Problem Gambling Foundation of New Zealand Narelle Nichelsen Practice Leader, Northern region
Beyond an Addictions paradigm
Outline for presentation Description of 5-step counselling method and rationale Who is it for? Who developed it? My experiences to date & how it changed my practice Successes, challenges, next steps
Who developed 5-Step counselling?
Rationale for 5 Step Invisibility in the research - Experience of AFM affected by another person s harmful gambling and AOD issues Lack of comprehensive assessment tools Lack of information about AFMs Services typically do not market themselves effectively to AFMs All has led to a lack of support for AFMs
Why I took up the challenge 5-step supports practitioners and organisations to roll out Supporting Parents Healthy Children guidelines within NZ Supporting people to be well supported parents As a practice leader I am passionate about championing interventions that support family members and to build resiliency within families Gambling harm creates highly stressful experience for whole whanau AFMs present high nervous system arousal, behavioural indicators of stress, anxiety and depression, suicidal risk AFMs focus on person experiencing harm, do not notice own needs for support, care and attention Practitioners becoming advocates for AFMs
What is 5 Step counselling method? Structured, short term counselling approach Evidence-based intervention & assessment tools for AFMs in their own right Stress strain coping social support (SSCS) developed by researchers Model suggests coping may play moderator role in relationship between AFMs stress and symptoms (strain) Includes client & practitioner workbooks
What is in each step? Copello, Templeton, Krishnan, Orford, Velleman 2000, 2010; George & Bowden-Jones 2015, Velleman et al 2011 Step 1 Describe their experiences of living with a relative (colleague or friend) with a gambling problem Complete family member questionnaire Step 2 Provide useful information targeted to addiction and other areas Step 3 Explore options for coping Assertive; engaged emotional, tolerant inactive; withdrawal Step 4 Explore social support Social network diagram Step 5 Summary and planning for additional support Couple, family or individual counselling; facilitation to another service
Family Member Questionnaire Completed at step 1, step 5 and 3 months follow up Each person has 3 scores Therapeutic and assessment function Raises awareness of range of issues Normalises, reduces stress and isolation, acknowledgement
FMQ sample questions Last three months..
Scoring for FMQ total family burden score
Initial Gambling data N = 14 12 people were living with person experiencing gambling harm 86% female, 14% male
Initial Outcomes Step 1, Step 5 & 3 month N= 8
Client snapshot: Stress Up, Strain down Total family burden score increased between step 1 and step 5. Stress levels up (arguments with extended family who took sides with gambler; not being believed about gambling misuse, feeling ostracised) Strain has gone down, coping better, feeling stronger; not worrying about what others think
Stress and strain reducing over 5 steps for clients
Client feedback What have you noticed has improved since you started 5-step? understanding need to educate myself around options and support rather than solely being in a reactive role 45 years NZ European, current female partner I feel relaxed about the situation, before 5-step I felt worried, now I have the insights that the programme delivers and I am able to think calmly and rationally Mother of adult son with gambling harm I feel more confident about talking to the person I am supporting if I have concerns or want to check in 55 years, NZ European female
Client feedback What have you noticed has improved since you started 5-step? I have better defined boundaries, feel able to accept others for what they think of me without taking on board their comments and feeling hurt 46 years, NZ European female, ex partner I have improved my mind and body 39 years, NZ born Vietnamese ex-husband If you had to pick one thing to say about 5-Step, what would it be and why? although tough at times to go back and explore painful relationships that I have left behind, I realise that I am stronger for doing so feel less affected/impacted by the lies and much calmer in myself 46 years, female, NZ European ex partner
How 5-Step changed my practice Built competency for working with AFMs Assessment tool for AFMs and skills based approach Coping skills Clients leave programme more resourced and capable, resilient Increased satisfaction 5-step effectively normalises their experience, reduces isolation and stress and increases safety
Client feedback positive Successes Reduction in total family burden score at step 5 & follow up Stress & strain reducing over 5 steps Coping better, accessing social support even when gambler is relapsing 80% AFMs completed 5-step programme & follow up Retained AFMs in counselling for longer to complete 5 sessions & liked structure
Challenges Ongoing commitment from agencies & addiction sector workforce is required Ongoing staff training in 5-step and support the completion of accreditation Practitioners need to be able to continue with accreditation if employment changes and remain in addiction sector Need dedicated 5-step practitioners in all addiction agencies Family friendly and engaging marketing and advertising to promote 5- step Provide information about 5-step at all points of entry to service. Low referral rates - agencies need to re-orient their services to AFMS
Next steps? How to become a 5-Step practitioner 1. Organisation endorsement 2. Complete 5-step training with Matua Raki & Abacus to become accredited 5-Step practitioner 3. Complete competency based assessment - Assessors who are members of AFINet UK* (Orford, Templeton, Velleman et al) 4. For more information about 5-Step: Contact suzy.morrison@matuaraki.org.nz For minimising gambling harm workforce: contact Mary Anne Cooke at Abacus: ma@acts.co.nz or Narelle on narelle.nichelsen@pgf.nz Contact PGF: 0800 664 262; www.pgf.nz *Addiction and the Family International Network