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T HINK T ANK. State-funded Gambling Treatment Programs JUNE 22-23, BOSTON, MASSACHUSETTS. Massachusetts Council on Compulsive Gambling
- Dinah Melton
- 3 years ago
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1 State-funded Gambling Treatment Programs T HINK T ANK JUNE 22-23, BOSTON, MASSACHUSETTS Massachusetts Council on Compulsive Gambling Massachusetts Department of Public Health Harvard Medical School, Division on Addictions
2 March 2001 THE RESULTS OF A NATIONAL THINK TANK ON STATE- FUNDED GAMBLING TREATMENT PROGRAMS A Massachusetts Initiative Massachusetts Council on Compulsive Gambling Massachusetts Department of Public Health Harvard Medical School, Division on Addictions
4 TABLE OF CONTENTS INTRODUCTION... 1 PARTICIPANT AND PROGRAM CHARACTERISTICS: THE STATE OF STATE FUNDED GAMBLING TREATMENT PROGRAMS... 2 Participant Characteristics... 2 Program Characteristics... 3 THINK TANK PROCEDURES... 5 FINDINGS:ADMINISTRATIVE STRUCTURE AND FUNDING... 6 Designing an Effective Structural Model (Worksheet 1)... 6 Designing an Effective Funding Model (Worksheet 2)... 7 Public Funding... 7 Private Funding... 8 Self-Payment... 9 Insurance Coverage FINDINGS:TREATMENT DELIVERY PART I, MODALITIES AND SETTINGS...11 Designing an Effective Treatment Model (Worksheet 3) Treatment Modalities Treatment Settings FINDINGS:TREATMENT DELIVERY PART II, ASSESSING IMPACT AND EFFICACY Designing an Effective Client Recruitment & Retention Model (Worksheet 4)...12 Client Recruitment...12 Client Retention...14 Impacting High-risk Populations...15 Measuring Effectiveness of Recruitment and Retention Efforts Designing an Effective Assessment Model for Treatment Programs (Worksheet 5) FINDINGS:A PATIENT BILL OF RIGHTS...17 Designing a Model Patient Bill of Rights (Worksheet 6) Patient Rights / Expectations...17 Patient Obligations/Responsibilities FINDINGS: BEST PRACTICE GUIDELINES Designing Model Best Practices Guidelines (Worksheet 7)... 18
5 TOWARD THE FUTURE...19 Clarifying the Nature of Gambling Disorders Improving Client Assessment Instruments and Applications Considering the Relationships Among Treatment Modalities and Settings...19 Individualizing Approaches to Assessment,Treatment and Evaluation Resolving Issues Associated With Self-payment for Services...20 Focusing on the Public Health Dimensions of Problem Gambling Developing In-patient Treatment Resources...20 Attracting Financial Support for Problem Gambling Treatment Programs From Indian Tribes That Operate Casinos CONCLUSIONS...21 REFERENCES...22 APPENDIX I: LIST OF THINK TANK PARTICIPANTS Planning Committee APPENDIX II: LIST OF BREAK-OUT ASSIGNMENTS APPENDIX III:THINK TANK WORKSHEETS Worksheet 1 Program Structure and Funding: Designing an Effective Structural Model Worksheet 2 Program Structure and Funding: Designing an Effective Funding Model Worksheet 3 Treatment Delivery, Part 1: Designing an Effective Treatment Model Worksheet 4 Treatment Delivery, Part 2:Assessing Impact and Efficacy by Designing an Effective Client Recruitment/Retention Model Worksheet 5 Treatment Delivery, Part 2:Assessing Impact and Efficacy by Designing an Effective Assessment Model for Treatment Programs Worksheet 6 Patient Rights: Designing a Model Patient Bill of Rights Worksheet 7 Best Practices Guidelines: Designing Model Best Practices Guidelines... 35
6 INTRODUCTION As legalized gambling has become more common throughout the United States (National Gambling Impact Study Commission, 1999; National Research Council, 1999), treatment programs to address gambling related problems have emerged. Harvard Medical School s Norman E. Zinberg Center for Addiction Studies and the Massachusetts Council on Compulsive Gambling hosted the first national Think Tank on Pathological Gambling on June 3 & 4, During April 1995, the Minnesota Council on Compulsive Gambling joined Harvard Medical School's Division on the Addictions and the Massachusetts Council on Compulsive Gambling to host the first North American Think Tank on Youth Gambling. On June 22 & 23, 2000, the Massachusetts Council on Compulsive Gambling, in cooperation with the Harvard Medical School Division on Addictions and the Massachusetts Department of Public Health, hosted a national Think Tank on State-Funded Gambling Treatment Programs. The project was supported primarily by special funding from the Massachusetts Department of Public Health, Dr. Howard Koh, Commissioner. Additional support was provided by The National Center for Responsible Gaming, The Center for Substance Abuse Treatment, Trimeridian/The Custer Center, and the Institute for Problem Gambling. The first national think tank was designed to identify the nature of gambling, its potential adverse consequences and the extent of the problem; the second was intended to draw attention to the issue by focusing on youth.1 The recent Think Tank on State-Funded Gambling Treatment Programs was the first national event dedicated to treatment, suggesting that the field is beginning to mature. Forty invited participants attended, representing each of the 13 states with state-funded gambling treatment programs. A complete list of participants and the planning committee is included as Appendix I. The primary purpose of this Think Tank was twofold: (1) gather information about the structure and scope of existing state-funded treatment programs and (2) create a blueprint for the future development of such programs in jurisdictions where limited or no treatment programs presently exist. To help develop this blueprint, Think Tank participants shared their views about six distinct areas of gambling treatment program operation: a Administrative Structure and Funding a Treatment Delivery: Modalities and Settings a Treatment Delivery: Client Recruitment and Retention a Assessing Impact and Efficacy a Patient Rights a Best Practice Guidelines 1 The late Tom Cummings, a principal architect of the first two Think Tank events, would be very proud indeed at the development of this special treatment event. We owe him a great debt and dedicate this project to his enduring influence and memory. 1
7 PARTICIPANT AND PROGRAM CHARACTERISTICS:THE STATE OF STATE-FUNDED GAMBLING TREATMENT PROGRAMS Seventy-three people were invited to participate in this think tank. Of these 48 accepted invitations, yielding a 65.8% acceptance rate. Of the 48 who accepted, 8 were unable to participate for one reason or the other, reducing the number of participants to 40 and the participation rate to 54.8%. To stimulate thinking and provide a point of departure, participants were asked to complete a survey developed specifically to assess the status of gambling treatment programs in the United States. The Think Tank steering committee identified topics and items of importance that would be relevant to the activities of the Think Tank process and provide participants with an overview of gambling treatment program characteristics. A draft version of the survey was completed on March 15, 2000 and then reviewed by the steering committee. Several revisions were made to the original version and the final survey was completed and distributed on April 24, Surveys were sent to all invitees who accepted the invitation to participate, as well as to some who were unable to participate but wished to submit a completed survey as a means of contributing to the think tank process. A total of 53 were sent out and 47 of them were returned. Thirty-eight of the forty participants completed surveys. In addition, nine surveys were received from non-participants, yielding an 88.7% survey completion rate. Currently, there are 13 states with state-funded gambling treatment programs. These states are Connecticut, Delaware, Indiana, Iowa, Louisiana, Massachusetts, Minnesota, Missouri, Nebraska, New Jersey, New York, Oregon and South Dakota. To avoid misrepresenting larger states with more gambling treatment programs, the survey data was weighted by state. That is, whenever more than 1 person represented a state, the data was weighted proportional to the state s representation. For example, where two representatives responded from one state, the surveys were weighted.5 each; where four representatives responded from one state, each survey was weighted.25 and so on. Participant Characteristics Regarding their work responsibilities, 34% of the participants were treatment program administrators, 23% were government administrators, 19% were frontline clinical service providers and 24% classified themselves as other. Similarly, 33% of the participants were treatment funders, 52% were fundees and 15% neither. Program Characteristics Figure 1 (opposite page) shows the participant affiliation pattern with state-funded gambling treatment program openings. The first state-funded gambling treatment program represented at the think tank opened during 1982 and the last during The figure reveals a steady pattern of treatment program openings during the last two decades of the twentieth century. These programs were sited in many different venues. For example, 51% of the participants reported that their treatment programs were located in mental health centers, 45% in gambling specific treatment centers, 32% in hospital outpatient settings, 32% in hospital inpatient settings, 24% in private practice, 23% in prisons, 17% in residential settings and 10% in other community settings. 2
8 Figure 1: Percentage of participants affiliated with first state funded gambling treatment program opening Percentage Year state opened first gambling treatment program Within these settings, in addition to self-help, clinicians employed a wide array of treatment modalities, as described in Figure 2. Gamblers Anonymous was the most common form of assistance (89%) and medication was the least common (20%). The treatment modalities figure summarizes the variety and prevalence of clinical services among the treatment programs represented by the think tank participants. Figure 2:Treatment Modalities GA Counseling Assessment Screening Family Tx Group Tx Couples Tx Cognitive Behavioral Tx Hotline Self-help Psycho-Ed Psychotherapy Medication clinic Other
9 As Figure 3 reveals, almost 50% of the participants represented programs that received more than $300,000 in annual funding; at the other end of the spectrum, 20% of the programs received $50,000 or less in annual funding. In addition, 86 percent of the participants reported receiving state funding; 61% also accepted fees for service; and 49% received private funding. In addition, participants reported that the funding for treatment services derived primarily from self-pay (33%), pro-bono (31%) and insurance (20%) sources. Of the patients seeking gambling services, 5% of the programs referred clients elsewhere, 5% denied treatment services, and 2% referred the treatment seeking patient back to their insurance company. Figure 3:Total operating budget <5K 5-25K 25-50K 50-75K K K K K K >300K Participants reported that their treatment programs provided services for gamblers (94%), spouses of gamblers (84%), other family members (84%) and others (43%). For the period between July 1, 1999 and February 29, 2000, the median number of treatment seekers for all programs represented at the think tank was Of these, the median number with insurance was 53.64, but only 9.52 paid with insurance. Full time employees represented 58% of the staff of these programs; 52% were part-time employees and 14% were hired per diem. In addition, 21% of the programs reported using consultants. With regard to training and supervision, there were limited resources and different perspectives offered by gambling program staff and funders. As Figure 4 illustrates, program staff consistently reported receiving training more than funders thought the staff received training. Despite this difference of perspective, only 27% or fewer program participants reported that there was regular clinical supervision or other program based training for gambling treatment programs. Figure 4: Different perspectives on required training activities Gambling Program Funder Weekly clinical supervision In-service education Continuing education Other training 4
10 THINK TANK PROCEDURES The entire think tank was coordinated and guided by a facilitator. 2 Intersession plenary talks were provided to prime the participants thinking by reviewing key concepts in relevant areas. These talks were limited to about 15 minutes each. Participants were assigned to one of six breakout groups. They were directed to envision the ideal gambling treatment program, with specific attention to each of the general topic areas listed above. A list of the breakout group assignments is included as Appendix II. To assist in their deliberations, participants were provided with worksheets detailing each assignment and presented specific questions to be addressed under each of the general topic areas outlined. These worksheets are included as Appendix III. Upon completion of its work, each breakout group presented its findings to the entire assembly. The meeting facilitator recorded the presentations for inclusion in this summary report. While most of the professionals attending the Think Tank held similar views on fundamental questions of program structure and funding, opinions varied, in some cases widely, on other issues addressed during the session. When no consensus was reached, the differing perspectives offered by Think Tank participants were noted and summarized. The following discussion summarizes the group s findings on each of the six treatment program areas described earlier. 2 Marsha Kelly of Kelly Media Counsel, 6 West 5th St., Suite 700, St. Paul MN facilitated and helped to organize the entire project. She contributed significantly to this final report. We owe her a great debt of gratitude and extend our special thanks. 5
11 FINDINGS: ADMINISTRATIVE STRUCTURE AND FUNDING Designing an Effective Structural Model (Worksheet 1) The first assignment for each group was to design a structural model for the ideal gambling treatment program. Participants addressed a series of questions to help them focus on key structural issues such as legislation, administrative structure, staffing, and accountability. They recommended a structural approach to developing gambling treatment programs that would rest upon legislation incorporating three key elements: Clearly stated authority and accountability to senior administration officials Participants felt that states should establish a separate department or office to handle problem gambling programs, independent from programs that address other addictive behaviors (e.g., alcohol, drug abuse) or other public health issues. The department should be clearly identified with the words problem gambling services in the title. The think tank participants thought that this separate identity would reinforce the notion that problem gambling is a unique problem requiring specialized solutions.3 According to participants, the ideal problem gambling program should be structured to report to high-level administration officials within state government, or even to the Office of the Governor. This high-level accountability was deemed consistent with the importance of gambling revenues to state budgets. It also was deemed useful in marking the program as a high priority for the state. Continuity of management, even in the face of political changes, was an important issue for Think Tank participants. Although a political appointee might hold the top position in a problem gambling department, they felt that second-level program administrators should be qualified civil servants who would remain in place despite changes in administration. Participants also recommended the establishment of an independent advisory board to include qualified problem gambling and mental health professionals, educators, academicians and others with special interest or expertise in the problem gambling field. The advisory board would assist the state agency responsible for problem gambling programs by developing qualifying standards for independent contractors seeking to provide services to the department; reviewing and evaluating proposed contracts; developing job descriptions for program administrators and clinical staff; interviewing and making recommendations on prospective hires; providing information on new trends in the field, and helping to identify public needs. Dedicated funding mechanisms to ensure funding continuity There was strong agreement among Think Tank participants that legislation establishing a problem gambling treatment program must include a mechanism for ongoing funding of the program in an amount sufficient to meet the cost of the mandated services. Participants felt that linking program funding directly to state gambling revenues was the most logical way to ensure funding continuity. As a practical matter, lottery or other state gambling revenues at least partly fund most existing problem gambling treatment programs. Earmarking a fixed percentage of state gambling revenues for problem gambling treatment was considered the best and most appropriate funding mechanism. 3 Readers should keep in mind that this and other suggestions represent the group s opinions. Empirical evidence is not always available to support these positions. For example, it has not yet been demonstrated that gambling is sufficiently unique from other mental disorders to require distinct treatment programs. 6
12 Specificity as to services to be provided and the qualifications/credentials of those who are to provide such services Participants noted that legislation defining the services to be provided should clarify expectations, but also should leave room for flexibility, as new needs emerge and new program trends become apparent. Most important, they noted, was the need to avoid restrictive legislation that might limit the ability of a problem gambling treatment program to provide services appropriate to the client, either directly or under private contract. Participants noted that states should require problem gambling service providers to be licensed and/or certified under state guidelines or national standards. This licensure or certification should require training specific to the field of problem gambling. Although training in other addictions might be helpful and perhaps even be required, there was strong agreement that problem gambling-specific training should be a condition of state licensure or certification. Similarly, where states might choose to contract for services with private vendors, participants agreed that gambling-specific licensure or certification of those responsible for delivery of services should be required as a condition of the contract. Designing an Effective Funding Model (Worksheet 2) Participants were asked to identify public and private funding for problem gambling treatment programs and to assess the advantages and disadvantages of each. In addition, the group examined self-payment and insurance strategies for delivering funding. Public Funding Potential sources of public funds include federal, state and local governments. Participants identified several arguments in favor of seeking public funds: Availability In most states, public funds have been the primary source of support for newly established gambling treatment programs. Participants noted that public funds often become available in response to a perceived need, sometimes documented through needs assessments or incidence/prevalence studies. In addition, public funding can be tied directly to specific funding mechanisms such as lottery revenues, gambling taxes or event taxes. Flexibility Participants noted that public funds often are available for a broader range of purposes than private funds, which are seldom available for capital projects or administrative uses. Accountability Participants noted that public funding commitments often can be structured to include mandated quality control mechanisms for superior accountability. 7
13 Participants also identified several arguments against seeking public funds: Risk of Politicization Because gambling can be controversial, public funding for gambling treatment programs can sometimes fall victim to internal legislative or partisan politics. Funding also can be hampered by charges of conflict of interest when the legislators who raise gambling revenues are also asked to allocate funds for gambling treatment. Cost and Timeliness The slow and cumbersome nature of most state appropriation processes makes it difficult to obtain funding commitments quickly. Retaining lobbyists to assist in the process can become expensive. Legislative Earmarking While public funds are usually available for a broader variety of purposes than private funds, it is also true that most appropriations are earmarked for specific purposes and cannot be diverted to uses other than those intended, even if needs change. Participants noted that most public funding to date has originated at the state level with little, if any, federal involvement in problem gambling programs. They suggested that federal funding for such programs is needed to balance funding inequities that currently exist from state to state, or within a state from disorder to disorder. In most states, funding for problem gambling is allocated through the state s standard legislative appropriation process. Where independent advisory councils exist as an adjunct of state-funded programs, Think Tank participants recommended that the councils assist in the development of recommended budgets and state appropriation requests. They suggested a two-track approach, where funding would be directed to the responsible state agency, allowing for individual reimbursement options; or to private vendors under a system where treatment dollars follow the client to the provider of choice. Private Funding Participants identified two arguments in favor of private funding. First, they noted, it often takes less time to obtain private grants than public funds. Second, private grants often allow for more creativity and innovation in programming. Private funding sources include: Gaming and Gaming-Related Companies Participants noted that gaming and gaming-related companies should be considered primary targets for gambling treatment fundraising efforts. Such companies face both ethical and practical imperatives to contribute to gambling treatment programs. Non-Gaming Companies Participants pointed to financial institutions, pharmaceutical companies and insurance companies as businesses that are likely to be negatively affected by problem gambling, and therefore represent prime targets for fundraising. 8
14 Charitable Organizations and Endowments Community-based charities, regional or mission-specific foundations, estates and endowments are useful potential funding sources. Participants identified several disadvantages of private funding: Lack of Availability and Awareness The pool of available private funds is far smaller than the pool of available public funds, and there may be less awareness of gambling problems in the private sector than in the public sector. Difficulty and Cost of Fundraising Raising funds from private sources can be expensive and time-consuming, and often requires special fundraising expertise. Loss of Program Control Private funders sometimes demand unwarranted control over programs, causing conflict and putting program quality at risk. Self-payment Participants discussed the concept of funding through self-pay programs, and acknowledged advantages and disadvantages of the self-pay approach. The advantages of the self-pay approach include: Perceived Value According to participants, people tend to place a higher value on services they pay for themselves. Therapeutic Message Paying for treatment may help reinforce therapeutic messages of no bailout. Financial Impact Patient payments can create a stable funding base for the treatment program. The disadvantages of the self-pay approach: Regulatory Conflicts Requiring self-payment could violate state or HMO rules. Disincentive Effect Patients who need treatment might be discouraged by fees or might use cost as a reason to avoid treatment. In turn, families may be hurt if patients cannot or will not pay for treatment. Fairness Given the often considerable debt associated with gamblers who are entering treatment, it is frequently difficult to set fair fee structure. This group is often without gainful employment or faced with enormous financial obligations that complicate the fee for service relationship. 9
15 Insurance Coverage The role of insurance coverage in paying for problem gambling services was the subject of considerable discussion. Participants identified several steps that might encourage insurance providers to cover the cost of problem gambling treatment at parity with other mental health disorders: Recognition of Problem Gambling as Disease Participants noted that insurance companies might be more inclined to cover treatment if they were aware that problem gambling has been recognized as a disorder in the same way that chemical dependency and other mental health disorders have been recognized for insurance purposes. Such recognition and subsequent response by insurance companies could vitiate the need for legislation. Equal Access to Treatment Participants said insurance companies are less inclined to cover treatment when there are geographic and/or other disparities that cause their customers to have unequal access to treatment services. Broader access to treatment would remove this barrier to coverage. Improved Treatment Credibility Participants felt insurance companies would look more favorably on the coverage of gambling treatment if there were more information available on the efficacy of various treatment programs, and if the credibility of clinical professionals could be enhanced through upgraded certification and licensure programs. Legislation Absent insurance industry action, state legislatures could be asked to require insurance providers to cover gambling treatment as they currently cover other mental health disorders including alcohol and/or drug addiction. Such legislation could be structured to make the state the payer of last resort and fund co-pay requirements or deductibles. 10
16 TREATMENT DELIVERY FINDINGS PART I: MODALITIES AND SETTINGS Designing an Effective Treatment Model (Worksheet 3) Treatment Modalities Participants agreed that screening and assessment are critical elements in the continuum of care, irrespective of the treatment modalities in use. They noted the particular importance of appropriate and thorough assessment instruments that identify medical, psychiatric, personality and intelligence and neurocognitive concerns. Think Tank participants identified a range of treatment modalities, ancillary and support services that should be available in state-funded treatment programs. These services include individual counseling, group counseling, family counseling, peer counseling, spiritual counseling, psychological testing and aftercare or continuing care. In addition, the participants suggested that state-funded treatment programs provide opportunities to consider and integrate emerging or experimental treatments into the program (e.g., Eye Movement Desensitization Reprocessing (EMDR) and hypnotherapy). Participants also recognized the importance of evaluating experimental treatments to assure safety and efficacy. Think Tank members also pointed to a series of support services that they believe are important adjuncts to treatment, including community outreach and education, reimbursed case management, occupational counseling, financial and bankruptcy counseling, psychoeducation4, smoking cessation, and intervention. Finally, participants stressed the desirability of providing prescription medication, transit to treatment, childcare services, and translation of materials for non-english speaking patients. Treatment Settings According to participants, gambling treatment services should be provided in a full range of settings. There was agreement that rural settings tend to have more limited resources, while urban settings usually offer more resource options. In addition, it was suggested that urban patients might be more receptive to treatment because treatment programs for alcohol and chemical dependency often are well publicized and visible in urban settings. Participants felt a mobile treatment unit would be highly desirable to service patients in rural communities. Other settings viewed as optimum for providing gambling treatment services included residential facilities such as homes, halfway houses or housing developments; inpatient and outpatient hospital and clinic facilities; schools and universities; correctional facilities; community sites such as youth and senior centers, women s shelters and churches; workplace locations; internet chat rooms and gambling locations. Licensure and Certification Participants were asked to indicate what type of licensure or certification should be required of problem gambling program staff. They responded: a Supervisors should be multi-credentialed (i.e., qualified in problem gambling counseling as well as other addiction and mental health fields). a Entry-level staff should have problem gambling-specific training regardless of other credentials. a National and/or state certification should be required, with an additional requirement of at least twenty hours of relevant gambling-specific continuing education every two years. 4 Education related to psychological and social skills and attitudes 11
17 TREATMENT DELIVERY FINDINGS PART II: ASSESSING IMPACT AND EFFICACY Designing an Effective Client Recruitment & Retention Model (Worksheet 4) To provide context for the discussion of treatment impact and efficacy, Dr. Howard Shaffer presented a definition of two essential terms, noting that treatment efficacy refers to the net positive effects and duration of treatment, while treatment impact is a function of efficacy and patient participation. According to Shaffer, since gambling treatment programs currently attract only a small percentage of gamblers who might make use of such care, treatment protocols that attract larger numbers of people into treatment might ultimately result in higher impact than those that attract fewer numbers, even if the treatment efficacy rates are higher in the smaller group (e.g., Prochaska, 1996). As an example, he cited two scenarios: Clinical Protocol A: 100 patients x 50% efficacy rate = 50 patients treated successfully Clinical Protocol B: 1,000 patients x 25% efficacy rate = 250 patients treated successfully Protocol B yields 5 times more treatment impact than protocol A in spite of having only half the efficacy. Shaffer suggested that current treatment approaches might be repelling potential patients, since some potential patients are put off by their perception of excessive treatment demands, such as having to change or never gambling again. He noted that, although it is likely, there is no evidence that higher levels of treatment efficacy, per se, encourage more participation in treatment. For this reason, he concluded, effective client recruitment and retention strategies are critical to maximizing treatment impact and helping more disordered gamblers. Client Recruitment Think Tank participants were asked to identify optimal methods of attracting clients into treatment programs. Specifically, they addressed ways of getting the message, that gambling problems can be treated and that treatment is available, out to the general public, the individual gambler, and family members of gamblers. They also identified the key messages to be delivered. In each case, participants noted that public information campaigns are pointless, and even counterproductive, if the systems and services necessary to meet the needs of those who will seek assistance are not in place. If a troubled gambler seeks help and is unable to get it due to a system failure, that individual may not seek help again unless or until a major crisis develops. Key Principles for Public Messages a Educate the public about the symptoms of disordered gambling and how to recognize problem gambling. a Emphasize hope for recovery by noting the availability and accessibility of help. a Avoid scare tactics. a Promote hotline or referral numbers for quick access in crisis. Public, Gambler and Family Outreach Participants noted that systems must be in place to handle hotline inquiries and referrals generated by the approaches suggested here. It should be noted that many of the outreach methods suggested here would be useful in reaching all three groups the general public, gamblers themselves, and the families of problem gamblers. The following grid presents each of the outreach vehicles mentioned, and the target audiences that might be reached by each. 12
18 RECOMMENDED OUTREACH VEHICLES BY TARGET GROUP Vehicle Type General Gamblers Gamblers Public Families News media/news coverage News media/paid or PSA Specialty media targeted by market segment Educational web site Internet Chat Room w/ access to Counselors Educational curriculum for junior/senior high students School/university libraries Workplace HR/EAP offices, employee newsletters, pay envelope stuffers Casinos, lottery, pull tab sales outlets; message on lottery tickets, pull tab backs, parimutuel ticket backs Casino employee education Billboards, signs at sporting events Professional offices, organizations and conferences Information to medical providers, hospitals and clinics, addiction treatment centers and self-help/12-step groups 24-Hour walk-in crisis center at mental health or addiction treatment center Community events, fairs, festivals Social service agencies and veterans service offices Law enforcement community (police, bankruptcy court, criminal court, judges, probation officers, attorneys) Retail stores, service shops Banks, check cashing sites, pawn shops, consumer credit agencies National Problem Gambling Screening Day: free screening at treatment centers, by phone, Internet or in person at other selected sites = Target group 13
19 Client Retention Think Tank participants emphasized that treatment must be matched to individual clients to maximize outcomes and enhance client retention. Every gambler is different and approaches that work for one may be ineffective or counterproductive for another. Given this caveat, participants identified an extensive list of factors that, where appropriate, might encourage clients to stay in treatment. Comprehensive, Reliable Assessment As previously noted, participants felt this is a key factor in client retention, since information gained in the assessment process drives the development of an individualized treatment plan. Group members felt that an effective and reliable assessment process requires quality staff as well as appropriate assessment instruments. Immediate, Effective Crisis Response and Follow-Up Immediate response by a live voice to callers in crisis, including Saturday/Sunday nights and late nights (24/7) as well as timely follow-up and callbacks by referring agents were recommended. Helpful, Supportive Attitudes and Environment Coordinating scheduling of appointments to promote attendance and optimize access to treatment activities; facilitating connections with appropriate therapeutic or community-based support groups; facilitating child care, transportation or other potential barriers to regular attendance; demonstrating helpful attitudes, experience and understanding among treatment staff; employing culturally sensitive communication and treatment methods; evaluating payment options and potential impacts on client s participation in treatment. Appropriate Case Management Participants recommended: developing individual client-appropriate treatment plans based on individual client strengths, and including realistic, flexible and individually appropriate treatment goals; engaging family in treatment program; coordinating with other systems and bureaucracies affecting client; offering/facilitating treatment of co-existing disorders and mental health issues; offering on-site Gamblers Anonymous meetings as well as alumni/mentor/peer counseling; providing financial counseling and crisis assistance; ensuring active follow-up by clinician after treatment; and knowing when to discharge clients from treatment. 14
20 Impacting High-Risk Populations Think Tank participants agreed that special programs should be developed to reach high-risk populations and those from diverse cultures who may not be reached by traditional educational approaches. Examples of such programs are shown on the following grid: RECOMMENDED STRATEGIES FOR HIGH-RISK POPULATIONS HOTLINE/ON-SITE EVALUATION AND TREATMENT SIGNAGE NEWS/ADS CAPABILITIES EDUCATION/INFO OTHER Seniors Senior centers, Senior publications Senior centers Senior centers, agencies, senior buses clients and staff Youth Schools and School and Schools and Counselors, coaches, youth centers youth publications youth centers school drug/alcohol counselors Ethnic Ethnic-based Culturally specific Culture-specific Culturally specific Research/input Minorities community media, to targeted community centers community service from targeted centers demographics with multi-linguistic providers cultural groups counselors High-Risk Populations Associations of professionals working with addiction disorders Homeless Missions, food Missions, food kitchens, kitchens, shelters shelters Measuring Effectiveness of Recruitment and Retention Efforts Participants agreed that two primary criteria might be used to measure the effectiveness of client recruitment efforts: Statistical Analysis including analysis of numbers of hotline inquiries compared to first appointment, compared to completion/discharge; analysis of client demographics to identify participants from high-risk or targeted populations; use of the formula to determine treatment impact (patient participation x efficacy). Client Surveys including pre- and post-tests to determine quality and appropriateness of referrals and client satisfaction surveys. 15
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text:
Nathan Outteridge and Iain Jensen, the defend 49er World Champions extended their lead the 2012 World Championship overnight, with Outteridge aiming for his fourth world title and Jensen his third.
Matt Belcher and Malcolm Page are the defending champions and will start favourites in the Mens 470 World this weekend in Barcelona. It they win they will have something like ten 470 World titles between them.
With more World Championships ahead we look forward to the Golden Girls Elise Rechichi and Belinda Stowell taking another step forward on their short Weymouth journey and newest Australian Olympic squad member Finn sailor Brendan Casey also having great world championships in Falmouth.
Quite a way forward to the Womens Match Racing world championship in Gothenburg Sweden in late June, where Olivia Price, Nina Curtis and Lucinda Whitty carry the flag for Australia
With Tom's great result and our 49er guys in front, this has been a very good week for Australian sailing, may there be many more.

subset: commoncrawl


text:
A fast train with Chinese characteristics
The Chinese built a 2,298km High Speed Rail line in just seven years. In Australia it's estimated to take more than 40 years to complete 1,748km of track. Can that be right, asks Jeffrey Sheehy.
"It's certainly a cracker of a tunnel", Deputy PM Albo remarked when releasing the $20 million feasibility study into High Speed Rail (HSR) along Australia's east coast.
The tunnel he was referring to is the 67km of underground rail needed to access Sydney's CBD. Considering Australia's longest transport tunnel is currently the Airportlink road tunnel in Brisbane (6.7km), Deputy PM Albo's assessment was not just true blue, but spot-on.
According to the study, the proposed 1,748km rail route linking Brisbane, Sydney, Canberra and Melbourne and has been estimated to cost $114 billion with the Sydney-Canberra-Melbourne leg taking at least 17 years to be operational and the whole line not complete for more than 40 years.
These figures offer a sobering comparison with the current global superpower of HSR construction.
Despite only having very limited HSR lines at the start of this century, China now has more than 10,000km of operational HSR line (that is, trains which run above 200km/h).
On Boxing Day last year, the Beijing - Guangzhou line was officially opened. At 2,298km, it is the longest HSR line in the world - coincidentally about 500km longer than the proposed Australian HSR line. But while Australia will take 45 years to complete a shorter line, it took the Chinese seven years to construct a line that is 500km longer.
Can that be right? It will take Australia 38 more years than China to build a 'comparable' HSR line? Apparently so.
The Ministry of Railways has announced China is on course to reach 18,000km of HSR by 2015 - nearly doubling current line distance. This will be the completion of the "backbone" of China's HSR consisting of four north-south lines and four east-west lines in a country with a similar land area to Australia.
Of course there are factors which inhibit a comparison between our countries.
Firstly, Australia's population is less than two per cent of China's, which obviously impacts projected passenger demand.
Secondly, compulsory acquisition of land in Australia is generally subject to "just terms" under the Australian Constitution – Section 51 (xxxi) - and in practice, State Governments offer consultation and compensation schemes, for example Queensland's compulsory land acquisition scheme, despite their inherent power to seize land for public purposes as written, for example, in the NSW Constitution Act 1902 which states that the legislature has power to "make laws for the peace, welfare and good government of NSW", subject only to the Commonwealth of Australia Act.
By contrast, China's railways ministry can afford more of a 'straight-line mentality'. While the Ministry of Railways does offer compensation for affected land users and owners, priority is given to the development of the railway line over individual property rights in a 'take-it-leave-it' approach. For example, here.
Add to this a huge labour force, less stringent planning/environmental processes and ample state capital, and HSR fits nicely into the CCP's economic and social development goals.
For Australia, it's not about usurping property rights or trying to match the Chinese - that is futile. What the Chinese boom demonstrates for us however, is that HSR can be built efficiently and reap enormous benefits for a country.
Admittedly, China's HSR is no utopia - 40 people were killed in a crash in 2011 in Wenzhou, while the Railways Minister, Liu Zhijun has been imprisoned for corruption.
Labour rights are also an issue of big concern, with reports of lengthy shifts and unreasonable work targets. Workers themselves are devoid of similar western-style workplace rights and are required to work throughout China's harsh seasons. Despite numbering in the hundreds of thousands (if not millions), the rail workers' stories are not heard.
Nonetheless, the benefits of HSR are clearly felt in China. China's immigrant workforce population are as mobile as ever, average citizens are crisscrossing the country every day for leisure, the economy is far more connected than it ever was, incomes are becoming more comparable across the rural/urban divide and HSR has not faced any other major incidents since the lowering of speed limits by 50km/h. Effectively the country has shrunk.
If Australia gives in to vested interests (surely the airlines won't be too happy about HSR…) and loses sight of the long-term benefits of HSR, then the project will surely flop. Informed public debate should occur given the cost and scale of this project, but we need to get out of the three-yearly election cycle mentality, otherwise we'll be left even further behind from our northern neighbours.
Perhaps this need for a mental switch will come to a head when the country needs to decide who will build the railway line. The Government's refusal to allow Huawei to build the NBN comes to mind, but would we let the Chinese, clearly a global superpower of railway construction, build our HSR with the goal of reducing that 38 year construction difference?
Once the proper due diligence is done, it might be the opportunity for us to 'walk the walk' on our Asian Century rhetoric.
Jeffrey Sheehy works for an international law firm with extensive experience in the provision of large infrastructure projects, including power plants, ports and railway, throughout the Asia-Pacific. View his full profile here.
Topics: rail-transport, rail
First posted
Comments (21)
Comments for this story are closed.
28 Aug 2013 10:40:49am
In China. road freeways & flyovers are so speedily developed, bus and distance coach drivers get lost sometimes on their usual routes esp. on city access roads. The rail lines and rail overpasses use giant gantries on the leading edges to have lines set and bolted in the blink of an eye. Surfaces on comparatively new roads were very poor, but have improved to world standard. Their fast trains are a wonder and very widespread, surprisingly popping up everywhere. Still, would one between Melb.- Syd be worth it ultimately? Presumably you'd need a double track for starters, for multiple trains. But it could kickstart plans for extensions, across Victoria and to Qld & beyond. A drawback is in our millenium train for instance, although very comfy and very stylish, has very jerky accelaration & deceleration. And is it our Sydney tracks or the Tangara that jerk us side to side?
gerard oosterman:
28 Aug 2013 10:43:00am
It would be nice to have a reasonable S.S.R (slow speed rail). At the moment the Bowral to Central (Sydney) takes almost 2 hours to travel a bit more than 100kms, and that's if a wombat doesn't de-rail the time-table. The train lurches dangerously from side to side and makes an awful crunching noise. There is no place to rest your arm and looking outside is limited by the numerous scratched graffiti windows. Most passengers look on their devices for relief. Talking about relief, one needs camel like bladders, no toilets and hydration is only available with dragging ones own supply.
High speed rail! Ha, ha ha, how funny...it will keep me amused for years.
Mike (the other one):
28 Aug 2013 10:45:28am
Couldn't care less about emulating an overcrowded, overpopulated northern hemisphere and encouraging human beings to breed and destroying more of the natural world to make way for our 'needs'. Much rather see a stable population in Australia and a steady improvement of existing infrastructure.
Now that would be real world leadership - actually setting an example for the future.
28 Aug 2013 2:07:16pm
So you want stable population,
and you couldn't care more about the country with the most proactive population control measures?
that fines people for breeding,
as opposed to the boby bonus and large family bonuses in australia
Mike (the other one):
28 Aug 2013 11:39:19pm
First of all MK I said the 'northern hemisphere' as per the author's reference 'northern neighbours' which of course is not a country but I will assume that the 'country with the most proactive population control measures' you refer to is China as per the article.
Proactive? Yes, they have had a policy for a long time now but in reality it doesn't seem to be working as figures would indicate (up 11.7%, 1990 - 2000 and up another 5.8%, 2000 - 2010), a 206,000,000 total increase in population for the above time frames. Population growth rate on a global scale also places them at about 160 out of 230 - hardly at the bottom and unlike Australia where the increase is from immigration, I don't think this is the case in China, it is an internal increase. Countries like China create the problems while countries like Australia buffer them.
Add to that the fact that China is expanding its military, buying up farmland, mines, timber etcetera and exerting their influence wherever they can around the globe I would have to reiterate that no, I couldn't care less about emulating any polluted, overcrowded, overpopulated country and I certainly wouldn't sell my country to them to help them along their way.
As for baby bonuses, large family bonuses (and PPL for that matter) it's all just pork barrelling and red herrings on a grand scale as far as I can make out.
Waterloo Sunset. 2014:
28 Aug 2013 11:01:18am
The idea is sound. I've posted my support several times over the years.
It would need some due diligence in the opposite mould of The NBN due diligence.
The Reg:
28 Aug 2013 11:26:39am
Many hands make light work especially when those hands are cheaper as well.
We couldn't build a two lane bridge over the Murray river in the same time for the same price!
28 Aug 2013 12:00:56pm
To build 2298km track in 7 years, how many engineering design, manufacturing, quality and safety shortcuts were taken?
How many lives have been lost and endangered as a result? You mentioned one accident - is that the full story?
28 Aug 2013 1:51:20pm
That the best you can do Micky? The article is a cogent and correct masterpiece compared to most of the baseless opinion pieces we see here - if we don't reward the effort Mr Sheehy made with an intelligent response we risk only getting the politically provocative crap that's usually served up.
28 Aug 2013 12:10:19pm
Fast rail will never be built because construction might kill an endangered parrot or disturb a sacred site.
28 Aug 2013 12:25:30pm
AU is known to be inefficient in everything. A simple roundabout upgrade in my local area took approx 6 months that during which caused so much inconvenience for all.
Sydney's railway system is a joke. How about the bumpy highways and the really badly timed traffic lights. Bureaucracy crap with local councils... Lists goes on and on. Can't compare to other developed countries. I wish my tax dollar could be put to better use.
28 Aug 2013 12:34:38pm
There is no way in the world that this country can afford to build and maintain a high speed rail network. They are great in highly populated countries with relatively short travel distances. They are hideously expensive to build and on average are three times more expensive to maintain than traditional railways. We do not have the population and our travel distances are too great.
Hudson Godfrey:
28 Aug 2013 12:42:38pm
Something's rotten in the state of Denmark when you can furnish broadband over the course of a decade for $43ish Billion and yet for nearly three times that we can't drive a decent railroad between Sydney and Melbourne in 40 years.
I don't know who's supposed to be engineering this but I've a sneaking suspicion they work for the airlines.
There is nothing so impossible as something you don't want to do!
Tony Bailey:
28 Aug 2013 1:12:04pm
"Considering Australia's longest transport tunnel is currently the Airportlink road tunnel in Brisbane (6.7km),"
The Epping to Chatswood rail line is some 13 kms long - all underground.
28 Aug 2013 1:47:59pm
Nothing Rudd says can be believed , credibility precisley ZERO so just forget it.
28 Aug 2013 2:51:28pm
The economics of flying will at least match those of high Speed Rail when it is in service and be much more flexible as to timing and availability of services.
Long distance rail freight is a much better investment.
28 Aug 2013 3:02:36pm
Just a few cursory musings:
The question of whether we "allow"the Chinese, or any one else, to build any infrastructure which needs government support, including finance, planning, changes to laws, is not one of whether that party, or country has experience, or is even excellent in implementing their own infrastructure objectives.
There are other ways to look at this and one of the obvious is that there is more than one definition of excellence. Replicating an existing model, even an excellent one, is not necessarily excellent in an absolute sense, will not necessarily yield excellent results in other contexts.
One of the sacrifices in replication is innovation, even if replication has some efficiencies, a country being inventive for its own particular challenges, perhaps even doing better than the most excellent example available at the time.
China itself is reported to have used technology transfer agreements in its high speed rail, before engineering its own versions, so "allowing"the Chinese means also allowing that the technology may be that of other countries or companies.
Why can Australia not boost local innovation, research and technology?
The riders of high speed rail in China are not the whole population, which is over 1 billion, but are reported to be only 1million.Therefore, a parralel system exists even in the example being offered to us of China.Whether a parrallel system, a potential white elephant and burden on the taxpayer,would exist in Australia is another issue, with the government still forced to subsidise a lower-cost system alongside a private rail system.
Excellence as applied to the Australian case of high speed rail needs to ask basic questions, such as how to power high speed rail how?Can the power be something innovative and unique and more efficient, or will it be the excuse used to argue for nuclear power, or other forms of privatised power?
How is the Chinese high speed rail powered? If one is designing high speed rail the source of power and a power source independent of other power grids needs to be considered, which means that HSR is not only an issue of speed, or economics, but also an environmental issue.
Apart from the above issues, the rationale for the commonwealth constitutional requirement of acquisition on "just terms" is controversial because it touches other issues, such as state constitutions, which in turn are a double-edged sword that we have seen before in the history of railway building in this country.
It is misleading to cite the commonwealth constitution and then refer to various bits of state legislation without acknowledging that each state has its own constitution, the states do not pick up a "just terms"clause simply because the commonwealth has one and the lack of compensation by states has been controversial.
John Coochey :
28 Aug 2013 4:05:36pm
A reality check is that China has abandoned its maglev system after a short experimental section. Study after study in Australia has shown it will be unviable despite the mindless advocacy of such as the mayor of Goulbourn. Every election we get another study which tells us what we already know it will cost billions and loose billions once opened. Everyone likes it until they realise the true costs. There have in all been something like fifteen studies all coming to the same conclusion. Even the one paid for by the VFT Consortium and done by Access Economics said it could only be viable if air and road were not deregulated. They have both been deregulated.
28 Aug 2013 4:44:23pm
That one serious accident you mentioned was a direct result of the official corruption you didn't tie it to. But given that the corruption mentioned was in respect to materials and methods, allowing this company to come try out similar work seems to be asking for trouble.
29 Aug 2013 4:00:35am
I remember when I started work in the 1960's, people were talking about a high speed rail link down the east coast then. Now I am retired and we still haven't started on one.
The reason for delay was given, back then, on the high cost of implementing it and the small population likely to use it. Not much has changed, except the cost has become much greater.
Now there is a new factor in play. Decades ago, Australia had discovered enough oil reserves to serve our own domestic needs. Now we have to import about half of what we consume. The bitumen on our roads is sourced in the heavy crude oil imported from the Middle East. Therefore, our highways are going to become ever more expensive to produce and maintain.
We need to expand our rail networks in the very near future, with as much of them capable of high speed as possible, in order to be able to ship our freight around our large country. The movement of people is a bonus that would ease the growing congestion of our major airports.
We have the iron ore to make the steel, and Horror! Plenty of coal to generate the power to drive an electrified network, located in accessible places to drive it with minimal loss.
As to the expertise to build it, the Japanese got it right a long time ago, and so have the Germans. Why source advice from China, who have utilized the technology the others developed? Australia already has some of the best tunneling skills in the world: our mining engineers are highly competent.
So we have a choice. We can agree to utilize our low cost energy in our coal deposits, to build a transport option which will mean less hydrocarbons burned over a longer time period, or we can stand around and keep arguing until the oil we need has become hideously expensive, or is unavailable. Then we can return to using the horse and cart.
29 Aug 2013 10:17:03am
There ain't gonna be any Asian or any other century. Peak oil mates, peak oil. Energy makes money and surplus energy provides growth. Who is not paying more for energy? Going into debt for expensive high tech energy intensive projects is a folly and it is unlikely to be repaid.
Invest in rail yes, high speed rail no. China's high speed rail has come at a severe environmental cost. Population reduction will remove the need for expensive infrastructure and will ease stresses on energy supplies.
Comments for this story are closed.


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CSUF News Service
ROTC Obstacle Course Opens to Train Future Military Leaders
Dedicated to the Memory of Fallen Cadet Roy Lopez
April 25, 2016
Cal State Fullerton's Army ROTC cadets now have an obstacle course of their own to challenge them physically and mentally on their path to future military careers.
The Roy Lopez Army ROTC Obstacle Course opened April 22 with a celebration attended by cadets, ROTC and campus leaders, retired military officers and veterans and community supporters.
"Once the ceremonial ribbon is cut, our ROTC program becomes one of only a handful of programs in California that can boast a military-grade obstacle course in its backyard," said Shari McMahan, deputy provost. "This course raises the prestige of our program and our entire University, and affirms Cal State Fullerton's commitment to the men and women in uniform and all students who aspire to serve their country."
Laurie Roades, dean of the College of Health and Human Development, which houses the Army ROTC program, and Lt. Col. Mark A. Waters, chair and professor of military science, were among those who delivered remarks.
The course is dedicated to ROTC cadet, the late Roy Lopez, whose mother, Adriana Mraz, donated $150,000 to build the campus obstacle course. Mraz thanked the military program's leaders and instructors for their support and dedication to students, including her son, and also for the idea to create the obstacle course in her son's memory.
"At a time where I suffered the greatest loss imaginable, you don't realize sometimes some of the blessings that are to follow," said Mraz. "My soul became intertwined with a brand new family … part of an Army family. The friendships that I've made within the program and the University are just incredible. I cannot find the proper words to explain the impact people have had on me and the opportunity to make a difference in somebody else's life."
Additional donations of $50,000 helped the college to complete the new course, located between the Titan Sports Complex and Fullerton Arboretum. The college is continuing to seek donations to establish an endowment.
The course, which took 18 months to complete, features 10 obstacles, such as the belly crawl, rope climb, balance log, 6-foot vertical wall and towering "The Tough One," where cadets must climb a 15-foot rope, then walk across slats, climb up a 15-foot ladder, crawl over a beam, then rappel down a cargo net. The course was designed to challenge cadets' strength and endurance in a fun and mentally engaging way, Waters said.
The Army ROTC program is expected to save $10,000 annually in costs, since previously the program had transported cadets to Camp Pendleton for training, said Waters. In the future, other University departments and local organizations can look forward to having access to the course.
Cadet Joshua Klee, a history major, is excited about having the course to help him train to build confidence and stamina. He's completed the course twice, and at the opening celebration, wowed visitors as he demonstrated "The Tough One."
"It's a good way to face your fears," Klee laughed. "It's a lot of fun."
Cadets Christine Yu, a health science major, and Susan Wagerer, a criminal justice major, also look forward to the challenge. "Having the course will give us a good opportunity to build teamwork — and courage," said Yu, who has not yet tried the course.
Wagerer has completed the course and admitted it's difficult: "It challenges you, but it also shows that you can get through any obstacle put in front of you."
Tag Cloud


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Thu, 26 February 2009 at 1:48 pm
Johnny Depp: Brasserie Lipp Lover
Johnny Depp and longtime love Vanessa Paradis arrive at the Ritz Carlton Hotel in in Paris, France on Monday (February 23).
On Wednesday (February 25), the 45-year-old actor and his partner were seen leaving French restaurant Brasserie Lipp. Paradis was seen rushing out to the car before cameras had a chance to capture her.
Depp, Christian Bale, Channing Tatum, and Marion Cotillard can next be seen in the new crime drama, Public Enemies, out July 1.
Just Jared on Facebook
Photos: Bauergriffinonline, ANG/Fame Pictures Posted to: Johnny Depp, Vanessa Paradis
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|Nothing says "love" like an expensive rock from the earth.
If your partner proposed to you and you were surprised (or vice-versa), then you two are probably not ready for marriage.
It's a bold claim, but hear me out. First and foremost, let me say that I'm brutally skeptical of the value of marriage as a social institution and I hardly view it as an immutable contract, but the chances are if you proposed or were proposed to in the traditional western way, then you probably think marriage is a big deal. Right about now, if you're the type of person I'm describing, you might be thinking "This can't possibly be true. Most marriages begin with a traditional proposal." You'd be right, but you'd also be forgetting that more than half of all marriages end in divorce (at least in the US). If you like fifty-fifty odds, then by all means go for it.
The next thing you might be thinking is "Well, I know my parents had a traditional proposal and marriage, and they've been together for my entire life and then some." That's sincerely nice for your parents and family, but anecdotal evidence doesn't amount to much. Especially considering the fact that we all know at least one person whose parents are divorced (unless you've been severely sheltered).
If you're the type of couple to take matrimony seriously, but yet have not for whatever reason discussed it openly and honestly enough that you can anticipate your partner's thoughts on the subject, then to me this implies that there probably are other important life issues that you two haven't discussed. It amazes me how many people know so little about their long-term significant others. Important issues too, like whether they want children or not, what their long-term goals in life are, what their political views are, what their financial situation is like, etc.
I don't mean to harp on this sort of couple, and I certainly am not proposing that only one type of romantic bond works (though some definitely work better than others). I'm merely suggesting that perhaps the reason you proposed or were proposed to in the exact same way as hundreds of millions of people before you is because of social norms and pressure, and not due to genuine desire. Keep in mind that I don't mean genuine emotion here, I don't deny that couples like the ones I'm describing feel genuine love; that's not the issue at hand. What I am saying is that perhaps sometimes people propose just because "it's what you're supposed do."
Consequently, couples rush into marriages that they're not ready for with partners whom they don't really know. Worse still, the people who tend to fall for this trap believe so much in marriage that they refuse to gracefully end the marriage when it's clearly failing. Instead, they pump an absurd amount of emotion, money, and time into attempting to resuscitate the failed marriage when it shouldn't have existed in the first place.
I view proposals as catch-22s. If you have to propose to get an answer from your partner about the rest of your life, then you aren't ready for the affirmative answer. If you're intimate enough with your partner to know that you two are spending the rest of your lives together, then you don't need to propose in the first place.


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It starts with our basketball history and ends with a quote from the Bible.
New York City released its video pitch to LeBron James with Mayor Bloomberg playing center.
"Willis on one leg, Clyde with a steal, Dr. J soaring from the line. Come on LeBron write the next chapter in NYC basketball history," Bloomberg pleads at the start of a 49-second video released by NYCGo.com today.
Bloomberg conveniently forgets the Scott Layden and Isiah Thomas chapters, which New Yorkers are hoping James can help erase by signing with the Knicks this offseason. The reference to Julius Erving could be seen as a nod to New Jersey, but Dr. J's time with the Nets came when they were playing on Long Island.
After the Mayor's opening talk, the video extols the virtues of the city with shots of Manhattan and sayings "This is the world's greatest stage" and "This is where you can have the biggest impact."
Cleveland also made videos of its own to try and convince James to stay. The Bulls and Nets are also in the running to land James, who recently said the Cavaliers have "the edge" in an interview with Larry King.
Bloomberg wraps up the video by quoting the Bible.
"As the good book says, 'Lead us to the promised land,'" Bloomberg says. "And hey, that's a quote from the King James version."
New York's campaign also includes Facebook and Twitter accounts.
"New York City is fit for a king – there's no better place in the world to live, to play or to win," Bloomberg said in a release. "New Yorkers want LeBron to come to the greatest city in the world, and we're launching the C'mon Lebron campaign to capitalize on their energy and creativity in making their own cases for why he should choose New York. There are terrific cities all over the country, but none match the excitement of the greatest City in the world


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SEVERAL Wrexham councillors have been accused of turning their backs on homeless refugees after the Caia Park riots.
Housing officials faced resistance in finding emergency accommodation in the aftermath of two nights of violence involving Iraqi Kurds.
Wrexham labour leader Sh'n Wilkinson said six or seven councillors out of 52 had been directly approached by officials - but only two said yes to refugees coming to their wards.
It was then decided not to consult elected members because of the difficulties, she said.
More than 40 asylum seekers and refugees were re-housed following the unrest, sparked by a dispute between some refugees and local men.
It is understood young Iraqi Kurds have now left the area.
Police made more than 70 arrests after the disturbances on June 22 and 23.
Coun Wilkinson said: "It's too simplistic to say they refused to have them but there was certainly a problem in getting the support of members.
"I am sure that Wrexham councillors are no different to any other cross-section of the population. Not all members were approached.
"It revealed to me that when people are frightened and shocked, it sometimes brings out the best in them and often the worst."
She said a local vicar had housed some displaced people in an emergency shelter.
Mark McCrossan, a development officer for the Wales TUC in Wrexham, said tensions arose from "misinformation, myth and even pure lies".
Writing in the anti-fascist and anti-racism magazine International Searchlight, the former resident and teacher in Caia Park said the violence had caused shock, anger and remorse with in the community.


text: Devotees of the 67-year-old Cleveland Home & Garden Show may be a little confused about the changes in the event that previously took place at the IX Center starting the second week in February. Now, due to rising costs, the promoters have moved the event to a new facility — the Great Lakes Expo Center (1200 Babbitt Rd.), a former K-Mart across from Euclid Square Mall — and gave it new dates: It opens at 11 a.m. today and runs through January 31. There are some key advantages to the new venue: There's free parking, it's right off the freeway and it's closer to downtown. And the earlier date means you can start dreaming about spring sooner, temporarily forgetting the snow you have to shovel as you visit the usual array of model homes, celebrity and feature gardens, home-improvement vendors, and cooking, gardening and home-repair demonstrations. In recent years, shows have revolved around different countries. This year's theme is "Wonderful Germany," so expect an Oktoberfest atmosphere, with German food, wares, music (including popular local polka musician Fred Ziwich), dancers and guys in lederhosen — hopefully, guys with good legs. Admission is $12; kids 12 and under are free. — Anastasia Pantsios