Pending arrest/eviction/repossession – Threats, destabilizing factors– Spirituality, support groups– Other counseling– Individual Initiative
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Focus Areas
• SUICIDALITY; THREAT TO SELF/OTHERS:– Ideation/statement/attempt– Inhibitors– PLAID PALS Screen
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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)
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Administrative
• PROVISIONAL TREATMENT PLAN & DISCHARGE/TRANSITION CRITERIA– Recommended treatment approach– Goals at each LOC– Transition to subsequent LOC– Aftercare
©2008 The GPPC Initiative 27
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
©2008 The GPPC Initiative 28
GPPCContact, Information &
Assistance• www.TheGPPC.com• 1.877.979.4774
(1.877.979.GPPC)• (775) 284.7234• (775) 284.5336 fax
©2008 The GPPC Initiative 29
We’re Here
• Assistance• Consultation• Collaboration• Referral• Training• Outreach
©2008 The GPPC Initiative 30
The Future of Gambling Patient Placement