As a gambling harms lived experience charity our Theory of Change (ToC) model involved outlining the steps and conditions necessary to achieve our long-term charitable goals.
Our structured approach to developing this model was as follows:
1. Define the Long-Term Goal
Our Charitable Goals as outlined in our Governance Document (as lodged with the Charity Commission) have two strands, and are defined as:
- THE RELIEF OF THOSE IN NEED DIRECTLY OR INDIRECTLY AS A RESULT OF AN ADDICTION TO OR A MISUSE OF GAMBLING INCLUDING (BUT NOT EXCLUSIVELY) BY PROVIDING PEER SUPPORT SERVICES;
- THE ADVANCEMENT OF EDUCATION BY RAISING PUBLIC AWARENESS ON THE NATURE AND ISSUES SURROUNDING GAMBLING, GAMBLING RELATED HARMS AND THE MISUSE OF GAMBLING.
In addition to those stated goals it also had to be a primary consideration in creating out model of change that it also reflected the central ethos of Lived Experience embodied purpose – a selfless purpose of ensuring that the lessons, knowledge and understanding that has been born out of real life adversity can be harnessed in ways which prevent other individuals and families from needlessly having to experience similar harms and adversities in the future.
2. Identify Preconditions and Outcomes
We asked ourselves what were the necessary conditions that would have to be met to in order to achieve these long-term goals. We saw these as being.
• Increased Awareness:
Raised public awareness about the risks and harms of gambling, and of the legacy impacts upon individuals and families.
Outcome: Removal of the “hidden” tag from Gambling being seen as the “Hidden addiction” so that families are more able to associate gambling with being a potential source of harm to their loved ones, and more aware of how to react if a family member shows signs of harmful gambling.
•Reduced Stigma:
Reduced barriers to people admitting, talking about, or accessing support around gambling harms.
Outcome: A de-stigmatised perception of harmful gambling, whether internalised within the individual themselves or manifested in public attitudes towards the causes and/or stereotypes around individuals engaging in or being impacted by harmful gambling will increase the likelihood of earlier and preventative intervention being possible.
• Accessible Support Services:
Increased numbers and variety of locally accessible treatment and support services, along with more visible signposting of support and recovery services providing relief for those affected by harmful gambling.
Outcome: Increased availability of services which are referrable into from local primary healthcare, statutory agencies and addiction/community services will improve outcomes for individuals experiencing harms from gambling. Greater range of services available (treatment, support, and aftercare) will better help meet person-centric needs.
• Policy Influence:
Stronger regulations and policies to reduce and prevent gambling harms; raised awareness of the tangential impacts of harmful gambling within other policy areas (Healthcare, Housing, Household finances, Statutory and Local Government provided services).
Outcomes: Regulations which give better protections to individuals around exposure to harmful gambling will provide enhanced protections for those at risk of experiencing harm, will limit the extent of harm experienced before external intervention occurs (thus reducing duration/recovery gap of harm legacy), and will lead to a holistic/whole system approach to harm prevention and recovery. A Public Health approach to gambling harms involves priority being given to prevention of harm, and protection of individuals’ wellbeing at societal level over any commercial profits or tax revenues being raised.
• Research and Knowledge:
Better understanding of gambling harms, and meaningful inclusion of Lived Experience derived knowledge around all aspects of treatment, support, prevention and education.
Outcomes: Insights into nature and causes of gambling harms will improve regulation, prevention of harms, treatment, and recovery pathways.
• Community Engagement:
Fostering of community networks which support individuals in recovery and raise awareness of the impacts of harmful gambling in diverse communities.
Outcomes: Social support frameworks have a significant role to play in providing supportive systems around an individual’s life. Addiction is often seen as being a driver towards social isolation, and the
antithesis of addiction is often seen as being greater connection with others. Communities are the embodiment of social connection, and empowering communities to have greater understanding of gambling harms can allow them them to create support mechanisms which support their own members in ways which align with other personal characteristics and shared values, and which also act to lower barriers to seeking and admitting the need for support. Peer led groups are also important sources of mutual support which foster and help build recovery capital.
• Behavioural Change:
Identified discrete populations, and stages of gambling, which allow targeted intervention designed to bring about lasting behavioural change.
Outcomes: Discrete populations (e.g. Military, Emergency First Responders, Foreign Students) can experience greater levels of harm and exposure to risk of harm from gambling. Recognising which populations are are greater risk of harm, the drivers for this being the case, and identifying interventions which can be applied at population level to bring about behavioural change will be far more effective in reducing impact and scope of gambling harms than if having to address these issues at individual level.
At a general population level, the individual journey (drift) along the spectrum of developing harm from non-harmful (limited leisure based gambling) to full-addiction presents a very narrow window of gambling engaged activity where evidence of harm developing align with receptivity to intervention designed to bring about behavioural change. Intervene too soon in the journey and the person does not accept the relevance of intervention (does not believe they are at risk of harm). Too late and the strength of the engagement already exerted by gambling will prevent the individual from being open to intervention. Understanding how to identify the indicators of optimum change can allow a successful population level intervention model to be developed and implemented. Lived Experience can offer a unique reflective insight into identifying the environmental indicators which can allow external agencies to know when and how to exert interventive engagements which maximise effectiveness of resources and messaging in order to bring about preventative behavioural change.
3. Map Activities to Outcomes
We set ourselves the challenge of identifying activities or interventions that will lead to the desired outcomes.
• Awareness Campaigns:
Collaborate with others in conducting public awareness campaigns through various media channels (including self-publishing and social media). Ensure that Lived and Living Experience is effectively involved in the design and delivery of awareness campaigns at national and local levels. (e.g. GambleAware’s Tackling Stigma campaign, Slough Borough Council’s Raising Awareness of Gambling Harm in Slough workshop, Scotland Reducing Gambling Harms roundtable activities). Create resources and training which allow Lived Experience Advocacy to be rolled out in consistent, effective and safe manner.
Outcome: This will act to make the public more conscious of gambling as a source of harm, and give access to Lived Experience informed advocacy at local and regional level.
• De-stigmatising Addiction, and Humanizing Recovery Services:
Using the diversity of human experience embedded within Lived Experience to make talking openly about Gambling Addiction and Gambling related Harm less stigmatic to those impacted; Demystifying services designed to deliver treatment and support by producing videos and other materials which highlight the human elements of those services and make the people accessing and delivering those services relatable to those seeking support.
Outcome: These will act to reduce stigma and increase accessibility to support services.
• Support Programs:
Work with providers who offer counselling, support groups, and helplines for individuals and families to make these visible and accessible to those suffering harmful impacts of gambling. Develop directories signposting to all types of support, with embedded cross-referral pathways to ensure that there is a “no wrong door” approach. Highlight that recovery is person-centric and that there is no “right” or “wrong” way – but that there will always be a right way for that person.
Outcome: Making existing services more easily identifiable and understandable will increase access to support.
• Advocacy Efforts:
Engaging with policymakers to influence gambling regulations; responding to open consultations (e.g. Gambling Act White Paper, Scottish Gambling Harms Framework); leveraging conferences and speaking events (e.g. GambleAware Annual Conferences, Public Policy Exchange seminars, Scottish Gambling Education Conference).
Outcome: These will act to influence debate and policy.
• Community Programs:
Develop peer support networks and community events to support recovery; engage with networks supporting communities based on identities/characteristics other than gambling harms (e.g. host webinars and community events in partnership with networks representing Neurodiverse conditions, LGBTQ+, Military Veterans, and Criminal Justice exposed individuals/communities).
Outcomes: These will act to increase community engagement and prevention impact.
• Local Awareness Initiatives:
Develop resources allowing individuals with Lived Experience to raise awareness around gambling harms at local community level; develop frameworks to allow local authorities to embed awareness of harms caused by gambling, and to develop services aimed at alleviating gambling harms at local/authority level which create links to social assets and statutory services.
Outcomes: These will act to increase community engagement and make services more accessible and needs focused.
• Research and Knowledge Improvements:
Partner with academic institutes in developing areas of research which improve understanding of gambling harms; develop tools which give greater sectional insights around harmful gambling or which allow different stages of harm to be better gauged (e.g. partnering with Plymouth University on new Gambling Harms Severity Index framework to replace/supplement PGSI as a standardised tool); actively link Lived Experience with research and participation opportunities designed to improve wider understanding of harmful gambling and diverse harms caused by it; promote and disseminate findings from Experiential Research projects which allow Lived Experience to be shared as a knowledge resource.
Outcomes: These will act to ensure research is based on empirical, theoretical and experiential evidence. Greater recognition of importance of Lived Experience involvement and experiential learning as a source of expanded understanding around gambling harms (and associated/comorbid conditions).
• Generational and Population Targeting:
Use collective experiential wisdom of LLE to identify characteristics and signs which can help identify groups of individuals who are both at risk of developing harm from gambling, who are reachable at population level, and who are open to intervention designed to bring about remedial behavioural change (targeted population change); Identify lessons drawn from LLE which can be used to inform preventative education aimed at building resistance to developing harmful gambling behaviours in future generations (generational population change).
Outcomes: Changing behaviours at population level which are more effective than focusing on individual change.
4. Assumptions
We identified assumptions underpinning our theory of change. These are our beliefs about how and why change will happen, and also the danger of complacency.
• Assumption 1: Increased public awareness will act to prevent individuals developing harm.
• Assumption 2: Increased public education will enable individuals to better detect and positively respond to signs of gambling harms impacting those around them.
• Assumption 3: Reduced stigma around gambling harms will reduce barriers preventing individuals admitting harmful behaviors and accessing support for gambling harms.
• Assumption 4: Demystifying/humanizing treatment and support services will improve recovery uptake and outcomes.
• Assumption 5: Stronger policies will reduce the prevalence and impacts of gambling harms.
• Assumption 6: Better community support will enhance the recovery process and make support more relevant to local and personal circumstances.
• Assumption 7: Behavioural change at population level offers greater and more lasting impact than at individual level.
• Assumption 8: Equipping existing relationships (e.g. Family/Loved Ones) with tools and awareness to offer intervention and long-term support offers greater and more lasting impact at individual level.
• Assumption 9: Collaboration founded on shared goals improves effectiveness and inclusiveness of change.
• Assumption 10: Collaboration between Academia and Lived Experience with increase applicable understanding around gambling harms.
• Assumption 11: Environmental flux (e.g. social and technological innovation) will create evolving challenges around gambling – necessitating regular “review and refine” adaptation cycles to Model of Change.
5. Indicators of Success
Indicators of progress towards our outcomes and long-term goals will come from internal and external sources.
• Awareness Indicators: Number of people reached through campaigns, observed changes in public attitudes, media articles and mentions, uptake in followers/members/impressions.
• Support Indicators: Number of individuals accessing treatment and support services, improved recovery rates, standardised metrics evidencing increasing performance success across all services.
• Research Indicators: Number of research project engagements, number of Lived Experience participants, wider recognition and inclusion of experiential research in academic journals, adoption of new tools and metrics for gauging harm, recovery and efficacy of treatment/support.
• Policy Indicators: Changes in gambling regulations, number of policy engagements, NHS Health Surveys, Gambling Commission’s Gambling Survey for Great Britain output showing prevalence of gambling engagement and harm, Industry statistics.
• Community Indicators: Participation in community programs, feedback from participants, socio-economic impact reporting at local levels.