Problem Gambling Prevention and Treatment Services
|Level of Government:||State & Local|
|Posted Date:||Apr 7, 2019|
|Due Date:||Apr 15, 2019|
MHASD is seeking a providers to increase awareness and provide education to prevent and treat problem gambling issues across Multnomah County.
3/1/2019 8:00 AM PST
4/15/2019 4:00 PM PDT
Problem Gambling Prevention and Treatment Services
MHASD is seeking a providers to increase awareness and provide education to prevent and treat problem gambling
issues across Multnomah County.
3/1/2019 8:00 AM PDT
4/15/2019 4:00 PM PDT
Request for Programmatic
Sealed Until 4/15/2019 4:00 PM PDT
Phone +1 503-988-9287 ext. 89287
0% 0, Net 30
25 March 2019
There will be a optional pre-proposal conference for this sourcing event on March 13, 2019 at 1:30 P.M. at the Multnomah
Building, Room 126 at 501 S.E. Hawthorne Blvd., Portland, Oregon 97214.
Attendance is: Optional
INTRODUCTION AND PROGRAM HISTORY
Problem Gambling (PG) is a serious public health issue, characterized by high rates of suicide, domestic violence, bankruptcy,
divorce, property crime, poor health and other illnesses. Research suggests that the damage and disruption PG causes to the
lives of individuals who suffer from it is comparable to the destruction caused by substance use to individuals who suffer from
substance use disorders.
Legal gambling, which was severely limited during most of the 20th century in the U.S began to explode in the 1980s and
1990s. This was a result of the introduction of electronic gambling machines that contain random number generators, and
legislators creating state lotteries in lieu of increasing taxes. Gambling has become a leading form of entertainment in the U.S.,
with Americans losing more than $117 billion a year, about three times more than they spend going to movies. While a very
small percentage of people who gamble have a gambling disorder prevalence rates are similar to other conditions that receive
important public health attention.
Major Service Components Include:
The purpose of the prevention portion of this RFPQ is to qualify one or more prevention providers who can use evidence-based
prevention strategies to increase awareness of problem gambling (PG) and work to reduce PG rates within Multnomah County.
Strategies could include (but are not limited to): expanding community awareness of problem gambling issues; infusing problem
gambling prevention messages into prevention education; providing alternative activities; utilizing community-based processes;
and/or advocating for policy change. If the providers offers other services in addition to PG prevention, PG awareness will be
incorporated into those services.
The purpose of the treatment portion of this RFPQ is to qualify treatment providers who can integrate problem gambling
awareness and early intervention into their behavioral health programs and also provide assistance to individuals in the
community who have disordered gambling, and to their significant others. Individuals who have PG are an underserved and
stigmatized population. It is challenging to engage them in services. This RFPQ will qualify suppliers to provide both outpatient
treatment services and client-finding outreach services to: a) individuals assessed as needing treatment for problem gambling
and; b) significant others who are experiencing relational problems due to the gambling behavior of someone close to them.
There will be no fees charged to individuals for any treatment services provided under this procurement.
GOALS, VALUES AND OTHER IMPORTANT CONSIDERATIONS
Multnomah County has a long history of providing help to individuals and families impacted by problem gambling, as early as
1992 becoming the site of one the earliest Oregon treatment programs, even before a statewide system was developed.
Multnomah County Mental Health and Addiction Services Division (MHASD) is currently seeking to qualify providers to
provide problem gambling prevention services and outpatient treatment and client-finding services for the County.
Approximately 16,000 Multnomah County residents have a gambling problem. For each individual who suffers from the
disorder, it’s estimated that six others are negatively impacted. Individuals who have gambling disorder are high consumers of
behavioral health services but rarely seek help for their gambling problems. They are more likely to present to behavioral health
services with complaints of anxiety, depression, substance use disorders or relationship problems. Among individuals who are
in treatment for substance use disorders problem gambling rates are high. This is particularly true for opioid-dependent people.
Between 17% and 46.2% of methadone maintenance patients have Gambling Disorder. These individuals are more likely to
have positive urine samples and drop out early from treatment. Gambling activity also puts individuals who are in recovery from
substance use disorders at high risk of relapse, as alcohol and other drugs are widely available at both legal and illegal gambling
venues. Clearly, addressing problem gambling is a component of a comprehensive approach to combating the opioid epidemic.
As with other addictive disorders ambivalence about change is a major factor that prevents individuals from seeking problem
gambling help. But there are other societal factors that are also critical. One major reason is the stigma identified with having a
gambling problem. In a 2015 U.S. survey only 6% of the general population identified gambling addiction as a medical
problem, while 49% identified it as a “personal or moral weakness.” (6) Another reason individuals rarel2y5sMeaerkchh2e0l1p9 for their
gambling problems is due to the marginalization of problem gambling within the healthcare system and relative lack of funding
and accessibility. In the U.S. it is four times more likely that someone will have a substance use disorder than a gambling
disorder. Yet public funding to treat substance use disorders is 338 times larger than funding to treat gambling disorders. All
public funding for problem gambling prevention and treatment is local. The Federal government does not spend a single dollar
on problem gambling research, prevention or treatment. Behavioral health and other health clinicians rarely receive training in
this area, and Medicare and almost all Medicaid and third-party private insurance plans do not reimburse counseling for
Gambling Disorder. (7) Given these characteristics of problem gambling, the overall goals of MHASD Problem Gambling
Treatment and Prevention Program are to reduce the negative impact of problem gambling on public health by:
1. Working to reduce the stigma associated with problem gambling.
2. Better integrating help for problem gambling into the behavioral health and medical systems.
3. Employing prevention and early intervention strategies to reduce the number of individuals who will develop a gambling
4. Actively working to identify and engage in services individuals who suffer from disordered gambling.
5. Providing direct outpatient treatment services to those who have a gambling problem and to their significant others.
TARGET POPULATION SERVED
The prevention program will develop and offer activities involving participants across the age spectrum, with the goal of
integrating culturally-specific programming into the work across the county. The statistics in the following sections are broken
down to show current trends among specific community subpopulations, but are not intended to be the only focus of this
The treatment and targeted outreach program must serve individuals of all cultures and have culturally responsive means to
address these populations to produce positive outcomes. Another goal is to increase access to treatment for underserved
geographical areas of the county. For example, currently no services are available in North Portland or Gresham, where there
are very high rates of video lottery gambling. An important aim is to enroll in services more of those individuals who experience
distress due to the gambling behavior of a significant other, whether or not the significant other is enrolled.
Problem Gambling Prevention Statistics
According to results from the 2016 Oregon Adolescent Prevalence study, 55% of Oregon adolescents have gambled in their
lifetime, with 39.7% having gambled in the past year. Preferred games in the past year included: gambling on the internet
(without money) 15.1%, sports betting 14.%, charitable gambling 13.6%, and gambling on personal skill 13.1%.
Over half (54%) of youth surveyed believe that gambling can become a problem for young people, and 94% believe that
gambling problems can be prevented through education and awareness (Moore 2017). The 2018 “past 30 day” surveys of
Multnomah County students in 6th, 8th, and 11th grades show that forms of gambling activity appear as early as sixth grade. In
the 2018 Student Wellness Survey, gambling is defined as betting something of value (money, a watch, soda, etc.) on a game or
event. Most notably, the two most reported types of gambling included betting on games of personal skill and betting on a sports
team. The table below has additional data relevant to current gambling trends among adolescents in Multnomah County.
2018 Student Wellness Survey - Multnomah County
6th Grade 8th Grade 11th Grade
% who gambled in the last 30 days
% whose parents have talked to them about the risks of betting/gambling 47.8
% whose teachers have talked to them about the risks of betting/gambling 17.6
Among most adult Oregonians, gambling is a form of entertainment and recreation. A recent study of Adult Gambling behavior
in Oregon showed that 56.6 % of adults have gambled in the past year, with nearly 86% of adults gambling in their lifetime.
Knowing the prevalence of gambling, it is necessary to address stigma and concern for any and all Oregonians who are at risk of
developing a gambling problem and/or are negatively impacted by gambling.
A recent statewide study was conducted by the Center for Health & Safety Culture in order to better understand engagement
with the Oregon Problem Gambling Resource (OPGR). This study found that 46% of people are moderately (or more)
concerned about problem gambling in Oregon. While asking those respondents about OPGR as a resource, 40% felt it would be
scary to contact OPGR if they were concerned about some else’s gambling behaviors. This leaves our state and county with
25 March 2019
opportunity to address stigma and fear around problem gambling behaviors as well as bolster messaging around OPGR as a
helpful resource for anyone concerned about problem gambling in Oregon.
2018 Oregon Student Wellness Survey https://oregon.pridesurveys.com/dl.php?pdf=Multnomah_Co_2018.pdf&type=county
2018 Oregon Problem Gambling Survey Key Findings Report - Montana State University Center for Health and Safety
Oregon Adult Gambling Behavior Study, 2016, Oregon Council on Problem Gambling in Multnomah County.
Adult Problem Gambling Statistics
The table shown below is a snapshot of the gambling treatment clients in Multnomah County in Fiscal Year 2017-2018. See
Estimated adult population:
(18 years and above)
Number of gamblers enrolled in treatment:
Gender of gamblers seeking treatment:
Ethnicity of gamblers seeking treatment:
Asian American 8.3%
Line Games 51.1%
Primary gambling activity:
Video Poker 28.3%
All Others 4.5%
Gambling Helpline 32%
Previous/Current Client 10.6%
Source of referral to the treatment program:
Community based MH/SUD 10.6%
All other 29%
Number of family members enrolled in treatment: 46
Source: Thomas Moore, Herbert & Louis, 2018
SCOPE OF SERVICES
Problem Gambling Prevention Services Description
MHASD is seeking a provider to increase awareness and provide education to prevent problem gambling issues across the
entire county. Prevention services are an integrated combination of strategies designed to prevent problem gambling issues.
Multnomah County uses the Institute of Medicine (IOM) Continuum of Health Care Model to provide a strategic framework
for defining target populations and activities addressed by various addictions prevention efforts. Services must be classified as
Promotion, Universal, Selective, or Indicated according to the IOM Model, and should be implemented through one or more of
the Center for Substance Abuse Prevention (CSAP) strategies. Prevention contractor(s) will be required to meet with the
MHASD Addictions Prevention Coordinator for the purpose of identifying these unique problem gambling prevention
strategies and write a plan to be submitted for approval by State of Oregon Addictions and Mental Health (AMH) Division as
part of the State Biennial Implementation Plan or other planning process(es).
Currently, MHASD and contractors are working with Oregon Health Authority (OHA) to conduct a community readiness
assessment that will identify the level of awareness of current prevention messaging and programing. MHASD will be using
the assessment in the development of its Biennial Implementation Plan. In addition to collaborating on the Biennial
Implementation Plan, providers will be asked to evaluate and reassess the community as needed and/or requested by the
25 March 2019
Any changes/revisions to the strategies submitted under the indicated prevention funding plan will be reduced to writing and
incorporated into the agreement by reference herein after approval by State OHA. Prevention contractors will be responsible for
reporting Problem Gambling program outcomes on at least a quarterly basis, as required by County contract and described
below in the Performance Measures/Performance Contracting section. Future funding of this project will depend, in part, on
State AMH’s assessment of the project’s success in meeting goals and outcomes identified in the indicated Multnomah County
Problem Gambling Prevention Implementation Plan.
MHASD will require prevention provider staff to complete the Problem Gambling Prevention Coordinator Training series
within two years of hire. More information on this requirement can be found at: https://www.oregonpgs.org/prevention/new-
coordinator-training/. In addition, any prevention program staff providing more than .5 FTE will be required to attend a
minimum of 15 hours of OHA Problem Gambling approved trainings per biennium.
Outpatient Problem Gambling Treatment & Targeted Outreach Services Description
Outpatient problem gambling treatment services include: problem gambling targeted outreach; assessment, treatment and
rehabilitation services delivered on an outpatient basis or intensive outpatient basis to individuals who exhibit one or more
Diagnostic and Statistical Manual (DSM)-5 symptoms of Gambling Disorder and who are not in need of 24-hour supervision in
order to make progress in recovery; family therapy for families negatively impacted by a member who engages in disordered
gambling; counseling for individuals who have a significant other who is gambling problematically and, as a result, are
experiencing relational or behavioral health problems.
Specific services allowed are currently defined in Oregon Administrative Rules (OAR) 309-019-0170, and by the 2019 Oregon
Health Authority Problem Gambling Services Billing Codes.
Developing and Implementing a Targeted Client-Finding Outreach Plan
Because individuals impacted by problem gambling are reluctant to access problem gambling services and are rarely mandated
to treatment by the criminal justice system or employers, it falls on the shoulders of treatment providers to actively solicit
referrals to the county problem gambling treatment system. Targeted outreach efforts are an essential activity for every problem
gambling treatment provider and the time spent on this activity is reimbursed. Targeted outreach is defined as either outreach to
high-risk populations -- for example making a presentation to individuals who are receiving substance abuse treatment services
-- or as meeting with other professionals who by the nature of their work are likely to come in contact with individuals who
qualify for services and may refer them for treatment -- for example attorneys, clergy, physicians or behavioral health
professionals. Treatment advertising and exhibiting at professional conferences are also reimbursed as client-finding outreach.
Every proposing organization that provides other behavioral health services in addition to problem gambling treatment will
implement Gambling Brief Intervention and Referral to Treatment (GBIRT) in their organization. GBIRT is the current best
practice model for screening and early intervention and is strongly recommended by the Oregon Health Authority Problem
Gambling Services for all providers.
Provider will maintain a referral and intake process that facilitates client access and engagement in treatment. This process will
be culturally sensitive and target the unique barriers experienced by individuals who have gambling problems. Emphasis will
be paid to engaging significant others throughout the course of treatment.
For the individual with disordered gambling the assessment process begins with the first contact, initially focusing on making a
diagnosis(es), if/when appropriate, increasing motivation for change and motivation for treatment. and developing an initial
treatment plan. Part of the initial process is a financial assessment and suggested level of care referenced by the American
Society of Addiction Medicine (ASAM) Patient Placement Criteria. Over time, a more complete biopsychosocial assessment
will further guide treatment planning. For significant others the assessment can be more limited to relational issues and family
structure unless a diagnosis of a disorder related to the gambling is a treatment target.
Each plan can include -- as appropriate -- individual, couples, family, financial and group counseling; psychiatric assessment
and medication management; case management; recovery mentor services; physical health services; and using flex funds to
support building a stronger recovery environment. Treatment service effectiveness should be monitored by the provider and
individual or family receiving services, including obtaining frequent written feedback from those who are receiving services,
which can help guide any adjustments to their service plans.
Family services: The program shall actively work to engage in services family members of individuals who have a gambling
problem. Treatment staff will have capability to provide couples counseling and family therapy using a systemic approach.
Program shall comprehensively address the transition and discharge planning process and include a written wellness plan. The
discharge process must begin to be addressed early in treatment to ensure a smooth transition. The wellness plan must feature
natural and community–based support systems. Variances for extended services are requested when appropriate.
Continued Care Services
Continued care services must be designed to help prevent relapse and address relapse intervention, PG providers will connect
clients with recovery supports, and collaborate with recovery-oriented organizations to provide spaces and ongoing services for
individuals engaged in, and exiting from treatment. Examples include (but are not limited to): partnering2w5 iMtharcVho2i0c1e9s of
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