Massachusetts prevention initiatives for problem gambling were largely informed by the regional planning process, placing the lived experience of community members at the center of program development. During the regional planning process, one of the recurrent themes was the desire of men in the substance misuse recovery community to share their knowledge and experience with others, including the well-documented relationship between substance misuse and gambling [20, 21]. This finding informed the development of the Massachusetts Ambassador Project, a novel, peer-based, community-centered, and culturally responsive approach for men of color who have a history of substance misuse to engage other men of color in their communities in problem gambling prevention discussions through individual, group, and community-level interactions.
The Massachusetts Ambassador Project: Project Design
In 2018, OPGS contracted with two recovery-oriented organizations to pilot test the Ambassador Project and to participate in a formative evaluation. These two organizations were also provided with intensive training and technical assistance from the Massachusetts Center of Excellence on Problem Gambling Prevention (MCOE PGP), a state-supported training and technical assistance center housed within a non-profit organization.
The goals of the project were to (a) prevent or reduce problem gambling among individuals, priority populations, and communities with elevated or disproportionate levels of risk and (b) develop and foster the awareness, skills, and behaviors needed to protect against developing problems with gambling. In developing the specific parameters for the project, OPGS drew extensively from the literature on peer support interventions , health and behavioral health education and outreach [23, 24], and brief interventions [25, 26]. The use of peers to deliver prevention, health promotion, and recovery support services is commonplace across a wide variety of fields, including substance misuse prevention, HIV/AIDS prevention, and violence prevention. As described by Valente and Pumpuang , peer providers, including but not limited to those with direct lived experience with the health or behavioral health issue being addressed, tend to be more adept at using appropriate language and expressions, are often intrinsically motivated to help others with shared experience, and can be perceived as being a more credible source of information than non-peers. Other investigators have noted that peer providers are uniquely and experientially qualified to draw on their lived experience to establish or reinforce norms, leverage resources within local settings, and reach members of historically difficult-to-engage populations [27, 28].
Theoretically grounded in the socio-ecological model, the MA Ambassador Project included a comprehensive set of objectives and corresponding activities at the individual, interpersonal, organizational, and community levels. The focus at the individual level was on training, empowering, and supporting two to three Ambassadors in each recovery organization as catalysts of change. While the core of their knowledge is experiential and based on lived experience, the literature suggests that peer providers should also receive structured training consistent with other paid staff in areas such as ethics, coaching skills, relationship building, public speaking, and peer education [7•]. Upon hire, MCOE PGP provided each Ambassador with 15 hours of training on problem gambling prevention, the relationship between substance use disorder and problem gambling, building health and racial equity, and engaging peers in group and individual conversations. This training was supplemented by ongoing opportunities for training, technical assistance, and professional development. Ambassadors were encouraged and supported in pursuing certification as recovery coaches and were invited to participate in monthly community of practice sessions with other Ambassadors for peer sharing and support. Within their host organization, Ambassadors also received weekly supervision and support from a dedicated project supervisor.
The objective at the interpersonal level was for Ambassadors to actively engage, involve, and empower individuals disproportionately affected by or at risk for problem gambling. Following training, Ambassadors were expected to use lived experience to raise awareness of problem gambling, emphasize the relationship between substance misuse and problem gambling, provide resources, and support behavioral change through individual and group interactions. Individual interactions tended to be time-limited and based on capitalizing upon natural opportunities to engage individuals in discussion (e.g., street outreach). Group interactions were more structured in nature and based on requests to provide presentations at partner organizations such as acute treatment facilities, institutional corrections facilities, and faith-based settings.
At the organizational level, Ambassadors established relationships with community-based organizations that prioritize men of color and/or allies in recovery. The objective was to effect systems change by encouraging these organizations to institutionalize problem gambling prevention within their services, enhance their capacity to support problem gambling prevention, and meet the needs of individuals at elevated risk on the shared risk factor of gambling and substance addiction.
At the community level, Ambassadors were expected to increase community awareness of problem gambling and provide education about susceptibility to problem gambling—including recognition of environmental exposure to gambling and the connection between problem gambling and other health and behavioral health issues. To this end, Ambassadors engaged with the broader community through the distribution of OPGS informational materials and resources at community events.
The Massachusetts Ambassador Project: Pilot Period Outcomes
The 12-month pilot implementation period, which lasted from July 2018 to June 2019, was externally evaluated . Emphasis was placed on understanding the extent to which Ambassadors were able to successfully engage with the community, the feasibility of the project, and the identification of needed adjustments to the activities in advance of moving the project to scale. The primary evaluation inputs were an online monthly reporting form completed by the project supervisor at each recovery-oriented organization, multiple site visits with the supervisor and Ambassadors at each project site, and process discussions with representatives from OPGS and MCOE PGP.
Over the course of the pilot period, Ambassadors reached a total of 4388 individuals through individual outreach, group sessions and presentations, and material dissemination. Throughout this, Ambassadors reached communities of color—critical to engaging a population disproportionately impacted by gambling. For example, 43% of the individuals who participated in the group sessions and presentations identified as a person of color (1326/3067). In addition to their direct work with individuals and groups, Ambassadors engaged and developed relationships with 36 different community organizations.
Initial anecdotal reports from supervisors, Ambassadors, OPGS, and MCOE PGP suggest the project enhanced the capacity of Ambassadors to act as catalysts of change in the community, successfully engaged individuals and organizations in lived experience discussions about problem gambling, and was well received by individuals and the community as a whole. One Ambassador stated, “They like my group because I am honest with them and they can sense that… they are more engaged because they feel more familiar with me and know what to expect.” The project is currently being replicated in four settings and plans are underway to conduct a more robust process and outcome evaluation.