Is more better? The relationship between outcomes achieved by problem gamblers and the number of counselling sessions attended

This paper addresses the question of how much intervention is necessary for the effective treatment of problem gambling by exploring the relationship between the number of counselling sessions attended and the degree of problem resolution achieved for 613 individuals who attended problem gambling counselling services in Victoria. While those who achieved partial or full resolution of presenting problems attended more sessions than those who finished counselling with their problems still unresolved, problems were typically reported as being resolved in fewer than five sessions. It is concluded that for some problem gamblers a relatively brief intervention may be sufficient.

Partners of problem gamblers who present for counselling: demographic profile and presenting problems

This study examined the characteristics of partners of problem gamblers. The study participants were 440 partners, who sought help in a 12-month period from the publicly-funded Break Even counselling services in the state of Victoria, Australia. The analyses revealed that the partners of problem gamblers were far from an homogenous group, with having to face the consequences of another person's problematic gambling seeming to be the only common characteristic. Almost one-third (29.6%) of clients were male and with the exception of financial problems, which were more likely to be reported by females, the presenting problems were similar. When compared to all Victorians aged 15 years and over, greater proportions of male and female partners of problem gamblers were participants in the labour force.

The influence of demographic, behavioural and treatments characteristics on problem gambling counselling outcomes

The paper considers the influence of client characteristics and gambling behaviour as well as treatment modality on the resolution of gambling behaviour for 591 clients who sought help from the publicly funded BreakEven counselling services in the state of Victoria between 1 July 1996 and 30 June 1997. Statistical data about clients and their consultations was collected in the form of a Minimum Data Set. On their own, client demographics accounting for 12% of the variance were identified as discriminating between problem gamblers who achieved some resolution of their gambling behaviour and those whose behaviour did not change. Variables associated with gambling behaviour accounted for 10% of variance and treatment variables for 12% of variance in treatment outcomes. Collectively, the three types of data could explain 26% of the variance in problem resolution. Importantly, these findings demonstrate that the resolution of problematic gambling behaviour is affected by a complex interplay of client characteristics, their gambling behaviour and the treatment they receive. It is argued that the evaluation of treatment programs for problem gambling, and potentially all counselling programs in the primary health arena, needs to include measures from each of these domains.

Not the same : a comparison of female and male clients seeking treatment from problem gambling counselling services

Previous studies of problem gamblers portray this group as being almost exclusively male. However, this study demonstrates that females comprised 46% of the population (n = 1,520) of persons who sought assistance due to concerns about their gambling from the publicly-funded BreakEven counselling services in the state of Victoria, Australia, in one 12-month period. This suggests that the model of service delivery which is community based counselling on a non-residential basis may be better able to attract female clients than treatment centres where males predominate such as veterans centres. A comparative analysis of the social and demographic characteristics of female and male gamblers within the study population was undertaken. As with previous studies, we have found significant differences between males and females who have sought help for problems associated with their gambling. Gender differences revealed in this study include females being far more likely to use electronic gaming machines (91.1% vs. 61.4%), older (39.6 years vs. 36.1 years), more likely to be born in Australia (79.4% vs. 74.7%), to be married (42.8% vs. 30.2%), living with family (78.9% vs. 61.5%) and to have dependent children (48.4% vs. 35.7%), than males who present at these services. Female gamblers (A$7,342) reported average gambling debts of less than half of that owed by males (A$19,091). These gender differences have implications for the development and conduct of problem gambling counselling services as it cannot be assumed that models of service which have demonstrated effectiveness with males will be similarly effective with females.

The effectiveness of callback counselling for smoking cessation: a randomized trial

Aims. The development of acceptable, widely available and effective smoking cessation methods is central to public health strategy for tobacco control. We examined the effectiveness of a telephone callback counselling intervention, compared to the provision of self-help resources alone.

Methods. Participants were 998 smokers calling a state-wide "Quitline" service randomly allocated to either callback counselling or ordinary care. The callback condition consisted of a series of brief counselling calls at strategic times in addition to ordinary care. The number of calls varied according to caller needs, and most occurred generally just before the person's quit day and in the week or two after it. The service was delivered by trained telephone counsellors.

Results. At the 3-month follow-up, significantly more participants in the callback group (24%) reported that they were quit, compared to those in the usual care comparison group (13%). The difference in point prevalence of smoking declined to 6% by the 12-month follow-up. Using sustained abstinence there was a significant benefit of callback counselling at 12-month follow-up. Treating dropouts as smokers reduced the overall magnitude of the effects somewhat. The benefit of callbacks was to marginally increase quit attempts and to significantly reduce relapse.

Conclusion. Our findings are consistent with those of other studies demonstrating benefits of callback telephone counselling to facilitate cessation. Such counselling provides a flexible, relatively inexpensive and widely available form of cessation service. It appears to encourage a greater proportion of quit attempts and to reduce the rate of relapse among those quitting. Further research is required to determine ways to enhance effectiveness, particularly studies of how to reduce relapse.

Cost-effectiveness of physical activity counselling in general practice

AIM: To assess the cost-effectiveness of the 'Green Prescription' physical activity counselling programme in general practice.
METHOD: Prospective cost-effectiveness study undertaken as part of a cluster randomised controlled trial with 12-month follow-up of 878 'less-active' patients aged 40-79 years in 42 general practices in the Waikato. The intervention was verbal advice and a written exercise prescription given by general practitioners, with telephone exercise specialist follow-up compared with usual care. Main outcome measures included cost per total and leisure-time physical activity gain from health-funders' and societal perspectives.
RESULTS: Significant increases in physical activity were found in the randomised controlled trial. Programme-cost per patient was NZ170 dollars from a funder's perspective. The monthly cost-effectiveness ratio for total energy expenditure achieved was 11 dollars per kcal/kg/day. The incremental cost of converting one additional 'sedentary' adult to an 'active' state over a twelve-month period was NZ1,756 dollars in programme costs.
CONCLUSION: Verbal and written physical activity advice given in general practice with telephone follow-up is an inexpensive way of increasing activity for sedentary people, and has the potential to have significant economic impact through reduction in cardiovascular and other morbidity and mortality.

Development of an instrument for the analysis of problem gambling counselling practice

This article provides an overview of the development and validation of a Counsellor Task Analysis (Problem Gambling) [CTA (PG)] instrument undertaken in order to document the activities of counsellors in problem gambling services. The CTA (PG) aims to provide a broad overview of the complexity of the counsellor's role; specify the range of tasks they perform; and document the relationship between the frequency of task performance and the counsellor's beliefs about the importance of the tasks performed.

The CTA (PG) instrument addresses nine dimensions of practice activity through nine subscales, all of which demonstrate internal consistency. It appears to be a strong instrument in terms of its measurement error characteristics for recommending its use with counsellors engaged in the field of gambling. The CTA (PG) gives counsellors the opportunity to document their practice and theories in use when dealing with a problem gambler, a member of the problem gambler's family and the community at large. The psychometric findings reported in this article should be viewed as the preliminary results of an ongoing research effort and further psychometric testing is anticipated.

An examination of financial counselling discourses in Victoria

This thesis investigates the model of practice invoked by the Victorian financial counselling sector. It analyses why community development is inconsistent with the sector's casework approaches to practice, identifies the emergence of a different model of practice and explains financial counselling within the current theoretical context of risk society.