Transcript The Future of the GPPC

The Future of Gambling Patient Placement
GPPC
©2008 The GPPC Initiative
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The GPPC Initiative
• The GPPC Team
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• Advisory Members
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.
– Rena Nora, M.D.
– Ken Winters, Ph.D.
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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?
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So What’s the Problem?
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Lack of mutually agreed-upon criteria
Lack of evidence basis
Lack of continuity
Lack of outcome tracking
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So What’s the Point?
• The GPPC suggests ways to identify and link
best practices in placement
• The GPPC suggests ways to link:
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Screening
Assessment
Optimum placement
Effective treatment
Continuity of Care
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The GPPC
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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
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The Game Plan
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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
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The Timeline
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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
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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”)
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The GPPC Toolkit
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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
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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 / Complications
3. Cognitive/Behavioral/Emotional Conditions
4. Readiness to Change
5. History/Potential of
Relapse/Continued Problem
6. 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 impairment
or distress
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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
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We Get the Client’s Drift
Duration
Recurrence
Intensity
Financial impact
Type
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Dimension 1
Pri/Cur
D1) FREQUENCY/INTENSITY/DURATION OF DISORDER
(DRIFT; Date/Amount last gambled; Urgency
Co-occurring or Concurrent disorder; ATOD use; Big Win/Loss)
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Duration – How Long
Recurrence - How Often
Intensity - How Much
Financial Impact – How Deep
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/surgery
Hx of head trauma
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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
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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
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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
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Dimension 6
D6) RECOVERY/LIVING ENVIRONMENT:
Employment
Housing
Transportation
Cohabitants
Family/Friends; Social constellation
ATOD/Behavioral environment
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Focus Areas
• DRIVING DIMENSIONS:
– For this phase of treatment
– Any remarkable presentation
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Focus Areas
• VULNERABILITIES/STRENGTHS:
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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
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Recommended treatment approach
Goals at each LOC
Transition to subsequent LOC
Aftercare
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Administrative
• DISPOSITION / FOLLOW-UP / APPOINTMENT /
RE-INTERVIEW:
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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
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GPPC
Contact, Information & Assistance
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www.TheGPPC.com
1.877.979.4774 (1.877.979.GPPC)
(775) 284.7234
(775) 284.5336 fax
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We’re Here
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Assistance
Consultation
Collaboration
Referral
Training
Outreach
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The Future of Gambling Patient Placement
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