Social Workers and Gambling Harms? Evaluating an Initiative in Three English Local Authorities

Abstract

Summary

We report on the evaluation phase of a study which developed questions to identify people who were affected by gambling harms for use in adult social care services and piloted them in three English local authorities. The questions were designed to identify those affected by gambling harms, including family or friends of those who gamble. The evaluation involved interviews with staff and service users (n = 28) assessing the acceptability, feasibility and appropriateness of asking about gambling harms in adult social care. Transcripts were analyzed using thematic analysis. We also assessed the feasibility of collecting question response data, and whether it was possible to determine if one of our two candidate questions could be recommended.

Findings

Social work practitioners agreed that identifying and supporting people being harmed by gambling was an acceptable area of practice. They found it more feasible and appropriate to ask about gambling harms in welfare advice and debt support, integrated learning disability and multiagency safeguarding hub, rather than adult social care, single-point-of-access “front-door” services.

Applications

Facilitators to embedding enquiry about gambling harms in adult social care were: funded staff training, ongoing support, and management capacity. Barriers were: staff perceptions about relevance to service users, staff discomfort with the topic, and competing demands. Based on our findings, two questions for identifying gambling harms to individuals/affected others are recommended: Is your gambling or that of someone else causing you any worries? Do you feel you are affected by any gambling, either your own or someone else's?

Introduction

In England, the National Institute for Health and Care Excellence (NICE) guidance (NICE, 2025a) states that social care practitioners and healthcare workers in all settings should consider asking people about gambling harms, when asking about smoking, alcohol, or substance use, for example, as part of health checks, holistic assessments or service registration. The guidance presents a range of circumstances where citizens might be at increased risk of gambling harms, and enquiries could be made, such as when there are concerns about safeguarding, violence or domestic abuse, in mental health settings, when financial concerns/abuse are raised, or when someone is at risk of, or experiencing, homelessness.

This NICE guidance is in line with social care practice, which is increasingly recognizing the effect of gambling harms on service users and its disproportionate impact on disadvantaged communities (Raybould et al., 2021). In England, the Local Government Association (LGA) (2018, 2023a) reports that citizens may approach local authorities for support with a range of gambling harms, for example problems related to mental ill health (Marionneau & Nikkinen, 2022; Ostinelli et al., 2021), debt (Hahmann et al., 2021), housing instability (Sacranie et al., 2024), homelessness (Deutscher et al., 2023), social isolation, financial abuse (Adolphe et al., 2019), domestic violence (Dowling et al., 2016) and suicidality (Roberts, Rogers, Petrovskaya, et al., 2024).

Individual English local authorities have undertaken work in addressing gambling harms, for example, estimating gambling participation rates, harms and costs in Manchester, Leeds and the Midlands (Greater Manchester, 2022; Kenyon et al., 2017; OHID, 2022), undertaking staff training initiatives (Derbyshire County Council, 2024; Devon Public Health, 2018; LGA, 2023a) and establishing integrated NHS and social care support services, based within a local authority setting (Elbers et al., 2020). Meanwhile, at a strategic level, the LGA has highlighted concerns about how local authorities can enforce regulation of operators within their own areas (LGA, 2023b). In addition, Bristol Council has taken the lead on banning gambling advertising on its own billboards (Coalition to end Gambling Ads, 2025).

Despite this work, the acceptability, feasibility, appropriateness and cost consequences of embedding a gambling harms question in adult social care services are to a large extent unknown (Blank et al., 2021; Forward et al., 2022; LGA, 2023a). There is also little research about the views of social workers on gambling harms as an area of practice, and their effectiveness in providing support in this area (Bramley et al., 2019a; Heath et al., 2025; Rogers 2013). Blank et al.'s (2021) international systematic review found a limited evidence base for introducing screening for risk of gambling-related harms in health, care and support settings, identifying three papers (based on general practice, substance abuse and mental health settings) indicating evidence of effectiveness, six papers addressing feasibility and acceptability in various settings, and 13 gray literature items. Sacco et al. (2019) described successfully introducing a brief screening into a credit support service in the United States of America, confirming this as a suitable setting for asking about gambling harms. An interview study in mental health services in Australia (Rodda et al., 2018) explored views on the potential barriers and facilitators of implementing screening. These authors identified challenges, for example, staff focused on immediate risks with so-called problem gambling perceived as a relatively rare and a longer-term condition; while facilitators included the use of an appropriate brief screening tool, mandating its use, and funded workforce development. Reid et al. (2024) found that where people were routinely asked about gambling harms (n = 130) within an Australian general practice and community service setting, barriers to doing this included referral pathway complexity, and concerns about the three-item screening tool used. The authors concluded screening provides important evidence about levels of harm, which is important when advocating for reform of gambling legislation. Research is underway in England into the feasibility of introducing gambling harms screening in mental health and drug and alcohol services (Roberts, Rogers, Sharman, et al., 2024) in which social workers are likely to be employed.

Collating data about gambling harms to enable service planning is hindered in nongambling treatment settings by the lack of a single-item, validated question (Dowling et al., 2019; Forward et al., 2023; Otto et al., 2020; Stinchfield & McCready, 2014). The NICE guidance (2025a) notes that due to the stigma around gambling, people will often struggle to raise the issue, and it advises using direct, open-ended questions. These guidance recommendations also apply to family members/affected others, in recognition that they may be severely impacted. This inclusion of “affected others” (Dowling et al., 2022; Riley et al., 2021) in enquiries about gambling harms is particularly appropriate in local authority services, given that service users are often vulnerable adults, that investigating financial abuse is often central to safeguarding practice (Manthorpe et al., 2017), and that on average, for every one person experiencing problems with their gambling at least six other people are affected (Goodwin et al., 2017).

Against this background, we report on the second stage of an evaluation of a National Institute for Health and Care Research (NIHR) funded study that aimed to codevelop (with people with lived experience of gambling harms and those working within local authority social care departments) a question that social workers and others could use to identify individuals and affected others at risk of gambling harms. The study consisted of two stages (stage 1: question design and development; stage 2: pilot implementation and evaluation). It was designed following Medical Research Council guidance on developing and evaluating complex interventions (Craig et al., 2013; Skivington et al., 2021).

In the first stage, our research team worked with three local authorities and the study's people with lived experience (PWLE) group (n = 8) to develop candidate questions for use in adult social care departments. To this end, we reviewed the research literature covering gambling harm screening tools (Forward et al., 2022). We then developed candidate questions based on findings from two expert panels (total n = 13), cognitive testing interviews with local authority staff, service users and a further group of people with lived experience of gambling harms (n = 18), test/retest interviews with service users (n = 20) and a population survey (n = 2,000) (see Forward et al., 2023). This resulted in the production of two candidate questions which had reasonable sensitivity and good positive predictive power and correlated with other gambling harm measures as expected (see Forward et al., 2023). These were taken forward for piloting in three local authorities.

Also, within Stage 1, researchers worked with GamCare (the leading provider of treatment for gambling harms across Britain), the three local authorities and people with lived experience of gambling harms who lived in each participating area, to develop training materials, tailored for social workers and those working with them. This involved holding workshops in each site with practitioners, service users, recruited via local HealthWatch (service advocacy) organizations, and people with gambling harms (n = 10). Pilot training was delivered by GamCare to 31 staff across the three local authorities. Two training sessions also involved a staff member from BetKnowMore (a third sector organization specializing in peer-to-peer support for people experiencing gambling harms) who shared personal experience insights and answered questions. Amendments were made to training materials based on qualitative and quantitative feedback gained using a posttraining survey (Norrie et al., 2023). Qualitative findings revealed high satisfaction with the pilot training, with participants noting training had increased their knowledge about gambling harms, as well as their confidence and motivation to ask about them (Norrie et al., 2023).

Table 1.

Evaluation Participants.

	Site 1	Site 2				Site 3
Service area	Single point of access (SPA)	SPA	Multiagency Safeguarding Hub	Integrated Learning-Disability Service (ILDS) (including LD MASH)	Welfare Advice and Debt Support team	SPA
Participant role	6 staff	5 staff	2 staff	2 staff	4 staff	7 staff/2 service users

Method

Site-Specific Implementation

The second stage of the study (pilot implementation and evaluation) involved staff training in three local authorities (total n = 60), who then asked enquirers/service users the questions in their single-point-of-access (SPA) services. These are the “front door” access point for the public enquiring about adult social care services (such as a social work assessment or care provision) via the telephone. One local authority also introduced the question into its integrated learning disability service, multiagency safeguarding hub, and welfare advice and debt support service. The integrated learning disabilities service offers support (in-person and via telephone) to adults with learning disabilities. The multiagency safeguarding hub offers joined-up, cross-agency safeguarding services for vulnerable adults at risk of harm, abuse or neglect, including people with learning difficulties (in person and via telephone). The welfare advice and debt support service offers telephone support to people seeking assistance with local council tax and other personal debts. The questions were asked over a period of 6 weeks to 6 months in the different services.

This article reports on the evaluation data collected during stage two, to ascertain the acceptability, feasibility and appropriateness to social care staff (qualified and nonqualified) and the public, of asking a gambling harms question. We also assessed the feasibility of collecting quantitative data regarding gambling for use by local authorities, and whether it was possible to determine which of our candidate questions should be recommended for use in adult social care. Cost data findings are reported elsewhere (see Norrie et al., 2023).

Our evaluation was based on staff and service user interviews and focus groups. Following Lewis et al. (2018), we report staff and service users’ views on: acceptability (the degree to which stakeholders find an intervention attractive, agreeable or palatable); feasibility (extent to which the initiative could be successfully used or deployed within a specific context); and appropriateness (whether the innovation is suitable or compatible with existing services). The study is reported following Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines (Tong et al., 2007).

Our evaluation answers the following research objectives which are addressed in turn in our findings below:

Is embedding a question about gambling harms within adult social care acceptable to (a) staff and (b) enquirers/service users?

Is embedding a question about gambling harms within adult social care feasible for (a) staff and (b) users?

Is embedding a question about gambling harms appropriate in adult social care to (a) staff and (b) users?

To what extent are staff within adult social care able and willing to collate responses to the gambling questions to generate localized data for their local authority?

Can we determine which of the two candidate questions should be recommended for use in adult social care?

Researchers contacted managers by email, providing an information sheet and consent form to invite them to participate in evaluation interviews. Managers were asked to invite staff who had participated in the initiative to contact researchers, and a suitable time for an interview was then arranged. Staff were asked to recruit enquirers and service users—both those affected by gambling harms and those who were not—who consented to share their contact details with researchers and participate in an interview. These participants were offered a £25 voucher as payment for their time. One local authority included recruitment information in its staff electronic system as a way of reminding staff of this request.

Managers and local authority staff participated in face-to-face and online interviews which were conducted by two researchers (CN and CF) throughout the study implementation phase (April 2022 to August 2023). Interviews followed semistructured schedules tailored for different groups. Managers, staff and service users’ interview schedules addressed the acceptability, feasibility and appropriateness of asking (RQs 1–3) and recording (RQ4) a gambling harms question and their thoughts on question wording (RQ5). Staff were offered continuing professional development certificates, upon request, in acknowledgement of their assistance.

Qualitative interviews were recorded and transcribed, with permission. Data were coded, analysed and managed within NVivo using applied thematic analysis (Darshini, 2023) which allowed exploration following interview questions, while also enabling exploration of arising themes and electronic search results.

Anonymous quantitative data about numbers of enquirers/service users answering the gambling harms question were collected by staff asking the question in the three sites, and shared with researchers, following ethical procedures. Data were analysed using SPSS v25 to calculate the prevalence of harms to individuals/affected others. Data were compared across local authorities, different candidate questions and service user areas. We triangulated evaluation data in a data synthesis team meeting (CN, CF, SB, HW) to make a final recommendation about which question(s) to recommend (RQ5).

Our people with lived experience advisory group (n = 8) met 5 times over the course of the study and members were involved in the development of the questions, training materials and study outputs, as well as dissemination activities. The group consisted of those who had experienced gambling harms through their own or someone else's gambling, and who were also social care service users.

The study received approval from the Health Research Authority (HRA) Social Care Ethics Research Committee, reference: 21/IEC08/0017. Our protocol covered the confidentiality of evaluation interviews/focus groups and the possibility of them causing distress, being triggering for anyone with experience of gambling harms, or of safeguarding concerns being raised, with processes in place for responding to each of these.

Findings

Interviews were conducted with managers/staff (n = 26) and service users (n = 2) (See Table 1). Participants included registered social workers, social work assistants, welfare advice and debt support team advisors, and occupational therapists. Participants were male and female, ages ranged from 18 to 64, and included individuals from non-White/non-British backgrounds. Due to the small number of service users/enquirers who agreed to participate, the findings largely comprise staff viewpoints.

Overview

Across participating services, practitioners were concerned about gambling harms, eager to support affected service users, and viewed this as a legitimate and acceptable element of social work practice. However, engagement and perceived feasibility varied by service context: staff from the welfare advice and debt support service, multiagency safeguarding hub and integrated LD services, reported smoother integration than the SPA services. Appropriateness of asking about gambling harms was shaped by perceived relevance to the presenting issue, staff training and ongoing support, management capacity, and IT support. Staff struggled to record data about asking a gambling harms question, but two questions were determined for identifying people affected by gambling harms in adult social care contexts. These findings are explored in detail below, structured around the five research questions.

(1) Acceptability of Asking about Gambling Harms (Managers, Staff, and Enquirers/Service Users)

Managers discussed gambling harms as an acceptable, timely, new area of enquiry which they viewed as of benefit to service users. One manager reflected a commonly raised theme: that staff needed to keep up-to-date with social changes to better support citizens. “We need to be changing, we can focus on what's important in the CQC [Care Quality Commission], but we also need to make time to adapt to the issues in society” (Site 1, SPA, Manager 1). Staff also typically recognized gambling harms as a societal problem affecting service users with many expressing disapproval of prolific gambling advertising and welcoming a public-health lens to addressing it. Staff commonly noted feeling better attuned to the pervasiveness of gambling promotions due to their participation in this study.

Most staff reported enquirer/service users found it acceptable to be asked about gambling harms. One practitioner (Site 2, SPA, Social Work Assistant, I3) stated: “Even though it was awkward for us, it seemed to be okay with them.” The two SPA enquirers commented that they found being asked about gambling harms acceptable in this context; one who was affected by gambling harms reported being pleased to receive signposting information. The other was non-affected, but considered that gambling harms were a relevant area for enquiry.

(2) Feasibility: The Importance of Service Area

Although gambling harms were viewed as an acceptable topic for adult social care, it proved more feasible to introduce a question about gambling harms in the welfare advice and debt support service, multi-agency safeguarding hub and integrated learning disability service than the three more general SPA services.

Welfare advice and debt support service staff reported being accustomed to asking people detailed financial questions, reviewing bank statements, and highlighting spending trends, so a gambling question was perceived as highly compatible with their work. In fact, questioning service users about potential gambling harms was already common practice. Training reportedly increased confidence and clarified available support; staff noted that repeated question use enhanced conversational ease with the topic. Welfare advice and debt support service staff also reported service users appeared to find being asked about gambling harms feasible in this setting and generally did not take offense, though those with active problems sometimes sought reassurance about data use.

Multiagency safeguarding hub staff stated they were experienced in probing about financial abuse (often in the context of domestic abuse) and found it feasible to incorporate a gambling harms question within conversations. One informant noted that introducing a gambling harms question was often better received after rapport was established and in person; they mentioned raising the topic during second visits as a successful approach in initiating useful conversations. Multiagency safeguarding hub staff also reported service users found it feasible to answer a question about gambling in this service, stating conversations were often brief and were well received. “It hasn’t been a taboo subject. Everyone I’ve spoken to has been very welcoming about having a conversation about it” (Site 2, Multiagency safeguarding hub, Social Worker, I4).

The Integrated learning disability service reported some initial staff reluctance due to existing workloads and discomfort with the topic, rather than the suitability of the topic to practice, but reported staff buy-in increased over time as practitioners became more accustomed to enquiring. It was highlighted that this is an especially relevant topic for the younger service user cohort and linked with individuals who had gaming problems. It was noted that in this context more time is needed to ask the question as service users can need clarification about what gambling is. It was also reported that learning disability service users are a relatively well-supported client group, and so problems may be less likely to arise. This manager (Site 2, LD, I1) highlighted there was “nil pushback from clients in terms of answering the question.” Another participant (Site 2, LD, I2) noted however that this topic could be sensitive for people with learning disabilities who might worry about accusations of failing to manage their own money, and commented that tailored electronic and paper resources were needed for nonverbal clients, as well as providing accessible information in different languages, which could be shared with families.

SPA staff, across the three sites, however, reported it was less feasible to incorporate a gambling harms question into their routine practice. Staff perceived weaker alignment between presenting care needs and a gambling question and felt uncomfortable discussing finances in brief, needs-focused telephone calls. Several participants reported sentiments similar to the quote below:

We find it difficult because most of the phone calls we get are for packages of care or equipment, and you’ve usually got that person on the phone who is anxious talking to you anyway because they need a bit of help, and you don’t feel it's appropriate to come out and say, ‘By the way, Mrs Smith, are you gambling at all? Do you do the Lotto and Bingo, things like that?’ We find that difficult because you get, ‘No, I don’t go out.’ (Site 2, SPA, Social Work Assistant, I5)

Three SPA practitioners used the term opening “a can of worms” to express their concern that enquiring about gambling could generate additional work. “I don’t prefer to unpick certain things which might open other cans of worms, when really the person is managing” (Site 2, SPA, Social Care Assessor, I6). A couple of participants also cited their local authority's use of strengths-based approaches as discouraging routine enquiries about matters that had not been raised by members of the public.

Nonetheless, several SPA staff members observed that when they combined the question with enquiries related to drugs and alcohol, it was better received by service users. As one practitioner (Site 2, SPA, Social Care Assistant, I3) reported, “It felt a bit awkward, I felt all along that it would be better if it was more of an addiction question rather than gambling on its own.” Placing the question at the end of the telephone conversation, after more rapport or trust had been established, also reportedly yielded more fruitful interactions.

SPA managers reflected on which access point was best suited to asking a gambling question, for example, the wider local authority “front door” (where questions come in about a range of services, for example, refuse collection), the adult social care access point (Site 1), or adult social care needs assessment entry point (Sites 2 and 3). Some SPA staff identified other locations/services they thought might be more feasible for asking a gambling harms question, suggesting, for example, housing, Citizen's Advice and befriending/social isolation services.

Service user/enquirer responses were reportedly more challenging for the SPA staff than in the other services, with some staff mentioning enquirers sometimes responded negatively or appearing affronted, which was disheartening.

Examples were also given of a minority of staff and service users being “triggered,” or reminded of distressing events by the question and preferring not to answer. “Some clients that are very reluctant to speak about it […] one particular client spoke about [family member] who committed suicide, due to a lot of gambling, […] She just said, ‘I don't really want to speak about it’”. (Site 3, SPA, Info and Advice Officer, I1)

(3) Appropriateness of Asking a Gambling Harms Question

The appropriateness of asking a gambling harms question was discussed by participants in relation to relevance to service users, staff training needs and ongoing support availability, and leadership capacity.

Staff discussed situations where enquiring was viewed as less relevant to service users, due to specific requests (e.g., client wishes a handrail), particular circumstances (e.g., client is rushed) or preconceived assumptions (e.g., about “typical” gamblers). Staff commonly reported tending to enquire when they suspected gambling likely, rather than routinely asking the question (despite training emphasizing study aims were to determine gambling harms prevalence, as well as reduce stigma by normalizing conversations about gambling harms). An information and advice officer for example (Site 1, SPA, I2) commented, “If somebody was, I don't know, very ill … I just thought, ‘it's not relevant in this occasion’. And so no, I didn't have any negativity back, but I just chose the ones that I thought, you know, it's appropriate.” Some staff relied on assumptions about who gambles, which risks missed opportunities for early identification. One participant noted, ‘You don’t even mention gambling if you’re going out to a Muslim family because you know they’re not going to be gambling’ (Site 2, SPA, Social work assistant, I5). Staff reportedly felt service users would not welcome being asked additional questions which would prolong conversations—a reservation also mentioned by one service user participant.

Staff reported that, without training, it would have been inappropriate to have been tasked with enquiring about gambling harms. Feedback was consistently high about the GamCare-delivered training. Practitioners particularly valued information about indicators of gambling harms and signposting details. They also appreciated the inclusion of a person with lived experience in the training.

Managers reported staff needed ongoing support to continue to ask the question, for example, scheduling reminders/discussion in meetings or appointing a lead or champion (welfare advice and debt support service/integrated LD service) to embed the question within practice. Site 2 provided a dedicated project manager who recruited service areas, reminded managers to support staff asking the question, and encouraged data recording. Likewise, staff reported valuing peer support in motivating them to ask the question. “We had meetings every couple of weeks, just kind of checking in on any feedback anyone provided. So that was quite useful” (Site 3, SPA, Occupational Therapist, I8).

Management capacity, context, and commitment affected feelings about the appropriateness of asking the question in different services. The study took place (2021–2022), after COVID-19 pandemic lockdowns, but staff were still being affected by upheaval, workload pressures and shifting priorities. Participants mentioned the study being affected by the burden of changes, such as the introduction of Care Quality Commission inspections, new IT systems, team reorganizations, remote working, staff sickness, turnover and shortages.

(4) Feasibility of Data Capture

Data on the number of eligible clients were recorded in two sites, one site failed to deliver data in a way that could be analyzed.

Overall:

150 people were asked the “worried” questions; 6 (4.0%) said yes

197 people were asked the “affected” question; 15 (7.6%) said yes

9 people were given brief intervention information

4 people were referred for further support.

Several factors may have contributed to limited data recording, including confusion over consent, unfamiliarity or uncertainty with IT recording, and resistance to “form filling.”

Practitioners’ imperative to gain consent from enquirers to take part in a research study before asking the question was reportedly off-putting and confusing for some people, as well as making the process more cumbersome for staff asking the question. In Sites 1 and 2, difficulties embedding the question within the routinely used electronic systems meant responses were recorded using Sharepoint, Excel or Word formats, which was reportedly inconvenient for staff. In Site 3, where the question was successfully embedded within the electronic data management system, this was made mandatory for one month (out of five). However, only 6% of clients consented to participate that month. It is possible that staff used the study consent process as a way to avoid asking the question. Alternatively, staff might have found the system confusing, leading them to mistakenly record “no” to the consent question rather than the gambling question. Furthermore, in all the sites, a recording option was provided for staff to note when they did not ask the question due to an individual lacking the ability to consent or in emergency situations; however staff did not use these options, although they later discussed these situations in interviews—indicating resistance to complete additional data recording.

(5) Which of the Two Candidate Questions Should be Recommended for Use in Adult Social Care?

Participants perceived both candidate questions as appropriate for identifying harms to individuals and affected others, and for use with a wide range of people in face-to-face or telephone contexts. They reported using the question in an introductory manner, rather than as a diagnostic tool and using personalized approaches: “we often are adjusting the question, so depending on who we’re engaging, we’re using different language and ways of communicating.” (Site 2, Multiagency safeguarding hub, Social Worker, I7)

Participants generally reported no complaints about understanding the wording of the questions. Staff preferred the “worried” question, considering it nonjudgmental. However, a few staff in the multiagency safeguarding hub and integrated learning disability service teams showed a slight preference for the “affected” question, perceiving it as more “professional” and potentially more effective in leading to support-focused conversations. Given the lack of an outright staff preference, combined with inconclusive quantitative data, we decided to recommend both questions for use in adult social care. A minority of staff in Site 3 reported service users sometimes understood our “worried” candidate question (Forward et al., 2023) hypothetically; in view of this, it was slightly amended. The following two questions are recommended for face-to-face and telephone use, and with a range of service users:

Is your gambling or that of someone else causing you any worries? Do you feel you are affected by any gambling, either your own or someone else's?

Discussion

Publication of the NICE (2025a) guidance has confirmed that tackling gambling harms is firmly on the agenda for the social work profession in England. Findings from this study highlight implications of this for social workers and social care assistants in practice.

Local authority staff may be tasked with incorporating enquiries about gambling harms into a range of social work and other services. Our work confirmed the importance of facilitators: choosing a service which is a good fit, funded staff training and ongoing support, management encouragement and capacity, and early planning of IT system modifications. Barriers included: staff perceptions about the relevance for service users, staff discomfort with the topic of gambling harms, and competing demands.

Practitioners from welfare advice and debt support, integrated learning disability and multiagency safeguarding hub services reported asking questions about gambling as more acceptable and feasible than those working in general SPA services. The reason for this is that there are generally more in-depth discussions, finance-focused conversations and longer-term service user relationships in these contexts, which made asking about gambling harms easier. Staff were more comfortable asking the question in settings where they were undertaking holistic or longer, comprehensive or general care planning, rather contexts where they were undertaking briefer needs assessments.

Asking social workers and other social care staff to enquire about gambling harms within SPA locations proved more challenging. While enquiring in this context raises the profile of gambling harms as a public health problem, managers need to consider balancing the benefits of staff raising the topic with larger numbers of enquirers/service users, with the risk of alienating staff or citizens with what could be perceived as a tokenistic exercise, or frustrating staff by increasing their workload. This underlines the point that decisions to undertake enquires in SPA services should be taken as part of a strategic, whole-council approach to tackling gambling harms (LGA, 2023a).

Our findings have implications for the design of social care assessment protocols, suggesting facilitators to embedding gambling harms enquiry are particularly important in SPA locations, for example, placing the question toward the end of an assessment or conversation, once rapport has been established, or locating it together with drug and alcohol questions.

Our study highlights that social workers and other practitioners agree that supporting people affected by gambling harms is within their scope of practice. However, comprehensive training and ongoing support are needed for staff to be motivated and comfortable asking a question about gambling harms as well as feeling confident dealing with disclosures and signposting (see Forward et al., 2023; Norrie et al., 2023). Whether gambling harms should be introduced into social work education and training has been addressed in the United Kingdom (Bramley et al., 2019b; Rogers, 2013) and Finland (Nower et al., 2023). Our findings show that indicators of gambling harms and signposting details were particularly appreciated by staff in training. This chimes with Blank et al.'s (2021) international systematic review which concluded that issues of implementation were staff training, clear referral pathways, and how practitioners are encouraged to screen for gambling harms.

We also found that some social care staff experience discomfort raising the topic of gambling, which is similar to findings from Wyllie et al.'s (2023) review of gambling harms training resources in healthcare, which noted that improving staff comfort in asking the question and understanding the stigma around gambling is central to training. We found another barrier to enquiring about gambling harms was social workers’ perceptions of the relevance to the service user population, which highlights ongoing stereotypes about the type of person who experiences gambling harms. The NICE guidance (2025a) highlights groups of people who are particularly at risk including those affected by depression, anxiety, self-harm, suicidal thoughts, or alcohol or drug dependence, neurodiverse people, those taking medication that may affect impulse control, and people experiencing safeguarding concerns, or who have a family history of gambling that harms. All of these are groups who may be in contact with social workers. It is possible that greater focus on these groups in staff training might encourage more enquiries. However, gambling harms can affect anyone—and this also should be borne in mind by social workers.

Social workers reported that management and peer support were important to maintain confidence and motivation. As with others, we found appointing dedicated gambling support leads to be successful (see Guilcher et al., 2020) as well as involving people with lived experience in training (see Jenkins et al., 2024). Consideration should be given to making the enquiries mandatory within electronic systems as part of the embedding process in order to increase the likelihood of them being asked. Our study also confirmed that managers should be aware that the topic may be triggering for some staff members and have responses available. The same would apply to social work training.

Our evidence confirms our questions are appropriate for social care settings for identifying impacted individuals and affected others in both face-to-face and telephone interactions, and with a range of service users; however additional tailored resources for nonverbal people with, or without, learning disabilitiess are needed. Our data highlight that social workers felt more comfortable tailoring our gambling questions to an enquirer/service user, rather than deploying them as diagnostic screening tools and this approach is more aligned with strengths-based practice (Caiels et al., 2021). This was similarly highlighted in an evaluation of a gambling screening initiative in Citizens Advice services across England (Kantar Public, 2021) which emphasized the importance of flexibility in screening questions to encourage more open conversation with clients, and that training should address managing uncomfortable conversations which may arise.

Our questions identify individuals experiencing gambling harms as well as affected others—the latter group are particularly relevant in social care. A growing body of literature highlights the significant harms experienced by affected others, including financial abuse or exploitation (Dowling et al., 2025). Evidence also shows that gambling is associated with domestic violence (Dowling et al., 2019). These developments underscore the importance of social workers considering whether gambling harms may be involved when working on adult safeguarding cases.

This study has wide implications for social work as it investigated a new area of practice which is currently of interest to policy makers. It has explored its acceptability and feasibility in a range of settings from the perspective of social workers, social work and care assistants, their managers and service users. It has identified scientifically tested questions which social workers can use in practice and for data recording purposes—and has discussed their use. More research (Blank et al., 2021; NICE, 2025b) is needed on the effectiveness and cost/benefit of asking about gambling harms in different social care settings, for example, within Children's Services.

Study Limitations

Only two service users were recruited by staff, both were from Site 3 (SPA service), so comparative feedback from across the local authorities and service areas was not possible. Service-user perceptions are therefore primarily reported through staff perspectives and may include filtering of views or misunderstandings. Practitioners may have hesitated to share their opinions with researchers and/or been reluctant to criticize a management-supported initiative. The study had strengths in covering three varied local authority areas with substantial diversity among practitioner and public populations. Partnership with GamCare enabled the training resources and delivery to reflect expertise and experience.

Conclusions

Local authority social care staff, such as social workers and social work assistants considered addressing gambling harms to be within their responsibilities. They were eager to learn about gambling harms and welcomed information on this new area of practice.

Staff reported that service users generally found being asked about gambling harms acceptable. However, asking about gambling harms proved more feasible in specialist welfare advice and debt support, integrated learning disability and multiagency safeguarding hub services, rather than frontline, generic SPA services, due to the type of assessments and interventions, and the nature of the interactions with those who use services. Facilitators were funded staff training, ongoing support and management capacity. Barriers were staff perceptions of relevance to service users, staff discomfort with talking about gambling, and competing work demands.

The following two questions are recommended for face-to-face and telephone use, and with a range of service users in the contexts covered in this study. Either (or both) can be used based on staff preference and service considerations.

Is your gambling or that of someone else causing you any worries? Do you feel you are affected by any gambling, either your own or someone else's?