Assisting an Australian Aboriginal and Torres Strait Islander person with gambling problems: a Delphi study

Background Gambling problems appear to be more prevalent in the Australian Aboriginal and Torres Strait Islander population than in the non-Indigenous population. Although gambling harms can be significant, treatment-seeking rates are low. The Delphi expert consensus method was used to develop a set of guidelines on how a family or community member can assist an Aboriginal or Torres Strait Islander person with gambling problems. Methods Building on a previous systematic review of websites, books and journal articles a questionnaire was developed that contained items about the knowledge, skills and actions needed for supporting an Aboriginal or Torres Strait Islander person with gambling problems. These items were rated over three rounds by an expert panel comprising professionals who provide treatment to or conduct research with Aboriginal and Torres Strait Islander people with gambling problems. Results A total of 22 experts rated 407 helping statements according to whether they thought the statements should be included in these guidelines. There were 225 helping statements that were endorsed by at least 90% of participants. These endorsed statements were used to develop the guidelines. Conclusion Experts were able to reach substantial consensus on how someone can recognise the signs of gambling problems and support an Aboriginal or Torres Strait Islander person to change. Electronic supplementary material The online version of this article (doi:10.1186/s40359-017-0196-x) contains supplementary material, which is available to authorized users.


How this questionnaire was developed
The statements in this questionnaire were derived from information collected during a literature review of websites, books, and journal articles on how to assist anyone with gambling problems, and also how to specifically assist an Aboriginal or Torres Strait Islander person with gambling problems. This review examined any written information about how a member of the public can assist a person with gambling problems.
Some of the statements may seem contradictory or controversial; however, we have included them because they reflect the wide range of people's beliefs about the best ways to provide assistance to someone with gambling problems. It is important to note that we do not necessarily agree with these statements; we have included them because we do not believe that we should decide what the best practice is in this area. Rather, we have invited you to be a member of the expert panel to help develop a set of guidelines that reflect current expert opinion.
You will note that there is a place for you to add comments at the end of each section. This is so you can suggest any additional statements you think are important to giving assistance to an Aboriginal or Torres Strait Islander person with gambling problems. These statements will then go into the Round 2 survey to be rated by the expert panel.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please complete the questionnaire by rating each statement according to how important you believe it is for inclusion in the guidelines for assisting an Aboriginal or Torres Strait Islander person with gambling problems. Please keep in mind that the guidelines will be used by the general public. The statements need to be rated according to their importance for someone without a counselling or clinical background assisting an Aboriginal or Torres Strait Islander person with gambling problems.
This questionnaire should take approximately 60 minutes to complete. You can complete the survey in two or more sittings. Your answers are saved when you click 'Next' at the bottom of a page. This marks your page and you can begin again at a later date on the next page. Please be aware that once you have logged on and started responding you must complete the questionnaire on the same computer.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
To participate in this research you must be 18 years or over AND: • Be a gambling counsellor or researcher who is informed about Aboriginal gambling AND • Have a minimum of 2 years' experience in researching or treating gambling problems in Aboriginal or Torres Strait Islander people.
1. Do you meet these criteria? * Yes, I meet these criteria.
No, I do not meet these criteria. If you answered "No" to question 1, please exit the survey. If you answered "Yes" please continue to the next page.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
It is important for you to know that participation in this study is completely voluntary. You are not under any obligation to participate and you can withdraw at any time.
We would like to thank you for your time and effort and encourage you to provide us with feedback on this process.

Best Wishes, The Mental Health First Aid Research Team
2. I understand that by submitting this survey I am giving my consent to participate in this study. * Yes, I understand.
I do not consent to participate in this study.
If you answered "I do not consent to participate in this study" to question 2, please exit the survey. If you answered "Yes" please continue to the next page.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
This survey is divided into the following section: First aider refers to a concerned family member, friend, work colleague, or work supervisor who provides assistance to an Aboriginal person with gambling problems.
The Aboriginal person refers to the Aboriginal or Torres Strait Islander person with gambling problems or suspected gambling problems.
Gambling is the staking of money on uncertain events that are driven by chance.
Gambling problems are difficulties over time in limiting money or time spent on gambling, which leads to adverse consequences for the person, others, or for the community. This could include someone whose gambling problems are at a clinically diagnosable level.
Venue refers to a virtual or land-based location offering gambling or gaming activities with the chance to win money.
Gambling first aid is the assistance given to the Aboriginal person who is developing a gambling problem, experiencing a worsening of their gambling problem or experiencing a mental health crisis related to gambling. The assistance is given until appropriate professional help is received or until the crisis resolves.

Information about you
Assisting an Aboriginal or Torres Strait Islander person with gambling problems 3. Which best describes your area of expertise: * I work for an Aboriginal Health or Gambling Service.
I work for a general Gambling Service, but have experience in assisting Aboriginal people with gambling problems.
I work for a general Health Service, but have experience in assisting Aboriginal people with gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
There are already guidelines on cultural considerations and communication techniques ( click here to access these guidelines ) for providing mental health first aid to an Aboriginal person who may be experiencing a range of mental health problems (access the full range of guidelines). We do not wish to replicate these guidelines. Rather, our aim is to develop guidelines on how to assist an Aboriginal person who is experiencing gambling problems.
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.
10. The first aider should know that Aboriginal people understand mental health within a broad context of health and wellbeing, which includes concepts of social, spiritual and emotional functioning.
12. The first aider should be aware that an Aboriginal person's sense of cultural distinctiveness is linked with their spiritual, emotional and social health and well-being.  13. Although these guidelines are being produced for use nationally, it is recognised that Aboriginal culture is not homogenous and first aiders will need to be aware of the cultural considerations specific to the community in which they are assisting. Therefore the first aider should: This section contains statements about the warning signs of gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.
Essential Important

Don't know/Depends Unimportant
Should not be included The person frequently thinks and talks about gambling.
The person frequently uses gambling terms in everyday conversation, e.g. bet, favourite.
The person checks sports scores or racing results frequently, e.g. online, mobile device.
The person gambles rather than doing things they previously enjoyed.
The person expresses a strong desire or craving to gamble.
The person reports dreaming about gambling.
The person gambles almost every day.
The person gambles every day of the week.
The person complains of boredom when they are not gambling.
The person is restless when they are not gambling.
15. The first aider should be aware that the following behavioural signs indicate that an Aboriginal person may have gambling problems:

*
The person expresses guilt about their gambling.
The person is evasive or defensive when questioned about missed events or responsibilities.
The person becomes defensive or angry when asked about their gambling.
The person blames others for their gambling or its consequences.
The person's family finds evidence of regular gambling, e.g. gambling receipts, Internet browser history, bank statements.
The person neglects the basic care of their children.
The person breaks promises to their children about buying them things or spending time with them due to gambling.
The person causes arguments so they can leave home and gamble.
The person lies to cover up gambling.
The person increases the number or range of venues they gamble in.
The person increases the time they spend gambling.
The person is evasive about gambling losses. The person boasts about gambling wins.
The person continues to gamble despite promising to stop.
The person has tried unsuccessfully to control, cut back or stop gambling.
The person has a pattern of gambling for longer than intended.
The person is away from home for unexplained periods of time.
The person lies to fund gambling.
The person commits illegal acts to fund gambling, e.g. embezzlement, fraud.
The person steals from family or friends to fund gambling.
The person has legal problems related to gambling.
Before gambling, the person expresses a fear that they may miss an opportunity to win, e.g. "If I don't gamble today my lucky numbers will come up and I will miss out." Before gambling, the person is over-confident or expresses fantasies about winning. After winning, the person expresses relief.
After winning, the person expresses a conviction that the win was the result of their skill.
After winning, the person appears to have an elated mood.
The person celebrates their wins by gambling more.
After losing, the person expresses fear of others finding out.
After losing, the person expresses worry over where they will get money to cover living expenses.
After losing, the person expresses anger towards themselves.
After losing, the person uses alcohol to forget about gambling problems.
After losing, the person expresses anger towards family or friends.
After losing, the person expresses hopelessness.
After losing, the person engages in risky behaviour.
The person reports that they cannot recall periods when they were gambling. 17. The first aider should be aware that the following signs indicate that an Aboriginal person may have gambling problems: The person stops gambling only when the venue is closing.
The person finds it difficult to stop gambling at closing time.
The person regularly starts gambling as soon as the venue is open.
The person asks venue staff to not let other people know that they are there.
The person has friends or relatives call or arrive at the venue asking if they are still there.
The person withdraws cash two or more times while at a gambling venue.
The person borrows money from others while at the venue.
The person asks for a loan or credit from the venue.
The person gambles with large wins.
The person leaves the venue to find money so that they can continue gambling.
The person rummages around in purse or wallet for additional money to gamble.
The person gambles until all the money they have with them is used up.
The person is shaking while gambling.
The person sweats a lot while gambling. The person displays anger, e.g. swears to themselves, grunts, kicks or strikes.
The person looks very sad or depressed after gambling.
The person cries after losing a lot of money.
The person sits with their head in their hands after losing.
The person blames venues or gaming machines for losing.
The person swears at or complains to staff about losing.
The person groans repeatedly while gambling.
The person shows significant changes in mood during a gambling session.
The person appears to avoid the cashier or appears evasive by only using cash machine.
The person gambles after having drunk a lot of alcohol.
The person plays the gaming machine very roughly and aggressively, e.g. with fists or slaps.
The person stands over other players while waiting for his or her favourite gaming machine. After winning on gaming machines, the person plays on quickly without stopping to listen to the music or jingle.
The person gambles on 2 or more gaming machines at once (where this is allowed).
The person plays faster than most (e.g. inserts large numbers of coins into the gaming machine very rapidly, presses the buttons very rapidly so that the spin rate is very fast).
The person performs ritualistic or superstitious routines while gambling, e.g. compulsively rubs belly of machine or screen while playing.
The person rushes from one gaming machine or gaming table to another.
The person is particular about reserving their machine while they take a break.
The person often gambles on their own. The person repeatedly violates company gambling policy.
The person's ability to work or study has been negatively affected as a result of gambling.
The person is away from work for unexplained periods of time.
The person's use of company money seems suspicious or inappropriate.
The person plans holidays around gambling.
The person receives visits or phone calls from debt collectors while at work.
The person asks for advances on their pay.
The person borrows money from co-workers.
The person argues with co-workers over money owed.
19. The first aider should be aware that the following signs indicate that an Aboriginal person may have gambling problems:

*
The person steals items from their company to resell.
The person sells items at work (either personal or stolen items).
The person arranges to have personal financial statements sent to work rather than home. Valuables disappear (and may reappear) without explanation.
The person makes promises to pay back family and friends but never does so.
The person is badtempered about money.
The person hides financial statements.
The person is secretive about money.
The person cannot explain missing amounts of money from the house or bank accounts.
The person alternates between having no money and having a lot of money.
The person constantly swaps money from one account to another.
The person has numerous personal loans.
21. The first aider should be aware that the following financial signs indicate that an Aboriginal person may have gambling problems: The family finds hidden and unexplained money, e.g. money in a separate bank account, cash hidden in a drawer.
The person's family has to hide money from the person in order to cover living expenses.
The person or their family has experienced financial hardship as a result of gambling.
The person is consistently late in paying bills or misses payments entirely.
The person's essential services are frequently being disconnected, e.g. electricity, phone.
The person complains about mounting debts.
The person has a history of defaulting on payments.
The person or their family is frequently bothered by debt collectors.
The person owes money to a loan shark.
The person takes on extra jobs or works for overtime pay, but has no money to show for it.
The person cashes in investments or other assets early.
The person is frequently short of money.
The person has a pattern of unexplained loss of money.

Essential Important
Don't know/Depends Unimportant Should not be included The person has a history of reporting that their money has been stolen or lost.
The person increases their usage of or acquires additional credit cards.
The person borrows money to gamble or to pay gambling debts.
The person has a pattern of spending all available funds in an episode of gambling.
Over time, the person increases the amount of money spent on gambling.
The person believes that gambling will solve their financial difficulties or bring material wealth.
The person does not want to spend money on anything but gambling.
The person is aware of all the ATM/money machines close to the venue. The person does not look after personal hygiene due to gambling problems.
The person has frequent unexplained mood swings.
The person has experienced negative emotions as a result of gambling, e.g. sadness, anxiety, stress, anger.
The person's family has experienced negative emotions as a result of gambling, e.g. sadness, anxiety, stress, anger.
The person's mental health has been negatively affected as a result of gambling.
The mental health of the person's family has been negatively affected as a result of gambling.
23. The first aider should be aware that the following mental and physical health signs indicate that an Aboriginal person may have gambling problems: * The person experiences remorse or feels depressed after gambling.
The person's selfesteem is tied to their gambling wins and losses.
The person gambles to escape problems.
The person's physical health has been negatively affected as a result of gambling.
The physical health of the person's family has been negatively affected as a result of gambling. The person's partner is threatening to leave or break up the family due to the gambling.
The person has conflicts with others about money.
The person is criticised by others for their gambling.
The person's reputation has suffered due to gambling.
The person disappears from social events where gambling is also available, in order to gamble.
The person is unable to be emotionally present or involved in social situations because they are pre-occupied with gambling.
25. The first aider should be aware that the following social and cultural signs indicate that an Aboriginal person may have gambling problems:

*
The person isolates themselves because of gambling.
The person exploits others to pay for their gambling.
The person does not meet their cultural obligations due to their gambling, e.g. Elders and role models neglecting to pass down traditional knowledge, lack of loyalty and respect to their culture.

Essential Important
Don't know/Depends Unimportant Should not be included 26. Please provide any additional social or cultural signs: 27. The first aider should give the Aboriginal person a list of the signs of gambling problems and ask the Aboriginal person to consider if any of the signs apply to them. Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Prevalence and risk factor for gambling and gambling problems
28. The first aider should be aware that gambling problems are more common in Aboriginal people than in the general population.   SECTION 3: Awareness about gambling and gambling problems (cont.)

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Motivations for gambling
33. The first aider should know about the common motivations for gambling, e.g. to win money, or because it is fun, exciting or social.  35. The first aider should know that while the motivations for gambling may be the same for Aboriginal and non-Aboriginal people, the motivation to gamble may be stronger in Aboriginal people due to the specific pressures some Aboriginal people encounter, e.g. need to get out of house due to overcrowding or other pressures at home, social and economic disadvantage, welfare dependence.     sharing common interests, building or maintaining social networks, reducing social isolation.  SECTION 3: Awareness about gambling and gambling problems (cont.)

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Awareness about gambling problems
43. The first aider should learn all they can about gambling problems by reading about them. 44. The first aider should know that some types of gambling can cause more problems than others (e.g. gaming machines), however any form of gambling can become a problem.  46. The first aider should be aware that people with gambling problems are likely to have other mental health problems, e.g. depression, anxiety, alcohol or other drug use problems.  48. The first aider should be aware that a person with gambling problems may not see them as a problem, even though it may be obvious to those around them. 49. The first aider should be aware that a person with gambling problems may not see them as a problem, until they experience a crisis that they cannot solve themselves.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Awareness about treatment and recovery
54. The first aider should understand that it is important to assist a person with gambling problems because of the possible significant consequences, e.g. relationship breakdown, criminal sanctions, loss of employment, suicide, poor physical and mental health.  57. The first aider should not assume that a gambling problem is a phase the Aboriginal person is likely to pass through. 58. The first aider should be aware that recovery from gambling problems is a slow process.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Awareness about treatment and recovery (cont.)
62. The first aider should be aware that some Aboriginal people view gambling problems as spiritual problems.       SECTION 4: Awareness about gambling treatment and recovery from gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Awareness about treatment resources
70. The first aider should be aware of available local Aboriginal specific services, e.g. Aboriginal gambling liaison person, Aboriginal gambling services, healing programs.     76. The first aider should be aware of the specific barriers to help-seeking that Aboriginal people experience, e.g. lack of knowledge about and confidence in gambling help services, lack of culturally appropriate help services.       Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Preparing to talk with the person
84. The first aider should be prepared for the full range of responses they may encounter when talking with the Aboriginal person about their gambling problems, e.g. relief, anger.     90. The first aider should know that it may be difficult to find an ideal time to talk with the Aboriginal person, therefore they should just talk with the Aboriginal person rather than wait for the 'perfect' timing.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines. 97. The first aider should avoid: * 98. Please provide any additional items or comments related to this section.

This section contains statements about what the first aider needs to know about communication
when providing assistance to an Aboriginal person with gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Talking with the person (cont.)
99. The first aider should be aware the Aboriginal person may make promises that they are unable to keep.  "Would you be comfortable seeing a gambling counsellor" rather than "You should go see a gambling counsellor".

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Dealing with difficulties when interacting with the person
113. If the first aider thinks that their ability to assist the Aboriginal person is impeded by any negative attitudes towards the Aboriginal person's gambling or gambling in general, they should suggest the Aboriginal person talks with someone else.        Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Encouraging help seeking
123. The first aider should talk with the Aboriginal person as soon as they suspect the Aboriginal person has gambling problems, as early intervention may reduce the negative impact.  Many people with gambling problems have benefited from support groups.
Many people with gambling problems have benefited from self-help strategies.
It is possible to recover from gambling problems.
Seeking help is not a sign of weakness.
Seeking help is a sensible thing to do when experiencing a problem, like seeing a doctor for a health problem.
The sooner the problem is addressed the easier it is to overcome.
Any professional help will be confidential.
125. The first aider can encourage help-seeking by pointing out that: * 126. The first aider should work with the Aboriginal person to agree on acceptable behaviours, e.g. talking to a professional, staying within agreed spending limits. Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Encouraging help seeking (cont.)
128. If the Aboriginal person asks, the first aider should go with the Aboriginal person to an appointment for professional help.  Tell the Aboriginal person that most people react in a supportive way when gambling problems are disclosed.
Suggest they see a financial counsellor.
130. If the Aboriginal person is reluctant to seek help, the first aider should: * 131. The first aider should be aware that Aboriginal people with gambling problems may be more likely to seek assistance for financial problems than for their gambling problems.  Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Supporting change
134. The first aider should be clear about what they are willing to help the Aboriginal person with and what behaviours they will tolerate, although these boundaries can be revisited over time.  137. The first aider should explain to the Aboriginal person about the common false beliefs that can lead to gambling problems, e.g. belief that they can beat the system or superstitions about luck.    Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines. 143. The first aider should not (cont.) 144. Please provide any additional items or comments related to this section.
This section contains statements about what the first aider needs to do when providing assistance to an Aboriginal person with gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Supporting change (cont.)
145. If the first aider pays the Aboriginal person's debts or expenses, they should make arrangements for the Aboriginal person to pay back the loan, even if it is a small amount each week.   SECTION 6: Gambling first aid actions (cont.)

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

If the person does not want to change
149. The first aider should be aware that the Aboriginal person may not want to change their gambling behaviours.     157. The first aider should tell the Aboriginal person that they will be available to assist the Aboriginal person when they are ready to change their gambling behaviours.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Should not be included
Limiting time spent on gambling.
Limiting money spent on gambling.
Only gambling with money that the Aboriginal person can afford to lose.
Restricting their gambling to activities where the Aboriginal person has greater control over their behaviour, e.g. paying cards because they have better control than when they play pokies.
Balancing time spent on gambling with other activities.
Keeping a record of gambling wins and losses.
Eating before gambling.
Stopping gambling after a win.
Taking regular breaks while gambling.
Gambling with someone who limits their gambling.
Leaving bank cards or credit cards at home.
Gambling only when all debts are paid off.
159. If the Aboriginal person decides to continue gambling, the first aider should encourage them to reduce the negative impact of gambling by: * 160. If the Aboriginal person decides to continue gambling, the first aider should discourage them from gambling with friends or family who have gambling problems. Trying to win back gambling losses.
Using borrowed money to gamble.
Using personal investments or savings to gamble.
Taking cash or bank cards to access extra money while gambling.
Gambling when their judgment is impaired by alcohol or other drugs.
Gambling to escape from problems or feelings.
Gambling when angry or upset.
Gambling alone.
161. If the Aboriginal person decides to continue gambling, the first aider should encourage them to reduce the negative impact of gambling by not: * 162. Please provide any additional items or comments related to this section.
This section contains statements about what the first aider needs to do when providing assistance to an Aboriginal person with gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Assisting the person who wants to change
163. If the Aboriginal person decides to seek professional assistance, the first aider should offer to support them during this, e.g. talk with them about issues, skills and exercises that come out of therapy.         SECTION 6: Gambling first aid actions (cont.)

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Assisting the person who wants to change (cont.)
173. The first aider should be aware that the Aboriginal person who has stopped or reduced their gambling may experience a gap in their life that gambling used to fill, e.g. reduction in social activities.      Accept that they will not win back past gambling losses.
Reduce the amount of time and money spent on gambling.
Avoid spending time with people who are associated with gambling.
Seek support from family, extended family, kin, friends or Respected Aboriginal people to assist them to change their gambling behaviour.
Share their successes in reducing their gambling reduction with supportive people.
Share their successes in gambling lapses with supportive people.
179. The first aider should encourage the Aboriginal person to do the following: * 180. Please provide any additional items or comments related to this section.
This section contains statements about what the first aider needs to do when providing assistance to an Aboriginal person with gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Supporting the person through relapse
181. The first aider should be aware that although relapse is a problem, a relapse does not indicate that the Aboriginal person cannot recover.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Financial strategies
186. The first aider should know that some of the general strategies for limiting access to money may not work for an Aboriginal person, e.g. leaving money at home may be a problem in shared households because others may take the money.  Setting up accounts and loans so that they require a second signature.
Receiving an allowance from a family member so that the majority of the money can be used for household expenses.
Paying all critical household expenses before paying off gambling debts.
Having a trusted relative or close friend take temporary control of the Aboriginal person's access to funds.
Arranging that they have access to a limited amount of money each day that covers daily expenses, e.g. lunch, parking, coffee.
Voluntarily using a basics card which cannot be used for gambling or cash withdrawals.
188. In order to limit access to money for gambling, the first aider should ask the Aboriginal person to consider the following:      Section 6: Gambling first aid actions (cont.)

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Intervention
An intervention is when a group of people who care about the person meet with the person to point out the behaviours that are causing problems and ask them to stop. An intervention includes a discussion around the consequences for the person if they do not get help for their gambling problem.
195. The first aider should not organise an 'intervention'.  Include family, extended family, kin, friends or Respected Aboriginal people who they know will be able to support the Aboriginal person in their recovery.
Plan the goals and content of the intervention.
Organise the intervention in a way that the Aboriginal person feels supported and cared for rather than punished or shamed.
Practice the intervention with someone who is trained in conducting interventions (if available).
Only list the behaviours that the first aider has observed, not what they have been told.
197. If the first aider decides to arrange an intervention, they should: * 198. Please provide any additional items or comments related to this section.

This section contains statements about what the first aider needs to do when providing assistance
to an Aboriginal person with gambling problems.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Concerns for safety
199. The first aider should be aware that suicidal thoughts and behaviours are more common in people with gambling problems.       206. If the Aboriginal person is involved in illegal activities related to their gambling, the first aider should: * 207. The first aider should be aware that supporting a person with a gambling problem can be difficult and should know how to access support for themselves. Thank you.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems
That is the end of the Round 1 survey. Thank you for sharing your time and expertise with us.
If participating in this survey has caused you distress and you wish to talk to someone about this, you can contact Lifeline on 13 11 14.
By pressing the 'Done' button your responses will be registered with our survey software. Once all panel members have lodged their responses, we will collate the data and send you a report on the findings and the Round 2 survey.
Kind Regards,

Purpose of this research
The purpose of this project is to develop a set of guidelines for the public on how to support an Aboriginal or Torres Strait Islander person with gambling problems. This project has received funding from the Australian Government Department of Health.

How this questionnaire was developed
The statements in this questionnaire were derived from the results of the Round 1 survey. You will note that each statement is marked as either a 'new' or 'rerate' item. New items were derived from the comments provided in the first survey. An item is rerated when 80-89% of the panel members rated it as 'essential' or 'important'.

Instructions
Please complete the questionnaire by rating each statement according to how important you believe it is for inclusion in the guidelines for helping a person with gambling problems. Please keep in mind that the guidelines will be used by the general public. The statements need to be rated according to their importance for someone without a counselling or clinical background.
This questionnaire should take approximately 45 minutes to complete. You can complete the survey in two or more sittings. Your answers are saved when you click 'Next' at the bottom of a page. This marks your page and you can begin again at a later date on the next page. Please be aware that once you have logged on and started responding you must complete the questionnaire on the same computer.

IMPORTANT NOTE:
There are already guidelines on cultural considerations and communication techniques ( click here to access these guidelines ) for providing mental health first aid to an Aboriginal person who may be experiencing a range of mental health problems (access the full range of guidelines). We do not wish to replicate these guidelines . Rather, our aim is to develop guidelines on how to assist an Aboriginal person who is experiencing gambling problems.

Structure of this survey
This survey is divided into the following section:

Definitions used in this survey
Aboriginal in this questionnaire refers to Aboriginal or Torres Strait Islander people.
First aider refers to a concerned family member, friend, work colleague, or work supervisor who provides assistance to an Aboriginal person with gambling problems.

The Aboriginal person refers to the Aboriginal or Torres Strait Islander person with gambling problems or suspected gambling problems.
Gambling is the staking of money on uncertain events that are driven by chance.
Gambling problems are difficulties over time in limiting money or time spent on gambling, which leads to adverse consequences for the person, others, or for the community. This could include someone whose gambling problems are at a clinically diagnosable level.
Venue refers to a virtual or land-based location offering gambling or gaming activities with the chance to win money.
Gambling first aid is the assistance given to the Aboriginal person who is developing a gambling problem, experiencing a worsening of their gambling problem or experiencing a mental health crisis related to gambling. The assistance is given until appropriate professional help is received or until the crisis resolves.

This section contains statements about what the first aider needs to know about Aboriginal
culture when providing assistance to an Aboriginal person with gambling problems.

SECTION 1: Cultural considerations when assisting an Aboriginal person with gambling problems
There are already guidelines on cultural considerations and communication techniques ( click here to access these guidelines ) for providing mental health first aid to an Aboriginal person who may be experiencing a range of mental health problems (access the full range of guidelines). We do not wish to replicate these guidelines. Rather, our aim is to develop guidelines on how to assist an Aboriginal person who is experiencing gambling problems.
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.
2. The first aider should learn about the specific gambling-related problems in the Aboriginal person's community, e.g. card games, pokies, online gambling. (New) * Essential Important Don't know/Depends Unimportant Should not be included 3. The first aider should know how the expectation of 'providing for family' may impact on gambling problems, e.g. other family members may provide for the person if they lose their money for rent or food. Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.
5. The first aider should give the Aboriginal person a list of the signs of gambling problems and ask the Aboriginal person to consider if any of the signs apply to them. (Rerate) * Essential Important Don't know/Depends Unimportant Should not be included 6. The first aider should be aware that the following behavioural signs indicate that an Aboriginal person may have gambling problems: 11. The first aider should be aware that the following social and cultural signs indicate that an Aboriginal person may have gambling problems: Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Prevalence and risk factor for gambling and gambling problems
12. The first aider should be aware that gambling problems are more common in Aboriginal people than in the general population. (Rerate) Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Awareness about treatment and recovery
20. The first aider should know that the goals of treatment could be either abstinence from gambling or restricting gambling. (Rerate) SECTION 4: Awareness about gambling treatment and recovery from gambling problems.
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Awareness about treatment resources
24. The first aider should be aware of available local Aboriginal specific services, e.g. Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines. Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.  Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines. Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines. 49. The first aider can encourage help-seeking by pointing out that: * 50. The first aider should be aware that Aboriginal people with gambling problems may be more likely to seek assistance for financial problems than for their gambling problems. (Rerate) Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.  Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Supporting
Assisting the person who wants to change (cont.)

74.
If asked by the Aboriginal person, the first aider should discuss with them possible strategies for handling gambling urges and encourage the Aboriginal person to use them. 76. If the Aboriginal person asks for the first aider's assistance to change their gambling, the first aider should offer: Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.

Don't know/Depends Unimportant
Should not be included a. Paying all critical household expenses before paying off gambling debts.
b. Voluntarily using a basics card which cannot be used for gambling or cash withdrawals. (Rerate) 77. In order to limit access to money for gambling, the first aider should ask the Aboriginal person to consider the following: * 78. If the Aboriginal person asks for money to help cover bills or debts, the first aider should refer them to a relief agency or financial counselling service, rather than giving them money. (Rerate) Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines. 82. If the Aboriginal person is involved in illegal activities related to their gambling, the first aider should: * Thank you.
Aboriginal in this questionnaire refers to Aboriginal or Torres Strait Islander people.
First aider refers to a concerned family member, friend, work colleague, or work supervisor who provides assistance to an Aboriginal person with gambling problems.
The Aboriginal person refers to the Aboriginal or Torres Strait Islander person with gambling problems or suspected gambling problems.
Gambling is the staking of money on uncertain events that are driven by chance.
Gambling problems are difficulties over time in limiting money or time spent on gambling, which leads to adverse consequences for the person, others, or for the community. This could include someone whose gambling problems are at a clinically diagnosable level.
Venue refers to a virtual or land-based location offering gambling or gaming activities with the chance to win money.
Gambling first aid is the assistance given to the Aboriginal person who is developing a gambling problem, experiencing a worsening of their gambling problem or experiencing a mental health crisis related to gambling. The assistance is given until appropriate professional help is received or until the crisis resolves.

Assisting an Aboriginal or Torres Strait Islander person with gambling problems -R3
There are already guidelines on cultural considerations and communication techniques ( click here to access these guidelines ) for providing mental health first aid to an Aboriginal person who may be experiencing a range of mental health problems (access the full range of guidelines). We do not wish to replicate these guidelines. Rather, our aim is to develop guidelines on how to assist an Aboriginal person who is experiencing gambling problems.
Please keep our definitions in mind when completing the survey. You can access the definitions here.
Please rate how important (from 'essential' to 'should not be included') you think it is that each statement be included in the guidelines.
1. Please provide us with your email address. (This allows us to track who completes the Round 2 survey and is then eligible to complete Round 3.)

Cultural considerations when assisting an Aboriginal person with gambling problems
2. The first aider should know how the expectation of 'providing for family' may impact on gambling problems, e.g. other family members may provide for the person if they lose their money for rent or food.  3. The first aider should be aware that the following behavioural signs indicate that an Aboriginal person may have gambling problems: * Awareness about gambling problems 4. The first aider should try to learn more about gambling problems, e.g. ring a gambling help line, talking with others, reading information. 6. The first aider should know that it may be a long-term investment to support an Aboriginal person with gambling problems, particularly if the first aider is not Aboriginal.    By pressing the 'Done' button your responses will be registered with our survey software. Once all panel members have lodged their responses, we will use the results to write the guidelines. We will send a final draft of the guidelines for your final endorsement.

Kind Regards,
The Mental Health First Aid Research Team