Title: Can a ‘trigger’ question to identify gambling harms to individuals or affected others be validated and used in three local authority (LA) Adult services departments (ASDs)?
Funder: Department of Health and Social Care

Abstract: Research question Can a trigger question to identify gambling harms to individuals or affected others be validated and used in three local authority (LA) Adult services departments (ASDs)? Background Close to half of the British adult population gamble with around two million being either &ldquo;problem gamblers&rdquo; or at risk of developing problems. Additionally, the typical problem gambler negatively affects up to six other people. Local authorities (LAs) are being asked by government to identify and support people experiencing gambling harms such as poverty, debt, mental health problems, domestic violence and housing instability. Early recognition in social care should be a critical tool in identifying, preventing and managing gambling s harmful consequences. To date, no tool has been scientifically assessed to do this. Working with GamCare, the UK's largest gambling support charity, we plan to validate a 'trigger' question which can be used with enquirers/service users. This would allow benchmarking across LAs and over time. This is important as there is a lack of empirical evidence about gambling harms despite substantial publicity about the industry s expansion and the harms to individuals. Aims and objectives This study aims to develop an acceptable 'trigger' question for identifying gambling harms to individuals, and affected others, which can be validated and used by practitioners in adult service departments (ASD) in three LAs. It also aims to provide participating LAs with data about numbers of enquirers/service users affected by gambling harms which they can incorporate into evidence-based service planning. Methods Phase 1 Development: A scoping review will be conducted to identify potential trigger questions; their validity will be explored using quantitative and qualitative methods. Potential questions will be developed and reviewed by lay groups and experts, cognitively tested and sensitivity and specificity assessed against gold standard measure(s) (n=2100). GamCare, ASD staff and lay representatives will co-produce and test training materials and guidance to accompany the trigger question. Phase 2 Implementation: We will train staff in three LAs to use the trigger question with enquirers/service users and signpost those affected by gambling harms. Phase 3 Evaluation: We will compare question responses across the three sites, evaluate acceptability to enquirers/service users and staff, assess staff training and guidance, barriers and facilitators to implementation and calculate costs to LAs. This project has been co-developed with People with Lived Experience (PWLE) partners, and GamCare and LA staff. Our PWLE group will work with us throughout the project. Our Advisory Group will also include social care practitioners and public health representatives as well as gambling experts. We will disseminate findings widely; working with our Advisory Group (representatives from: Local Government Association, Social Care Institute for Excellence, Association of Directors of Adult Social Services, Skills for Care, Chief Social Worker, GambleAware, Gambling Commission, Department for Health and Social Care) to ensure impact and help the trigger question become widely adopted. Timelines for delivery: Phase 1: Scoping review and validated trigger question (mth 10); Phase 2: implementation in three LAs (mth 17); Phase 3: Evaluation and Dissemination (mth 22).

Lay abstract: What is the problem? Many people in Britain gamble and do so without problem. But around two million people experience difficulties with their gambling and some experience harm such as debt, problems at work, poor health, difficulties with relationships and, sometimes suicidal thoughts and attempts. Friends and family of people with gambling problems are also harmed. Councils are being asked to identify and support people experiencing gambling harms. Currently social care staff in Councils do not have a question they can use to ask people about gambling harm that has been tested scientifically to ensure it identifies people who might need help. Why is it important to social care? Gambling harms are more likely to affect vulnerable adults but staff working in Council social services are not sure how many people are affected or how to help. They may be well placed to ask people if there is a problem related to gambling and then tell them about support services. Currently, people working in Councils social services departments ask questions about misuse of alcohol and drugs, and feeling safe, but not about gambling harms. Unlike alcohol or drug misuse, gambling is often a hidden problem so people may need to be asked about it. GamCare, the UK s leading organisation supporting people affected by gambling harms, trains social care staff. GamCare told us that social care staff frequently request a brief, simple tool or trigger question to help them identify and support people affected by gambling harms. The study We will test the introduction of a trigger question in adult service departments for identifying and supporting adults affected by gambling harm. We will work with three different councils whose staff will be trained by GamCare so they are confident in administering the trigger question and providing information on helping services to those who need support. The study has three parts: 1) we will review the evidence and develop potential trigger questions; 2) we will see what happens when potential trigger questions are asked in three Councils; 3) we will ask staff and people being asked the trigger question whether they found it acceptable. We will work out how much it costs the council to use. People with lived experience of gambling harms, council staff and gambling support charities have helped us develop this proposal and will help us with the research. We will report our findings about the trigger question and how many people are affected by gambling harm to Council managers, staff, and national social work organisations, training providers and policy-makers so that other Councils can start using the trigger question. GamCare will also promote use of this trigger question in its training sessions after the study.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH