Adaptation and Feasibility Testing of a Gambling Specific SBIRT Intervention in the Real World Clinical Setting

University of Kentucky: Scope of Work Adaptation and Feasibility Testing of a Gambling-Specific SBIRT Intervention in the “Real World” Clinical Setting Specific AIM 3: Randomized Controlled Trial Approximately 100 participants will be randomized to receive either the Gambling Specific SBIRT Intervention or enhanced control. Step 1: Clinicians and will be consented to participate in the SBIRT Project. Step 2: Clinicians will meet to discuss and train on the SBRIT intervention. The training will focus on: 1. Basic education in medical and psychosocial problems related to disordered gambling as well as developing rapport with patients; 2. Develop skills to administer problem gambling screening – the Brief Biosocial Gambling Screen (BBGS); and 3. Develop skills to administer a problem gambling brief intervention. Step 3: We will recruit, consent and screen approximately 10 participants per trained clinician. Eligible participants will then complete the following baseline measures: 1. Demographics: This questionnaire includes items regarding age, gender, education, employment status, and housing status. 2. Timeline follow back to assess number of days gambled and amount of money spent per day on gambling in the last 30 days 3. Gambling Behaviors: Gambling behaviors over the past year will be examined. 4. Depressive symptoms: We will use the Center for Epidemiologic Studies Depression Scale (CES- D). 5. Drug and alcohol use: The Addictions Severity Index Lite (ASI-Lite) and CAGE will be used to evaluate frequency and severity of substance use. 6. Impulsivity symptoms: The Impulsiveness Subscale from the I.7 Impulsiveness Questionnaire will be used to assess symptoms of impulsivity. 7. Randomization will be completed based on substance use. Step 4: Participants randomized to the intervention will meet with their clinician and receive the SBIRT intervention. The intervention will be based on the participant’s gambling history. Approximately 25% of the intervention will be audio recorded. The clinician will complete the BBGS with their participants. The BBGS is a 3-item screen that evaluates Withdrawal, Lying, and Borrowing Money. Participants randomized to the enhanced control condition will receive a handout with gambling resources. Step 5: We will conduct a follow up interview approximately 4 weeks post baseline with all participants. The same assessment measures from the baseline will be used for the post interview. An additional satisfaction measure will be used for anyone randomized in the intervention condition. Step 6: Chart reviews will be conducted after approximately 30 days to assess the percentage of patient encounters in which the clinicians documented screening and the provision of a brief intervention (when appropriate) or referral to treatment (when appropriate) for problematic gambling. Particular attention will be paid to identifying clinicians who appear to be conducting SBIRT at a lower rate than other clinicians in that clinic. We will also review a sample of the intervention recordings for adherence and fidelity purposes. Step 7: Reconvening Expert Panel The expert panel will be reconvened. The experts will be sent a copy of the results from the randomized trial. A teleconference will be set up so the expert panel can systematically review the results of AIM #3. The teleconference will be audiotaped and transcribed to ensure that all recommendations from the meeting are appropriately documented. Step 8: Final Revision of the SBIRT Intervention: The research team will incorporate the recommendations and modifications from the expert panel. This will be the final version of the SBIRT intervention.