Quick Healthcare Quiz

What problem in the U.S. costs the government approximately $274 per adult annually?

If you guessed gambling, give yourself one point.  According to the latest research, nearly 6 million Americans have a serious gaming problem—a number that is on the rise.  One-third of the Nation’s adults visit a Casino every year, losing according to the latest figures an estimated 100 billion dollars.

Which problem is more common?  Substance abuse or problem gambling?

If you guessed the former, give yourself another point.  Problems related to alcohol and drug use are about 3.5 times more common than gambling.  At the same time, 281 times more funding is devoted to treating drug and alcohol problems.  In March 2014, the National Council on Problem Gambling reported that government-funded treatment was provided to less than one quarter of one percent of those in need.

Does psychotherapy work for problem gambling?

If you answered “yes,” add one to your score.  Research not only indicates that psychological treatment approaches are effective, but that changes are maintained at follow up.  As with other presenting problems (e.g., anxiety and depression), more therapy is associated with better outcomes than less.

What is the key to successful treatment of problem gambling?

If you answered, “funding and getting people into treatment,” or some variation thereof, take away three points!

So, how many points do you have left?  If you are at or near zero, join the club.

Healthcare is obsessed with treatment.  A staggering 99% of resources are invested in interventions.  Said another way, practitioners and healthcare systems love solutions.  The problem is that research shows this investment, “does not result in positive implementation outcomes (changes in practitioner behavior) or intervention outcomes (benefits to consumers).”  Simply put, it’s not enough to know “what works.”  You have to be able to put “what works” to work.

Enter the BC Responsible and Problem Gambling Program—an agency that provides free support and treatment services aimed at reducing and preventing the harmful impacts of excessive or uncontrolled gaming.  Clinicians working for the program not only sought to provide cutting-edge services, they wanted to know if they were effective and what they could do to continuously improve.

Five years ago, the organization adopted feedback-informed treatment (FIT)—routinely and formally seeking feedback from clients regarding the quality and outcome of services offered.    A host of studies documents that FIT improves retention in and outcome of psychotherapy.  Like all good ideas, however, the challenge of FIT is implementation.

Last week, I interviewed Michael Koo, the clinical coordinator of the BCRPGP.  Listen in as he discusses the principles and challenges of their successful implementation.  Learn also how the talented and devoted crew achieve outcomes on par with randomized controlled trials in an average of 7 visits while working with a culturally and clinically diverse clientele.

As you’ll hear, implementation is difficult, but doable.  More, you don’t have to reinvent the wheel or do it alone.  When FIT was reviewed and deemed “evidence-based” by the Substance Abuse and Mental Health Services organization in 2013, it received perfect scores for “implementation, training, support, and quality assurance” resources.  Regardless of the population you serve, you can:

• Join a free, online, international community of nearly 10,000 like-minded professionals using FIT in diverse settings (www.iccexcellence.com).  Every day, members connect and share their knowledge and experience with each other;
• Access a series of “how to” manuals and free, gap assessment tool (FRIFM) to aid in planning, guiding progress, and identifying common blind spots in implementation.
• Attend the upcoming, 2-day FIT Implementation workshop.  Held once a year in August, this event provides an in-depth, evidence-based training based on the latest findings from the field of implementation science.

Come meet managers, supervisors, practitioners, and team leaders from around the world. You will leave the tools necessary to “put ‘what works’ to work.”

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence