Final Report on
Problem Gambling Research:
Delivery of Problem Gambling Services to Prisoners
9414953/332802/00
UniServices Task number (23459)
Auckland UniServices Limited
A wholly owned company of
The University of Auckland
Prepared for:
The Ministry of Health
Date: September 2013
Prepared by:
Brian McKenna
Robert Brown
Fiona Rossen
Claire Gooder
Centre for Gambling Studies
The Centre for Mental Health Research
Faculty of Medicine and Health
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given in UniServices reports should be stated in full.
McKenna, B., Brown, R., Rossen, F., & Gooder, C. (2013). Delivery of Problem Gambling
Services to Prisoners. Centre for Gambling Studies and The Centre for Mental Health
Research, Prepared for the Ministry of Health. Auckland UniServices Limited, The University
of Auckland.
Disclaimer
The Department of Corrections through its Strategic Analysis and Research team has
reviewed this report and approved it for publication. This final version reflects the views of
the author, which are not necessarily the views of the Department.
The researchers identify limitations to the research (set out on page 13). With respect to
these limitations, the Department wishes to emphasise that the bulk of the fieldwork
investigation was carried out early in 2011, at a time in which the Department was making
significant changes to its services to offenders. These changes, which include both the
quality and range of gambling services, mean that some of the findings of this report are no
longer applicable.
2
Table of Contents
List of Tables ........................................................................................................................................... 5
Executive Summary................................................................................................................................. 6
Introduction and Background...............................................................................................................14
Literature Review .................................................................................................................................. 15
Problem gambling interventions in prisons ..................................................................................... 17
Problem gambling interventions for the general population .......................................................... 20
Other addiction interventions in prisons ......................................................................................... 24
Cultural considerations in interventions ......................................................................................... 27
Conclusions from the literature ....................................................................................................... 28
Methodology......................................................................................................................................... 29
Research Aims.................................................................................................................................. 29
Research Design ............................................................................................................................... 29
Phase One: Literature Review.......................................................................................................... 29
Phase Two: Stock-take and Review of National, Regional and Local Prison-specific Policies for
Problem Gambling Interventions .................................................................................. 30
Phase Three: Case Studies of Problem Gambling Services in Two Prisons...................................... 30
Phase Four: National Anonymous Survey of Prisons ....................................................................... 33
Results: Policy and Procedures Review................................................................................................. 36
The Ministry of Health ..................................................................................................................... 36
The Department of Corrections ....................................................................................................... 36
Results: Case Studies............................................................................................................................. 44
Screening ...................................................................................................................................... 44
Referrals ........................................................................................................................................ 47
Interventions................................................................................................................................. 50
Follow - up .................................................................................................................................... 58
Additional themes......................................................................................................................... 60
3
Results: Survey ...................................................................................................................................... 63
Survey response rates and descriptions of samples ..................................................................... 63
Screening ...................................................................................................................................... 64
Referrals ........................................................................................................................................ 68
Interventions................................................................................................................................. 72
Follow - up .................................................................................................................................... 81
Discussion.............................................................................................................................................. 85
Screening ......................................................................................................................................... 86
Referrals ........................................................................................................................................... 88
Interventions.................................................................................................................................... 89
Follow-up and continuity of care ..................................................................................................... 92
Developing a ‘best practice model’ ................................................................................................. 93
Challenges of the prison environment ....................................................................................... 93
Cultural Issues ............................................................................................................................. 93
Type of intervention ................................................................................................................... 94
Timing ......................................................................................................................................... 94
Prioritising problem gambling among other criminogenic behaviours ...................................... 95
Continuity of care/follow-up for re-integration ......................................................................... 95
Evaluation and increasing effectiveness..................................................................................... 96
Conclusion – best practice model .................................................................................................... 96
References ............................................................................................................................................ 97
Appendix A: Case Study Interview Schedule ...................................................................................... 102
Appendix B: Participant Information Sheet, Case Studies .................................................................. 107
Appendix C: Consent Form, Case Studies ........................................................................................... 109
Appendix D: Survey for Prison Staff .................................................................................................... 111
Appendix E: Survey for Providers........................................................................................................ 127
4
List of Tables
Table
Title
Page
Table 1
The process of screening and assessment of problem gambling
40
Table 2
Prison Staff and gambling service providers’ perceptions of screening process
for problem gambling
65
Table 3
Prison Staff and gambling service providers’ perceptions of the outcome of
screening for problem gambling
67
Table 4
Prison staff and gambling service providers’ perceptions of the process of
referral for problem gambling
69
Table 5
Prison Staff and gambling service providers’ perceptions of the outcome of
referral for problem gambling
71
Table 6
Prison Staff and gambling service providers’ perceptions of general education
in prison for problem gambling
73
Table 7
Prison Staff and gambling service providers’ perceptions of problem gambling
interventions
74
Table 8
Prison Staff and gambling service providers’ perceptions of problem gambling
therapist needs
77
Table 9
Prison Staff and gambling service providers’ perceptions of culturally
appropriate interventions for problem gambling
78
Table 10
Prison Staff and gambling service providers’ perceptions of the outcome of
problem gambling interventions
79
Table 11
Prison Staff and gambling service providers’ perceptions of engagement
across other service providers
80
Table 12
Prison Staff and gambling service providers’ perceptions of follow up for
problem gambling prior to leaving prison
82
Table 13
Prison Staff and gambling service providers’ perceptions of follow up for
problem gambling
84
5
Executive Summary
The research project outlined in this report aimed to examine and explore the provision of
problem gambling services in New Zealand prisons. A mixed-methods approach was
adopted, and consisted of four phases: a review of the relevant literature; a stock-take and
review of national, regional and local prison policies for problem gambling interventions;
case studies of problem gambling services in two prisons; and a national anonymous survey
of prison staff and problem gambling service providers in New Zealand prisons. Fieldwork
for this research project was undertaken from late 2010 to mid-2011.
The literature review revealed that most of the research of problem gambling service
provision in prisons is based on individual case studies and is therefore site specific (for
example: Marotta, 2007; Nixon, Leigh, & Nowatzki, 2006; Walters, 2005). However, there
are some encouraging themes which should guide future development of services. In terms
of treatment approach, cognitive behavioural therapy (CBT) is most commonly cited as
efficacious in the treatment literature (Blaszczynski & Silove, 1995; Lopez Viets & Miller,
1997; Oakley-Browne, Adams, & Mobberley, 2000; Toneatto & Ladouceur, 2003). The
literature suggests that any form of intervention is beneficial (when compared to nontreatment), with brief or incomplete interventions providing a degree of behavioural change
(Krebs, Brady, & Laird, 2003; McCorkle, 2002; Moore, 2002; Petry, Weinstock, Morasco, &
Ledgerwood, 2009). The literature points to the benefits of screening and/or interventions
at various points in an offender’s incarceration: prior to sentencing, at the start and during
imprisonment, prior to release and in the process of re-entry into the community (D.J.
Williams, 2010). Compared to problem gamblers in the general population, problem
gamblers in the prison setting often have concurrent concerns: lower educational and socioeconomic status, personality disorders, or alcohol and other drug related difficulties
(Abbott, 2001b). Cultural relevance needs to be considered; New Zealand research has
identified a need for gambling interventions to address specific cultural needs (L. Perese,
2009; Robertson, et al., 2005; Tse, et al., 2008; Tse, Wong, & Chan, 2007).
The review of the Ministry of Health and the Department of Corrections’ policies identified
consistency in preventing and minimising gambling related harm in prisons throughout the
country. However the present study identified some discrepancies between these national
policies and the services provided by individual prisons and service providers.
This project developed a framework to describe the provision of problem gambling services
for prisoners. Four interrelated components emerged from the findings: Screening and
preliminary assessment; referrals; interventions; and follow-up. The results from the case
studies and the survey have been reported using this framework.
6
Screening & Preliminary Assessment
The responsibility for the screening and preliminary assessment of offenders rests with
prison staff, though the process is initiated before offenders enter into prison. Pivotal to this
process is the use of the Problem Gambling Severity Index (PGSI), known as the NINE (G9).
This is usually completed by probation officers in the Community Probation Services during
the standard pre-sentence assessment. The results of the NINE are used by prison sentence
planners in the development of an Offender Management Plan. The sentence planning
process allows the cross referencing of several sources of data, including an in-depth
interview of the prisoner by the sentence planner.
Regarding the use of the NINE there was general recognition that the NINE was easy to use
and quick to apply. However, both prison staff and problem gambling providers indicted
that the NINE failed to detect problem gambling for a significant number of prisoners.
Participants in the study gave a number of possible explanations for inaccurate NINE results,
including offenders’ not understanding the NINE or its items due to language difficulties
and/or its lack of cultural appropriateness and the potential for prisoners to misrepresent
their situation during the screening process (perhaps due to a motivation to manipulate the
system, a reluctance to disclose, or lack of self-awareness). Even when gambling problems
are identified by the NINE, there is potential for gambling issues in individual offenders to be
overshadowed by the presence of a ‘higher priority’ issue such as a drug or alcohol addiction
and violence.
Solutions to these difficulties focused on the need to improve detection by using the NINE
throughout the prisoner’s sentence. It was emphasized that the NINE is a screening tool
only. Positive screens should initiate a structured interview mirroring that which takes place
during sentence planning and the gathering of co-lateral information which enable the more
detailed account of problem gambling and associated needs.
Finally the study indicated that both prison staff and problem gambling service providers
were willing to improve inter-agency communication and supported education in the use of
the NINE to improve implementation strategies. This appears to be an opportunity to
improve the collaboration between prison staff and problem gambling providers to ensure
comprehensive and accurate screening of prisoners for gambling problems.
Referrals
The official process of referral is standard in all prisons and is primarily organised by prison
staff. Prison staff in this study generally believed the referral system was functioning
satisfactorily, in that it is comprehensive, and operates relatively smoothly and in a timely
manner for those prisoners identified as problem gamblers. Those involved in the study saw
no reason to change the status quo.
However prison staff were aware of other referral processes initiated by prison custodial
staff, prison psychologists, and those initiated by prisoners directly to the problem gambling
7
service provider. There appeared to be a deviation from national Department of
Corrections’ policy towards prison-specific processes, in some instances.
Unfortunately this part of the research was hampered by a number of ‘don’t know’
responses to the survey. For prison staff this knowledge deficit may have been either due to
the role of those surveyed being not closely associated with the process, or a changing
emphasis on rehabilitation by the Department of Corrections and associated staffing shifts
which overlapped with the study.
Problem gambling service providers also had a limited understanding of the referral process
and felt disconnected from it. However, they expressed concern that the existing referral
system missed some problem gamblers and in some cases there was a lack of
communication about the results of screening procedures. The passive role of problem
gambling service providers in the referral process may help explain the negative views
expressed by some problem gambling service providers on the effectiveness and efficiency
of the referral system.
In providing solutions to the perceived short-comings of the existing system, prison staff
saw present difficulties in the referral process as being rectified through moves by the
Department of Corrections to improve rehabilitation in prisons. For service providers the
limitations most commonly mentioned were relationship issues, with an emphasis placed on
the need for prison staff to be more supportive. When asked about suggestions to improve
the existing referral process both prison staff and providers highlighted the need for better
communication between prison staff and external problem gambling agencies.
Interventions
The Department of Corrections’ policy and individual prison requirements determine the
timing and assigned priority of problem gambling interventions for prisoners through the
referral process and scheduling. The intervention process is the domain of the service
providers.
Consideration needs to be given to whether a general health education approach would be
an appropriate and cost effective method of addressing the important public health issue of
problem gambling among the prisoner population. Both prison staff and problem gambling
service providers agreed with this need. However, broad education alone was not seen as
sufficient and needed to be combined with targeted interventions for problem gamblers.
A range of problem gambling interventions were being employed, including practical
worksheets, cognitive behavioural therapy (CBT), learning coping strategies, motivational
interviewing, the writing of reflective diaries and the development of relapse management
plans. The focus was on intense, short, self-contained one-on-one sessions with specific
goals, rather than long-term counselling.
8
Within the current focus on individual specialist interventions, it is interesting to note that
both prison staff and problem gambling service providers were amenable to the idea of
integration with more generic addiction or general rehabilitation programmes. The benefit
being that such integration would raise awareness about problem gambling and encourage
prisoners to work with one therapist over a range of issues.
Presently remand prisoners are not involved in problem gambling education or
interventions. Yet international research has indicated that this period of high stress is well
suited to address problem gambling close to when the behaviour is occurring, even though
the programme may be brief and interrupted by release from prison (Krebs, et al., 2003;
McCorkle, 2002).
Some prison staff had limited knowledge of the specifics of the interventions being
provided, which could affect their ability to be proactive in facilitating referral to such
services. This lack of awareness related to the quality of the relationship and level of
communication between prison staff and problem gambling service providers, which were
acknowledged as requiring improvement. Regular meetings were highlighted as a key factor
in establishing good working relationships and mutual respect between prison staff and
providers.
There is a need for education of prison staff on problem gambling, to off-set a perception
that addressing gambling is not a priority emphasis in rehabilitation. Like prison staff,
service providers could benefit from education on the links between screening, referral,
service provision and follow-up, so that both understand the entire process and can
facilitate the responsibilities of each other.
Follow-up and continuity of care
For those prisoners released under parole board conditions, probation officers are
responsible for monitoring and ensuring that offenders meet the specified conditions, which
may include criteria relating specifically to problem gambling. For the majority of prisoners
who are serving less than a 2-year prison sentence, there was no such provision for the
systematic follow-up of prisoners to address problem gambling needs. Following release
from prison the offender was to some extent left to his or her own devices in re-adjusting to
society and in resisting societal pressures that may facilitate gambling.
Prison staff and service providers acknowledged the lack of systematic follow-up and
support. There is a need for service providers to be involved in pre-release assessments and
planning. Systematic patterns of community referral need to be developed which contribute
to the continuity of service occurring in prison. Many providers considered that the ideal
scenario would be for those who had been providing a service to a prisoner to follow-up
with service provision post release, if this was pragmatically possible.
9
Developing a ‘best practice’ model
This study has endeavoured to describe the current situation in New Zealand in respect of
providing services to prisoners experiencing problem gambling and to identify strengths and
limitations of these services. This enables the projection of a ‘best practice’ model for
future service delivery. In order to move toward developing a best practice model, it is
necessary to address a number of elements identified in this study.
1. Challenges of the prison environment
Impediments or challenges caused by the prison environment include security issues,
prisoner transfers, disciplinary procedures, limited access to programmes, prison stressors,
and prison culture (Nixon, et al., 2006). Prison services are subject to impediments including
site-based divisions, institutional apathy (of both prisoners and staff), and poor relations
between prisoners, prison staff and external agencies that may be able to assist (Geller,
Johnson, Hamlin, & Kennedy, 1977).
This study confirms the presence of the above challenges in the accurate identification of
those with problem gambling issues and the subsequent provision of appropriate services.
Improving the communication channels between prison staff and those involved in the
provision of problem gambling interventions seems a necessary step to achieve greater
awareness and mutual respect of each other’s philosophies, cultures and objectives. Many
of the challenges that are currently apparent could be significantly addressed through open
and regular communication to build respectful professional relationships.
2. Cultural issues
Māori and Pacific peoples are over represented in problem gambling prison populations
(Bellringer, et al., 2009; L. M. Perese, Bellringer, Williams, & Abbott, 2009). The Department
of Corrections policy recognises the importance of addressing cultural needs within
rehabilitation services, “in order to reduce the likelihood of further reoffending”
(Department of Corrections, 2010c, p.6).
New Zealand research has shown that a gambler’s cultural background needs to be
considered in both screening and treatment (L. Perese, 2009; Tse, et al., 2007). This research
study highlights that there remains a need to integrate a Māori perspective more
comprehensively into problem gambling services provided to problem gambling prisoners
who are Māori. Regarding cultural concerns more generally, concerns were expressed over
offenders’ difficulty in understanding NINE screening items due to its lack of cultural
appropriateness; and the extent to which the problem gambling interventions currently in
place are culturally appropriate or inclusive of family or whānau involvement. It appears
likely that better addressing specific cultural needs would increase the take up and success
rates of prison-based interventions.
10
3. Type and timing of intervention
Tse and colleagues (2008) have noted that only cognitive and CBT therapies have a strong
evidence-base for success in addressing problem gambling. However, it should be noted
that Jackson et al. (2003) found limitations in the CBT approach, for example in its neglect
of important factors in a gambler’s life, including co-morbidity, substance dependence,
marital problems, financial hardship, isolation and loneliness, family and relationship
problems, post-immigration adjustment, and employment issues. These factors could be
particularly relevant for problem gambling prisoners. It is concluded that best practice for
addressing problem gambling is achieved through a combination of interventions (Jackson,
et al., 2003).
Our current findings suggest that some form of CBT or its derivatives are the most common
approaches used in New Zealand prisons, with a reluctance to use group interventions and
brief interventions. However, service providers find the prison environment challenging.
Support from prison authorities and staff is a necessary precursor for increasing provider
confidence sufficiently to facilitate more innovative intervention approaches.
Research suggests that the earlier in the sentence the prisoner is engaged in treatment, the
better the outcome (Krebs, et al., 2003; Moore, 2002). Yet rehabilitative interventions for
remand prisoners (close to the time of the problem behaviour) are not a Department of
Corrections requirement. Further, prison operational considerations may mean individual
sentenced prisoners are not offered interventions until late in their period of incarceration,
if at all.
Results in this study support a best practice of screening at multiple points in an offender’s
incarceration. It is suggested that all prisoners (both remand and sentenced) be screened,
and if identified as having a gambling problem, referred and offered interventions as soon
as it is practicable.
4. Prioritising problem gambling versus other criminogenic behaviours
Some researchers have recommended that where prisons have established programmes for
other addictions, attaching gambling interventions to these programmes could be an
effective way of capitalising on structures in place, using limited resources, and reaching
those in need (Emshoff, Zorland, Mooss, & Perkins, 2008).
In line with the above findings, the present study found that gambling is frequently
overshadowed by other addictive behaviours in New Zealand’s prison system. Providers as
well as prison staff generally considered that there was the possibility of combining
gambling interventions with more generic addiction based or rehabilitation based
programmes (though our study did not ascertain the extent to which this is already
happening). A feasible approach to absorbing gambling into other intervention programmes
has been outlined in the report by Wilson and Williams (2006).
11
5. Continuity of care/follow up for re-integration
Research has identified a lack of follow-up treatment once ex-prisoners are released into
the community (D.J Williams & Walker, 2009). They suggested educating parole and
probation officers about problem gambling and where to get treatment, so they can pass
this information on to prisoners prior to release (D.J Williams & Walker, 2009).
In this study, both prison staff and service providers highlighted a lack of continuity of care
in providing support for prisoners with problem gambling needs once they returned to the
community. There was even a lack of certainty as to who should take responsibility for
ensuring the continuity of care. We advocate for the active involvement of both prison staff
and service providers in the re-assessment of problem gambling need and release planning
to address this need at least six weeks prior to release, and the provision of regular contact
and follow-up support. Where ex-prisoners stayed in the local area, ideally follow-up should
be provided by the same prison therapist to enable continuity of care, within the context of
an existing therapeutic relationship. This initiative would require good communication and
relationship building between prison staff, probation staff and agencies providing problem
gambling services.
6. Evaluation and increasing effectiveness
Research evaluating the efficacy of problem gambling interventions mostly assesses single,
specific programmes, often involving only a small number of participants, and sometimes
studies do not include a control group. Some reviews have questioned the validity of such
evaluations on the basis of a lack of standardisation and poor methodological approach
(Oakley-Browne, et al., 2000; Toneatto & Ladouceur, 2003; Westphal, 2007). Researchers
have highlighted the need for further work in the area of determining best practices to treat
problem gambling amongst offender populations (Emshoff, et al., 2008).
Research has also emphasised the need to regularly evaluate prison problem gambling
programmes (Devilly, Sorbello, Eccleston, & Ward, 2005; Geller, et al., 1977). It is positive
that at least one national provider in New Zealand prisons has instigated a sessional process
evaluation protocol with prison interventions. There is a need to progress this process
evaluation to evaluation of treatment efficacy with offenders at post release follow-ups. In
this study, both prison staff and service providers expressed enthusiasm about being
actively involved in facilitating such research.
Conclusion - best practice model
On the basis of the literature review and this research, we propose the following ‘best
practice’ model for problem gambling interventions within prisons:
-
Good communication between prison staff and those involved in the provision of
problem gambling interventions to achieve greater awareness and mutual respect of
each other’s philosophies, cultures and objectives.
12
-
Thorough incorporation of cultural needs within problem gambling service
provisions (screening, referral, intervention and follow up).
-
General public health education on problem gambling for all prisoners and staff.
-
Integration of problem gambling into prison based rehabilitative programmes (e.g.
alcohol and drug units).
-
Active involvement by both prison staff and service providers in the re-assessment
and release planning of needs for problem gambling at least six weeks prior to
release, and the provision of regular contact and follow-up support.
-
Evaluation of the treatment efficacy with offenders at post release follow-ups.
This discussion has considered a number of the elements that appear necessary for
developing a best practice model of problem gambling services in prisons, based on the
literature review and the findings from this prison study. Such developments would require
collaboration between prison staff, probation officers and problem gambling service
providers based on strong, committed and supportive relationships.
Limitations
The authors want to highlight that this is a small scoping study and is not intended as an indepth analysis. The number of participants involved was relatively small, so detailed
statistical analysis did not result in inferential outcomes. The findings have been reported in
general terms because breaking the information down by prison or role could compromise
the confidentiality of individual participants who were interviewed and those who
completed the survey. The study includes the views of major stakeholders, but does not
include the important perception of prisoners.
The aim of this project was to provide a snapshot of the current provision of problem
gambling services in New Zealand prisons. As such it is a descriptive survey and can only be
taken to represent the situation at the point when the research was undertaken. It is
important to note that the research was undertaken at a time when Rehabilitation and
Reintegration Services (RRS) was being established within the Department of Corrections.
Many of the staff interviewed for the Problem Gambling report were new to their new roles
at the time of their participation in the research. Consequently, the information reflected in
the report is not an accurate portrayal of the intentions behind the reorganisation, nor is it
an accurate portrayal of the way in which the Department now works to identify offenders’
needs and manage the range of interventions in response to those needs.
13
Introduction and Background
The aim of this research project was to examine and explore problem gambling
interventions in New Zealand prisons. The project adopted a mixed-methods approach, and
consisted of four phases:
-
A review of the literature (Literature Review, pp.15–28);
-
A stock-take and review of national, regional and local prison policies for problem
gambling interventions (Results: policy and procedures review, pp.36–43);
-
Case studies of the problem gambling services provided in two prisons (Results: Case
Studies, pp.44–62); and,
-
A national anonymous survey of prison staff and providers of problem gambling
services in New Zealand prisons (Results: Survey, pp.63–81).
Details relating to the specific aims for each of these phases can be found in the
Methodology chapter, pp.29–35. The implications of the findings of these four phases are
discussed in the Discussion chapter, pp.82–94.
14
Literature review
Introduction
Research has shown that gambling creates serious social, financial and personal problems
(Abbott, 2001b) and that people with such problems need help in learning how to control
their urge to bet (Walters, 2005). The literature generally agrees that gambling exists on a
three-stage continuum: social or recreational gambling, problem gambling, and pathological
gambling (R. J. Williams, Royston, & Hagen, 2005). The latter two stages result in significant
psychosocial consequences for the individual and/or for those in their immediate social
network (R. J. Williams, et al., 2005). Yet it is ‘pathological gambling’ that receives a
psychiatric diagnosis and therefore treatment often focuses on a “medicalised addictive
model approach to rehabilitation” (Lahn & Grabosky, 2003, p.34). Current prevalence of
problem and pathological gambling within the general New Zealand adult population is
estimated at between 0.3 and 1.1 percent (Abbott, 2001b).
Certain groups of the New Zealand population are at greater risk of problem gambling
(Abbott & Volberg, 1991, 2000; Rossen, 2008). Within the prison population, 23% of men
and 34% of women met the criteria for probable problem and pathological gambling within
the six months prior to imprisonment (Abbott & McKenna, 2000; Abbott, McKenna, & Giles,
2000). International studies show a similar rate of gambling problems in prison populations
(Anderson, 1999; Kerber, 2000; Maden, Swinton, & Gunn, 1992; Templer, Kaiser, & Siscoe,
1993; Walters, 2005; R. J. Williams, et al., 2005). Compared to the profile of problem
gamblers in the general population, those in the prison setting often have concurrent
concerns: lower educational and socio-economic status, personality disorders, and/or
alcohol and other drug related difficulties (Abbott, 2001b).
As Māori have high rates of problem gambling and are over-represented in the prison
population (Abbott, McKenna, & Giles, 2005; Te Herenga Waka o te Ora Whanau, 2004),
gambling interventions in prisons have particular significance for Māori health outcomes
(Bellringer, et al., 2009). Pacific peoples are also over-represented in prisons, making up 6%
of the general population but 11% of the prison population (Department of Corrections,
2005), and have been “identified as being the most at-risk ethnic group for developing
problem and pathological gambling behaviour” (Abbott & Volberg, 2000; Ministry of Health,
2006; L. M. Perese, et al., 2009, p.55).
The prison population is affected by broader demographic changes in the New Zealand
population. Through higher fertility rates for Māori and Pacific people, and increases in net
migration rates for Asian people, Māori, Asian, and Pacific populations are estimated to
increase. It is estimated that Māori will make up 16.2 percent of the New Zealand
population by 2026 (14.9 percent in 2006); the Asian population will make up 15.8 percent
15
(9.7 percent in 2006); and the Pacific population will constitute 9.6 percent compared with
7.2 percent in 2006 (Statistics New Zealand, 2010, pp.4-5).
The ethnic breakdown of the prison population does not directly correlate to the national
population. The current total prison population from New Zealand’s twenty prisons is 8,747
(representing 199 per 100,000 population). This figure includes both remand and sentenced
prisoners. Out of this number, men comprise 93.6% (n=8189) and women, 6.4% (n=558).
The current composition of the prison population by ethnicity is Māori (50.9%), European
(33.7%), Pacific peoples (11.2%), Asian (2.7%), with ‘other’ or ‘unknown’ making up the
remainder (1.5%) (Department of Corrections, 2010b).*
Future projections indicate a prison population of 10,795 by June 2016, representing 235
per 100,000 population (Ministry of Justice, 2008). Present ethnic over-representation and
future general population trends indicate a growing Māori, Pacific and Asian prison
population. Department of Corrections policy recognises the importance of addressing
cultural needs within rehabilitation services in stating that “in order to reduce the likelihood
of further reoffending, the Department takes into account the cultural background, ethnic
identity, faith and language of offenders to assist in their rehabilitation and reintegration
back into the community” (Department of Corrections, 2010c, p.6).
This literature review examines the existing research on problem gambling interventions
within prisons. Although treatment programmes and/or interventions are in place, there is
limited research focused on evaluating interventions in prison (Walters, 2005). Therefore
this review also considers evaluated interventions within the prison context for people
experiencing tobacco, alcohol and/or drug dependencies, as problem gambling “has
parallels with alcohol and other drug dependencies” (Abbott, 2001b, p.28; Lorains,
Cowlishaw, & Thomas, 2011; see also Winters & Kushner, 2003). Impediments or challenges
caused by the prison environment (e.g. security issues, prisoner transfers, disciplinary
procedures, limited access to programmes, prison stressors, and prison culture) have been
noted for both gambling (Nixon, et al., 2006) and other addiction intervention programmes
(Baker, et al., 2006; Krebs, et al., 2003; Richmond, et al., 2009). As there are “no
internationally established models of best practice in problem gambling services” (Emshoff,
et al., 2008; Jackson, et al., 2003, p.6) this review has considered a range of treatment
interventions available within New Zealand and internationally. The overall aim of the
literature review is to further develop the concept of a best practice model for problem
gambling interventions within prisons.
*
Offenders are assigned their most recent preferred ethnicity group as recorded in Corrections data base
where this is known. Where such an ethnicity group is not known the offender ethnicity data is supplemented
with historic data from the Ministry of Justice (MOJ) data warehouse. The MOJ data warehouse in turn
inherited the ethnicity data from the Law Enforcement System (LES) running since the mid-1970s. The LES
supplementary data is based on Police assessment of someone's ethnicity, whereas the bulk of the data (and
all of it since 1998) comes from Corrections and is based on offender self-identified preferred ethnicity.
16
Problem gambling interventions in prisons
Prison-based gambling interventions can include training correctional staff, providing
prisoners with access to telephone counselling services, broad ‘addiction-based’
interventions, or specific programmes for prisoners with gambling problems (Lahn &
Grabosky, 2003). Although gambling occurs within prisons it is officially prohibited and most
prisoner gambling assessment focuses on gambling that occurred prior to imprisonment (D.J
Williams, 2008). However complex gambling issues can develop during incarceration (D.J
Williams, 2009) and this has implications for determining at what point during a prison
sentence problem gambling screening and treatment is most appropriate (D.J. Williams,
2010). Moreover, treatment is not always made available, with a New Zealand study finding
that only 9% of female prisoners identified as pathological or problem gamblers received
treatment while in prison (Abbott & McKenna, 2000). International studies reveal similar
findings about limited offender treatment availability (Walters, 1997).
Available treatments are not always those most suited to the environment or the
participants’ needs; the 12-step Gamblers Anonymous programme used in some prisons
internationally is best suited to older, married and higher income participants, yet problem
gambling offenders tend to be younger, unmarried and of low income (Walters, 2005).
Pathological gamblers in prison often have more severe problems than those in the
community (Abbott, 2001b) and this is something prison-based interventions need to
consider. Research indicates that the reduction in correctional costs (arrests and
imprisonment) and social and property costs through effective treatment of problem and
pathological gambling make such interventions cost-effective (Emshoff, et al., 2008).
Complex links between gambling and crime have been noted in the literature (Bellringer, et
al., 2009; Lahn & Grabosky, 2003; Meyer & Stadler, 1999; R. J. Williams, et al., 2005) with
conclusions drawn that offering problem gambling treatment to offenders could help
reduce the cycle of gambling, debt and crime (Anderson, 1999; Griffiths, Bellringer, FarrellRoberts, & Freestone, 2001; Nixon, et al., 2006; Turner, Preston, Saunders, McAvoy, & Jain,
2009). However, internationally there are few evaluation studies of existing prison-based
problem gambling interventions. Three studies (Marotta, 2007; Nixon, et al., 2006; Walters,
2005) evaluated ‘psycho-educational’ programmes undertaken in North America. Psychoeducation reduces barriers to treatment by de-stigmatising the addiction, educating
problem gamblers to better understand their addiction, and building on each person’s
strengths and resources to change behaviours and avoid relapse.
In the first study, Walters (2005) compared the disciplinary reports (for all issues, not just
gambling-related incidents) of 203 male prisoners before and after they completed a 20week psycho-educational programme in an American prison. These reports were then
compared with those of a control group of prisoners (n=124) who initially signed up with the
programme, but were transferred before it began. The psycho-educational group
programme focused on lifestyle issues; advanced criminal, drug and gambling lifestyle; and
17
relapse prevention. Walters (2005) found that while those who participated in the
programme had fewer disciplinary reports compared to the control group, this did not reach
statistical significance.
A second evaluation of a ‘psycho-educational’ gambling programme for prisoners in Canada
consisted of six group sessions that were provided to both male and female prisoners (n=49)
over an 18 month period (Nixon, et al., 2006). The sessions covered topics such as:





Facts about gambling
Problem gambling and its negative consequences
Mistaken thinking about the odds of gambling
Barriers to quitting problem gambling
Alternatives to gambling and management of lifestyle
The prisoners volunteered to take part and were surveyed at the beginning and end of each
session. The survey aimed to measure their awareness of gambling, attitudes towards
gambling, odds calculation skills, cognitive skills and behaviour. Measures included the use
of the South Oaks Gambling Screen (SOGS), the Canadian Problem Gambling Index (CPGI)
and a questionnaire designed to measure attitudes towards gambling. Nixon et al (2006)
found a significant difference between pre-test and post-test scores in relation to cognitive
errors and attitudes towards gambling. No significant change was found in the prisoners’
odds calculation (maths) skills. The authors concluded that the programme met its objective
of educating prisoners in terms of improving attitudes, knowledge and behaviour towards
their problem gambling. They recommended a follow-up measure of ex-prisoners 6-months
and 12-months after release to provide a measure of sustained behavioural change (Nixon,
et al., 2006).
The third study was an efficacy evaluation of the Gambling Evaluation and Reduction (GEAR)
programme in an Oregon-based correctional facility (Marotta, 2007). The study involved
screening, a pre and post-treatment questionnaire, and 6-month and 12-month follow ups.
Screening of the female prisoners (n=378) identified 38% as problem or pathological
gamblers. Only 3% had previously sought treatment for gambling. The treatment consisted
of a self-help manual (Becoming a Winner: Defeating Problem Gambling) and six 90-minute
small group psycho-educational classes. Marotta (2007) identified that the challenges posed
by a prison-based treatment programme included prison culture, agency culture and mixed
prisoner populations, as well as logistical considerations. Prior to the intervention 71%
identified as pathological gamblers and 11% as problem gamblers. These levels dropped to
9% pathological and 4% problem gamblers at the 6-month follow up, and then raised slightly
to 12% for both pathological and problem gambling at the 12-month follow up (Marotta,
2007).
It is difficult to ascertain national approaches to problem gambling in prisons, as studies
have shown that interventions and policies differ across individual facilities, cities or states.
18
For example, a review of Australian policies found that correctional facilities differed by
state regarding gambling offender screening and problem gambling treatments (Lahn &
Grabosky, 2003). Lahn and Grabosky (2003) found that while all Australian states provide
treatment targeted at alcohol and drug use and sexual offending, only New South Wales
(NSW) and Victoria provided specific problem gambling interventions in prisons. The four
programmes provided in NSW did not address underlying behavioural issues, but instead
focused on raising awareness of risks involved with gambling (Lahn & Grabosky, 2003). The
literature notes variability in how North American prisons address problem gambling and
the small number of programmes available (Lahn & Grabosky, 2003; Nixon, et al., 2006; R. J.
Williams, et al., 2005). Limited access to interventions in prisons adversely affects prisoners’
opportunities to receive help for gambling problems (McCorkle, 2002).
Research on problem gambling within the general population has found that treatment is
rarely sought. In America, it has been estimated that 97% of problem gamblers do not seek
treatment, and that for those that do, the drop-out rate can be as high as 50% (Ladouceur,
Lachance, & Fournier, 2009). In New Zealand’s national gambling prevalence survey, less
than 10% of those who met the problem gambling criteria had sought professional help for
gambling issues (Abbott, 2001a). The captive nature of a prison population means that some
of the impediments to accessing treatment are alleviated. Through prisoner screening, or an
identified link between an offence and problem gambling, prisoners can be advised or
instructed via court orders to attend treatment as part of their prison-based rehabilitation.
In their report on gambling and corrections in the Australian Capital Territory (ACT), Lahn
and Grabosky (2003, p. 6) recommend that “gambling problems among offenders need to
be identified in the correctional system, as most will not identify themselves as having a
problem and most will not seek help on their own” (p.6). Similarly, Nixon et al. (2006) found
that many prisoners did not recognise the severity of their gambling problem, or attributed
problems to other addictions, and so voluntary programme attendance did not reach all
those in need. Coercive or compulsory treatment has been shown to be effective for
addressing other addictive behaviours within prison populations (Emshoff, et al., 2008).
More research is needed to ascertain whether there are significant differences in efficacy
between compulsory and voluntary-based problem gambling treatments.
In New Zealand, when offenders have been charged with a crime, they may be interned
within the remand prison. Rehabilitative interventions for remand prisoners are not a
Department of Corrections requirement. However, international research has indicated that
this is a time when prisoners can benefit from targeted treatment interventions, even
though they may only be able to access that particular treatment briefly (Krebs, et al., 2003;
McCorkle, 2002). However some studies have also shown that length of time in addiction
treatment, as opposed to treatment completion, has a positive influence on treatment
efficacy (Krebs, et al., 2003; Moore, 2002).
19
Although focused on gambling issues for prisoners re-entering the community, Williams and
Walker’s (2009) study raises difficulties with prison-based and community-based gambling
interventions for prisoners. Prison staff identified a lack of treatment within both the
prisons and the community. In the community, barriers to accessing treatment included
treatment expense and the time-consuming nature of some programmes (D.J Williams &
Walker, 2009). They also identified that correctional staff sometimes overlooked gambling
problems and prioritised services for other addictions such as substance abuse. They
suggested educating parole and probation officers about problem gambling and treatment
options, so they could pass this information on to prisoners (D.J Williams & Walker, 2009).
It is interesting to note that non-prison based gambling treatment may be of increasing
significance for people convicted of non-violent offences in New Zealand. In 2007 the New
Zealand government introduced a new policy to keep non-violent offenders out of prison
(Department of Corrections, 2010a). This policy change may have implications for people
charged with (non-violent) gambling offences. This could mean fewer offenders in prison for
offences primarily identified as gambling related. This affects where and how to target
interventions for problem gamblers who have committed an offence.
Problem gambling interventions for the general population
Evaluations of gambling interventions for the general population can provide useful
guidance for assisting problem gambling offenders, but as Abbott and McKenna (2005)
highlight, researchers must heed the variance in demographics (particularly age, education
levels, socio-economic status, and ethnic make-up) between custodial and general
populations. Problem gamblers are not a homogenous group, and may require a wide
variety of treatment approaches (Ladouceur, et al., 2009; Turner, et al., 2009). As
mentioned, problem gamblers often have other health and addiction issues and
interventions need to be cognisant of these concurrent concerns (Kim, Grant, Eckert, Faris,
& HArtman, 2006; Nalpas, et al., 2011).
Models of intervention
There are various approaches to managing problem gambling in the general population;
each underpinned by different explanatory models of gambling. Approaches include
residential therapy, behavioural therapy, cognitive behaviour therapy (CBT), motivational
enhancement and pharmacological treatments. Gamblers Anonymous (GA) groups, based
on the 12-step Alcoholics Anonymous model, operate in several countries (Lahn &
Grabosky, 2003).
CBT is the most commonly recommended approach (Blaszczynski & Silove, 1995; Lopez
Viets & Miller, 1997; Oakley-Browne, et al., 2000; Toneatto & Ladouceur, 2003). CBT
operates on the principle that behaviours and emotions result from cognitive processes and
that therapy can work to shift these processes to achieve a different way of feeling or
behaving. The therapy involves education, practicing communication skills, assertiveness
20
training, goal-setting, communicating feelings, problem solving, role-playing and modelling,
and cognitive restructuring (Toneatto & Ladouceur, 2003). CBT can be applied in an
individual, group or self-help setting. Tse, Campbell et al. (2008) outline 10 therapeutic
approaches in their study of New Zealand problem gambling services, and conclude that
cognitive therapies and CBT are the only ones with strong evidence-based success. They
acknowledge the complementary potential for the approaches of self-help, GA, brief
interventions, integrated approaches, some pharmacotherapies, and residential therapy
(Bellringer, Pulford, Abbott, DeSouza, & Clarke, 2008 (see pp.22-33 for a comprehensive
review of this literature); Tse, et al., 2008).
While reviews tend to conclude that CBT is the most efficacious treatment strategy, Jackson
Thomas et al. (2003) point to a limitation in the CBT approach: the neglect of other
important factors in a gambler’s life including co-existing substance dependence, marital
problems, court orders, financial hardship, isolation and loneliness, family and relationship
problems, post-immigration adjustment, and employment issues. They conclude that the
best practice for addressing problem gambling is through a combination of interventions
(Jackson, et al., 2003).
Abstinence remains the predominant gambling intervention treatment goal, despite
indications that controlled gambling might be an effective strategy for problem gamblers
(Blaszczynski & Silove, 1995; Ladouceur, et al., 2009).
Evaluation of problem gambling interventions
Research evaluating the efficacy of problem gambling interventions mostly assesses single,
specific programmes with a small number of participants. Evaluations note poor
methodological research designs within the field including the lack of control groups
(Oakley-Browne, et al., 2000; Toneatto & Ladouceur, 2003; Westphal, 2007). It has been
recommended that gambling treatment research could be strengthened by including
validated psychometric measures, process measures, and clearer definitions of
interventions and outcomes (Blaszczynski & Silove, 1995; Lopez Viets & Miller, 1997;
Toneatto & Ladouceur, 2003).
In their extensive review of gambling treatment studies, Blaszczynski and Silove (1995)
argue that an absence of a comprehensive model to explain the pathogenic process from
‘controlled’ to ‘pathological’ gambling has led to a variety of problem gambling treatments.
They conclude that for a treatment strategy to be successful it needs to address the
“complex and dynamic interaction between ecological, psychophysiological, developmental,
cognitive and behavioural components” that lead to pathological gambling (Blaszczynski &
Silove, 1995, p.196).
Access and provision of interventions
The access and provision of targeted interventions is also an area of concern. British-based
research into Primary Care Trusts, Foundation Trusts and Mental Health Trusts (n=327) has
21
shown that 97% did not provide any service for treating those with gambling problems in
the previous 12 months (Rigbye & Griffiths, 2010). Only one Trust offered dedicated
specialist help for problem gambling. In some cases gambling was not considered a mental
health concern, while others indicated that if gambling issues co-existed with alcohol or
drug addiction, gambling was not considered the primary issue (Rigbye & Griffiths, 2010).
Rather than state service provision, the delivery of gambling interventions in the United
Kingdom relied on private and charitable organisations (Rigbye & Griffiths, 2010).
Recent innovations in treatment
This review now outlines recent studies on innovations in gambling treatment: personalised
feedback, an emphasis on control rather than abstinence, use of a ‘brief intervention’
directed toward increasing the motivation to change gambling behaviour, and residential
programmes.
Canadian research has assessed the efficacy of a personalized feedback intervention used by
problem gamblers (Cunningham, Hodgins, Toneatto, Rai, & Cordingley, 2009). Unlike bookbased self-help exercises for problem gambling, the personalized feedback is a brief
intervention which allows problem gamblers to evaluate their own gambling by recording
their gambling activities and receiving summaries which compare their gambling to that of
the general population. It is believed that by providing normative feedback, problem
gamblers will recognise the extent of their problem and modify their behaviour
(Cunningham, et al., 2009). The initial 61 respondents were randomly assigned to either
receive the personalised feedback tool, or to be placed in a control group. The participants
who used the self-help evaluation (n=24) recorded less spending on gambling at the 3
month follow-up than those in the control group (n=25) (Cunningham, et al., 2009). Out of
those who used the intervention, 96% recommended it for other problem gamblers
interested in evaluating or modifying their gambling (Cunningham, et al., 2009).
Ladouceur et al. (2009) studied whether ‘controlled gambling’ was a viable treatment option
for pathological gamblers. The definition of controlled gambling was “a reduction of the
gambling activities in terms of frequency, time and money spent so that the activities
related to gambling do not cause any damaging consequences for the gamblers or their
environment” (Ladouceur, et al., 2009, p. 190, p.190). Canadian pathological gamblers were
recruited and screened for participation. The selected participants (n=89) were assessed
pre-treatment, post-treatment and at 6 and 12-month follow ups. The CBT treatment was
administered by psychologists and social workers, on an individual basis over 12 weekly
one-hour sessions. The sessions focused on seven areas: motivation enhancement, setting
personalised goals, identification of risk situations, analysis of erroneous beliefs, correction
of erroneous beliefs, exposure to simulated gambling, and relapse prevention.
Out of the original 89 participants, 61 (69%) completed the programme. For those that
completed the programme, 66% switched to an abstinence approach at least once during
treatment and by the 12 month follow-up 32% had a goal of abstinence (Ladouceur, et al.,
22
2009). The study processed the results in two ways – analysing all those who began the
programme (n=89) and those who completed the programme (n=61). At the end of
treatment 63% of the original participants no longer met the DSM-IV criteria for
‘pathological gambling’, and three-quarters had maintained their controlled gambling
objectives at the 12 month follow-up. When only those who completed the treatment
(n=61) were counted, the figure of those who no longer met the DSM-IV criteria for
‘pathological gambling’, rose to 92%. The researchers concluded that controlled gambling
can be a successful goal, and may be a more attractive and flexible option to encourage
pathological gamblers into treatment (Ladouceur, et al., 2009).
The benefits of a brief motivation intervention were investigated by Petry, Weinstock et al.
(2009) with college students who met the criteria for problem and pathological gambling
(n=117). The students were randomly assigned to one of four groups: assessment-only
control, 10 minutes of advice, one session of motivational enhancement therapy (MET), or
one session of MET and three sessions of CBT. MET aims to “increase motivation to change”
(Petry, et al., 2009, p.1570). In this study, the MET consisted of a 50-minute individual
session where the therapist provided the student with personalised feedback about their
gambling. The student discussed their gambling and how it fitted in with their life goals and
then completed a change plan worksheet. Participants were assessed using the Addiction
Severity Index – Gambling (ASI-G) at baseline, 6 weeks and 9 months. The ASI-G showed that
participants in the three intervention groups reduced time and money spent gambling
compared to the control group. However, there was no significant difference depending on
which intervention was used; leaving the authors to conclude that brief interventions are
efficacious in reducing problem gambling (Petry, et al., 2009).
Finally, some guidance to what interventions might assist with problem gambling prisoners
is provided by a study on a therapeutic residential programme for problem gambling. The
Gordon House Association (GHA) is the United Kingdom’s only specialist and dedicated
residential facility for problem gamblers (Griffiths, et al., 2001). The GHA programme is split
into five stages after initial assessment: coping with today, coping with yesterday, coping
with change, coping with tomorrow, and coping on my own. The initial assessment
determines the individual needs, gambling context, and appropriate intervention approach.
A plan is drawn up between the client, key worker and consultant psychotherapist outlining
what the person hopes to achieve during their stay. The programme centres around two key
elements: communal living and addressing individual needs. The expectation is that all the
residents support each other’s progress (Griffiths, et al., 2001, p.164). Each gambler is
assigned a key worker who focuses on the particular needs for that gambler. Psychodynamic
group work and cognitive behavioural counselling are used, with residents encouraged to
also attend other counselling or gambling interventions as a concurrent therapy approach.
Toward the end of the residency, the programme focuses on practical elements of leaving
the programme, such as finding accommodation and employment, as well as targeted group
and individual therapy for relapse prevention. Once the residents leave the facility, an
23
intensive 12-week outreach programme is undertaken and on-going contact is maintained.
Anecdotal evidence points to the programme’s success but no methodical evaluation has
been undertaken.
Other addiction interventions in prisons
It has been identified that some marginalised sub-populations, including prisoners,
indigenous people, and people with mental health issues, have higher rates of addiction
problems when compared to the general population. These can include smoking, drug and
alcohol use, and problem gambling (Baker, et al., 2006). There is also often a significant
overlap of addiction behaviours within these sub-populations, which compounds the
complexity of addressing such issues. Health-related interventions are important in
targeting such populations (Richmond, et al., 2009). A small number of evaluations have
been made of prison-based interventions addressing smoking, drug and/or alcohol
addictions. All conclude that health interventions within prisons need to be cognisant of the
environment including limited access to programmes, specific prison stressors, and the
prison ‘culture’. Research has also noted that interventions in prisons are subject to certain
impediments including site-based divisions, institutional apathy (of both prisoners and
staff), and poor relations between prisoners and staff or professional advisors (Geller, et al.,
1977). Prison-based interventions require administrative, financial, and philosophical
support from within the institution, as well as at a policy level. Geller, Johnson et al. (1977)
reinforce how crucial it is to have all levels of prison staff on board ( not just top-level
administrators) because progress can be blocked by those ‘on the ground’. Research has
also emphasised the need to regularly evaluate programmes (Devilly, et al., 2005; Geller, et
al., 1977).
Within prison-based interventions, as with any interventions, issues around voluntary or
compulsory attendance, possible incentives for involvement, the best treatment approach,
and definitions of desired outcomes have to be considered. Certain stresses of prison life
can adversely affect the efficacy of the intervention; these include unexpected prison
transfers, boredom, lockdown, and family or legal stressors (Baker, et al., 2006). Conclusions
and recommendations from studies of smoking, drug and alcohol addiction interventions
can inform best practice for problem gambling interventions within prisons. Some
researchers have recommended that where prisons have established interventions for other
addictions, attaching gambling interventions to these interventions could be an effective
way of capitalising on existing structures, using limited resources, and reaching those in
need (Emshoff, et al., 2008).
General and/or broad-based interventions
Devilly et al. (2005) reviewed prison-based health related peer-led education programmes
that addressed HIV/AIDS, drug and alcohol abuse, sexual assault, sexual offending, prison
orientation, and suicide prevention. Peer-based programmes for prisoners cover a wide
24
range of approaches, including peer-training, peer-modelling, and/or peer-counselling, but
the fundamental intention is that they are “by inmates, for inmates” (Devilly, et al., 2005,
p.221). This study provides a best practice model for offender-led rehabilitation
programmes in four phases: planning and development, training and implementation,
maintenance and evaluation, and monitoring. While Devilly et al. (2005) identified some
potential ethical concerns of the process (accountability, peer-confidence and
confidentiality), overall they concluded that these were outweighed by the benefits of peerbased education, both for those receiving the treatment and those delivering it.
Bond (1998) profiled a 12-week voluntary intervention programme for British-based
prisoners with recognised alcohol, drug, and gambling addictions. The programme was
delivered on a ‘rolling’ basis, so at any one time participants would be at varying stages
along their treatment. Those further along could then help newcomers adjust. Rather than a
focus on addiction, the approach was biopsychosocial, encouraging participants to adopt a
healthy lifestyle and change behavioural patterns to avoid relapse (Bond, 1998). The
treatment programme consisted of group formation, therapy, goal setting, relapse support,
peer-evaluation, and aftercare support. The programme also provided one-to-one
counselling and addressed issues surrounding release, including relationships with family
and friends, and the continuum of care. The research attributed the programme with a
significant reduction in drug use (from 98% positive tests down to 8%) and a reduction in
prison disciplinary actions (Bond, 1998). More than 50% of those who had undertaken the
programme were still abstinent and had not re-offended once in the community (Bond,
1998).
Smoking
Two Australian-based studies on smoking cessation programmes amongst prisoners have
wider relevance to addiction interventions and health strategies within the prison
environment. Prisoners have a smoking prevalence that is estimated to be three times
higher than the general population. Richmond, Butler et al. (2009) conducted a qualitative
study using prisoner focus groups to determine best practice for prisoner smoking cessation
interventions. Based on the information from the participants (n=40) within the seven focus
groups, Richmond, Butler et al. (2009) argued that health promotion within the prison
setting needs to take into consideration the unique stressors of the prison environment, as
well as understanding the role of smoking and tobacco within the prison ‘culture’.
A 2006 Australian study looked at a number of tobacco-control strategies targeting subpopulations, including prisoners (Baker, et al., 2006). Baker et al. (2006) found that smoking
cessation interventions in prisons that used a multi-component approach (combined
nicotine replacement therapy, pharmacotherapies, and CBT) had a high success rate. It was
noted that in order to be successful, interventions needed to address “the entrenched
nature of smoking in the prison culture” (Baker, et al., 2006, p.90).
25
Drug and Alcohol
Compared to the general population, prisoners have a higher rate of substance use and
abuse (Krebs, et al., 2003). Links between substance use and crime mean that effective
treatment interventions can help reduce the rate of recidivism (Wilson & Williams, 2006).
An American-based study analysed five substance-user treatment programmes in jails to
assess which were the most successful, based on retention rates (Krebs, et al., 2003).†
Krebs, Brady et al. (2003) argue that positive post-treatment outcomes were directly related
to the length of time in treatment, as opposed to the completion of treatment programmes,
which is often the marker of ‘success’ in the literature. Data for offenders (n=720) across the
five programmes was collected. The five programmes used various approaches including
psycho-education, the 12-step approach, relapse prevention, and/or curriculum-based
education. It was identified that prisoners with the lowest retention rates were under 25years, reported methadone use, and/or were awaiting sentencing. Recognising
characteristics that indicate greater or lesser retention rates allows for targeted
interventions (Krebs, et al., 2003; Wilson & Williams, 2006).
A study into the effectiveness of dedicated drug and alcohol treatment units in New Zealand
prisons found that undergoing treatment significantly reduced recidivism (Wilson &
Williams, 2006). The study assessed prisoners (n=291) who had attended one of three
prison-based Alcohol & Drug (AOD) treatment units. These were compared to a control
group (n=589) who did not undergo treatment. The treatment involved CBT with an
overarching relapse prevention framework. It was delivered within a therapeutic community
context. The treatment group showed a significant reduction in recidivism and reimprisonment compared to the control group. The results showed no significant difference
in re-offending rates between Māori and Pākehā participants. Programme completion
positively affected treatment success, which contrasts with some international research
conclusions that treatment efficacy is affected by length of time in treatment rather than
treatment completion (Krebs, et al., 2003; Moore, 2002). Wilson and Williams (2006)
recommend that substance treatment programmes should address the multiple
criminogenic needs of participants in order to be successful. The study highlighted that age
and gender affected the efficacy of the programme; female offenders did not respond as
well to the treatment as their male counterparts and younger offenders had poor recidivism
outcomes. Treatment success was increased where residential treatment in prison was
followed by post-release community aftercare (Wilson & Williams, 2006).
†
In America a jail and a prison are different institutions. A jail is where people are housed when awaiting trial,
sentenced for a short period (usually 12 months or less), or are in the process of moving between facilities.
Prisons are used for long-term sentences (usually 12 months or more). A jail is akin to the remand prison in
New Zealand.
26
Cultural considerations in interventions
There is little evaluation of the impact of cultural factors on interventions. Some research
has questioned whether cultural grouping is a major determinant in gambling attitudes and
involvement or if other factors, such as socio-economic status or migrant adjustment, are
responsible (Duong & Ohtsuka, 1999). Generally, however, research has shown that cultural
factors impact on perceptions of gambling, rates of gambling, and help-seeking behaviour
(Bellringer, et al., 2008; Dhillon, Horch, & Hidgins, 2011; Dyall, Tse, & Kingi, 2009; Raylu &
Oei, 2004). A recent study has highlighted religious beliefs as another consideration in
gambling behaviours (Ellison & McFarland, 2011). More research is needed to ascertain
whether targeting specific cultural needs might change the success rates of interventions
with general or prison-based populations.
New Zealand research has shown that a gambler’s cultural background needs to be
considered in both problem gambling screening and treatment (L. Perese, 2009; Tse, et al.,
2007), yet there is a dearth of research internationally that evaluates gambling and
addiction interventions with a cultural focus. While some literature on gambling screening
takes into account the variables related to culture or ethnicity (eg. Anderson, 1999; Nixon,
et al., 2006; Walters, 2005; R. J. Williams, et al., 2005), some researchers indicate the
importance of creating culturally cognisant interventions (Raylu & Oei, 2004), and others
note the existence of culturally targeted interventions e.g. Vietnamese (Lahn & Grabosky,
2003).
In New Zealand the high rates of Māori prisoners and the high rates of Māori problem
gamblers underlie the importance of creating culturally appropriate and congruent gambling
interventions for Māori. Māori health models, which take a holistic approach and
incorporate family, community, socio-historical, and spiritual factors, can provide a context
for understanding ways of approaching gambling interventions for Māori. In their research
on effective gambling treatments for Māori, Robertson, Pitama et al. (2005) note that
“cultural affiliation and involvement has been mooted as contributing to the successful
treatment of addictive behaviours” (pp.36-7) They identify the following factors as essential
when creating effective gambling intervention services for Māori:





Catering for the diversity of participants’ experiences of ‘being Māori’
Whanaungatanga – and incorporation of whānau in treatment services
Māori practices and content
Māori health promotion material
Practitioners (Māori or non-Māori) and treatment modalities that are responsive to
Māori needs and aspirations.
Huriwai’s (2002) study on creating ‘culturally congruent’ alcohol and drug treatments for
Māori is relevant although it is not prison-based. The study argues that dedicated Māori
treatment services help participants reconnect with their identity as Māori (Huriwai, 2002).
27
Huriwai, Sellman et al. (1998) found that dedicated Māori drug and alcohol services had
higher retention and satisfaction rates than those that were not culturally dedicated.
Tse, Campbell et al. (2008) specifically focused on four population groups (European, Māori,
Pacific and Asian‡) to ascertain views, experiences and effectiveness of gambling treatments
as determined by service users (n=58) and service providers (n=27). With more similarities
than differences expressed across the four population groups, the researchers identified five
main themes of effective treatment: knowledgeable and effective practitioners, the
importance of family involvement, the availability and accessibility of services, the ability to
address a wide range of gambling-related issues, and the inclusion of cultural needs. Māori,
Pacific and Asian clients cited the use of cultural frameworks, culturally specific language,
and the practitioner’s ability to consider a client’s cultural background as important factors
in good service delivery (Tse, et al., 2008). All practitioners mentioned the importance of
incorporating culturally appropriate methods and approaches (Tse, et al., 2008). The study
indicated that providing clients with a range of intervention options would more effectively
address a variety of needs that might be age, gender or culture-related (Tse, et al., 2008,
pp.199-200).
Recognising cultural difference in relation to help-seeking for problem gambling can provide
some insights for treatment interventions (Bellringer, et al., 2008; McMillen, Marshall,
Murphy, Lorenzen, & Waugh, 2004; Raylu & Oei, 2004). Overall this literature stresses that
more than simply cognisance of cultural difference; effective treatment needs to reflect the
various concepts, approaches, and world-views of different cultural groups, as well as
potentially different understandings of shame, stigma, the role of family, and ideas about
mental illness.
Conclusions from the literature
The bulk of the research on interventions for problem or pathological gambling in prisons is
based on individual case studies of interventions and is therefore site and culture specific.
However, there are some common themes which emerge. CBT is most commonly cited as
efficacious in the treatment literature, though research does support combination
therapies. There is also evidence to suggest that linking problem gambling with other
addiction treatments might reach more people as well as allow the treatment to address the
inter-related nature of addictions. There are many factors which support treatment such as
access, delivery and cultural relevance. The literature suggests that any form of treatment is
beneficial (when compared to non-treatment), with brief or incomplete treatments still
providing a degree of behavioural change. The literature points to the benefits of screening
and/or treatment at various points in an offender’s incarceration: prior to sentencing, at the
start and during imprisonment, prior to release and in the process of re-entry into the
community.
‡
‘Pacific’ included Samoan, Tongan and Niuean peoples, while ‘Asian’ included Chinese and Korean peoples.
28
Methodology
Research Aims
In addition to the review of the literature, the methodological framework for this research
consists of three phases: a stock-take and review of national, regional and local prison
policies for problem gambling interventions; case studies of problem gambling services in
two prisons; and a national anonymous survey of prison staff and providers of problem
gambling services in New Zealand prisons.
Research Design
An Expert Reference Group (ERG) was established to assist in refining the design of the
research and to monitor the research process. This was designed to support the accuracy,
relevance and appropriateness of the research approaches and methodologies. This group
comprised of stakeholders from service provider organisations, the Department of
Corrections, and representatives of Māori, Pacific and Asian communities. Collectively these
ERG members provided a high level of practical advice and support to the research team in
undertaking the research within the prison context. Throughout the course of the research
the research team met with the ERG twice. The ERG also provided feedback and input into
the development of relevant documents (such as the survey employed in Phase Four) via email. The ERG also provided feedback on drafts of the final report.
The design of the research involved four phases. The aims and methods for each of these
are outlined below. Findings are outlined in subsequent chapters. Fieldwork for this
research project was undertaken from late 2010 to mid-2011.
Phase One: Literature Review
Aims
A literature review was conducted to ascertain current academic understanding of the
provision of problem gambling services in prisons internationally and locally. The scope of
the review included current working definitions of ‘problem gambling’, research findings
into gambling rates in prison populations, a profile of New Zealand’s prison population
(including ethnic makeup, and projected future prison populations), reported research on
problem gambling interventions in prisons, and evaluations of existing interventions for
problem gambling in prisons. Research on gambling interventions for the general
population, as well as other addiction treatments (general, smoking, and drug and alcohol)
in prisons, and cultural considerations in New Zealand- based interventions were also
covered. The literature review informed the other phases of the research project, including
the design of questions asked of prison staff and service providers as well as highlighting
potential best practice models for gambling interventions within prisons.
29
Methods
Publications in this review were accessed through computer searches of medical and
psychology databases, including PsychInfo, Web of Science, and Medline. Relevant articles
were also accessed through online searches using the internet search engine Google
(http://www.google.co.nz) and Google Scholar (http://scholar.google.co.nz). Cross-checking
was undertaken with references cited in key articles to ensure a broad coverage of
international and local research.
Phase Two: Stock-take and Review of National, Regional and Local PrisonSpecific Policies for Problem Gambling Interventions
Aims
This phase aimed to provide an understanding of the Department of Corrections and
Ministry of Health policies for problem gambling interventions for prisoners, at a national,
regional and localised (i.e., individual institution) level. In particular, this meant accessing,
reviewing and analysing national and regional policies that relate to the provision of
problem gambling services to prisoners.
Methods
The Department of Corrections and Ministry of Health policies relating to problem gambling
were located and sourced through information sent from key staff at the Department of
Corrections and the Ministry of Health, and thorough searches of the Ministry of Health and
the Department of Corrections websites.
The sourced policies were analysed with a focus on the examination of the policy objectives
and guidelines in policy application. This latter point included the use of
screening/assessment forms and intervention procedures, and responses to any
issues/concerns regarding problem gambling (e.g., delivery of interventions). The policies
are further outlined on pp. 36-43 of this report.
The policies were then thematically analysed using a general inductive approach. This
approach enables the analysis of the raw data to determine connectivity to the research
objectives.
Phase Three: Case Studies of Problem Gambling Services in Two Prisons
Aims
The case study method was chosen to provide an in-depth examination of problem
gambling services within prisons which could then illuminate themes and issues relating to:
-
The context of problem gambling counselling and/or intervention service delivery;
Local, prison specific policies that relate to the provision of problem gambling and
addiction services to prisoners;
30
-
Implications of local policies for delivering problem gambling services in these
settings;
Prison staff and service providers’ views of service delivery, including strengths and
barriers to effective service provision;
Exemplars of best practice.
This phase also aimed to provide a framework for Phase Four of this research (a national
survey of prison staff and problem gambling service providers in New Zealand prisons).
Methods
Two prisons were included as case studies, both of which were selected in discussion with a
representative from the Ministry of Health and advice from a senior Ministry of Corrections
programmes manager. The brief was to select two prisons in order to provide a variety of
experiences that might arise in different correctional facilities.
-
-
The first case study involved a men’s prison that accommodates 600 plus. It was
originally opened in 1960s. This prison has a minimum-security work and pre-release
unit.
The second case study involved a minimum to high-medium prison for 200 plus,
both sentenced and remand. It is a purpose-built women’s facility. The prison offers
a baby-bonding unit for prisoners with babies under 9-months of age.
Both sites offer rehabilitative programmes that fall into four main categories: motivational,
cognitive-behavioural, employment and education, and re-integrative programmes. The
sites provide employment opportunities and encourage prisoners to undertake further
education. Each provide two re-integrative programmes, namely Living Skills and Parenting
Skills, as well as having case workers working with prisoners on individual re-integrative
needs.
In the first prison case study there is an alcohol and other drug service provider who runs a
Short term drug treatment unit established in 2010 for offenders at high risk of re-offending.
This is an intensive 3 month residential programme developed to align with shorter prison
sentences associated with alcohol and drug related sentences. The intensive programme
includes psycho-therapy, psycho-education, and cognitive behavioural therapy. The
programme is part of a therapeutic community so an emphasis is on group processes. The
focus is on assisting offenders to learn to live with others, to be respectful, to face conflict
and resolve it, and to build a pro-social lifestyle.
This prison also provides a cognitive-behavioural programme called the Medium Intensity
Rehabilitation Programme (MIRP), designed for prisoners in the middle risk range (those not
considered high risk but who warrant participation in rehabilitation programmes). The
31
second prison offers the cognitive-behavioural Kowhiritanga (Making
Rehabilitation Programme, designed specifically for Māori female prisoners.
Choices)
At each prison the prison management were requested to identify at least two prison staff
to be interviewed – at least one of which should be a manager involved with overseeing
rehabilitation services and the second a custodial staff member with close contact in the
running of the rehabilitation services. Three people from case study one were interviewed
and five people from the case study two site.
External providers of prison-based gambling interventions for each site were identified
through interviews with prison staff and consultation with the ERG. Both prisons receive
gambling interventions through the same provider, which has a national contract with the
Department of Corrections with services funded by the Ministry of Health to provide
problem gambling intervention services in New Zealand prisons. Contact was made with this
service and key staff, a manager and a counsellor/therapist providing services to each prison
were identified and contacted for interviewing. The intent was to talk to the manager from
the problem gambling service and a therapist involved with each prison. However as one
manager had oversight of service provision to both prisons and a therapist with substantial
experience of providing services to prisoners had recently resigned, the four people
interviewed included two current therapists, the recently resigned therapist and the
problem gambling service provider practice manager.
The interview process in case study one identified the provision of problem gambling
services through the intensive Short term drug treatment unit. An interview was conducted
with the manager/therapist from this service provider. In total five people, representing two
providers were interviewed. One further interview was conducted with a Department of
Corrections probation officer who was responsible for writing pre-sentence reports on
offenders likely to be sentenced to imprisonment.
The interviews followed a semi-structured format, with areas for inquiry and the
opportunity for questions to arise during the interview process, rather than a formalised or
limited set of questions. The literature review and policy analysis informed the interview
schedule. The interview schedule was further refined by the ERG. Separate interview guides
were prepared to cover prison staff and service providers, though there was some overlap
with key items. The questions were grouped into the following areas: definitions,
recognition and understanding of gambling; screening for problem gambling; processes
initiated when gambling problems are detected; interventions for those with gambling
problems; processes initiated for those with gambling problems following release; and areas
for improvement (see Appendix A).
32
All participants approached agreed to be involved in the study following the processes of
informed consent. Prior to the interview, participants received an information sheet (see
Appendix B), and signed a consent form if they wished to participate (see Appendix C). Semistructured interviews were conducted with each participant and up to three researchers in a
separate room or private space within each of the two prisons or at the provider
organisations’ premises. The interviews varied in duration, ranging from 20 minutes to 2
hours. Corrections interviews were completed between September and November 2010.
Service provider interviews were completed between November and December 2010.
Analysis and Reporting
The interviews were audio-taped and later transcribed. The interviews were then
thematically analysed using a general inductive approach. This approach enables the
analysis of an extensive amount of raw data to determine connectivity to the research
objectives. The prison staff interviews and the provider interviews for the two case study
sites were analysed separately. The transcripts were read by all research team members to
identify recurring patterns. Five sub-themes emerged from the interviews: screening,
referral, intervention, reintegration and general. The researchers discussed the interviews
extensively and collectively agreed on the themes and content analysis.
Ethics and Corrections Approval
Prior to the study commencing, ethical approval for the research was obtained from the
Ministry of Health Northern Y Regional Ethics Committee (NTY/10/EXP/031). Permission to
proceed with the study and approach prison staff for interviews was obtained from the
Department of Corrections through the approval of a Specified Visitor Application and a
formal contract. With the development of the survey we were required to go back to the
Ethics Committee and the Department of Corrections for further approval. This was
obtained.
Phase Four: National Anonymous Survey of Prisons
Aims
This phase of the research aimed to assess prison staff and problem gambling service
providers’ views and opinions on the delivery of problem gambling services in correctional
facilities throughout the country. The following were of particular interest:

The perceived need of problem gambling services in correctional facilities.

Perceived barriers and facilitators to the provision of effective problem gambling
services for prisoners.
33
Other areas of interest included:

Current activities for providing problem gambling services to prisoners (including
screening and intervention/counselling services).

The perceived effectiveness and efficiency of national and local prison policies and
practices for supporting delivery of problem gambling services to prisoners.
With regard to prison staff, areas of interest also included:

Local policies relating to provision of problem gambling services to prisoners and
their implications for accessing services.

Implementation of national and local policies in relation to supporting prisoners to
access problem gambling (or comparable addiction services).

The perceived effectiveness and efficiency of any initiatives.

Requirements for offenders to participate in a follow-up study.
Methods
Two complimentary web-based surveys (hosted by ‘LimeSurvey’ – www.limesurvey.org, an
open source survey application) were developed – one for problem gambling service
providers and one for prison staff. The surveys were designed to take less than an hour to
complete.
An invitation to participate was sent to all the twenty one prisons and all the identified
prison-based gambling intervention providers in New Zealand along with instructions on
how to access the on-line survey. The surveys were based on the questions asked in the
case study interviews, but also built on information gathered from the two case studies
(Phase Three), analysis of Department of Corrections and Ministry of Health gambling
policies (Phase Two), and the literature review (Phase One). The ERG discussed the survey
drafts and provided helpful suggestions regarding refining the surveys and practical advice
in determining the best means of dissemination. Some minor adjustments were made
following feedback from the group to include a stronger focus on Māori interventions and to
reflect current Corrections organisational changes within the Rehabilitation and
Reintegration System (RRS).
Following advice from the ERG, the prison staff survey was sent to case managers and senior
case managers in prisons to best target those directly involved in rehabilitation and prisoner
management. Of the 21 prisons one was excluded from the survey as it was a remand only
prison. Therefore the total number of surveys expected was 40.
Identifying and contacting the service providers was more complicated. Although one main
service provider has a national contract with the Department of Corrections to provide
34
prison-based problem gambling intervention services, there are other smaller problem
gambling service providers and providers of other intervention services that we wanted to
identify and contact to complete the survey.
To reach the appropriate service providers, contact was made with the main provider’s four
regional Practice Leaders. They were asked to fill out the survey themselves and send on
the survey details to therapists/counsellors working in prisons as well as indicating any
other providers of whom they were aware. Contact was also made with the National
Coordinator of the Problem Gambling National Coordination Service (NCS) for further
identification of those who provide prison-based gambling services in New Zealand.
Although this was a thorough process, it is recognised that the process may have
unintentionally missed smaller, one-off, new, or intermittent providers. We expected
service provision in 20 prisons excluding the remand only prison. We were though aware
that some prisons are not targeting problem gambling. We were unable to determine how
many service providers might be reached through snowballing. We were anticipating
approximately 33 service provider responses.
The request to complete the survey was sent via email on 6/5/11. The cut-off date for
respondents to complete the online survey was 17/6/11 and two reminder emails were sent
on 3/6/11 and the 10/6/11. Respondents were asked to indicate whether or not they
consented to participating in the research by reading the Participant Information before
commencing the survey, and checking the ‘yes’ or ‘no’ box.
Analysis and Reporting
The survey produced both qualitative and quantitative data. The qualitative data were
collated and analysed using thematic analysis. The researchers discussed the thematic
analysis and reached consensus on the key themes identified. The quantitative data was
exported from Lime Survey into Microsoft Excel 97-2003 Worksheet and subject to
descriptive statistical analysis.
35
Results: Policy and Procedures Review
The Department of Corrections is responsible for preventing and minimising gambling harm
for those within the prison system. The Ministry of Health is responsible for funding and
coordination of problem gambling services under the Gambling Act (2003).
This section provides an outline and analysis of the Ministry of Health’s policies regarding
gambling and the Department of Corrections’ procedures and policies related to the
provision of problem gambling services in New Zealand prisons. Policies are subject to
change; this analysis only provides a snapshot of what was in existence at the time of this
review. These policies were sourced through information sent from key staff at the
Department of Corrections and the Ministry of Health, and thorough searches of the
Ministry of Health and the Department of Corrections websites. The sourced policies were
analysed with a focus on policy objectives, guidelines in policy application (including the use
of screening/assessment forms and intervention procedures), and responses to any
issues/concerns regarding problem gambling (e.g., delivery of interventions). In the case of
the Department of Corrections, many of the policies are rehabilitation policies that cover
gambling but are not gambling-specific.
The terms ‘gambling’ and ‘gambling harm’ are core to understanding the context and focus
of the services described in this report. The Gambling Act (2003) defines “gambling” as
“paying or staking consideration, directly or indirectly, on the outcome of something seeking
to win money when the outcome depends wholly or partly on chance” and defines
“gambling harm” as: “Harm or distress of any kind caused or exacerbated by a person’s
gambling, and includes personal, social or economic harm suffered by the person, their
spouse, partner, family, whānau and wider community, or in their workplace or society at
large.” (New Zealand Parliament, 2003, pp.15-16)
The Ministry of Health
The Ministry of Health is responsible for developing and implementing an integrated
nationwide problem gambling strategy to prevent and minimise gambling harm (Ministry of
Health, 2006, 2010). The objectives include providing and supporting accessible and
effective
interventions.
The
Ministry
of
Health
website
(http://www.moh.govt.nz/problemgambling) states that gambling harm services should
provide nationwide coverage, target priority populations, and improve Māori health gain.
The Department of Corrections
Within the context of prisons, the Ministry of Health’s objectives related to addressing
gambling and gambling harm sit alongside Department of Corrections policies related to
reducing crime and reoffending rates through education and rehabilitation. The Department
of Corrections has a system for offender assessment and referral as part of each offender’s
management plan.
36
The Department of Corrections’ policies related to offender management are outlined in the
Prison Services Offender Management Manual (Department of Corrections, n.d.1). This
states that:
“The key driver of offender management (OM) is reducing re-offending. OM
addresses this through a co-ordinated approach to managing offenders. The
approach is consistent throughout the offender’s sentence, and across all services. It
aims to: be culturally responsive; use resources effectively, and; meet the prisoner’s
needs in the areas of rehabilitation, re-integration, and safe, secure and humane
containment.” (Department of Corrections, n.d.1, Part 1: General Information
Index).§
Offender management aims for consistency and coordination between Prison Services (PS),
and Community Probation and Psychological Services (CPPS) in their approach to
assessment, working with offenders to identify relevant activities to address needs, and
managing an offender’s sentence to achieve these activities (Department of Corrections,
n.d.1). CPPS are responsible for pre-sentence assessment and offender management in the
areas of parole, residential restrictions and supervision. PS are responsible for offender
management while the offender is in prison.
Addressing the Drivers of Crime
In 2009 the New Zealand government began a new initiative: Addressing the Drivers of
Crime (Ministry of Justice, 2009). This approach to reducing offending and victimisation aims
to understand and address the factors that lead to criminal behaviour. The Department of
Corrections supports this policy through their education and rehabilitative services. The
policy is spearheaded by the Ministry of Justice, but draws on the support and input of other
government departments and community sectors. The Department of Corrections is
involved in helping the justice sector address the drivers of crime.
Rehabilitative Need
For the Department of Corrections, addressing rehabilitative needs is a component of
“offering pathways out of offending” (Department of Corrections, 2010c). This outcome is
achieved through a three-pronged approach: Offenders’ rehabilitative issues are addressed;
offenders acquire employment relevant skills and qualifications; and, offenders’ reintegrative needs are addressed (Department of Corrections, 2010c, p.14). The
establishment of the Rehabilitation and Reintegration Services (RRS) is one of the initiatives
developed to ensure that “offenders’ rehabilitative issues are addressed” (Department of
Corrections, 2010c, p.10).
Rehabilitation and Reintegration Services (RRS)
In 2010 the Department of Corrections established RRS as a new system for delivering the
Department’s services in these areas, with case management starting in April 2011. As
§
http://www.corrections.govt.nz/policy-and-legislation/offender-management-manual/part-1-generalinformation-index/chapter-1-1-offender-management---genernal-index/offender-management.html
37
outlined on the Department of Corrections website, the service “is focused on employment,
education, constructive activities, specialised treatment services and offence-focused
programmes. RRS works closely with other services and agencies and is in particular
committed to utilising Māori leadership and expertise from both within and outside the
Department to better support pathways out of crime for Māori offenders.”** RRS delivers
interventions to offenders and prisoners to address their offending behaviour through
interventions, programmes and special treatment units.
The re-integration component of RRS is to “ensure offenders have access to programmes
and services to help them reintegrate back into the community, leading to a reduction in reoffending” (Department of Corrections, 2010c, p.17).
In the Department of Corrections’ Statement of Intent (2010c) one of the key outcomes
identified is that “sentence options are used effectively” in order to allow the Judiciary and
Parole Board to make informed decisions. This intention necessitates that “The Parole
Board will receive information from a range of sources including staff in Prison Services,
Community Probation Services and Rehabilitation and Reintegration Services” (Department
of Corrections, 2010c, p.19).
RRS foregrounds an offender’s management plan. The plan involves assessments of a
sentenced prisoner to ascertain their rehabilitative needs, which are logged into the
Integrated Offender Management System (IOMS). A Sentence Planner then works out a
sentence plan, to provide “a pathway for offenders to be prioritised for assessment,
planning and interventions.”††
Integrated Offender Management System (IOMS)
IOMS is the primary database system for offender information. It covers offenders in prison,
those on parole, and those undertaking community service (including those undergoing
residential restriction and supervision). IOMS manages all the information about individual
prisoners including sentencing, behavioural records, education and healthcare. The system
allows for continuity of information if prisoners are transferred to a different facility or unit
or are placed under a different Corrections regime. In terms of programmes and education,
IOMS must contain information on every programme accessed.
The processes of screening and assessment of problem gambling
Table 1 (p.40) outlines how problem gambling is specifically detected and initially assessed
within the emphasis on rehabilitation in prisons, which has already been described. Some
points to note regarding Table 1: The three screening tests (related to alcohol, other drugs
**
http://www.corrections.govt.nz/about-us/structure/rehabilitation-and-reintegration-services.html, no page
reference. (accessed 16 April 2011)
††
http://www.corrections.govt.nz/about-us/structure/rehabilitation-and-reintegration-services.html, no page
reference (accessed 16 April 2011)
38
and gambling) relate to the past 12 months (regardless of whether the offender has been in
custody during this time); and the screening involves setting the questions in front of the
prisoner and reading the information aloud as the interviewer and offender work through it
together. It is not stated in the Department of Corrections manual if this is read in the
offender’s language of preference.
Offender Management Plans are created for all prisoners except for those who have been in
remand for less than 8 weeks or those serving sentences shorter than 28 days (Department
of Corrections, n.d.1, Part 4, Prepare Offender Plan). The Plan should be prepared and
finalised within 28 days of the sentence commencement date (SCD) for prisoners serving 26
weeks or less, and within 60 days of SCD for prisoners serving more than 26 weeks
(Department of Corrections, n.d.1, Prison Services Offender Management Manual, Part 4,
Prepare Offender Plan).
When timetabling an activity, the scheduler needs to use the following guidelines:






Rehabilitation programmes are a priority and are generally planned to finish near the
prisoner’s anticipated date of release.
Some activities may need to occur before the rehabilitation programme e.g.,
addressing literacy barriers by completing a literacy programme.
Prisoners can do more than one rehabilitation programme but if there is only
enough time to complete one programme, the programme that addresses the
primary offending need should be completed.
The drug treatment unit will allow prisoners to complete a programme at any point
in their sentence.
Some activities cannot start until the prisoner has reduced their security
classification.
Depending on the location of the prisoner, some programmes may not be available
while the prisoner remains at that location e.g., segregated prisoners (Department of
Corrections, n.d.1, Prison Services Offender Management Manual, Appendix 1,
Timetabling Activities).
The scheduler also needs to try and schedule the activities so that they have been
completed no more than 12 months after the parole eligibility date (PED) or by the statutory
release date (SRD) if the prisoner does not have a PED. If a prisoner appears before the New
Zealand Parole Board (NZPB) prior to completing their rehabilitative programme(s), their
report should indicate the start and end dates of any future scheduled programmes. The
NZPB may direct that a prisoner be permitted to participate in an earlier scheduled
programme or activity if the Board is satisfied with the prisoner’s overall progress to date
(Department of Corrections, n.d.1, Part 4, Prepare Offender Plan).
39
Table 1 The process of screening and assessment of problem gambling‡‡
‡‡
This table was compiled using information from: http://www.corrections.govt.nz/aboutus/structure/rehabilitation-and-reintegration-services.html, no page reference. (accessed 16 April 2011),
(Department of Corrections, n.d.1; n.d.2, Volume 1)
40
Gambling as a Rehabilitative Need
Gambling is listed under area four, ‘Health, Well-being, Lifestyle and Support’, within the
category ‘Physical and Mental Health’ in the ‘Offender Plan Areas’. It is one of the five
Specific Targeted Rehabilitative Needs (STNs).§§ STNs are more tangible than other
rehabilitative needs, and can often be ascertained in discussion with the offender about
their offending behaviour, as well as through screening tests (Department of Corrections,
n.d.1, Part 3, Offending and Needs Assessment). If the offender scores a 3 or more on the
NINE (G9) Problem Gambling Screening Test the activity recommended is to attend
counselling to address gambling problems. A referral is sent to the Programmes Manager.
With the exception of remand category prisoners, gambling counselling can be considered
for all prisoners (Department of Corrections, n.d.1, Appendix 1, Area 4). This activity is
considered “achieved” when counselling has been completed to the satisfaction of the
service provider (Department of Corrections, n.d.1, Appendix 1, Area Four).
The CPPS Operations Manual says that to be identified as a need there should be “a clear
association between the offender’s motivation to engage in an offence and their gambling
desire” (Department of Corrections, n.d.2, Volume 1, Types of Rehabilitative Needs).
The CPPS Operations Manual lists that the resources available to target gambling can
include: community gambling programmes; individual one-on-one gambling counselling;
and departmental programmes (MIRP/SRP - Medium Intensity Rehabilitative
Programmes/Short Rehabilitative Programmes), depending on the RoC*RoI score of the
prisoner (the Risk of re-Conviction x the Risk of re-Imprisonment measure designed to assist
in predicting an offender’s risk of re-offending and re-imprisonment).
Rehabilitation Interventions Available
Interventions for offenders are designed to address rehabilitative needs, reduce reoffending, and facilitate reintegration into the community. Offenders are assessed, and
programmes provided, based on three key principles of risk, need, and responsivity. Those
considered at high-risk of re-offending, those with a rehabilitative need directly related to
their offending, and those motivated to change take priority in programmes.
Problem gambling is addressed as a rehabilitative need through a variety of programmes.
The Problem Gambling Foundation (PGF) has a national contract with the Department of
Corrections with services funded by the Ministry of Health to provide problem gambling
interventions in New Zealand prisons. Gambling may also be addressed through other
programmes including cultural programmes, lifestyle programmes and departmental
programmes such as the Medium Intensity Rehabilitation programmes (MIRP), Short
Rehabilitation Programmes (SRPs), and Kowhiritanga, though there is no specific
information as to how this should be done.
§§ The five STNs are: Offence-related sexual arousal; violence propensity; alcohol and other drug; gambling;
relationships difficulties.
41
Medium Intensity Rehabilitation Programme - MIRP
MIRPs are delivered to groups of up to 10 offenders, over a period of approximately 13
weeks, and require attendance at four sessions each week for 53 sessions. Each session is
approximately 2.5 hours long, with the total programme taking approximately 134.5 hours.
To be eligible for the MIRP offenders need to be over 20 years old, male, have a RoC*RoI
score between 0.3 and 0.7, and be motivated to address their rehabilitative needs
(Department of Corrections, n.d.2, Volume 1, Special Conditions Related to Medium
Intensity or Short Rehabilitative).
Short Rehabilitative Programmes - SRP
SRP-W (Short Rehabilitative Programme – Women) is a programme for women prisoners to
reduce re-offending. It is delivered in groups of up to 3 offenders and requires attendance at
3 to 4 sessions per week for 16 to 18 sessions. Each session is 2.5 hours long with the
programme taking up to 45 hours. With the introduction of the SRP-W, female offenders are
no longer eligible to attend the MIRP (Department of Corrections, n.d.2, Volume 1, Special
Conditions Related to Medium Intensity or Short Rehabilitative).
SRP-M (Short Rehabilitative Programme – Men) is the programme for men who are
unsuitable for MIRP (due to responsivity barriers such as personality or behavioural
difficulties, or they are in locations where MIRP cannot be provided). It may also be offered
as an alternative where there are not enough participants to make the MIRP viable. The
SRP-M is delivered in groups of up to 3 offenders and requires attendance at 3 to 4 sessions
per week for 18 sessions. Each session is 2.5 hours long with the programme taking 45
hours. (Department of Corrections, n.d.2, Volume 1, Special Conditions Related to Medium
Intensity or Short Rehabilitative).
Kowhiritanga – “Making Choices”
The Kowhiritanga programme is designed to help women offenders examine the causes of
their offending and develop specific skills to prevent them re-offending. It is both prisonbased and run in the community. The programme is aimed at women with a risk of reoffending, and priority is given to Māori participants. The programme is delivered over 103
hours (40 sessions) by a programme facilitator and a psychologist to groups of up to 10
participants. Sessions are intensive and usually run for 2.5 hours, four days a week (except
the first and last two sessions, which run for 3.5 hours). The programme uses Cognitive
Behaviour Therapy techniques (CBT) and addresses issues including violence, anti-social
feelings, poor self-control and impulsivity, self-management and problem-solving skills,
substance abuse problems as they relate to the offence process, and relationship
difficulties.
Special Treatment Units
There are a number of rehabilitation programmes in Special Treatment Units located in
prisons. Two of these unit types may address gambling as part of the broader issues they
are addressing, though gambling is not the focus of the units.
42


Drug Treatment Units (DTUs) may address gambling as an issue related to addressing
other issues of addiction, impulsivity, or poor self-control. Corrections currently
have nine DTUs located in nine prisons, which enable treatment for 1000 prisoners
each year. There are six prisons with DTUs that offer a six-month programme
provided by CareNZ*** (Arohata, Rimutaka, Spring Hill, Christchurch Men’s, Waikeria
and Hawkes Bay) and three prisons with DTUs offered as an intensive three-month
programme by Care NZ (at Otago and Wanganui) and by Odyssey House (at Auckland
prison). These programmes target high, medium and low risk offenders, but those
with a higher risk of re-offending based on the RoC*RoI get priority of placement
(Department of Corrections, n.d.1, Appendix 2, Drug Treatment Programme (DTU)).
Māori Focus Units address a prisoner’s needs as they directly relate to offending,
including alcohol and substance abuse, or violence, but with a specific Māori cultural
perspective. Māori Focus Units are constituted on tikanga Māori principles and
operate within a tikanga Māori environment. Māori Focus Units are operating in five
prisons - Hawkes Bay, Rimutaka, Waikeria, Whanganui and Tongariro/Rangipo.†††
Problem Gambling Foundation (PGF)
In 2010 the Problem Gambling Foundation (PGF) signed a contract with the Department of
Corrections to provide problem gambling intervention services in all 20 New Zealand
prisons, according to demand, which was funded by the Ministry of Health. The objective of
the intervention is to promote an awareness of problem gambling, to help prisoners address
and resolve their problem gambling behaviours and to help prison staff create a safe
environment that does not perpetuate or encourage problem gambling or the harm caused
by it.
The Department of Corrections’ role in this agreement is to ensure an effective referral
system whereby prisoners are screened and assessed to identify need, and then referred to
the intervention through the Offender Management process. Once enrolled in an
intervention, prison staff are obliged to ensure prisoners attend all intervention sessions on
time and that prisoners are informed in advance of their participation in the sessions.
PGF staff must be cognisant of and abide by the relevant professional standards, legislation
and departmental policies and procedures. The intervention for each individual prisoner
must be maintained to ensure it reflects feedback gathered from prisoner evaluations,
facilitator feedback, best professional practice and intervention evaluation, and kept up to
date. Any changes within the intervention must be submitted to the Department for
approval.
***
CareNZ is the delivery arm of the charitable foundation NSAD (New Zealand Society on Alcohol and Drug
Dependence).
†††
http://www.corrections.govt.nz/about-us/fact-sheets/managing-offenders/specialist_units/maori-focusunits.html
43
Results: Case Studies
Although two case studies were undertaken, the results are presented here together
because once the themes were analysed a high level of similarity was recognised. Where
there were specific or outstanding differences between the responses related to the two
sites, this has been highlighted. For an overview of the prisons involved see pp.31–32 and
for the specifics of the case study methodology see pp.30–33 of this report.
Screening
Centrality of the screening tool
The NINE screening tool was central to the screening process for determining problem
gambling in both prisons. It was stated that all offenders are initially assessed for problem
gambling using the NINE. There was an expectation that this was completed by probation
officers during the standardised pre-sentence assessment. Probation officers do a
standardised pre-sentence assessment which involves working through a booklet that has
all the required tests and questions including the NINE. The results of this assessment were
conveyed in a report to the sentence planners with recommended interventions.
Cases were identified where the NINE had not been completed by the probation officer.
There was an expectation that prison staff would undertake this at the initial assessment of
the prisoner’s needs on entry to the prison, though there was some reluctance around this.
‘Yeah. If it hasn’t been done, if there’s no score there, we try and contact the
probation officer that wrote that report and see if they’ve got the scores in their
assessment material. Otherwise if we can’t do that, then we have to come
down and we have to do that test.’ (Prison staff)
Deficits in relying on the screening tool
Prison staff were adamant that every offender received a NINE rating. They generally found
the NINE easy to use and quick to apply (taking approximately 5 minutes to complete). They
perceived that the offenders seemed to understand the questions but, if required, it was
standard practice for the staff to clarify the questions.
‘we do keep explaining to make them understand, cause it’s a process that we
want to get right.’ (Prison staff)
However prison staff also indicated that there were difficulties in relying solely on the NINE
to detect problem gambling. The interviewees mentioned research findings that around
23% of men and 34% of women within the New Zealand prison population met the criteria
for probable problem and pathological gambling within the six months prior to
imprisonment (Abbott & McKenna, 2000; Abbott, et al., 2000). Prison staff said the
screening tool was not detecting the numbers of problem gambling offenders indicated in
44
this academic research. There was a perception that this inability could be partially
explained by offenders distorting their responses for ulterior motives.
‘Now some of these people are very good at hiding some stuff, right? And that,
to me, and that’s my own view, is that it’s about, it’s a shame thing, “I don’t
want to be giving out too much information...”’ (Prison staff)
Problem gambling service providers raised other explanations as to why the screen might
not be detecting the numbers indicated in academic research. They attributed the failure of
the NINE to detect the numbers of problem gambling offenders, to reluctance by custodial
staff to prioritise problem gambling and in some cases questioned whether the screening
tool was even applied.
‘We have that old culture where gambling is not seen as something that needs to
be focused on.’ (Service provider)
This reason is not necessarily a limitation of the NINE as a tool, but a commentary on the
place of problem gambling within the addiction hierarchy or an indication of issues in the
relationship between prison staff and problem gambling service providers.
It was also perceived that problem gambling behaviour often co-exists with other addictions
that were given greater priority in the screening process, or in some cases mistakenly seen
as the issue.
‘So then there were people, who were in prison for drug and alcohol convictions
and issues, but they actually didn’t have an addiction to alcohol, they had an
addiction to gambling, but that was never really identified.’ (Service provider)
Service providers felt that difficulties in screening might be attributable to inherent
inadequacies with the actual instrument. They highlighted that the NINE asks about
patterns of gambling in the 12 months before entering prison, yet some offenders may have
been in remand longer than this time, before being screened. The service providers also
questioned the extent to which the instrument was culturally appropriate.
Problem gambling service providers also pointed out that they often did not know the score
that the offender had received in the screening and saw value in this communication to
assist them in targeting specific interventions in therapy.
‘Yeah in terms of therapeutic care and consistency in this practice, it would be
useful to have the screen result that they obtain and then we would compare if
there’s been any changes or differences. Um, and we never see the results.’
(Service provider)
45
In both case studies there was a discrepancy between the prison staff and the problem
gambling service providers as to difficulties in the use of the NINE. Given the small sample
size of those interviewed, it is hard to ascertain the extent to which this is an accurate
reflection of divergent opinion or the confirmatory bias of the strong opinions of individuals
passionate about their own value in addressing problem gambling in prisons.
Best practice – a more comprehensive approach
In one of the prisons the NINE scores received on admission prior to prison were not
automatically accepted. If there was any indication in the communication between the
prison staff and the offender doubting the outcome of the original NINE score, then the
NINE was repeated to clarify the perception.
A strong rationale was provided by prison staff for screening using the NINE on a number of
occasions.
‘I think prior to them being sentenced, they might be reluctant to be telling
probation or anybody that they’ve got problems, in the hope that they might get
reduced sentences or not sentenced. Whereas once they come into prison then
they’re a bit more free with the information.’ (Prison staff)
Staff in the other prison also expressed misgivings about the NINE scores; in both prisons a
more comprehensive screening approach without a complete reliance on the NINE had
evolved. This approach occurred in the sentence planning process, soon after the offender’s
entry to prison and saw the NINE results combined with information elicited through the
offender planning interview and calculation of the RoC*RoI. Assessments of problem
gambling were made using a range of pre-prison information including;
‘Pre-sentence reports, probation reports, judge’s comments and personal
history.’ (Prison staff)
The importance of the relationship that developed between the offender and the sentence
planner was highlighted. It was this rapport that was viewed as allowing more in-depth
exploration of problem gambling behaviour.
‘And once the case officer and the prisoner start getting a rapport they will open
up, well she will open up a hell of a lot more.’ (Prison staff)
Once this information was in the file, it was seen as being crucial in assisting the sentence
planner to identify a problem gambling need and then planning for it to be addressed.
The sentence planning process allowed the cross referencing of several sources of data.
One such source of data was the documentation by the offender’s case manager of the
offender’s everyday life on the unit where they were residing.
46
‘Custodial staff keep file notes, regular file notes so that we always access them
to see what’s happening in the unit anything like that. You might find a file note
that they’re playing cards and betting cigarettes or something like that, stuff like
that yeah or a prisoner might tell us.’ (Prison staff)
Critique of best practice
Although the evolution of this comprehensive screening process was spoken about
positively, those who were interviewed also offered a critique of its use because it placed a
strain on already stretched staff resources and consequently could delay sentence planning.
Sentence planners were perceived as having high workloads, which could result in delays in
developing a plan which incorporated problem gambling needs.
‘Up to 5 months after arriving in prison – this falls outside the recommended 60
day maximum time frame to develop a plan.’ (Prison staff)
Further, sentence planners were also responsible for writing Parole Board reports and this
requirement was also seen as delaying the sentence planning.
‘The sentence planners actually spend a lot of their time doing court reports for
parole board hearings you see, they’re a priority because they must be done…
We’ve always been behind the eight ball on having prisoner’s sentence plan
within the required time frame’. (Prison staff)
Referrals
General satisfaction
In the two case studies there was general satisfaction expressed by both prison staff and
service providers with the process of referral. The procedure in these prisons closely
followed the policy outlined in Results: policy and procedures review (pp.36–43): the
sentence planner passed a problem gambling referral to the programmes manager who sent
it to the programmes scheduler, who in turn sent it to the problem gambling service
provider. Referral to address the need was prioritised by the programme scheduler
according to other offender needs. Offenders were also prioritised one against the other,
based on risk of re-offending rates determined in the RoC*RoI assessment.
‘So really, the ability for the problem to get addressed relies heavily on this
thorough, thorough planning process, which takes into consideration need of the
individual, sentencing processes, release processes, what services can be brought
in, and what can’t, and the ability of people to go maybe, to other institutions to
meet need - some of those sorts of complexities.’ (Prison staff)
47
Room for improvement
Problem gambling service providers questioned the comprehensiveness of the referral
system and believed cases were missed. Problem gambling service providers themselves
sometimes identified problem gamblers through discussions with offenders or prison staff
outside of the custodial screening/referral processes.
‘I was identifying people for myself as being in prison, when I was doing the
interventions’. (Service provider)
Despite staff in both prisons believing the referral systems worked, they also indicated areas
for improvement. Some of the prison staff involved in the process perceived their role to be
redundant. One programme manager made the following statement.
‘The sentence planners send a referral to me, which is a great big fat no use
actually, but I send it to the programme coordinators and they send it off to the
gambling counsellors, so triple handled, but that’s the way it happens’. (Prison
staff)
In reality, prison staff themselves indicated that the process was not always rigorously
adhered to, especially in relation to the scheduling of programmes. There was an indication,
that in some cases, scheduling occurred in a haphazard or impromptu manner.
‘Once it’s identified in the sentence plan it goes to the scheduler and their names
are there. She gets a call saying, “Right we’re going to be running a gambling
programme, give us some names.” Bang, she’ll go into her list and say, “Right
these ones are identified on the sentence plan as needing it.”’ (Prison staff)
One prison staff member indicated that the opportunity to enter the programme can also
be offered to prisoners on an ad-hoc basis to any prisoner wanting to participate. This
appeared to be far removed from the rigor outlined, and we were not able to determine the
accuracy of this perception.
‘We also sometimes put a sign up at the staff bases over there, asking if any
prisoners want to go on it… the drawback of that is of course some of them [do it
for ulterior motives]’. (Prison staff)
Waiting lists
Some problem gambling prisoners were on waiting lists to receive services. There was some
confusion over why some referred prisoners did not receive services immediately. Prison
staff and problem gambling service providers tended to have different takes on the reasons
for this situation.
The Department of Corrections policy on waiting lists for rehabilitation programmes relates
to offender suitability (e.g. they might be on a waiting list if already on another programme
or if unmotivated to address their needs). In terms of policy, a waiting list does not
48
necessarily indicate a lack of service provision. Prison staff provided a pragmatic explanation
for the waiting list.
‘If a prisoner needs to do a programme, the scheduler will wait list ... Now when
the programme facilitators are looking at doing a new programme, they’ll look
at that wait list and they’ll pull the people off that wait list for that programme.’
(Prison staff)
Prison staff also indicated that service providers were to some degree responsible for the
waiting list. They believed it related to insufficient numbers of therapists, and a tendency of
some therapists to by-pass the lists created by the sentence planner and to accept referrals
from other sources, such as other offenders and staff (i.e. ‘jumping the queue’).
Problem gambling service providers believed waiting lists in the prison for problem gambling
services were indicative that the referral system was not working properly. At the time of
the interviews in one of the case study prisons only six people were receiving one-on-one
therapy and approximately 20 people were on the waiting list.
Service providers were unaware of the full details of the waiting list and the reasons why
offenders were on it. They believed the waiting list related to pragmatic difficulties in
scheduling opportunities, the suitability of some offenders to engage in the therapeutic
process (e.g., if offenders were in a Special Needs Unit), the motivation of some offenders to
engage and the provider’s difficulties in gaining access into the prison.
‘Some people have to wait a bit because they’re not suitable to be seen, they
might be in an at risk unit or a special needs unit … and certainly I wouldn’t see
them like any vulnerable person if they’re not in a good frame of mind or they
were sick or whatever was going on.’ (Service provider)
Problem Gambling as a “driver of crime”?
In one case study inadequacies with the referral system for problem gambling offenders
were also identified by an alcohol and drug service provider in the prison. This agency was
referred people with drug and alcohol problems, but in their further assessment sometimes
identified co-existing problem gambling behaviours. Prison staff themselves conceded that
problem gambling was at times subsumed within a wider addiction agenda and then a
prioritisation of alcohol and other substance abuse occurred as these were perceived as
major “drivers of crime”.
‘Prisons are very needs driven. Because gambling isn’t prioritised as a key “driver
of crime” then it may be identified and a person put on the waitlist, but they will
have other issues dealt with first.’ (Prison staff)
49
Interventions
Re-assessment
After receipt of the referral, problem gambling therapists saw the prisoner and undertook a
comprehensive assessment of the offender in order to prioritise and individualise specific
interventions. In the prisons the same comprehensive assessment was used as that for
community problem gambling services. The gambling behaviour was fully assessed including
the degree of gambling harm, gambling severity and the mode of gambling, plus screening
for a range of common co-existing conditions. Individual therapists had their own suite of
additional evidence based screening tools to determine co-existing conditions. These
included the WHO Assist Screen for Methamphetamine and Other Drugs, the Beck
Depression Inventory and the State Trait Anxiety Screen.
Therapists talked about a commitment to rigorous, comprehensive, holistic assessment. This
assessment was undertaken through a formal interview.
‘The clinical interview is a very broad, it’s like a social interview ... So it’s a very
broad interview and it usually takes place over two, we do find that we need two
sessions to get that thorough understanding.’ (Service provider)
The problem gambling service providers talked about the extent to which these processes
were time bound. It appeared that these assessment processes needed to be thorough, but
also speedy in order to proceed with the interventions, given the time allocated to the
therapy by resource constraints and prison realities.
‘We’re operating under resource constraints here in terms of how many times
we’re allowed to see prisoners, before it used to be as much as possible, now
they’re saying they [Ministry of Health] want them [prisoners] seen three or four
times.’ (Service provider)
Motivation to change and an empowering relationship
Service providers acknowledged the fundamental importance of the offender’s motivation
to change their problem gambling behaviour. Individual motivation was perceived as vital
for any intervention to be successful, as the intervention strategies often involved work
which was self-directed. A therapist and prisoner relationship that was a collaborative
partnership was viewed as pivotal in sustaining or improving the motivation of the prisoner
to address their problem gambling behaviour.
‘Actually offering the clients how they would like to work, so they are interested
in having us support them in developing gradient scientific thinking in what they
do.’ (Service provider)
50
The seeds of this motivation in many cases were viewed as self-sown and the role of the
service provider was to identify and nurture these.
‘… [They] do not know the triggers for gambling so if you start looking at the
triggers for gambling they’re quite fascinated and that's when you get them
pulled in when they’re estimating their own triggers.’ (Service provider)
However the difficulties in establishing this relationship were also acknowledged. The
boundaries to the relationship were spelt out at the first session, as were the potential for
alternative therapeutic relationships, for example in situations where the prisoner did not
like the therapist.
‘I give them their ethics, their rights that they didn’t have to see me if they
objected to me for whatever reason, ethnicity, gender, age, or anything that was
not, or they didn’t like me, they were not, it was not a compulsory thing’. (Service
provider)
Individualised eclectic interventions
In both prisons, once the assessment was completed, an individualised plan was developed
in cooperation with the prisoner. Therapists and prisoners formulated a plan in partnership,
which included individual goals to be achieved during the intervention and beyond. There
was no template that all therapists followed. Even within a single organisation the package
proposed reflected the skills, experience and preferences of the individual therapist. In
developing their own package for interventions, therapists often borrowed from other
addiction interventions and adapted them for problem gambling.
‘[There is a] range of backgrounds that people come from who do this kind of
counselling and work, - some people will have a complete psychological
approach, some will have an addiction approach, some will have a bachelor of
social practice approach.’ (Service provider)
A range of interventions, targeted to individual needs were used and included practical
worksheets, cognitive behavioural therapy, learning coping strategies, motivational
interviewing, the writing of reflective diaries and the development of relapse management
plans. One therapist mentioned their focus on a psycho-educational approach.
‘In terms of education about gambling and its harms and consequences the
common interventions we do are the gambling cycle and the gambling triangle externalising their relationship with gambling and opening up the dialogue about
it …. So a lot of sort of pro’s and con’s and decisional sheets.’ (Service provider)
51
The introduction of innovative interventions reflected the conceptual orientation and staff
development of therapists. One innovation was assisting the offender to construct a
narrative. Another innovation was the use of Interactive Drawing Therapy.
‘So we get training in interactive drawing therapy. Um, encourage the client to
express themselves in other than words. Um, to link in their emotional
experiences to what they’re talking about. So encouraging them to use colour
and to draw different things that they’re talking about um so, IDT is very
common, now we’ve all had that foundational training.’ (Service provider)
Group therapy
There were no group-based generalised interventions for problem gambling undertaken at
either prison. The focus on one-to-one therapy stemmed from beliefs that group processes
present a challenge to security in the prison and that the prisoners were unwilling to discuss
“private details” publicly:
‘One-on-one counselling, and that’s what they went to, is good, it works, but the
group counselling, no, because they don’t want to stand up in front of the others
and tell them their history and what they’ve been up to.’ (Service provider)
It is interesting though that the alcohol and drug provider in one of the prisons who was also
addressing problem gambling focused on group based therapy. Many community based
alcohol and drug interventions include the sharing of experiences and coping strategies
within group situations.
‘Because the model is predominantly therapeutic we don’t actually do a lot of
one-on-one, it’s more to do with group stuff.’ (Drug and alcohol service provider)
Complex, co-existing needs
Therapists highlighted the need to be aware of co-existing needs that had the ability to
complicate the problem gambling interventions. Co-existing needs mentioned included
domestic violence, brain injury, and illiteracy. Some offender needs required referrals to
specific agencies specialising in that need.
‘Gambling cases are always exceedingly complex … I’m uncovering things like
brain injury or a health problem that is really giving them some grief issues, then
there’s often some family grief issues … I will facilitate it on to the appropriate
service for them to deal with it.’ (Service provider)
Cultural appropriateness
Neither of the two case study prisons had gambling interventions targeting Māori, but at the
time of the interviews one had a Pacifica focused programme under negotiation with an
external provider. In this instance, the Pacifica provider had approached the prison and
offered their services.
52
Despite no Māori specific problem gambling intervention programmes, service providers
were supportive of such a possibility.
A variety of initiatives were put in place to ensure a culturally appropriate aspect to the
existing programme. Some therapists adapted material to have a cultural focus or facilitated
the input from expert cultural advisors. Some therapists recommended Māori offenders
seek culturally appropriate input through other (non-gambling) programmes to address
needs co-existing with problem gambling behaviours. Other service providers directly
referred to cultural gambling services in the community following release from prison to
address problem gambling.
‘Given that Māori should be having their own problem gambling programme,
given to them by Māori providers, that option is not available. So I give them the
option.’ (Service provider)
Involvement of family/whānau
It is not standard practice for family or whānau to be involved in the problem gambling
interventions provided to the offender within either prison. Service providers discussed a
number of complications that make family involvement difficult; for instance gambling
might be a secret the family don’t know about or the family might have difficulty supporting
therapy while the offender is in prison due to access constraints. Security and logistics were
seen as major obstacles in the realisation of involving family.
‘You’ve got to be an approved visitor to get in here, because the same thing, you
know, they will take advantage of everything, and someone will screw it up by
bringing something [contraband] in.’ (Prison staff)
Family involvement tended to be initiated at the request of the offender and with their
consent. Service providers indicated that this occurred in the context of planned follow-up,
post-release from prison. In such cases, the service provider contacted the whānau,
provided an information pack, and offered assistance or referral.
Timing
The literature indicates that the best practice for timing a prisoner’s participation in a
problem gambling intervention needs to be flexible but preferably early in the sentence (if
not in remand), and as close as possible to the time that the problem gambling behaviour
was exhibited. Yet no problem gambling interventions occurred with remandees. This may
be because Department of Corrections policy is not to provide any intervention services
until offenders have been sentenced to a term of imprisonment (Department of
Corrections, n.d.1, Appendix 1, Area 4). Introducing treatment for offenders not yet
sentenced would have significant resource implications.
53
‘It’s just the sheer logistics of the numbers of actually sentenced prisoner – we’ve
got to concentrate on them. Some remand prisoners can have a sentence plan
though, but that’s ones who we know are going to be on a long remand and
they’re very few and far between.’ (Prison staff)
Parole Board requirements often dictated when the interventions would take place, as there
was an expectation that offenders would address criminogenic behaviour prior to
requesting parole. Conversely prisoners sometimes displayed increased motivation to
engage in interventions that could improve the likelihood of obtaining parole. Therefore the
problem gambling intervention tended to occur later in the sentence or sometimes in the
community after release from prison in a normalised environment with greater whānau
support available and at the Parole Board’s direction.
‘There’s a growing expectation that more and more of what we do needs to be
managed post release’. (Service provider)
There was also recognition that prison transfers can potentially disrupt the flow and timing
of the problem gambling intervention. However, generally the therapists and prison staff
felt comfortable with their attempts to link the offender to opportunities in the new prison
setting. The sentence plan and offender’s file notes identifying problem gambling were
transferred with the offender to the new location, which facilitated continuity of care.
‘Because you’ve got those networks it’s very easy to get your information to
people so that they can be picked up, that’s as long as the prison that they’re
being transferred actually has some emphasis on gambling? … Yeah that plan
goes with them, and it gets reviewed accordingly to that prison.’ (Service
provider)
The impact of “risk” on therapy
The opportunities that existed for problem gambling interventions were to a degree
dictated by the level of risk of re-offending assigned to the prisoner. This level of risk of reoffending was determined through the assessment of the prisoner’s RoC*RoI score. Within
the prison system high intensity treatment is generally confined to those with high risk
scores and targeted criminogenic behaviours (such as violence and alcohol or drug
behaviours) through specialist units based on a therapeutic community approach. Problem
gambling behaviour was not a focus of these specialist unit programmes, though those
interviewed for this survey believed that it might be indirectly addressed in the programmes
offered, if the offender broached their gambling problems.
54
Evaluation and appraisal
There was a perception by therapists that on the whole prisoners were receptive to the
interventions they engaged in. There was some recognition of resistance and down-playing
of the importance of addressing problem gambling by a few prisoners, but by and large
therapists felt offenders did not engage in therapy for ulterior motives. However, therapists
did concede that some prisoners recognise that they would move more quickly through the
prison system, if they addressed rehabilitation needs.
‘There are a number of clients in correction settings who just want it for their
parole board hearing. They just want the piece of paper ticked that they’ve done
it.’ (Service provider)
Therapists stated that evaluation was a mechanism built into the management plan to
determine progress for the prisoner and to evaluate the actual interventions, from a
problem gambling service improvement perspective. Evaluation was viewed as an important
part of the culture of problem gambling service delivery. Each problem gambling session
was evaluated using a Session Rating Scale, which was also used by the same organisation in
evaluating community-based problem gambling interventions. The practice manager
overseeing the therapists also audited files monthly to check practice standards and
consistency in approach. There was no evaluation of treatment efficacy at follow-up with
offenders once they had been released from prison. This was a short-coming but reflects the
resource constraints on problem gambling service providers and the difficulties inherent in
evaluative follow ups in the community (primarily difficulties in locating people).
However prison staff were far more guarded in their support for prisoner benefit, signalling
ulterior motives by prisoners for participating in interventions. Highest amongst these was
the motive of engagement to facilitate communication with peers and to relieve boredom.
‘Prisoners will use any opportunity to communicate with others they’re not
allowed to normally communicate with, so you’ve got to be aware of that too.
And some of them do it just to fill in time, they actually don’t really care about
the programme, they just do it to fill in time’ (Prison staff).
Prison-wide education
Given that problem gambling is a public health issue, those interviewed were questioned
regarding the provision of prison-wide health education on problem gambling both for
prisoners and for staff. No general education interventions on problem gambling were
available in the prison. Those interviewed saw merit in the potential of such an initiative and
felt that such an opportunity may get support from offenders and also from prison staff.
55
‘You might be able to go into a unit and say, “There’s going to be a gambling
programme, who wants to go?” And you might get ten prisoners saying, “Yeah
I’ll go to that programme”.’ (Prison staff)
If such an approach was possible, a group focus was indicated as the preferable mode of
broad-based ‘public health’ education for the prisoners. This has been provided in some
prisons previously (e.g. Auckland Central Remand Prison) and likely would not contravene
Department of Corrections’ policy on remand interventions. Nor should it be an issue with
participants divulging personal information in the company of others as was raised earlier in
the context of therapy group interventions. However prison security issues as identified in
respect of problem gambling therapy groups may also exist in respect of prison-wide health
education groups.
Prison staff did not always recognise the seriousness of gambling. Therefore service
providers endeavoured to educate prison staff about problem gambling, to raise their
awareness. There was little opportunity to use group processes to achieve this, therefore
awareness training with staff was done informally on a one-to-one basis.
‘In terms of allocating resources I think it would be great if a research project like
this identified the benefits of large scale public health interventions for staff [as a
form of professional development] within correction settings.’ (Service provider)
Educating staff about problem gambling was seen as a way of encouraging their support for
prisoner interventions. Support from prison staff was viewed as crucial, as it was custodial
staff that affirmed and assisted with the ‘homework’ from therapy.
‘Yeah well you need everyone [from the prison] to buy in so without that it would
crash.’ (Service provider)
The role of alcohol and drug services
In one of the case studies there was no intensive alcohol and other drugs specialist, while in
the other prison an alcohol and other drug service provider ran a Short term drug treatment
unit established in 2010 for offenders with a high risk of re-offending. This was an intensive
three month residential programme developed to align with shorter prison sentences
associated with alcohol and drug abuse. The intensive programme included psycho-therapy,
psycho-education, and cognitive behavioural therapy. The programme was part of a
therapeutic community so its emphasis was on group-based interventions. The focus was on
assisting prisoners to learn to live with others, to be respectful, to face and resolve conflicts,
and to build a pro-social lifestyle.
This service viewed problem gambling behaviour as an addiction that they had the ability to
address. At the time of interview they had 30 people in the unit and indicated that 20-30%
56
were problem gamblers. Another alcohol and drug service provider was also contracted to
undertake a prison-based alcohol and drug programme, though this did not include problem
gambling interventions.
Some of the interviewees from stand-alone gambling service providers in the case studies
expressed some value in considering gambling as part of other programmes that were
undertaken in the prison.
‘I saw a room full of people who were strongly identified as drug addicts or
alcohol dependency and related violence contingences for aggravated assault or
whatever and they’re in there identifying as that and not as gamblers. But if you
had the opportunity to talk about gambling that would be ideal’. (Service
provider)
Getting the prison staff on board
Therapists identified the importance of having good relationships with the prison staff to
facilitate the smooth running of the problem gambling interventions. From the point of view
of the therapists, this was not restricted to RRS staff, but included all prison staff they had
contact with. It was stated that this relationship took time to establish and was built on the
reputation of, and the rapport with, the individual therapist.
There was an acknowledged tension between the prison staffs’ emphasis on custody and
the therapists’ emphasis on therapy. The prison environment was viewed as making
therapeutic engagement difficult, in part because prison protocol had to be strictly
observed, to maintain safety and security.
‘When you come away from these prisons you feel very tired. Plus you can’t drink
or go to the toilet for two hours at a time. Yeah so it’s very hard on you as a
person ... It took quite a while for them to put one lot of prisoners away before
they take one lot out and that takes a lot of time and it’s quite tiring and you’ve
got to stand exactly where they put you or sit where they put you.’ (Service
provider)
However there was a feeling that this tension could be ameliorated by specific
communication improvements to facilitate therapists to do their work. For instance
therapists do not always receive the entire sentence planning assessment information,
which they felt would assist them in formulating strategies to assist in addressing problem
gambling behaviour.
57
Constraints on service provision
The contracted problem gambling service providing services to one prison was contracted to
deliver 3 to 4 one-hour, fortnightly sessions per prisoner referred for problem gambling
interventions. The contract signalled a preference for intense, short, self-contained one-onone sessions with specific goals, rather than long-term counselling. However flexibility exists
whereby therapists can apply to the practice leader of their organisation to hold more
sessions if needed.
Follow – up
Parole Board as a ‘safety net’
Prisoners who are sentenced for more than two years are evaluated by the Parole Board
prior to release. Parole Boards interview the offender and review documentation of
progress in prison prior to making decisions regarding release. The therapists stated that
they input into this reporting.
‘So if there’s a lot of board reports that we need to be doing. We’ve got to
prioritise that because we have timeframes that we do parole board reports in.’
(Prison staff)
Parole Board hearings served as a ‘safety net’ to monitor that the sentence plan had actually
been met prior to release. The Parole Board was unlikely to release someone who had not
completed programmes to address their risk of re-offending. If the requirements had not
been met, conditions on release may be applied for these requirements to be met in prison
prior to release or in post-release supervision in the community.
In the community, probation officers were responsible for ensuring prisoners met the
conditions set by the Parole Board. Prior to release the probation officers re-assessed
prisoners and at this point highlighted problem gambling needs that could be addressed in
the community.
In one of the prisons there was ambiguity expressed as to the extent that all of the issues
regarding problem gambling could or should be addressed in prison. There was a perception
by prison staff that problem gambling interventions in the prison could “only do so much”
and the problems needed to be addressed back in the community in which offenders
belonged.
It was felt by some therapists that the emphasis on therapy in the prison should target
those prisoners who did not have conditions on their release from prison. The Parole Board
and their agents in probation were perceived as being able to guarantee community therapy
options for those that had conditions imposed on their release.
58
‘It could be a condition of release, by community probation that, “You will attend
gambling, blah, blah, blah” … that could be part of that condition of those sorts
of things to happen’. (Prison staff)
However, there was a degree of uncertainty as to the extent to which the conditions of
release for offenders with gambling problems actually equated to a requirement for them to
engage in treatment options. Conditions of release were often perceived as controlling an
offender’s movement, for instance imposing a condition of not entering a premise with
gambling machines, rather than addressing the issues through treatment.
‘You will not enter any premise that contains gambling machines or sells alcohol
or anything like that, oh yes that is quite often put on. Yes, now you’ve said that
that does ring a bell, but yeah I’ve heard that quite often, not allowed anywhere
near any pokie machines.’ (Prison staff)
Automatic release
Prisoners on automatic release, with sentences less than two years, do not need to go to the
Parole Board. Thus it was stated that there was not the same degree of monitoring as to the
extent to which the risks of re-offending were addressed.
‘They could be missed because they’re just getting released from prison, and
they’re going out in the community. A prisoner can be out on standard conditions
for up to six months past their sentencing date … standard conditions don’t cover
anything special like attending gambling counselling’. (Service provider)
Both prison staff and gambling service providers indicated that if a therapist knew a prisoner
was up for automatic release, then they needed to re-assess that prisoner and inform them
about gambling treatment services outside of prison.
Continuity of care
There was a realisation that prison was an artificial environment in which to address
problem gambling. The real test lay in the return to life in the community in which family
and significant others may actually support gambling by the offender.
‘Then they go outside and like I said straight back into the environment ... and
it’s a shame because some of the women are, you know, if they were in the right
place and with the right environment you’d never see them again, but it’s just
the environment they go back to.’ (Prison staff)
There were questions over whether existing problem gambling services provided adequate
continuity of care, follow-up and support for offenders when they were transitioning back
into the community, where opportunity and pressure to gamble was abundant. Presently,
therapists assisted by making referrals and giving information to prisoners about community
problem gambling services and specialist cultural problem gambling services.
59
‘Certainly anyone that we’ve been seeing in the prison that would be released on
our patch would be referred to colleagues around the country. Yeah, that's been
done, I’ve seen that done.’ (Service provider)
A best-practice scenario was projected by those interviewed in which problem gamblers
were systematically supported upon release, with regular contact and follow-up by the
same providers in prison thus providing continuity of care.
‘An ideal way of supporting them on their release is the group here, the support
group, for a strong link to relapse prevention being to attend support group
regularly. So that’s one way that we do keep in contact.’ (Service provider)
Clearly it would be useful if problem gambling service providers who have been involved in
the offender’s intervention in prison were also involved in this continuity initiative.
Additional themes
The specific issue of methamphetamine
Both prison staff and therapists highlighted growing concerns about the link between
methamphetamine use and problem gambling among prisoners. It was believed that
methamphetamine use created in the user a sense of hyperactivity and an impulse to
undertake activities which were self-absorbing and do not require social interaction.
Gambling machines and specifically those in casinos which are open all night were viewed as
a means of pursuing this need during periods of insomnia.
‘Yeah, if you’ve got a problem when you’re in prison because you’ve gone out of
control with P, you are almost guaranteed that gambling will be riding under
that hat … we’re seeing more where the dominant incentive is P use and
gambling is being picked up on screening.’ (Service provider)
This link was perceived as being indicative of the need for therapy to address both issues
concurrently.
Gambling in prison
There was a general indication from both problem gambling service providers and prison
staff that although gambling in prisons was prohibited, it was still a common activity.
Limited social activities in prison, to pass the time, were sighted as the reasons for its
prevalence. Gambling especially for cigarettes, food, or phone cards was viewed as a part of
prison life. Anything could be viewed as potentially open to gambling (e.g., Scrabble), and its
link to such was hard to detect and to prove. If offenders were caught gambling, a note in
their file recorded this and they could lose privileges. However, in one of the prisons the
staff interviewed minimalised the significance of gambling behaviour by prisoners.
60
‘…probably they won’t call it gambling, they call it trading (laughter) … if I was in
prison I’d be doing exactly the same thing. And I enjoy a flutter, but you ain’t
interviewing me.’ (Prison staff)
Prison staff indicated that it was not the gambling activity in prison that was the problem
per se, but the violence that might be associated with it.
‘You can gamble with anything if you’re going to do that - that in itself isn’t the
issue, it’s when it becomes a trigger for violence for stand-overs and everything
else that’s generated by the gambling. I think it’s human nature to gamble.’
(Prison staff)
Research focusing on offenders
There was a belief that prisoners in general and specifically those who had been released
from prison would be receptive to being involved in research about problem gambling.
Therapists expressed a willingness to facilitate contact and initial engagement once
offenders were released into the community. One therapist informed the interviewer that
her service provider organisation maintained a database and strong links with clients once
they left prison and continued community-based therapy. In this instance, contact for
research purposes might be feasible.
Some prison staff interviewees pointed out that successful prison visits for such purposes by
anyone outside of the prison required careful planning, an understanding of the prison
system and building a supportive relationship with key prison staff. If such steps were
undertaken prison staff expressed a willingness to assist.
‘We’d just escort you down to, like you wouldn’t have the prisoners up here.
We’d escort you down to an interview room down there and you’d get to
interview them.’ (Prison staff)
It was expressed by prison staff that the researcher needed to realise that research needs
were secondary to the safety and security needs of the prison.
‘You come at the right time, like you never come on a Friday afternoon, cause it’s
lock-down, and between twelve and one is usually lock-down on the high side but
not on the low side, so you can still interview through the low side.’ (Prison staff)
The processes of informed consent with prisoners requires a third party introduction, as
ethically the researcher is not supposed to know who is in prison, or who might be able to
be approached to participate. The prison staff voluntarily offered to undertake this
requirement.
‘It would be feasible if you could give us a profile and then I could get the list of
names ... and I could go through and have a look and say yes this one would suit
61
this ... I’d be prepared to be interviewed and if they say, “No piss off,” that’d be
it.’ (Prison staff)
The on-site work undertaken in this case study has informed the researchers in the critical
aspects of establishing positive relationships and in obtaining full cooperation from prison
staff, in undertaking research within the prison setting.
62
Results: Survey
This section outlines the results from two anonymous online national surveys of prison staff
and of external providers of problem gambling services in New Zealand prisons. See pp.33–
35 of this report for the specific methodology used in the national survey. This phase of the
research assessed prison staff and problem gambling service providers’ views on the
delivery of problem gambling services in correctional facilities across the country. The two
survey schedules are included in Appendices D and E.
The tables in this section show results from the relevant closed questions only. The
discussion below uses the information from the tables but also includes some of the
information from the open questions where respondents provided additional comments.
Survey response rates and description of samples
The prison staff survey was sent to case managers and senior case managers in all 21
prisons to best target those directly involved in rehabilitation and prisoner management.
One prison was excluded from the survey as it was a remand only prison. Therefore the total
number of completed surveys expected was 40. Thirty responses were received, one of
which only answered the first question and another only the first two questions. Both of
these were discounted from the data set. The remaining 28 responses, out of an anticipated
40, represented a 70% response rate. As the survey progressed, some respondents stopped
answering questions; out of those 28 responses, 25 completed the whole survey.
Case managers made up 57% (n=16) of the respondents, senior case managers 32% (n=9)
and those whose job titles were listed as ‘other’ were 11% (n=3). Fourteen of the 20 prisons
(70%) were represented by the respondents. In order to ensure anonymity we have
presented the findings in such a way that staff position or prison cannot be identified.
The second survey was sent to all the identified prison-based gambling intervention
providers in New Zealand. One main service provider has a national contract with the
Ministry of Health to provide prison-based problem gambling intervention services and we
were aware of one other national provider of such services. We were also aware that there
was potentially other small problem gambling service providers to prisons that we wanted
to contact to complete the survey.
Contact was made with the contracted service provider’s six practice coordinators. They
were asked to fill out the survey themselves and send on the survey to
therapists/counsellors working in prisons as well as indicating any other providers of whom
they were aware. With the other major provider, there were seven practice co-ordinators.
They were asked to fill out the survey themselves and send on the survey details to
therapists/counsellors working in prisons as well as indicating any other providers of whom
63
they were aware. This sampling by snowballing was further enhanced through contact being
made with the National Coordinator of the Problem Gambling National Coordination Service
(NCS) for further identification of those services providing prison problem gambling
interventions in New Zealand. Survey details were sent out through this network.
We expected service provision in 20 prisons excluding the remand-only prison. With the
addition of the practice co-ordinators (n=13), we were anticipating 33 service provider
responses. The total number of provider surveys received was 31, but three of these had
answered no questions and so were discounted. Therefore the remaining 28 responses out
of an estimated 33 possible respondents indicate an 85% response rate. Despite our best
efforts there was little response obtained from providers other than the two nationwide
services.
Practice co-ordinators overseeing the services made up 29% of the respondents;
therapists/counsellors implementing the gambling intervention were 57% of the
respondents; and 14% listed their job titles as ‘other’. Seventeen out of the 20 prisons (85%)
were represented by our respondents.
Screening
Table 2 shows the responses on screening from prison staff and service providers for the
questions from the survey. The surveys catered for the distinctiveness of problem gambling
provider and prison staff roles. Therefore they were not identical. The ‘not applicable
indicators’ highlight when an item was not asked of a particular role.
Prison staff clearly indicated the centrality of the screening process. They indicated that
screening was happening in the prisons and alongside problem gambling service providers
clearly viewed it as important. The NINE screening tool was pivotal to the screening process
but a significant minority of prison staff indicated the value of more detailed probation
officer and case manager assessments, and the value of scanning a variety of
documentation on prisoners to elicit an indication of problem gambling. The prison staff
perceived that prisoners seemed to understand the questions in the NINE, but it was
standard practice for the staff to assist in completing the screening tools.
There was an expectation that screening was completed by probation officers during the
standardised pre-sentence assessment. However there was also recognition by prison staff
that this was not always completed prior to prison by probation officers and flowed over
into early arrival into prison, where it became the responsibility of case managers.
64
Table 2 Prison Staff and gambling service providers’ perceptions of screening process for
problem gambling
Survey item
Screening occurs in the prison
Yes
No
Don’t know
Screening is important
Yes
No
Don’t know
Screening consists of: *
NINE gambling screening tool
Detailed probation officer assessment
Detailed case manager assessment
File notes/pre-sentence report
Screening occurs: *
At sentencing
When developing a sentence plan
Other
Screening is completed
Prior to prison
On arrival at prison
Within one month of arrival at prison
Other
Who undertakes the screening procedure *
Probation officers
Case managers
The screening acknowledges the severity of the problem gambling
Yes
No
Don’t know
The link between gambling and offending is outlined in screening
Yes
No
Don’t know
People involved in the screening are trained
Yes
No
Don’t know
Screening is culturally appropriate
Yes
No
Don’t know
Missing value
Assistance is given to fill out the screening forms
Yes
No
Don’t know
N=28
%
Service
Providers
N=28
%
25
1
2
89
4
7
N/A
N/A
N/A
25
1
2
89
4
7
26
8
6
11
87
27
20
37
N/A
N/A
N/A
N/A
15
18
10
50
60
33
N/A
N/A
N/A
18
1
6
3
64
4
21
11
N/A
N/A
N/A
N/A
26
20
87
67
N/A
N/A
25
1
2
89
4
7
N/A
N/A
N/A
19
5
4
68
18
14
N/A
N/A
N/A
13
5
10
46
18
36
N/A
N/A
N/A
2
15
11
7
53
40
15
4
9
54
14
32
Prison Staff
28
0
0
4
9
13
2
100
0
0
15
35
50
N/A
N/A
N/A
*Multiple responses
65
For sentence planning purposes, the majority of prison staff indicated that the screening
process indicated both the severity of the problem gambling and the links between the
problem gambling and patterns of offending.
There was uncertainty by those surveyed regarding the training needs for screening. This
level of uncertainty was to a degree predictable, given the changes occurring in the
Corrections infrastructure as previously noted. However, a small number of respondents
(mostly case managers) specified that they were not given training in the application of the
Nine:
“I am only required to use the form ... to use the form, no specialised training is
required as the information obtained is only what the offender self-reports”. (Prison
staff)
The importance of being trained and/or ‘qualified’ to conduct screening was highlighted by
a small number of service provider participants indicating that screening should be
undertaken by a person who is:
“… suitably trained [with] an awareness of the issue of problem gambling and an
understanding of the impact it has on those affected by problem gambling”. (Service
provider)
Both prison staff and providers were asked if screening was culturally appropriate. There
were high numbers of ‘don’t know’ responses from both sample cohorts. For those who
thought it was not, a need was expressed for the NINE to be translated into different
languages (Māori, Pacific, Asian):
“It would be important to have screens in different languages with questions that
have been cleared by cultural advisors.” (Service provider)
Table 3 indicates perceptions of the outcomes on the screening process. Both prison staff
and problem gambling service providers generally found the screening tool and the
screening process easy to use and quick to apply (the NINE taking approximately 5 minutes
to complete).
66
Table 3 Prison Staff and gambling service providers’ perceptions of the outcome of
screening for problem gambling
Survey item
Is screening efficient (easy to undertake)
Efficient
Not efficient
Neutral
Screening identified everyone who has a gambling problem
Yes
No
Don’t know
Are any prisoners falsely identified as problem gamblers
Yes
No
Don’t know
Prison Staff
Service
Providers
N=26
%
N=28
%
13
1
14
46
4
50
6
3
17
23
12
65
4
15
9
14
54
32
5
15
7
18
56
26
3
14
11
11
50
39
5
12
9
19
46
35
However, staff and providers gave a very similar response range when asked whether
screening identifies everyone who has a gambling problem, with more than half of
respondents in both groups selecting ‘no’. When asked to quantify what percentage of
problem gamblers were identified with the screen, the majority of providers (73%) and
prison staff (50%) thought that between 0-25% were identified.
Service providers and prison staff were asked to elaborate on what led them to this
conclusion about low screening numbers. Responses from the service providers highlighted
prisoner denial or unawareness of their problem and a lack of prioritisation by Department
of Corrections’ staff. Some problem gambling providers indicated that other issues (e g.
alcohol and drug abuse, and violence) were prioritised over gambling. Therefore gambling
was not always duly considered. Similarly, prison staff also discussed a lower prioritisation
of problem gambling need in relation to other rehabilitation. The lack of assessment
procedures for remand prisoners was also raised as reflecting in lower than anticipated
identification of problem gambling by two participants.
The reliance in the screen on self-reported data and/or the possibility that prisoners may
not be entirely truthful with their responses was a frequent response by prison staff to the
lack of identification of problem gambling. As stated by one participant,
“The screening test is directed at the prisoner’s perception, not the actual situation.
There are no questions to help contradict the prisoners perception answers if they are
not being truthful or are ignorant of their problem”. (Prison staff)
There was also a belief from some prison staff that prisoners use the system to get attention
to alleviate prison boredom.
67
The survey asked respondents whether they felt any prisoners were falsely identified as
problem gamblers. Prison staff and service providers again gave similar responses to each
other; those believing there were falsely identified prisoners were in the minority (see Table
3).
Referrals
This section of the survey received a sizeable number of ‘don’t know’ responses to
questions about aspects of the referral process from both the prison staff and the service
providers. For prison staff, parts of the referral process are possibly seen as outside the
remit of respondents, who were senior case managers and case managers. Also a level of
uncertainty to questions asked may be attributable to the changes occurring in the focus on
rehabilitation by the Department of Corrections as previously noted. For the service
providers, there is a relatively passive role in receiving referrals from prison staff and this
appears to be reflected in their lack of in-depth knowledge about the specifics of the
referral process. This is despite both prison staff and problem gambling providers seeing the
referral as important for prisoners accessing problem gambling interventions.
As Table 4 below shows, prison staff clearly indicated there was a standard referral process,
though there was uncertainty as to whether this reflected a national policy or a prison
specific policy. While nearly half of problem gambling service providers did not know there
was a standard referral process, which is understandable given that providers have a passive
role in the referral process.
Despite the emphasis on screening using the NINE, prison staff respondents identified a
number of other sources of referrals. These included the Parole Board, prison officers, the
prisoners themselves, prison psychologists and other addiction programme co-ordinators.
68
Table 4 Prison staff and gambling service providers’ perceptions of the process of referral
for problem gambling
Survey item
Standard referral process exists
Yes
No
Don’t know
Referral is important
Yes
No
Don’t know
Referral is based on
National (Department of Corrections) policy
Prison specific policy
Random application
Other
Referral consists of *
Assessment
Sentence planning
Development of a specific gambling intervention plan
Programme and service identification
Note in offender’s file
Notification to the prison health officer
Notification to the programmes coordinator
Assignment to a programme or wait-list
Referral occurs *
At prison reception
When developing a sentence plan
At the instigation of the Parole Board
Close to release
Other
The referral procedure is completed
On arrival
Within one month of arrival at prison
Within 2-3 months of arrival at prison
Other
The referral procedure is undertaken by*
Probation officers
Prison officers
Sentence planners
Case managers
Other
Prison Staff
Service
Providers
N=25
%
N=27
%
24
2
1
89
7
4
26
0
1
96
0
4
N/A
N/A
N/A
13
11
1
2
48
41
4
7
N/A
N/A
N/A
N/A
18
14
5
7
6
8
14
8
60
47
17
23
20
27
47
27
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
4
22
5
3
8
13
73
17
10
27
N/A
N/A
N/A
N/A
N/A
2
9
7
9
8
33
26
33
N/A
N/A
N/A
N/A
9
6
5
23
6
30
20
17
77
20
N/A
N/A
N/A
N/A
N/A
14
7
4
56
28
16
69
Other referral sources*
Parole Board
Sentencing judge
Any prison officer
Prison doctor
Prison psychologist
The prisoner
Family members
Other prisoners
Service providers
Other programme coordinators
Other
Severity of the gambling problem is acknowledged in the referral
Yes
No
Don’t know
The link between gambling and offending is outlined in referral
Yes
No
Don’t know
Referral is culturally appropriate
Yes
No
Don’t know
18
10
15
6
13
17
6
2
11
14
5
60
33
50
20
43
57
20
7
37
47
17
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
15
4
8
55
15
30
N/A
N/A
N/A
11
6
10
41
22
37
N/A
N/A
N/A
2
10
15
7
37
56
1
7
17
4
28
68
*Multiple responses
Participants acknowledged the importance of in-depth assessment following referral. From
this process, sentence planning and specific problem gambling intervention planning
evolved. This was followed by programme identification, communication with rehabilitative
staff (including the programme scheduler) and determination of intervention timing, by
assigning people to a waiting list.
All of this process occurred primarily at the time of sentence planning and the case manager
was pivotal in its development, with the assistance of probation officers, sentence planners
and other key rehabilitative staff. The referral process took a varying amount of time to
complete and a third of prison staff indicated that the time was greater than three months.
The respondents were not aware of the reasons for this lapse of time.
When asked whether the referral process was culturally appropriate, both staff and
providers were generally not sure. Some respondents questioned the degree to which the
referral process needed to be culturally appropriate, as it occurred independently of
prisoner input. However, the need for liaison with cultural expertise in the planning process
was acknowledged.
70
Table 5 Prison Staff and gambling service providers’ perceptions of the outcome of referral
for problem gambling
Survey item
The referral process is effective
Yes
No
Don’t know
The referral process is:
Efficient
Not efficient
Neutral
Percentage of those identified who are referred for therapy
0-25%
26-50%
51-75%
76-100%
Waiting lists for therapy exists
Yes
No
Don’t know
Percentage of those identified are on waiting lists?
0-25%
26-50%
51-75%
76-100%
Should problem gambling be referred over co-existing issues
(such as violence or drug and alcohol issues)
Yes
No
Don’t know
Prison Staff
Service
Providers
N =25
%
N=27
%
3
4
20
11
15
74
5
13
7
20
52
28
7
3
17
26
11
63
5
12
8
20
48
32
7
3
4
13
26
11
15
48
19
3
1
2
76
12
4
8
11
2
14
N=7
1
0
2
4
41
7
52
36
56
8
14
0
14
72
9
14
2
N=5
5
0
0
0
100
0
0
0
8
10
9
30
37
33
19
1
5
76
4
20
Table 5 shows a large majority of prison staff did not know if the referral process was
effective or efficient, whereas approximately half of the gambling service providers thought
that the referral process was neither. A conclusive understanding of the questions asked
could not be gained because of the large number of ‘don’t know’ responses. For similar
reasons, findings were hampered in achieving an understanding of respondents’
perceptions of the percentage of prisoners referred for treatment who actually received it
and perceptions of the existence of a waiting list. However, one possible interpretation of
these results is that prison staff did not have knowledge of the referral processes.
Respondents were asked to rate how important it was that prisoners were referred for
problem gambling intervention over co-existing issues. Only a minority (30%) of prison staff
rated problem gambling interventions as important when compared to issues like violence
or alcohol and drugs. Whereas the majority of problem gambling service providers said this
71
was important. This latter result is perhaps unsurprising given that these respondents were
from those committed to working in niche problem gambling services.
When asked to identify strengths and limitations of the problem gambling referral process, a
number of concerns were raised by respondents. Prison staff saw present difficulties in the
referral process as being rectified through moves by Department of Corrections to improve
rehabilitation in prison. For service providers the limitations most commonly mentioned
were relationship issues, with an emphasis placed on the need for prison staff to be more
supportive. As stated by one service provider:
“Currently referrals are based on the relationship between the local counsellor and
the prison. In cases where prison staff have an attitude that problem gambling isn't
important, then it is very difficult to make headway with referrals”. (Service provider)
When asked about suggestions to improve the existing referral process both prison staff and
providers highlighted the need for better communication between prison staff and external
problem gambling agencies.
Interventions
Given that problem gambling is a public health issue, the survey asked questions regarding
the provision of prison-wide health education on problem gambling both for prisoners and
for prison staff (see Table 6). Both prison staff and problem gambling service providers
thought general education for prisoners was a good idea. However ‘don’t know’ responses
by both sample cohorts hampered an understanding of whether this education was actually
occurring, and if so, whether it was perceived to be of benefit.
The few respondents who indicated general education was happening in their prison stated
that it was dependent on being initiated by individual health teams, nurses and case
managers, or that it happened in the prison’s Drug Treatment Unit (DTU) and in alcohol and
other drug (AOD) programmes.
The few respondents that indicated that prison staff received general education also
highlighted isolated events through the efforts of medical and nursing staff, or education
exposure through posters, Employee Assistance Programmes (EAP) and Cornet (the
Department of Corrections’ intranet).
72
Table 6 Prison Staff and gambling service providers’ perceptions of general education in
prison for problem gambling
Survey item
All prisoners should have education about problem gambling?
Yes
No
Don’t know
Education about problem gambling is available to all prisoners
Yes
No
Don’t know
Similar education is available to prison staff
Yes
No
Don’t know
General education is effective in addressing gambling problems
Yes
No
Don’t know
Prison Staff
Service
Providers
N =23
%
N =25
%
18
1
6
72
4
24
21
0
2
91
0
9
5
5
15
20
20
60
3
10
10
14
43
43
4
7
14
16
28
56
3
11
9
13
48
39
6
2
17
24
8
68
10
6
7
44
26
30
Table 7 shows survey participants’ responses to specific questions about problem gambling
interventions. When asked if interventions were available in their prisons only half of the
prison staff responded ‘yes’. Out of those who answered that there were interventions
available, only a few knew who ran them. Two respondents named the Problem Gambling
Foundation, and two named the Salvation Army. Some respondents made it clear that as
case managers their involvement ended once the problem was identified, so they did not
know what happened regarding interventions.
Problem gambling service providers were asked the detail of the therapeutic process. After
receipt of the referral, problem gambling counsellors undertook a comprehensive
assessment of the offender in order to prioritise and individualise specific interventions.
Participants indicated that this process included an assessment of the prisoner’s motivation
to change.
A range of therapeutic approaches then occurred including a 12-step programme,
psychotherapy/transactional analysis, solution-focused therapy, a Te Whare Tapa Whā
(holistic) approach, the completion of self-help homework modules from Canada, existential
therapy and dialectical behaviour therapy. This assortment of approaches indicated the
individualised approach given to therapy, which was dependent on the therapist involved
and the individual prisoner’s needs. However the problem gambling service providers
indicated that in most cases prisoners did not have a choice of gambling service provider,
nor do they have a choice of therapist (see Table 7). Therefore therapeutic opportunity was
dependent on the ability of individual therapists. Most of this therapy occurs on a one-to73
one basis between the prisoner and the counsellor and usually includes the development of
a relapse prevention plan.
Table 7 Prison Staff and gambling service providers’ perceptions of problem gambling
interventions
Survey item
Problem gambling interventions are available in the prison
Yes
No
Don’t know
Therapists assess prisoners prior to commencing intervention
Yes
No
Don’t know
Prisoner motivation to change is assessed
Yes
No
Don’t know
The intervention approach is:*
Pre-designed to suit everyone
Designed to suit the individual
Determined by the therapist’s orientation and training
Other
The intervention is based on:
Individual therapy
Group therapy
Individual/group combination
Other
Prisoners choose between gambling service providers
Yes
No
Don’t know
Prisoners choose their therapist
Yes
No
Don’t know
Therapeutic approaches include*
Counselling
Motivational interviewing
Cognitive behavioural therapy (CBT)
Teaching coping strategies
General problem gambling education
Interactive drawing therapy
Journaling
Narrative therapy
Other
N=25
%
Service
Providers
N =23
%
14
6
5
56
24
20
N/A
N/A
N/A
Prison Staff
N/A
N/A
N/A
3
3
17
74
13
13
N/A
N/A
N/A
18
1
4
79
4
17
N/A
N/A
N/A
N/A
7
17
14
4
23
55
45
13
N/A
N/A
N/A
N/A
12
1
7
3
52
4
31
13
N/A
N/A
N/A
8
10
5
35
43
22
N/A
N/A
N/A
6
14
3
26
61
13
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
19
18
18
20
18
11
9
9
11
61
58
58
65
58
36
29
29
36
74
Relapse prevention plans are part of the intervention
Yes
No
Don’t know
The most effective time for problem gambling interventions is
As close as possible to release
Post-release from prison
Any time during the sentence (makes no difference)
Don’t know
Other
Flexibility with the number of sessions is provided
Yes
No
Don’t know
Other intervention needs are referred to other services?
Yes
No
Don’t know
Problem gambling must relate to offending for intervention
Yes
No
Don’t know
Remand prisoners are involved in interventions
Yes
No
Don’t know
N/A
N/A
N/A
19
0
4
83
0
17
28
0
52
12
8
4
3
8
2
6
17
13
35
9
26
N/A
N/A
N/A
19
0
4
83
0
17
N/A
N/A
N/A
20
0
3
87
0
13
4
10
11
16
40
44
9
8
6
39
35
26
1
15
9
4
60
36
3
13
7
13
57
30
7
0
13
3
2
*Multiple responses
The literature indicates that the timing of a prisoner’s participation in problem gambling
interventions needs to be flexible, but should occur early in the sentence as close as
possible to the time that the problem gambling behaviour was exhibited (Krebs, et al., 2003;
McCorkle, 2002; Moore, 2002; D.J Williams, 2009; D.J. Williams, 2010). Yet half of the
gambling service providers and a third of prison staff felt the timing made no difference and
over a quarter of service providers felt that it should occur close to the time of release. The
majority of participants also indicated the exclusion of remand prisoners in accordance with
the Department of Corrections’ policy.
Providers stated that the average duration of a therapeutic session varied from 30 minutes
to an hour and a half. A range of responses was also given when providers were asked how
many sessions were on average received by prisoners. The lowest number was a single
session and the highest number of sessions mentioned was 10. The most common number
cited was 6 sessions (n=8 of 18, 45%). Respondents mentioned that the number of sessions
depended on the cognitive abilities and health of the prisoner. Where there were complex,
and co-existing needs (such as depression or trauma), more sessions were often required or
referral options initiated.
75
Table 8 indicates that the service providers of problem gambling interventions were
primarily trained counsellors. The service providers overwhelmingly saw a good relationship
with prison staff as vital to them successfully undertaking their role, given that they are
visitors to the prison environment. Prison staff were less inclined to value the centrality of
this relationship, which may have reflected a disconnection with the process of service
delivery.
Prison staff and providers were asked to rate the quality of relationships currently in their
prison. Only a minority of problem gambling service providers and few prison staff rated the
relationship as ‘good’. There was an acknowledged tension between the prison staffs’
emphasis on custody and the therapists’ emphasis on therapy. The prison environment was
viewed as making therapeutic engagement difficult, in part because prison protocol had to
be strictly observed, to maintain safety and security.
Staff and providers were asked to comment on what makes a ‘good’ relationship. The
majority of respondents indicated that communication (e.g. through on-going meetings),
was a key factor in ensuring the establishment of good working relationships and mutual
respect between prison staff and problem gambling service providers. There was an
emphasis on the need to appreciate each other’s expertise, perspectives and roles in order
to develop trust, respect and reliability. As stated by one provider,
“We worked together, although this took time and patience. I think that staff need
time to trust providers and understand that counselling can be useful in improving
behaviour”. (Service provider)
The induction, which the majority of service providers said they received, is a likely starting
point for exploring an understanding of each other’s roles and cultures.
76
Table 8 Prison Staff and gambling service providers’ perceptions of problem gambling
therapist needs
Survey item
Prison Staff
N=25
Problem gambling therapy is provided by
Trained counsellors
Trained therapists
Registered health professionals
Other
A good relationship between prison staff and problem gambling
is important
Important
Not important
Neutral
How good is this relationship currently
Good
Poor
Neutral
Service providers receive an induction regarding prison
procedures
Yes
No
Don’t know
%
Service
Providers
N =23
%
N/A
N/A
N/A
N/A
13
3
3
4
57
13
13
17
16
2
7
64
8
28
22
1
96
4
0
1
8
16
4
32
64
9
6
8
39
26
35
14
0
11
56
0
44
20
0
3
87
0
13
“Don’t know” responses from prison staff to a question regarding the cultural
appropriateness of interventions indicated their unfamiliarity with the interventions used
(see Table 9). However, it is of concern that almost half of the problem gambling service
providers indicated that they did not know if the interventions they used were culturally
appropriate. This is irrespective of the indication that the majority of service providers had
links with Māori service providers, ostensibly to ensure a culturally appropriate aspect to
the existing interventions.
The case studies indicated that it was not standard practice for family or whānau to be
involved in the problem gambling interventions provided to the prisoner while in prison. Yet
half of the service providers surveyed indicated that family/whānau were involved in the
interventions to assist problem gambling prisoners (see Table 9).
77
Table 9 Prison Staff and gambling service providers’ perceptions of culturally appropriate
interventions for problem gambling
Survey item
Interventions are culturally appropriate
Yes
No
Don’t know
Links are made with Māori service providers
Yes
No
Don’t know
Family/whānau are involved in interventions
Yes
No
Don’t know
Prison Staff
Service
Providers
N =23
%
N=25
%
0
2
23
0
8
92
5
7
11
22
30
48
N/A
N/A
N/A
15
4
4
66
17
17
N/A
N/A
N/A
11
9
3
48
39
13
From Table 10, it is clear that session evaluation was embedded into intervention delivery
primarily to improve the sessions to follow. However rigorous evaluation at the completion
of the sessions appeared to be missing. Therefore, prison staff and problem gambling
service providers were both asked about how effective and how efficient interventions are
in addressing gambling problems. Prison staff overwhelmingly stated a “don’t know”
response. This may be indicative of a disconnection from the initiated interventions and/or
reflect that prison staff lack knowledge on the effectiveness of such interventions. This area
would benefit from further investigation. Providers were understandably much more
positive about how effective and efficient interventions were.
For service providers, prison transfers had a significant impact on the perceived benefit of
interventions, presumably through interruption of the flow of continuity of therapy.
However, this disruption is potentially mitigated by the ease of the ability to hand over
therapy to a therapist in the new prison (see Table 10).
78
Table 10 Prison Staff and gambling service providers’ perceptions of the outcome of
problem gambling interventions
Survey item
Prison Staff
N=25
Intervention evaluation occur:*
For individual sessions
Once the therapy has finished
At intervals throughout the therapy
No evaluation occurs
Don’t know
Prison transfers impact on intervention continuity
Yes
No
Neutral
Hand-over to a therapist in the new prison
Yes
No
Don’t know
Interventions are effective in addressing gambling problems
Yes
No
Don’t know
Interventions are efficient in addressing gambling problems
Yes
No
Don’t know
%
Service
Providers
N =23
%
N/A
N/A
N/A
N/A
N/A
11
4
9
2
4
36
13
29
7
13
N/A
N/A
N/A
18
0
5
78
0
22
N/A
N/A
N/A
11
3
9
48
13
39
2
4
19
8
16
76
18
1
4
79
4
17
2
4
19
8
16
76
18
1
4
79
4
17
*Multiple responses
Another key finding in this section related to integrating problem gambling intervention
services with other addiction interventions when prisoners exhibited complex, co-existing
needs. The majority of both service provider and prison staff surveyed believed gambling
interventions should be integrated (see Table 11). Service providers who favoured
integration advocated for programmes to address a range of different and sometimes
intersecting addiction issues. It was felt integration would raise awareness about problem
gambling and also allow a single therapist to address a range of issues, rather than the
prisoner having to connect with a number of different therapists.
The survey attempted to ascertain if problem gambling services were also undertaken by
external AOD or Kaupapa Māori service providers, and/or internal AOD or Kaupapa Māori
Units (see Table 11). The survey indicated that AOD units sometimes included problem
gambling interventions. However, the responses relating to other specialist AOD providers,
Kaupapa Māori Units and Kaupapa Māori providers were less conclusive. Only one
respondent (a provider) said that one of these groups (a specialist Kaupapa Māori provider)
provided gambling interventions.
79
Table 11 Prison Staff and gambling service providers’ perceptions of engagement across
other service providers
Survey item
Prison Staff
N=25
There are other gambling services providers operating in this
prison
Yes
No
Don’t know
Gambling interventions should be integrated with other
addiction interventions
Yes
No
Don’t know
There are specialist AOD units in this prison
Yes
No
Don’t know
Other AOD providers (not AOD units) provide services in this
prison
Yes
No
Don’t know
Specialist Kaupapa Māori units run in this prison
Yes
No
Don’t know
Other specialist Kaupapa Māori providers provide services in this
prison
Yes
No
Don’t know
%
Service
Providers
N =23
%
N/A
N/A
N/A
7
14
2
30
61
9
16
4
5
64
16
20
15
2
6
65
9
26
15
7
3
60
28
12
18
1
4
78
4
18
14
3
8
56
12
32
2
6
15
9
26
65
14
10
1
56
40
4
10
6
7
44
26
30
11
4
10
44
16
40
6
2
15
26
9
65
At the end of the survey section on interventions, staff and providers were asked if they had
any additional comments about problem gambling education and interventions in prison,
including strengths and limitations. Most of the remarks from prison staff centred on the
availability of interventions, with some indicating that the current levels were good (“It is
great that we have a problem gambling counsellor on site and available to prisoners”) and
others indicating that availability was currently insufficient (“Counselling is not widely
available”).
For service providers the most commonly raised issue concerned relationships. Participants
thought that collaborative relationships, between prison staff and service providers were
the key to successfully implementing gambling interventions. Awareness and
acknowledgement of problem gambling issues by prison staff was also raised as an issue;
poor awareness by prison staff was thought to result in difficulties with providing services.
80
Finally, respondents were given an opportunity to suggest improvements to be made to
existing problem gambling interventions. This was an open comment box, and a number of
responses were received. For prison staff, most of the comments related to the structure of
the current interventions, with respondents expressing a preference for recognised, unit
based group programmes (as opposed to individual sessions) or the integration of gambling
with other addiction programmes. For service providers, suggested improvements focused
on communication and relationships between prison staff and service providers. Training
and raising awareness of problem gambling issues were both seen as playing a key role in
improving relationships.
Follow – up
Table 12 focuses on post -release planning for problem gambling prisoners prior to release
into the community. In regards to the re-assessment required for this planning, the clear
majority of prison staff respondents indicated that problem gambling was part of this reassessment. Responsibility for this re-assessment primarily rested with case managers. The
assessment requires an in-depth interview with the prisoner and a detailed review of
documentation by the therapist and prison staff.
Planning for community based follow-up for problem gambling, rests with probation
officers, with a tendency for them to refer to specialist problem gambling services.
For gambling service providers, the Parole Board is an important part of the post-release
process. Almost all providers indicated that they were required to write Parole Board
reports for prisoners who had undergone interventions. These reports focused on offender
motivation to change, the prisoners relationship with whānau/family and discussion of the
probability of the offender continuing follow-up upon release. It was felt that the reporting
of the problem gambling intervention was influential in the Parole Board’s decisions and the
setting of conditions for release. Prison staff agreed that involvement in a problem gambling
intervention would positively affect parole, especially if gambling was linked to the
prisoner’s offending:
“It would likely be viewed positively by Parole Board members however I’m not sure if
it would affect parole on its own-it would depend on extent to which it contributed to
offending”. (Prison staff)
The majority of prison staff believed that the Parole Board were able to determine
community follow-up, for those prisoners that had conditions imposed on their release.
81
Table 12 Prison Staff and gambling service providers’ perceptions of follow up for problem
gambling prior to leaving prison
Survey item
Post-release assessments consider problem gambling
Yes
No
Don’t know
Assessments are undertaken by*
Probation officers
Prison officers
Senior/ Case managers
Other
Assessments are based on*
Another G9/NINE screen
Therapist/Counsellor notes
File notes
In-depth interview
Discussion between therapist and staff
Other
Problem gambling community follow up is arranged by
Probation officers
Prison staff
Therapist/Counsellor
No one does
Other
Problem gambling services in the community referred to*
Problem gambling specific services
General addiction services
AOD providers
Kaupapa Māori gambling interventions
Other
Parole Board reports for problem gamblers are required
Yes
No
Don’t know
Gambling intervention are part of Parole Board conditions
Yes
No
Don’t know
Parole Board determine the degree of community follow up
Yes
No
Don’t know
N=25
%
Service
Providers
N =23
%
16
5
3
64
20
12
N/A
N/A
N/A
6
3
18
5
20
10
60
17
N/A
N/A
N/A
N/A
8
11
11
13
7
5
27
37
37
43
23
17
N/A
N/A
N/A
N/A
N/A
N/A
7
1
4
6
7
28
4
16
24
28
8
4
4
1
6
35
17
17
5
26
22
11
1
3
2
73
37
3
10
7
19
6
7
7
6
61
19
23
23
19
N/A
N/A
N/A
21
1
1
92
4
4
N/A
N/A
N/A
19
0
4
83
0
17
Prison Staff
15
0
10
60
0
40
N/A
N/A
N/A
*Multiple responses
82
Table 13 focuses on post-release problem gambling services for prisoners after release to
the community. At the point of release the process of managing community follow-up rests
with probation officers who were not surveyed for this research. This transfer of
management to an agency external to the prison helped to explain the high number of
“don’t know” responses of prison staff to items in this section; prison staff members may
simply not have knowledge of these processes. The service providers were also
disconnected from this process. Although many had an opinion of how this process worked,
the number of “don’t know” replies made it difficult to draw conclusions to the questions
asked.
When asked to comment on the shift from prison into the community, comments were
generally supportive of the need for continuity of care in the community.
“Connecting upon release will be crucial in maintaining the relapse prevention plan
and maintaining changes the person made during therapy”.
There was a general sense from service providers that the continuity of care for problem
gambling prisoners was lacking or not managed effectively. For instance statements such as
“I have major concerns for all prisoners leaving prison in terms of continuity of care”
Factors mentioned which impinged on the effectiveness of continuity of care included the
prisoners lack of transport, and relocation (moving to a different geographical location).
Likewise among prison staff, only a minority considered the release planning process as
effective. In terms of improvements, staff responses focused on relationship building,
including the need to improve communication and cooperation between prison staff,
probation staff, and the agencies providing problem gambling interventions:
“There needs to be a better and more informed relationship between the services so
that the staff referring are completely aware of what is available in the community
and how it works so that this can be fully discussed with the prison with some
authority. At present this is not the case”. (Prison staff)
83
Table 13 Prison Staff and gambling service providers’ perceptions of follow up for problem
gambling
Survey item
There are standard referral processes to assist with community
problem gambling
Yes
No
Don’t know
There are attempts to involve family/whānau in community
follow up
Yes
No
Don’t know
The release planning process is effective in connecting exprisoners with problem gambling services
Effective
Not effective
Neutral
The release planning process is efficient in connecting exprisoners with problem gambling services
Efficient
Not efficient
Neutral
Prison Staff
Service
Providers
N =23
%
N=25
%
5
7
13
20
28
52
12
2
9
52
9
39
7
8
10
28
32
40
15
3
5
65
13
22
3
7
15
12
28
60
7
6
10
30
26
43
4
9
12
16
36
48
9
6
8
39
26
35
The survey concluded with an opportunity for respondents to add comment on community
follow- up and suggestions for improvement.
There was a realisation that prison was an artificial environment in which to address
problem gambling. The real test being the return to life in the community, where family and
significant others may enable gambling.
There were questions over whether existing problem gambling services provide adequate
continuity of care, follow-up and support for offenders when they were transitioning back
into the community, where opportunity and pressure to gamble were abundant. Presently,
therapists assisted by giving information to prisoners about community problem gambling
services and specialist cultural problem gambling services.
A best-practice scenario for continuity of care was projected by those surveyed in which
problem gamblers were systematically supported upon release, with regular contact and
follow-up by the same service providers who addressed their need in prison. Clearly it
would be useful if problem gambling service providers who have been involved in the
offender’s intervention in prison were also involved in this continuity of care initiative.
84
Discussion
The research project outlined in this report aimed to examine and explore the provision of
problem gambling interventions in New Zealand prisons.
The research consisted of four phases, beginning with a review of the relevant literature and
a stock-take and review of national, regional and local prison policies for problem gambling
interventions. These were followed by case studies of the problem gambling services being
provided in two prisons and a national anonymous survey of prison staff and those
providing problem gambling services in New Zealand prisons.
As discussed in detail in an earlier section of this report (see Results: policy and procedures
review, pp.36-43), the Ministry of Health is responsible for developing and implementing an
integrated nationwide problem gambling strategy to prevent and minimise gambling harm.
Within the context of prisons, the Ministry of Health’s objectives relate to the Department
of Corrections’ policies to reduce crime and re-offending rates through education and
rehabilitation. Thus there is the need for a common understanding, consistency of approach
and mutual support in achieving like objectives between problem gambling providers
(implementing the Ministry of Health objectives) and prison staff.
In this study the initial literature review and case study interviews resulted in the
researchers developing a framework to describe the provision of problem gambling services
for prisoners. Four interrelated components emerged from the data: screening and
preliminary assessment; referral; interventions; and follow-up. We believe that this
categorisation has considerable conceptual value and enables a meaningful descriptive
approach to understanding problem gambling service delivery. It is our hope that the
analysis utilising this framework will contribute to a better understanding of the processes
operating in the provision of problem gambling services in correctional facilities; a better
understanding of the factors underlying and driving these processes; and ultimately lead to
the development of ‘best practice’ initiatives and more effective models for the provision of
problem gambling services to prisoners.
Within these four inter-related components there are some processes that are driven by
prison staff, some processes driven by problem gambling service providers and some where
both agencies interact. However even when one agency is not directly involved, it is
important that they are knowledgeable and well informed of the tasks of the other, in order
to support the process in total. The present study demonstrated that this is not always the
case. It is important that such knowledge deficits are bridged through communication and
the building of relationships, in order for the two groups to recognise and understand each
other’s roles and support each other in achieving the Department of Corrections and
Ministry of Health’s aims of reducing problem gambling harm.
85
Screening
The responsibility for the screening and preliminary assessment of offenders rests with
prison staff, though the process is initiated before offenders enter into prison.
Pivotal to this process is the use of the Problem Gambling Severity Index (PGSI), known as
the NINE (G9) for problem gambling. There is an expectation that this screening instrument
is completed by probation officers in the Community Probation Services during the standard
pre-sentence assessment. If, for some reason, the gambling screen has not been completed,
then this is undertaken by prison staff on entry into the prison.
The results of the NINE are used by the prison sentence planners in the development of an
Offender Management Plan which should be prepared and finalised within 28 days of the
sentence commencement date (SCD) for prisoners serving 26 weeks or less, and within 60
days of SCD for prisoners serving more than 26 weeks (Department of Corrections, n.d.1,
Prison Services Offender Management Manual, Part 4, Prepare Offender Plan). The NINE
results are reviewed alongside information elicited through the offender planning interview.
The rapport developed between the offender and the sentence planner allows more indepth exploration of problem gambling behaviour. This information is crucial in assisting the
sentence planner to identify a problem gambling need and then plan for it to be addressed.
The sentence planning process allows the cross referencing of several sources of data,
including the documentation by the offender’s case manager of the offender’s everyday life
on the unit, where they were residing. This process allows determination of both the
severity of the problem gambling and the links between the problem gambling and patterns
of offending.
Regarding the use of the NINE there was general recognition that the NINE was easy to use
and quick to apply (taking approximately 5 minutes to complete). There was a general
perception that offenders seemed to understand the questions and if not, it was standard
practice for prison staff to clarify the questions with prisoners.
However, despite the importance attributed to problem gambling screening and despite the
perception of the ease of its use, both prison staff and problem gambling providers
indicated that the NINE failed to detect a number of problem gambling prisoners. Over half
of both prison staff and service providers surveyed indicated that the screening procedure
did not identify the majority of prisoners with a gambling problem.
On one hand this failure was attributed to inherent inadequacies with the actual
instrument. For instance the NINE asks about patterns of gambling in the 12 months before
entering prison, yet some offenders may have been in remand longer than this time, before
being screened. The problem gambling service providers also questioned the extent to
which the instrument was culturally appropriate. The lack of screening for remand prisoners
was also perceived as a reason for low detection rates.
86
On the other hand, prison staff placed the lack of detection when using the NINE firmly back
on the prisoners. The reliance in the screen on self-reported data and the possibility that
prisoners might not be entirely truthful with their responses was a frequent response by
prison staff for the lack of identification of problem gambling.
Furthermore, problem gambling providers attributed failure of the NINE to detect problem
gambling offenders to a tendency of prison staff not to prioritise problem gambling.
Problem gambling service providers believed that even when gambling problems were
detected by the NINE, there was the potential for gambling issues to be given a low priority
by prison staff, as opposed to the value given to other health-related issues such as a drug
or alcohol abuse and violence. This stance is not surprising given the New Zealand
Government policy priority of addressing the “drivers of crime” (factors that lead to criminal
behaviour). An emphasis on the “drivers of crime” is given to violent behaviour, and drug
and alcohol abuse (Ministry of Justice, 2009).
Therefore a variety of reasons are projected to explain the discrepancy between the
numbers of problem gamblers detected in screening and the number of problem gamblers
projected in prison numbers, which is highlighted as being between 25-33% (Abbott &
McKenna, 2000; Abbott, et al., 2000).
Solutions were also provided by the respondents in this study to improving the detection
rates of the NINE. The first was the use of the NINE periodically throughout the prisoner’s
sentence. Respondents advocated for regular screens by trained staff throughout the
sentence, rather than the NINE only being used as a pre-sentence screen.
However it should be emphasised that the NINE is a screening tool only. Positive screens
should initiate a structured interview mirroring that which takes place during sentence
planning and the gathering of co-lateral information (such as offender files and court
reports) which enable the more detailed determination of problem gambling need.
Finally responses in the case studies and surveys from this study indicated that both prison
staff and problem gambling service providers were willing to improve inter-agency
communication and supported education in the use of the NINE to improve implementation
strategies. This appears to be an opportunity to improve the collaboration between prison
staff and problem gambling providers to ensure comprehensive and accurate screening of
prisoners for gambling problems.
87
Referrals
The official process of referral is standard in all prisons. The referral process is primarily
organised by prison staff. Once the sentence planner has indicated the need for problem
gambling interventions in the Offender Management Plan, a referral is sent to the
programme manager. With input from the prisoner’s case manager, decisions are made on
the right approach to address the need. Once this is determined the programme scheduler
is notified. The programme scheduler enters the course details on the Integrated Offender
Management System and schedules the prisoner for input from the problem gambling
service provider. In doing so the programme scheduler is cognisant of the total
rehabilitative emphasis occurring in the prison, at any one time (see Results: policy and
procedures review, pp.36-43). When timetabling an activity, the scheduler takes into
consideration what activities may need to occur before the rehabilitation programme (e.g.
addressing literacy barriers); the number of other programmes the prisoner needs to
complete; and consideration of the prisoner’s security classification.
The scheduler tends to schedule the intervention no more than 12 months after the
prisoner’s parole eligibility date or by the statutory release date (if the prisoner does not
have parole processes occurring). For those with parole requirements the New Zealand
Parole Board may direct a prisoner to an earlier scheduled programme or activity, if the
Board is satisfied with the prisoner’s overall progress (Department of Corrections, n.d.1,
Part 4, Prepare Offender Plan).
Prison staff in this study generally believed the referral system was functioning satisfactorily,
in that it is comprehensive, and operates relatively smoothly and in a timely manner for
those prisoners identified as problem gamblers. Those involved in the study saw no reason
to change the status quo.
However prison staff were aware of other referral processes initiated by prison custodial
staff, prison psychologists, and those initiated by prisoners directly to the problem gambling
service provider. There appeared to be a deviation from national Department of
Corrections’ policy toward prison-specific processes, in some instances. Respondents in this
research did not indicate the exact mechanisms by which these informal referrals occurred.
The national survey undertaken in this study received a number of ‘don’t know’ responses
from prison staff to questions about aspects of the referral process. Parts of the referral
process were possibly seen as outside the remit of respondents, who were senior case
managers and case managers. The survey also coincided with a changing emphasis on
rehabilitation by the Department of Corrections and associated staffing shifts. New staff
may simply have had little time to develop knowledge of the detail of the referral process.
Problem gambling service providers also had a limited understanding of the referral process
and felt disconnected from it. However, they expressed concern that the existing referral
88
system missed some problem gamblers, either through a failure to identify problem
gamblers or through ‘glitches’ or holdups in the referral process. Providers also expressed
concern regarding a lack of communication about the results of screening procedures: in
some instances where offenders were referred for problem gambling intervention, their
NINE score was not made available to providers.
The lack of understanding of the referral process by service providers was highlighted in
their perception of the waiting list for prisoners to receive problem gambling services. The
Department of Corrections policy on waiting lists for rehabilitation programmes relates to
offender suitability (e.g. prisoners might be on a waiting list if already on another
programme or if unmotivated to address their needs). Problem gambling service providers
saw waiting lists in the prison for problem gambling services as indicative of the referral
system not working. Service providers were unaware of the full details of the waiting list and
the reasons why offenders were on it.
Both staff and service providers questioned the degree to which the referral process needed
to be culturally appropriate as it occurred independently of prisoner input. However, the
need for liaison with cultural expertise in the planning process was acknowledged.
The passive role of problem gambling service providers in the referral process may help
explain the negative views expressed by some problem gambling service providers on the
effectiveness and efficiency of the referral system. This passive role appears to be reflected
in their lack of service providers’ in-depth knowledge about the specifics of the referral
process. This highlights the need for education to inform all interested parties.
In providing solutions to the perceived short-comings of the existing system, prison staff
saw present difficulties in the referral process as being rectified through moves by the
Department of Corrections to improve rehabilitation in prisons. For service providers the
limitations most commonly mentioned were relationship issues, with an emphasis placed on
the need for prison staff being more supportive. When asked about suggestions to improve
the existing referral process both prison staff and providers highlighted the need for better
communication between prison staff and external problem gambling agencies.
Interventions
The Department of Corrections’ policy and individual prison requirements determine the
timing and assigned priority of problem gambling interventions for prisoners through the
referral process and scheduling. While prison staff on the whole have a good grasp of
screening and referrals, the intervention process is the domain of the service providers.
General Education
Consideration must be given to whether a general health education approach would be an
appropriate and cost effective method of addressing the important public health issue of
problem gambling amongst the prisoner population. Both prison staff and problem
89
gambling service providers believed general education about problem gambling should be
available to all prisoners, though this was not happening in the majority of prisons.
Implementation of Interventions
For the most part prison staff had limited knowledge of the specifics of the interventions
being provided, even to the extent of not knowing if problem gambling interventions
occurred in their prison. Although it is not expected that prison staff should know
everything about the intervention process, to not know whether an intervention service
exists in their prison would presumably affect whether or not prison staff are proactive in
facilitating referral to that service.
This lack of awareness appeared to relate to the quality of the relationship and level of
communication between prison staff and problem gambling service providers, which was
acknowledged by prison staff in this study as requiring improvement. Awareness can also be
improved through education. An induction for prison staff is required that includes
discussion of the importance of focusing on problem gambling, to off-set a general
perception that addressing gambling is not a priority and therefore not an important
emphasis in rehabilitation. The induction also needs to discuss the links between screening,
referral, service provision and follow-up, so that the total process of meeting need is
understood. This induction should be extended to external problem gambling service
providers to assist in the smooth functioning of the system where the two groups interact.
Problem gambling service providers indicated that a referred prisoner is comprehensively
assessed by a service provider to determine the severity of gambling, degree of harm
incurred and presence of co-existing co-morbid conditions. An intervention plan is then
developed collaboratively with the offender, taking into account the individual’s
motivational, family, employment and social factors. Each intervention plan must take into
consideration accessibility determined by prison security requirements and Department of
Corrections’ sentence management policies.
A range of interventions are targeted to individual problem gambling needs and include
practical worksheets, cognitive behavioural therapy, learning coping strategies, motivational
interviewing, the writing of reflective diaries and the development of relapse management
plans. The introduction of innovative interventions such as constructing a narrative and
drawing therapy reflects the passion of individual service providers. There is no emphasis
on group-based interventions for problem gambling undertaken in prisons. The focus is on
one-to-one therapy, which stems from beliefs by the service providers that group therapy
presents a challenge to prison security and that prisoners are unwilling to discuss “private
details” publicly.
Service providers described therapy on average involving three or four one-hour, fortnightly
sessions per prisoner. The focus was on intense, short, self-contained one-on-one sessions
with specific goals, rather than long-term counselling. However flexibility existed whereby
90
therapists hold more sessions following consultation with the practice leader of their
organisation.
Support for the interventions from prison staff was viewed as crucial, as it was custodial
staff that affirm progress and assisted with the ‘homework’ from therapy. There was an
acknowledged tension between the prison staffs’ emphasis on custody and the therapists’
emphasis on therapy. The prison environment was viewed as making therapeutic
engagement difficult, in part because prison protocol had to be strictly observed, to
maintain safety and security. However both prison staff and service providers in this study
indicated that the tension could be ameliorated by effective communication between all
those involved.
Problem gambling service providers in this study indicated an attempt to meet the cultural
needs of prisoners through relationships with Māori problem gambling service providers.
However, few participants in this study considered the problem gambling interventions
currently in place to be culturally appropriate or inclusive of family or whānau involvement.
This is despite New Zealand research which has shown that a gambler’s cultural background
needs to be considered in both screening and treatment (L. Perese, 2009; Tse, et al., 2007).
Within the current focus on individual specialist interventions, it is interesting to note that
both prison staff and problem gambling service providers indicated support for combining
gambling interventions with more generic addiction or general rehabilitation programmes.
It was projected that this integration could work by providing specific problem gambling
modules in these programmes. It was believed that integration would raise awareness
about problem gambling and encourage prisoners to work with one therapist over a range
of issues, rather than having to connect with a number of different therapists. However
service providers also noted that integrated programmes should not be the sole source of
problem gambling service provision because there were problem gambling prisoners
without co-existing issues.
Efficacy of Interventions
There was a perception by problem gambling service providers that prisoners were
generally receptive to the interventions they engaged in, though there was an
acknowledgment of reluctance by a few prisoners to engage. However, historically, there
has been little attention paid to evaluating problem gambling interventions undertaken
within prison settings, despite evaluation being viewed as an important part of the culture
of problem gambling service providers.
More recently, there has been a move toward the use of session rating scales by one
provider to evaluate individual interventions. The intent is to progress this process
evaluation to evaluation of treatment efficacy with offenders at post release follow-ups. A
value was placed on independent evaluation, which service providers and prison staff could
91
support through third party initiated introductions to prisoners or by facilitating access to
data bases that might support evaluation.
Presently, remand prisoners are not involved in problem gambling education or
interventions. Yet international research has indicated that this period of high stress is well
suited to address problem gambling close to when the behaviour is occurring, even though
the programme may be brief and interrupted by release from prison (Krebs, et al., 2003;
McCorkle, 2002).
Overall, this research project revealed that prison staff and service providers acknowledged
the importance of communication in raising awareness and improving knowledge around
problem gambling interventions, and ultimately improving the outcomes of these
interventions for prisoners. Regular meetings were highlighted as a key factor in establishing
good working relationships and mutual respect between prison staff and providers.
Follow-up and continuity of care
For those prisoners released under parole board conditions, probation officers are
responsible for monitoring and ensuring that offenders meet the specified conditions, which
may include conditions relating to problem gambling. For the majority of prisoners who are
serving less than a 2-year prison sentence, there was no such provision for the systematic
follow-up to address problem gambling needs. Following release from prison the offender
was to some extent left to his or her own devices in re-adjusting to society and in resisting
societal pressures that may facilitate gambling. Prison staff and service providers
acknowledged the lack of systematic follow-up and support.
All those who participated in this study recognised the difficulties facing offenders on
release as they transitioned back into the community and generally recognised the need to
re-assess prior to release and, at the very least, inform prisoners about gambling treatment
services in the community. To date, service providers have not managed to establish a
systematic follow-up post release support for all prisoners, however individual providers
reported endeavouring to make community referrals for released individuals and thereby
contributing to continuity of care in prisoners transitioning back into the community. Many
providers considered that the ideal scenario would be for those who had been providing a
service to a prisoner to follow-up with service provision post release.
This research indicated that problem gambling service providers were involved in writing
pre-release reports for Parole Board decisions on those prisoners identified with problem
gambling issues. The formal involvement of service providers in pre-release assessments
and planning was less evident, but clearly required. There appeared to be a lack of
accountability for issues relating to continuity of care with neither party taking responsibility
for the provision of follow-up care.
92
A possible step towards best practice would be the re-assessment of need for every
identified problem gambling prisoner in the lead up to release (e.g. 6 weeks prior to release)
and the provision of regular contact and follow-up support. Where ex-prisoners stayed in
the local area it would be ideal if care was provided by the same therapist to enable
continuity of care, with service providers the prisoner already had an established
relationship with. Once again this involves better communication and some relationship
building between prison staff, probation staff and agencies providing problem gambling
interventions in order to explore possibility.
Developing a ‘best practice model’
This study has endeavoured to describe the current situation in New Zealand in respect of
providing services to prisoners experiencing problem gambling and to identify strengths and
limitations of these services. This enables the projection of a ‘best practice’ model for
future service delivery. In order to move toward developing a best practice model it is
necessary to address a number of elements identified in this study:
Challenges of the prison environment
Impediments or challenges caused by the prison environment include security issues,
prisoner transfers, disciplinary procedures, limited access to programmes, prison stressors,
and prison culture (Nixon, et al., 2006). Prison services are subject to impediments including
site-based divisions, institutional apathy (of both prisoners and staff), and poor relations
between prisoners, prison staff and external agencies that may be able to assist (Geller, et
al., 1977). Moreover, it has been identified in this study, and reflected in the international
literature, that problem gambling interventions may be less prioritised when compared to
other addiction intervention programmes (Baker, et al., 2006; Krebs, et al., 2003; Richmond,
et al., 2009).
This study confirms the existence of many of the challenges identified above, with both
service providers and prison staff reporting challenges in the accurate identification of those
with problem gambling issues and the subsequent provision of appropriate services.
Improving the communication channels between prison staff and those involved in the
provision of problem gambling interventions seems a positive necessary step to achieve
greater awareness and mutual respect of each other's philosophies, cultures and objectives.
Many of the challenges that are currently apparent could be significantly addressed through
open and regular communication to build respectful professional relationships.
Cultural issues
Māori and Pacific peoples are over represented in problem gambling prison populations
(Bellringer, et al., 2009; L. M. Perese, et al., 2009). The Department of Corrections policy
recognises the importance of addressing cultural needs within rehabilitation services, “in
order to reduce the likelihood of further reoffending” (Department of Corrections, 2010c,
p.6).
93
New Zealand research has shown that a gambler’s cultural background needs to be
considered in both screening and treatment (L. Perese, 2009; Tse, et al., 2007). This research
highlights that there remains a need to integrate a Māori perspective more
comprehensively into problem gambling services for prisoners who are Māori. Concerns
were expressed over offenders’ difficulty in understanding NINE screening items due to its
lack of cultural appropriateness; participants questioned the degree to which the referral
process needed to be culturally appropriate as it occurred independent of prisoner input;
and few participants considered the problem gambling interventions currently in place as
culturally appropriate or inclusive of family or whānau involvement. It appears likely that
better addressing specific cultural needs would increase the uptake and success rates of
prison-based interventions.
Type of intervention
In an extensive review of gambling treatment studies, Blaszczynski and Silove (1995) argue
that an absence of a comprehensive model to explain the pathogenic process from
controlled to pathological gambling has led to a variety of problem gambling treatments.
Tse and colleagues (2008) have concluded that cognitive and cognitive behavioural
therapies are the only ones with strong evidence-based success. They acknowledge the
complementary potential for the approaches of self-help, Gamblers Anonymous, brief
interventions, integrated approaches, some pharmacotherapies, and residential therapy
(Tse, et al., 2008). However, it should be noted that Jackson and colleagues (2003) found
potential limitations in the CBT approach. For example, it can be argued that a CBT approach
may neglect important factors in a gambler’s life, including co-morbidity, substance
dependence, marital problems, court orders, financial hardship, isolation and loneliness,
family and relationship problems, post-immigration adjustment, and employment issues.
These factors could be particularly relevant for problem gambling prisoners. Jackson et al.
(2003) conclude that best practice for addressing problem gambling is achieved through a
combination of interventions: “there appears to be support for a broad bio-psychosocial
approach, using cognitive-behaviourally oriented approaches and multimodal approaches,
delivered in community-based generalist agencies.” (p. 53).
Our current findings suggest that some form of CBT or its derivatives is the most commonly
used approach within New Zealand prisons supported by a wide range of complimentary
approaches to meeting need. In a setting as challenging as the prison environment,
understanding and support from prison authorities and staff would seem a necessary
precursor for further innovative intervention approaches.
Timing
As gambling is officially prohibited in prison, most prisoner gambling assessment focuses on
gambling that occurred prior to incarceration (D.J Williams, 2008). However, as complex
gambling issues can develop during incarceration (D.J Williams, 2009), there is the need for
on-going screening as the need arises (D.J. Williams, 2010).
94
Research suggests that the earlier in the sentence the prisoner is engaged in treatment, the
better the outcome (Krebs, et al., 2003; Moore, 2002). Yet rehabilitative interventions for
remand prisoners (close to the time of the problem behaviour) are not a Department of
Corrections requirement. Further, prison operational considerations may mean individual
sentenced prisoners are not offered intervention until late in their period of incarceration, if
at all.
Results in this study support a best practice of screening at multiple points in an offender’s
incarceration, and problem gambling interventions commencing as early as practicable. It is
suggested that all prisoners (both remand and sentenced) be screened, and if identified as
having a gambling problem, referred and offered interventions, within three months of
sentencing.
Prioritising problem gambling among other criminogenic behaviours
Compared to problem gamblers in the general population, problem gamblers in the prison
setting often have concurrent concerns: lower educational and socio-economic status,
personality disorders, or alcohol and other drug related difficulties (Abbott, 2001b). Yet our
study indicated that problem gambling is not considered a high priority for intervention by
prison authorities, relative to more strongly linked criminogenic behaviours such as violence
or alcohol and other drugs abuse. Williams and Walker (2009) also identified that
correctional staff sometimes overlooked gambling problems and prioritised monitoring of
other addictions such as substance abuse. Some researchers have recommended that
gambling interventions are attached to programmes established for other addictions, thus
capitalising on existing structures within existing resources constraints (Emshoff, et al.,
2008).
In line with the above findings, the present study found that gambling is frequently
overshadowed by other addictive behaviours in New Zealand’s prison system. It further
highlighted that both service providers and prison staff were amenable to the possibility of
combining gambling interventions with generic addiction and rehabilitation programmes, A
feasible approach to absorbing gambling into other intervention programmes has been
projected (Wilson and Williams, 2006).
Continuity of care/follow-up for re-integration
A study by Williams and Walker (2009) focused on the lack of problem gambling services
when prisoners re-enter the community. These researchers suggested educating Parole
Boards and probation officers about problem gambling and community services, so that this
information can be passed onto prisoners (D.J Williams & Walker, 2009).
In this study both prison staff and service providers highlighted a lack of continuity of care in
providing support for prisoners with problem gambling needs once they returned to the
community. There was even a lack of certainty as to who should take responsibility for
ensuring the continuity of care. We advocate for the active involvement of both prison staff
95
and service providers in the re-assessment of problem gambling need and release planning
to address this need at least six weeks prior to release, and the provision of regular contact
and follow-up support. Where ex-prisoners stayed in the local area, ideally follow-up should
be provided by the same prison therapist to enable continuity of care, within the context of
an existing therapeutic relationship. This initiative would involve good communication and
relationship building between prison staff, probation staff and agencies providing problem
gambling services.
Evaluation and increasing effectiveness
Our literature review examined the existing research on problem gambling interventions
within and outside of prisons. Although there are many, varied treatment programmes in
place for problem gamblers, there is limited research focused on evaluating them (Walters,
2005).
Research has emphasised the need to regularly evaluate prison programmes (Devilly, et al.,
2005; Geller, et al., 1977). Sessional evaluation as part of process evaluation has
commenced by some agencies. Best practice would see this practice extended to include
pre- and post-intervention follow-up evaluations of prisoners receiving problem gambling
services, including follow- up in the community.
Conclusion - best practice model
This discussion has considered a number of the elements that appear necessary for
developing a best practice model of problem gambling services in prisons, based on the
literature review and the findings from this prison study. Such developments would require
collaboration between prison staff, probation officers and problem gambling service
providers based on strong, committed and supportive relationships.
96
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101
Appendix A: Case Study Interview
Schedule
Key stakeholder interview themes
Problem gambling services in New Zealand prisons
Name of interviewee:
Job title:
Role in relation to problem gambling intervention:
Institution person aligns with:
Interviewer’s name:
Time, date and place of interview:
Screening for Problem Gambling

Are you aware of, or is there, a screening procedure for problem gambling in this
prison?

What screening process occurs for problem gambling?

Does the screening use a recognised screening instrument(s)?

Does it include broader interview and review of history/file notes?

Does it recognize the level of severity of the problem?

How and when does screening happen?

Does it occur individually or in groups?

Where does the screening take place?

Is the screening a part of larger process (e.g. receiving interview)?

Does the screening occur at reception or within what time period?

Who undertakes the screening – are they trained and experienced?

How effective is the screening in detecting problem gambling?
102

In your view are there many problem gamblers missed, or many falsely identified as
problem gamblers?

Are the screening processes in place culturally appropriate (e.g. for Māori, Pacifica
and Asian prisoners)?

Is assistance given to those who might have difficulty in understanding the screen
due to language or cognitive ability?
Referral Procedures Undertaken when Problem Gambling is Detected

What happens when problem gambling is detected?

Is there a standard referral process (please explain)?

How and when does the referral process happen?

How well does the referral process effectively link problem gamblers with a service or
assistance?

What number (or percentage) of identified problem gamblers are referred for an
intervention?

Is there a waiting list for treatment?

If there is a waiting list how are people prioritised (on the basis of severity of issue,
date of release, “first come first service”, security status, etc.)?

Are there any limits in the prison to prisoners attending the problem gambling
services?

Can you think of any ways that the referral process could be improved (i.e., to better
link problem gamblers with a service or assistance)?

What could Corrections/Justice do to improve the process?

What could providers do to improve the process?
Provision of Problem Gambling Education and Interventions

Education

What education about problem gambling is given in this prison?

Who provides it and how are they selected?

How did this education come about (who instigated it originally)?

How and when does it happen (Group versus individual, frequency of
intervention etc.)?

How effective do you think it is in addressing the gambling problem?

Do you think that prisoners engage in the education because they want to
address a gambling issue or do you think they sometimes have ulterior
motives? If so, what are these motives?
103



Are only people whose problem gambling relates to their past patterns of
offending involved in the education?

Is the education in place culturally appropriate (e.g. for Māori, Pacifica and
Asian prisoners)?

Is the education evaluated? If so how?
Interventions

What problem gambling interventions are used?

Who provides them and how are they selected?

How did these interventions come about (who instigated them
originally)?

How and when do they happen? (Group versus individual, frequency of
intervention, etc.)

How effective do you think the interventions are in addressing the
gambling problem?

Do you think that people engage in the interventions because they want
to address a gambling issue or do you think they sometimes have ulterior
motives? If so, what are these motives?

Are only people whose problem gambling relates to their past patterns of
offending involved in the interventions?

Are the interventions in place culturally appropriate (e.g. for Māori,
Pacifica and Asian prisoners)?

Are the interventions evaluated? If so, how?
General

Is there any attempt to involve the prisoner’s significant others in the
education and/or interventions?

Are problem gambling interventions, sometimes provided through other
forms of intervention or counselling services (e.g., alcohol or drug or
psychological counselling?)

Who are the other services and how effective do you think they are in
addressing problem gambling?

How are problem gambling services in the prison funded?

What impact do prison transfers have on continuity of involvement in
education/interventions?

Are prisoners on remand involved in the problem gambling
education/interventions?

Is there room for a refined education/intervention programme to address
the problem gambling needs of those on remand?
104
Problem Gambling Treatment Following Release

What planning occurs for prisoners with gambling problems at the time of
release?

Are there recognised referral processes to the community to assist with
problem gambling?

Is there any attempt to involve the prisoners significant others in this planning?

How and when does the release planning regarding problem gambling happen?

How effective is this process in engaging people with problem gambling once
they are released?
Gambling and Problem Gambling - Recognition and Understanding

Does gambling occur in this prison?

Is gambling specifically prohibited?

Is any form of gambling permitted-e.g., playing cards for cigarettes?

Can inmates somehow arrange gambling outside of the prison?

How prevalent is gambling in any of the above forms?

What forms of gambling are most prevalent while people are in prison?

Are people reprimanded (for gambling) in accordance with the prison “Code of
Conduct”?

What happens to prisoners in this regard?

How often does this happen?

Do you think that problem gambling is a recognised health need in this prison?

In your view, what constitutes “problem gambling”?

Do you use national policies/guidelines/procedural manuals in managing gambling
behaviour and meeting gambling related needs?

Are these translated into service specific documentation that you use (if so ask for a
copy)?
Potential for Improvement to Provision of PG Interventions?

Please comment on the relationship between the prison and those services
meeting prisoners’ problem gambling needs.

Can you give exemplars of best practice in delivering problem gambling
services in the prison

Are there any barriers to addressing problem gambling issues and what are
they?
105

How will addressing problem gambling shift with future policy directions e.g.,
the privatisation of some prisons, rising muster numbers, etc.

Can you make any suggestions on how to research the outcomes for
prisoners involved in problem gambling services?

How difficult would it be for this research to take place?

Have you anything else you would like to add regarding the use of problem
gambling interventions in this prison?
106
Appendix B: Participant Information
Sheet, Case Studies
The University of Auckland
Faculty of Medical and Health Sciences
Private Bag 92019
Auckland, New Zealand
www.health.auckland.ac.nz
20 April, 2010
Participant information sheet
Problem gambling services in New Zealand prisons
Principal investigators: Associate Professor Brian McKenna and Dr Robert Brown
To: Key Stakeholders
Introduction: You are invited to take part in this project funded by the Ministry of Health to
provide a stock take of current problem gambling services in New Zealand prisons. Your
participation is voluntary; you do not have to take part in this research.
The project will aim to provide a stock take of the current service provision for problem
gambling in New Zealand prisons. We are conducting case studies of two prisons as part of
this stock take. The case studies will closely examine the functioning of problem gambling
programmes already in place. Your prison has been chosen for one of these case studies and
you have been identified by the research team as a key stakeholder in the provision of
problem gambling interventions in your prison. You and other key stakeholders involved in
the running of this service are being asked to participate in this research
Your participation would involve partaking in one semi-structured interview. The interview
would focus on gaining your insights into facilitators and barriers to the effective provision
of the problem gambling initiative in your prison. The interview will be undertaken face-toface or by telephone and will take approximately 45-60 minutes of your time. The
interviews will take place at a venue convenient to you. Your involvement in the project will
107
in no way affect your employment and you are free to withdraw from the study at any time
without giving reasons. You may also withdraw any data you provided up to July 31, 2010.
All personal information will remain strictly confidential and no material that could
personally identify you will be used in any reports on this study. A member of the research
team will interview you and take notes on your answers. With your permission, the
interview will be recorded and later transcribed. The notes, transcriptions and recordings of
the interview will be kept in a locked location at the University of Auckland for the duration
of the project. Any information stored on computer files will be kept on the University of
Auckland server that requires a password for access. Following the completion of the
project, any de-identified information you provided will be handed over to the Ministry of
Health and securely stored for ten years. If you agree to take part, you will be required to
sign the consent form attached.
The research will be overseen by an expert reference group composed of representatives
from problem gambling services, the Department of Corrections and cultural expertise. At
the completion of the project (October 2010), information provided by you will be
contained in a report that will be submitted to the Ministry of Health. Once released for
publication, this report will be available on-line at the Ministry of Health’s website.
If you have any queries regarding this study please do not hesitate to contact Associate
Professor Brian McKenna on (09) 3737599 ext. 89554 or at b.mckenna@auckland.ac.nz. This
study has received ethical approval from the Northern X Regional Ethics Committee, ethics
reference number [insert]
108
Appendix
Studies
C:
Consent
Form,
Case
Faculty of Medical and Health Sciences
The University of Auckland
Private Bag 92019
Auckland, New Zealand
www.health.auckland.ac.nz
Consent form
Problem gambling services in New Zealand prisons
Principal investigators: Associate Professor Brian McKenna and Dr Robert Brown
I have read and understand the participant information sheet dated _________________
for volunteers taking part in the stock take of problem gambling services in New Zealand
prisons. I have had the opportunity to discuss and ask questions about the study with the
principal investigator and I am satisfied with the answers I have been given.
I understand that my participation in the study is voluntary (my choice) and acknowledge
that I can withdraw any data traceable to me up to July 31 st 2010. I understand that my
decision to participate or withdraw from this study will in no way affect my employment.
I understand that the information gathered from the interviews will be included in a report
that will be submitted to the Ministry of Health.
I acknowledge that all personal information will remain strictly confidential and no material
that could identify me will be used in any reports on this study.
I understand that the interview will be recorded with my permission and agree to the
interview facilitator taking notes of our discussion.
109
I understand that the notes and transcripts of the interview will be kept in a locked location
at the University of Auckland for the duration of the study. I understand that any
information stored on computer files will be kept on the University of Auckland server that
requires a password to access.
I acknowledge that following the completion of the study any de-identified notes and
transcripts of the interview will be handed over to the Ministry of Health for secure storage
and destroyed after 10 years.
I ___________________ (please print full name) hereby agree to take part in this study.
Date: ________________________________
________________________________
Signed:
English
I wish to have an interpreter
Yes
No
Māori
E hiahia ana ahau ki tetahi kaiwhaka Māori/kaiwhaka pakeha korero
Ae
Kao
Ka inangaro au i tetai tangata uri reo
Ae
Kare
Fijian
Au gadreva me dua e vakadewa vosa vei au
Io
Sega
Niuean
Fia manako au ke fakaaoga e taha tagata fakahokohoko kupu
E
Nakai
Sāmoan
Ou te mana’o ia i ai se fa’amatala upu
Ioe
Leai
Tokelaun
Ko au e fofou ki he tino ke fakaliliu te gagana Peletania ki na
gagana o na motu o te Pahefika
Ioe
Leai
Tongan
Oku ou fiema’u ha fakatonulea
Io
Ikai
Cook
Māori
Island
Other languages to be added following consultation with relevant
communities.
If you have any queries regarding this study please do not hesitate to contact Brian
McKenna from the University of Auckland on (09) 3737599 ext. 89554 or at
b.mckenna@auckland.ac.nz. This study has received ethical approval from the Northern X
Regional Ethics Committee, ethics reference number [insert].
110
Appendix D: Survey for Prison Staff
Survey of prison staff - perceptions of problem gambling interventions
You are invited to take part in this project funded by the Ministry of Health to provide a stock
take of current problem gambling services in New Zealand prisons. This research is
supported by the Department of Corrections. We have asked the Regional Managers
overseeing rehabilitation to forward this survey to two case managers or senior case
managers in each prison. Your participation is voluntary; you do not have to take part in this
research. The project will aim to provide a stock take of the current service provision for
problem gambling in New Zealand prisons. We are conducting a nationwide anonymous
survey as part of this stock take. It will examine the functioning of problem gambling
programmes already in place. The survey is being sent to all New Zealand prisons to be
completed by senior case managers and case managers. You and other key stakeholders
involved in the running of this service are being asked to participate in this research. Your
participation would involve completing a secure online survey. The survey focuses on
gaining your insights into facilitators and barriers to the effective provision of the problem
gambling screening, referral, intervention, and follow up processes in your prison. The
survey will be conducted online through the website LimeSurvey and will take approximately
45-60 minutes of your time. Your involvement in the project will in no way affect your
employment and you are free to withdraw from the study at any time without giving reasons.
We recommend that you clarify with your line manager if you can undertake this survey in
work time. The survey is anonymous, but any personal information provided will remain
strictly confidential and no material that could personally identify you will be used in any
reports on this study. The raw data of the survey will be kept in a locked location at the
University of Auckland for the duration of the project. Any information stored on computer
files will be kept on the University of Auckland server that requires a password for access.
Following the completion of the project, any de-identified information you provided will be
handed over to the Ministry of Health and securely stored for ten years. If you agree to take
part, you will be required to indicate your consent at the beginning of the survey. The
research will be overseen by an expert reference group composed of representatives from
problem gambling services, the Department of Corrections and cultural expertise. At the
completion of the project (May 2011), information provided by you will be contained in a
report that will be submitted to the Ministry of Health. Once released for publication, this
report will be available on-line at the Ministry of Health’s website. If you have any queries
regarding this study please do not hesitate to contact Associate Professor Brian McKenna on
(09) 3737599 ext. 89554 or at b.mckenna@auckland.ac.nz. This study has received ethical
approval from the Northern Y Regional Ethics Committee, NTY/10/EXP/031.
Thank you for your participation in this survey. Please tick one of the boxes in each of the
questions below, unless a multiple response is indicated. Please write your responses in the
lines indicated.
111
Name of prison:
____________________________
Job title:
 Case Manager
 Senior case manager
 Other, if so please specify _____________________________________
Screening for problem gambling
1.
How important do you think it is that prisoners are screened for problem
gambling?
1
2
Not at all Not very
important important
3
Neutral
4
5
Important Very important
2.
Is there a screening procedure for problem gambling in this prison?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
3.
If yes (to Question 2), is the screening procedure based on: National Department of Corrections policy
 A prison specific policy
 Random application
 Other, if so please specify _______________________________________
4.
What does the screening procedure consist of? (Multiple responses allowed)
 The use of the G9 gambling screening tool
 Another screening tool, if so please specify _________________________
 Detailed assessment by a probation officer
 Detailed assessment by a case manager/senior case manager
 Use of file notes/pre-sentence report
 Other, if so please specify _________________________
5.
When does the screening procedure occur? (Multiple responses allowed)
 At sentencing
 At prison reception
 At the development of the sentence plan
 Other, if so please specify _________________________
112
6.
When is the screening procedure completed?
 Completed prior to prison commencing
 Completed on arrival at prison
 Within one month of arrival at prison
 Other, if so please specify _________________________
7.
Who is responsible for undertaking the screening procedure? (Multiple
responses allowed)
 Probation officers
 Prison officers
 Case managers/Senior case managers
 Other, if so please specify _________________________
8.
Is the level of severity of the gambling problem acknowledged in the screening
procedure?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
9.
Is the link between a gambling problem and a prisoner’s offending outlined in
the screening procedure?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
10.
Are the people involved in the screening procedure trained to do so?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
11.
If so, what training are they given?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12.
Are the screening procedures in place culturally appropriate (e.g. provided in
different languages, recognition given to different cultural understandings of
gambling, etc)
 Yes, if so please specify how __________________________________________
 No
 Don’t know
 Not applicable
113
13.
Is assistance given to those who might have difficulty in understanding the
screening procedure due to language or cognitive ability?
 Yes, if so please specify how __________________________________________
 No
 Don’t know
 Not applicable
14.
In your view do the screening procedures identify everyone who has a gambling
problem?
 Yes
 No
 Don’t know
 Not applicable
15.
In your view, what percentage of problem gambling prisoners are identified
with the screening procedure?
 0-25%
 26-50%
 51-75%
 76-100%.
16.
What makes you think that the screening procedure is missing problem
gambling prisoners (e.g. offender later identified as having a gambling issue,
numbers don’t match research estimates, etc)?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
17.
In your view are any prisoners falsely identified as problem gamblers?
 Yes
 No
 Don’t know
 Not applicable
18.
If yes, in your view, what percentage of prisoners are falsely identified as
problem gamblers by the screening procedure?
 0-25%
 26-50%
 51-75%
 76-100%.
19.
How accurate is the screening procedure in detecting/identifying problem
gamblers?
1
2
Not at all Not very
accurate accurate
3
4
5
Neutral
Accurate
Very
accurate
114
20.
How efficient is the screening procedure (efficient in terms of the ease of
undertaking an assessment of problem gambling)?
1
2
Not at all Not very
efficient efficient
3
4
5
Neutral
Efficient
Very
efficient
21.
Have you any comments to make about the gambling screening procedure,
including strengths and limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
22.
Can you suggest any improvements that could be made to the screening
procedure?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Referral procedures undertaken when problem gambling is detected
1.
Are you aware of a standard referral process in place in your prison once
problem gambling is detected?
 Yes
 No
 Don’t know
 Not applicable
2.
How important do you think it is that prisoners are referred for a problem
gambling intervention?
1
Not at all
important
2
Not very
important
3
4
5
Neutral Important Very important
115
3.
Is the referral procedure based on: National Department of Corrections policy
 A prison specific policy
 Random application
 Other, if so please specify _________________________
4.
What does the referral procedure consist of? (Multiple responses allowed)
 Assessment
 Sentence planning
 Development of a specific gambling intervention plan
 Programme and service identification
 Note in offender file
 Notification to prison health officer
 Notification to programmes co-ordinator
 Assignment to programme or wait list
 Other, if so please specify _________________________
5.
When is the referral procedure initiated? (Multiple responses allowed)
 At prison reception.
 At the development of the sentence plan.
 At the instigation of the parole board
 Close to release or based on time left before release
 Other, if so please specify _________________________
6.
How long does the referral procedure take to complete (i.e., from the point of
positive screening to notification of the problem gambling service in the prison)?
 Completed on arrival
 Within one month
 Within 2–3 months
 Other, if so please specify _________________________
7.
Who is responsible for undertaking the referral procedure? (Multiple responses
allowed)
 Probation officers
 Prison officers
 Sentence planners
 Case managers/Senior case managers
 Other, if so please specify _________________________
116
8.
What other people are able to refer a prisoner directly for problem gambling
interventions? (Multiple responses allowed)
 The parole board
 Sentencing judge
 Any prison officers
 Prison doctor
 Prison psychologist
 The person themselves
 Family members
 Other prisoners
 Service providers
 Other programme co-ordinators e.g., AOD programmes, criminogenic programmes
 Other, if so please specify _________________________
9.
Is the level of severity of the gambling problem noted in the referral
procedure?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
10.
Is the link of the gambling problem to offending outlined in the referral
procedure?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
11.
Are the referral procedures in place culturally appropriate (e.g. for Māori,
Pacifica and Asian prisoners)?
 Yes, if so please specify how _______________________________
 No
 Don’t know
 Not applicable
12.
What percentage of identified problem gambling prisoners are referred for
therapy?
 0-25%
 26-50%
 51-75%
 76-100%
13.
Is there a treatment waiting list for prisoners identified as problem gamblers?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
117
14.
What percentage of identified problem gamblers are on the waiting list?
 0-25%
 26-50%
 51-75%
 76-100%
 Not applicable
15.
If there is a waiting list, how are prisoners prioritised (on the basis of severity of
issue, date of release, “first come first service”, security status, etc)?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
16.
How effective is the referral process in linking problem gamblers with a service
for assistance (i.e., how good is the “hit rate”)?
1
2
Not at all
Not
effective effective
17.
2
Not at all
Not
efficient efficient
5
Neutral
Effective
Very
effective
3
4
5
Neutral
Efficient
Very
efficient
How important do you think it is that prisoners are referred for a problem
gambling intervention over co-existing issues such as violence or drug and
alcohol issues?
1
Not at all
important
19.
4
How efficient is the referral procedure (i.e., how good is the hit rate for the
effort involved?)
1
18.
3
2
3
4
5
Not very Neutral Important Very important
important
If an offender is identified with having multiple issues requiring intervention
(e.g., violence, drug and alcohol), how are these prioritised in the referral
process?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
118
20.
What issues impact on the prioritisation of the referral process (e.g., is it
dependent on the offense committed, the RoCRoI score, needs relating to
transfers between prisons, availability of other programmes etc?)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
21.
Have you any comments to make about the gambling referral procedure,
including strengths and limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
22.
Can you suggest any improvements that might be made to the existing referral
procedure?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Provision of problem gambling education and interventions by outside
services
1.
How much need do you think there is for general health education about
problem gambling for prisoners in your prison?
1
2
No need Not much
at all
need
2.
3
4
5
Neutral Some need Great need
Is general health education about problem gambling available to all prisoners in
your prison?
 Yes, if so please specify how________________________________________
 No
 Sometimes
 Don’t know
 Not applicable
119
3.
Is general health education about problem gambling available to prison staff in
your prison?
 Yes, if so please specify how________________________________________
 No
 Sometimes
 Don’t know
 Not applicable
4.
How effective do you think general health education about problem gambling is
is in addressing gambling problems in prison?
1
2
Not at all Not very
effective effective
3
4
5
Neutral
Effective
Very
effective
5.
Are problem gambling interventions/therapies run in your prison?
 Yes, if so, what organisations provide this?_____________________________
 No
 Don’t know
 Not applicable
6.
How important are the relationships between prison staff and staff from
problem gambling services in ensuring the delivery of gambling
interventions within your prison?
1
Not at all
important
7.
2
Not very
important
3
4
5
Neutral Important Very important
How would you rate the quality of these relationships at the moment?
1
Very poor
2
3
4
5
Poor
Neutral
Good
Excellent
8.
What makes for a good relationship between prison staff and providers?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9.
Are gambling service providers given an induction by prison staff regarding
prison procedures?
 Yes, if so please specify what this consists of______________________________
 No
 Don’t know
 Not applicable
120
10.
Should gambling interventions be integrated with other addiction interventions
(e.g., criminogenic programmes)?
 Yes, if so please indicate why _______________________________
 No, if so please indicate why _______________________________
 Don’t know
 Not applicable
11.
Do specialist AOD units run in your prison?
 Yes
 No
 Don’t know
 Not applicable
12.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
13.
Do other specialist AOD providers (i.e., other than those who run the AOD units)
provide services in your prison?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
14.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
15.
Do specialist Kaupapa Māori units run in your prison?
 Yes
 No
 Don’t know
 Not applicable
16.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
121
17.
Do other specialist Kaupapa Māori providers (i.e., other than those who run the
Kaupapa Māori units) provide services in your prison?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
18.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
19.
Are only prisoners whose problem gambling relates to their past patterns of
offending involved in problem gambling interventions?
 Yes
 No
 Don’t know
 Not applicable
20.
Are the problem gambling interventions in place culturally appropriate (e.g. for
Māori, Pacifica and Asian prisoners)?
 Yes, if so please specify how _______________________________
 No
 Don’t know.
 Not applicable
21.
Are prisoners on remand involved in the problem gambling education or
interventions?
 Yes, if so please specify what this consists of______________________________
 No
 Don’t know
 Not applicable
22.
Of those prisoners identified as problem gamblers, what percentage would you
estimate actually receive a problem gambling intervention?
 0-25%
 26-50%
 51-75%
 76-100%
122
23.
How effective do you think the interventions are in addressing gambling
problems? (i.e., how much of an impact does the intervention have on a
prisoner’s gambling problem / behaviour )
1
2
Not at all
Not
effective effective
24.
3
4
5
Neutral
Effective
Very
effective
How efficient are the interventions in addressing gambling problems (i.e.,
considering the effort involved, how good is the impact of an intervention)?
1
2
Not at all
Not
efficient efficient
3
4
5
Neutral
Efficient
Very
efficient
25.
What effect, if any, does involvement in a problem gambling intervention have
on a prisoner’s parole?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
26.
Does a problem gambling intervention need to have been completed for it to be
recognised by the Parole Board?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_______________________________________________
27.
Have you any comments to make about the problem gambling education and
interventions in your prison, including strengths and limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
123
28.
Can you suggest any improvements that might be made to existing problem
gambling
education
and
interventions
in
your
prison?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Gambling interventions following release from prison
1.
Do post-release assessments (undertaken prior to a prisoner being released)
include/consider problem gambling?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
2.
Who undertakes these assessments? (Multiple responses allowed)
 Probation officers
 Prison officers
 Case managers/Senior case managers
 Other, if so please specify _________________________
3.
What are they based on? (Multiple responses allowed)
 Another G9 screen
 Therapist/Counsellor/Interventionist reports
 File notes
 In-depth interview
 Discussion between therapist and prison staff
 Other, please specify ________________________________
4.
Prior to release, who arranges community follow up for problem gambling for
the prisoner?
 Probation officer
 Prison staff
 Therapist/Counsellor/Interventionist
 No one does
 Other , please specify ________________________________
124
5.
Are there standard referral processes to the community to assist with problem
gambling?
 Yes
 No
 Don’t know
 Not applicable
6.
When do you think is the most effective time for problem gambling interventions
to be undertaken?
 As close as possible to the time of release from prison
 Post-release from prison
 Any time in a prisoners sentence (i.e., it makes no difference)
 Don’t know
 Other, please specify ________________________________
7.
What problem gambling services in the community does the prison refer to?
(Multiple responses allowed).
 Problem gambling specific services
 General addiction services
 AOD providers
 Kaupapa Māori providers of problem gambling interventions
 Other, please specify __________________________________________
8.
Does the Parole Board in your prison determine the degree of follow up in the
community?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
9.
Are there any attempts by prison staff to involve the problem gambler
prisoner’s family/whānau in community follow-up?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
10.
How effective is the release planning process in connecting prisoners, once they
are released, with problem gambling services? (i.e., how good is the “hit rate”) ?
1
2
Not at all
Not
effective effective
3
4
5
Neutral
Effective
Very
effective
125
11.
How efficient is this process in connecting people, once they are released, with
problem gambling services? (i.e., how good is the hit rate for the effort
involved?)
1
2
Not at all
Not
efficient efficient
3
4
5
Neutral
Efficient
Very
efficient
12.
Have you any comments to make about the provision of continuity of care, from
a prison environment into the community, for prisoners with problem
gambling issues (e.g., strengths and limitations)?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
13.
Can you suggest any improvements that might be made to the existing process
for providing community care for released prisoners with problem gambling
issues?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Conclusion.
Have you anything else you would like to add regarding the use of problem
gambling interventions in this prison and suggestions for improvements?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Many thanks for completing this survey.
126
Appendix E: Survey for Providers
Survey of providers of problem gambling services in New Zealand prisons
You are invited to take part in this project funded by the Ministry of Health to provide a stock
take of current problem gambling services in New Zealand prisons. This research is
supported by the Department of Corrections. The Problem Gambling Foundation has a
contract with the Department of Corrections to undertake problem gambling services in
prisons. We have asked the Regional Practice Leaders of the Problem Gambling Foundation
Regional Managers to forward this survey to their staff providing problem gambling services
in each prison. We are aware that providers other than the Problem Gambling Foundation are
delivering services in some prison. We have asked those involved in service delivery at the
Problem Gambling Foundation to forward the survey onto other providers they are aware of.
Your participation is voluntary; you do not have to take part in this research. The project will
aim to provide a stock take of the current service provision for problem gambling in New
Zealand prisons. We are conducting a national anonymous survey as part of this stock take.
The survey will examine the functioning of problem gambling programmes already in place.
As a provider of problem gambling services in prisons you have been identified by the
research team as a key stakeholder in the provision of problem gambling interventions in
prisons. You and other key stakeholders involved in the running of these services are being
asked to participate in this research. Your participation would involve completing a secure
online survey. The survey focuses on gaining your insights into facilitators and barriers to the
effective provision of the problem gambling screening, referral, intervention, and follow up
processes in the prison(s) in which you provide interventions. The survey will be conducted
online through the website LimeSurvey and will take approximately 45-60 minutes of your
time. Your involvement in the project will in no way affect your employment and you are
free to withdraw from the study at any time without giving reasons. We recommend that you
clarify with your line manager if you can undertake this survey in work time. The survey is
anonymous, but any personal information provided will remain strictly confidential and no
material that could personally identify you will be used in any reports on this study. The raw
data of the survey will be kept in a locked location at the University of Auckland for the
duration of the project. Any information stored on computer files will be kept on the
University of Auckland server that requires a password for access. Following the completion
of the project, any de-indentified information you provided will be handed over to the
Ministry of Health and securely stored for ten years. If you agree to take part, you will be
required to indicate your consent at the beginning of the survey. The research will be
overseen by an expert reference group composed of representatives from problem gambling
services, the Department of Corrections and cultural expertise. At the completion of the
project (May 2011), information provided by you will be contained in a report that will be
submitted to the Ministry of Health. Once released for publication, this report will be
available on-line at the Ministry of Health’s website. If you have any queries regarding this
study please do not hesitate to contact Associate Professor Brian McKenna on (09) 3737599
ext. 89554 or at b.mckenna@auckland.ac.nz. This study has received ethical approval from
the Northern Y Regional Ethics Committee, NTY/10/EXP/031.
Thank you for your participation in this survey. Please tick one of the boxes in each of the
questions below, unless a multiple response is indicated. Please write your responses in the
lines indicated
127
Name of prison(s) to which you provide problem gambling intervention services:
___________________________________________________________________________
Job title:
 Team leader overseeing gambling intervention
 Therapist/Counsellor/Interventionist implementing the gambling intervention
Screening for problem gambling
1.
How important do you think it is that prisoners are screened for problem
gambling?
1
2
Not at all Not very
important important
3
Neutral
4
5
Important Very important
2.
Who do you think should be performing this screening procedure?
_____________________________________________________________________
_____________________________________________________________________
3.
Are the screening procedures in place culturally appropriate (e.g. provided in
different languages, recognition given to different cultural understandings of
gambling, etc)?
 Yes, if so please specify how ________________________________
 No
 Don’t know
 Not applicable
4.
In your view do the screening procedures identify everyone who has a gambling
problem?
 Yes
 No
 Don’t know
 Not applicable
5.
In your view, what percentage of problem gambling prisoners are identified
with the screening procedure?
 0-25%
 26-50%
 51-75%
 76-100%.
128
6.
What makes you think the screening procedure is missing problem gambling
prisoners (e.g. offender later identified as having a gambling issue, numbers
don’t match research estimates, etc)?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7.
In your view are any prisoners falsely identified as problem gamblers?
 Yes
 No
 Don’t know
 Not applicable
8.
If yes, in your view, what percentage of prisoners are falsely identified as
problem gamblers by the screening procedure?
 0-25%
 26-50%
 51-75%
 76-100%
9.
How accurate is the screening procedure in detecting/identifying problem
gamblers?
1
2
Not at all Not very
accurate accurate
10.
4
5
Neutral
Accurate
Very
accurate
How efficient is the screening procedure (efficient in terms of the ease of
undertaking an assessment of problem gambling)?
1
2
Not at all Not very
efficient efficient
11.
3
3
4
5
Neutral
Efficient
Very
efficient
Have you any comments to make about the gambling screening procedure,
including strengths and limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
129
12.
Can you suggest any improvements that could be made to the screening
procedure?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Referral procedures undertaken when problem gambling is detected
1.
Are you aware of a standard referral process in place in the prison(s) in which
you provide interventions once problem gambling is detected?
 Yes
 No
 Don’t know.
 Not applicable.
2.
Are the referral procedures in place culturally appropriate (e.g. for Māori,
Pacifica and Asian prisoners)?
 Yes, if so please specify ________________________
 No, if so please specify ________________________
 Don’t know.
 Not applicable.
3.
What percentage of identified problem gambling prisoners are referred for
therapy?
 0-25%
 26-50%
 51-75%
 76-100%.
4.
Is there a treatment waiting list for prisoners identified as problem gamblers?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
5.
If yes, what percentage of identified problem gamblers are on the waiting list?
 0-25%
 26-50%
 51-75%
 76-100%
 Not applicable
130
6.
How effective is the referral process in linking problem gamblers with a service
for assistance (i.e., how good is the “hit rate”)?
1
2
Not at all Not very
effective effective
7.
4
5
Neutral
Effective
Very
effective
How efficient is the referral procedure (i.e., how good is the hit rate for the
effort involved?)
1
2
Not at all Not very
efficient efficient
8.
3
3
4
5
Neutral
Efficient
Very
efficient
How important do you think it is that prisoners are referred for a problem
gambling intervention over co-existing issues such as violence or drug and
alcohol issues?
1
2
Not at all Not very
important important
3
Neutral
4
5
Important
Very
important
9.
(e.g.
If an offender is identified with having multiple issues requiring intervention
violence, drug and alcohol), how are these prioritised in the referral process?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10.
Have you any comments to make about the gambling referral screening
procedure, including strengths and limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
131
11.
Can you suggest any improvements that might be made to the existing referral
procedure?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Provision of problem gambling education and interventions
1.
Is there a need for general health education to all prisoners about problem
gambling in the prison(s) in which you provide interventions?
 Yes
 No
 Don’t know
 Not applicable
2.
Is general health education available to all prisoners about problem gambling in
the prison(s) in which you provide interventions?
 Yes, if so how________________________________________
 No
 Sometimes
 Don’t know
 Not applicable
3.
Is general health education available to prison staff about problem gambling in
the prison(s) in which you provide interventions?
 Yes, if so how________________________________________
 No
 Sometimes
 Don’t know
 Not applicable
4.
How effective do you think public health education is in addressing gambling
problems in the prison(s) in which you provide interventions (e.g. “hit rate” and
possibly impact)?
1
2
Not at all Not very
effective effective
3
4
5
Neutral
Effective
Very
effective
132
5.
Do you feel that health education is sufficient to address gambling problems in
your prison or are individual or group interventions required in most cases?
 Yes, education is sufficient
 No, individual or group interventions are mostly required
 Don’t know
 Not applicable
6.
Are prisoners comprehensively assessed by a therapist prior to commencing the
interventions?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
7.
Is a prisoner’s motivation to change their gambling behaviour assessed by the
therapist prior to commencing the intervention?
 Yes
 No
 Don’t know
 Not applicable
8.
Is the intervention approach :- (Multiple responses allowed)
 Pre-designed to suit everyone
 Designed to suit the individual
 Determined by the therapist’s orientation and training
Other, please specify __________________________________________
9.
Is the intervention approach based on:-.
 Individual therapy
 Group therapy
 A combination of the above
 Other, please specify __________________________________________
10.
Does the prisoner have a choice between gambling service providers?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
11.
Does the prisoner have choice of the therapist?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
133
12.
If so does this choice include a culturally specific therapist?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
13.
What problem gambling interventions are used as part of the therapeutic
approach? (Multiple responses allowed).
 Counselling
 Motivational interviewing
 Cognitive Behavioural Therapy
 Teaching coping strategies
 General education regarding gambling/problem gambling
 Interactive Drawing Therapy.
 Journaling
 Narrative therapy
 Other, please specify __________________________________________
14.
Are relapse prevention plans developed as part of the intervention?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
15.
What is the average duration of a therapeutic session (please specify time)?
______________________________
16.
How many sessions are given on average to a prisoner (please specify the number
of sessions)?
______________________________
17.
Is flexibility allowed in the number of sessions given to each person?
 Yes
 No
 To a limited extent (Specify range)_____________________
 Don’t know
 Not applicable
18.
If flexibility occurs, is this outside of the contracted time?
 Yes
 No
 Don’t know
 Not applicable
134
19.
Do you refer other intervention needs onto other services?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
20.
Who provides the problem gambling therapy? (Multiple responses allowed)
 Trained counsellors
 Trained therapists
 Registered health professionals, please specify _________________________
 Other, please specify ___________________________________________
21.
How important are the relationships between prison staff and staff from
problem gambling services in ensuring the delivery of gambling
interventions within the prison(s) in which you provide interventions?
1
Not at all
Important
22.
2
3
Not very
important
Neutral
4
5
Important Very important
How would you rate the quality of these relationships at the moment?
1
2
3
4
5
Very poor
Poor
Neutral
Good
Excellent
23.
What makes for a good relationship between prison staff and providers?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
24.
Are gambling service providers given an induction by prison staff regarding
prison procedures?
 Yes, if so please specify what this consists of______________________________
 No
 Don’t know
 Not applicable
25.
Are only people whose problem gambling relates to their past patterns of
offending involved in the problem gambling interventions?
 Yes
 No
 Don’t know
 Not applicable
135
26.
Are the problem gambling interventions in place culturally appropriate (e.g. for
Māori, Pacifica and Asian prisoners)?
 Yes, if so please specify how_________________________
 No
 Don’t know
 Not applicable
27.
If identified as a need, do you link in with Māori providers of gambling
interventions or Māori cultural programmes?
 Yes, if so, how ___________________________________
 No
 Don’t know
 Not applicable
28.
Are family or whānau involved in the problem gambling interventions?
 Yes, if so please specify how___________________________________________
 No
 Sometimes, if so please specify how_____________________________________
 Don’t know
 Not applicable
29.
Does evaluation of problem gambling intervention occur:- (Multiple responses
allowed)
 Of individual sessions
 Once all of the therapy has finished
 At intervals throughout the therapy, please specify duration__________
 No evaluation occurs
 Don’t know
 Not applicable
30.
What impact do prison transfers have on continuity of involvement of problem
gambling offenders in education/interventions?
1
2
No impact Not much
impact
31.
3
4
5
Neutral
Some
impact
Great
impact
Can you hand over to a therapist operating in the prison that the prisoner is
transferred to?
 Yes, if so please specify how_________________________
 No
 Don’t know
 Not applicable
136
32.
Are prisoners on remand involved in the problem gambling education or
interventions?
 Yes, if so please specify what this consists of______________________________
 No
 Don’t know
 Not applicable
33.
How effective do you think the interventions are in addressing gambling
problems?
1
2
Not at all Not very
effective effective
34.
3
4
5
Neutral
Effective
Very
effective
How efficient are the interventions in addressing gambling problems (in terms
of effort involved)?
1
2
Not at all Not very
efficient efficient
3
4
5
Neutral
Efficient
Very
efficient
35.
Are you aware of other gambling service providers operating in the prison(s) in
which you provide interventions?
 Yes, if so please specify________________________________
 No
 Don’t know.
 Not applicable.
36.
If there are other providers, how effective do you believe they are in meeting
problem gambling needs?
1
2
Not at all Not very
effective effective
37.
3
4
5
Neutral
Effective
Very
effective
Should gambling interventions be integrated with other addiction therapy?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
137
38.
Do specialist AOD units run in the prison(s) in which you provide interventions?
 Yes
 No
 Don’t know
 Not applicable
39.
If so, do they also provide services for those with gambling problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
40.
Do other specialist AOD providers (i.e., other than those who run the AOD units)
provide services in your prison?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
41.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
42.
Do specialist Kaupapa Māori units run in the prison(s) in which you provide
interventions?
 Yes
 No
 Don’t know
 Not applicable
43.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
138
44.
Do specialist Kaupapa Māori providers provide services in the prison(s) in which
you provide interventions?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
45.
If so, do they also provide gambling services for those prisoners with gambling
problems?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
46.
Have you any comments to make about the problem gambling education and
interventions in the prison, including strengths and limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
47.
Have you any suggestions for improving problem gambling education and
interventions?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Problem gambling therapy following release from prison
1.
Prior to release, who arranges community follow up for problem gambling for
the prisoner?
 Probation officer
 Prison staff
 Therapist
 No one does
 Other , please specify ___________________________
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2.
Are there standard referral processes to the community to assist with problem
gambling?
 Yes
 No
 Don’t know
 Not applicable
3.
Are you required to write Parole Board reports for offenders who have
undergone/are undergoing problem gambling interventions?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
4.
If so, please indicate if any of these are considerations for your Parole Board
report (Multiple responses allowed)
 Whether the offender completed the intervention or not
 Offender motivation
 Issues regarding probability of continuing intervention on release
 The report is completed with the offender
 The offender has no knowledge of what is in the report
 Time left to serve on sentence
 Offender’s relationship with whānau and significant others
 Other, if so please specify _________________________
5.
Do you feel that an offender’s gambling intervention plays a part in the Parole
Board conditions and decisions for that offender?
 Yes
 No
 Sometimes
 Don’t know
 Not applicable
6.
When do you think is the most effective time for problem gambling interventions
to be scheduled?
 As close as possible to the time of release from prison
 Post-release from prison
 Any time in a prisoners sentence (i.e., it makes no difference)
 Don’t know
 Other, please specify ________________________________
7.
What problem gambling services in the community do you refer to? (Multiple
responses allowed).
 Problem gambling specific services
 General addiction services
 AOD providers
 Kaupapa Māori providers of problem gambling interventions
 Other, please specify __________________________________________
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8.
Are there any attempts to involve the prisoner’s family/whānau in community
follow-up?
 Yes
 No
 Don’t know
 Not applicable
9.
How effective is the release planning process in connecting people, once they are
released, with problem gambling services? (i.e., how good is the “hit rate”) ?
1
2
Not at all Not very
effective effective
10.
3
4
5
Neutral
Effective
Very
effective
How efficient is this process in connecting people, once they are released, with
problem gambling services? (i.e., how good is the hit rate for the effort
involved?)
1
2
Not at all Not very
efficient efficient
3
4
5
Neutral
Efficient
Very
efficient
11.
Have you any comments to make about providing continuity of care into the
community for prisoners with problem gambling issues, including strengths and
limitations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12.
Have you any suggestions for improvements in continuity of care into the
community?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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Conclusion
Have you anything else you would like to add regarding the use of problem
gambling interventions in the prison(s) in which you provide interventions?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Many thanks for completing this survey.
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