Characteristics of Persons With Mental Illness in a Representative Payee Program

Conrad, Kendon J.; Matters, Michael D.; Hanrahan, Patricia; Luchins, Daniel J.; Savage, Courtenay; Daugherty, Betty

doi:10.1176/ps.49.9.1223

Cited by 24 publications

(19 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another bundled money management-based intervention is the assignment of a representative payee to manage SSI and/or SSDI payments for patients who are judged incapable of managing their own funds. Beneficiaries are frequently assigned payees to restrict their substance use (4, 5), and both quasi-experimental (6) and clinical trial data (7) suggest that properly-implemented payee programs can reduce substance use.…”

Section: Introduction and Overviewmentioning

confidence: 99%

Overview of Special Sub-section on Money Management Articles: Cross-Disciplinary Perspectives on Money Management by Addicts

Rosen

2012

The American Journal of Drug and Alcohol Abuse

View full text Add to dashboard Cite

How addicts manage their funds can be understood from studies of the neurobiology of impulsive spending, contingency management, self-reported expenditures, behavioral economics and anthropology. To show how these differing perspectives can provide theoretical explanations for observed behavior, they were applied to the question of when extra “windfall” funds are spent on substances of abuse. The treatment implications of Behavioral Economic and related approaches include targeting behavioral mechanisms of substance use with money management-based interventions, configuration of reinforcers other than substance use, and therapeutically framing the choice between abstinence and alcohol use.

show abstract

Section: Introduction and Overviewmentioning

confidence: 99%

Overview of Special Sub-section on Money Management Articles: Cross-Disciplinary Perspectives on Money Management by Addicts

Rosen

2012

The American Journal of Drug and Alcohol Abuse

View full text Add to dashboard Cite

show abstract

“…The DONREP’s questions, developed from focus groups with case managers and input from an expert panel define financial capability in terms of ability to meet basic needs, vulnerability to victimization, addiction, and psychiatric impairment. Although the DONREP items have not been tested more formally, their scope is consistent with other working definitions of financial capability, including reasons identified by case managers for recommending a payee (Dixon et al, 1999; Luchins, et al, 1998; Luchins, et al, 2004), target outcomes of money management educational interventions (Elbogen et al, 2011, 2013; Rosen et al, 2003, 2010), statistical models differentiating beneficiaries with and without payees (Conrad, et al, 1998), legislative history of assigning representative payees to individuals because of disabling substance use (Swartz et al, 2000) and expert recommendations for defining capability that emphasized substance use, impairment, and the ability to meet basic needs (Rosen & Rosenheck, 1999). …”

Section: Introductionmentioning

confidence: 93%

“…The construct was operationalized more formally by Conrad and colleagues’ (1998) Determination of Need for a Representative Payee (DONREP) questionnaire. The DONREP’s questions, developed from focus groups with case managers and input from an expert panel define financial capability in terms of ability to meet basic needs, vulnerability to victimization, addiction, and psychiatric impairment.…”

Section: Introductionmentioning

confidence: 99%

Development of the Clinician Assessment of Financial Incapability (CAFI)

Black

McMahon

Rosenheck

et al. 2014

Psychiatry Research

View full text Add to dashboard Cite

The Social Security Administration (SSA) provides financial support to adults disabled by psychiatric conditions to provide for their basic needs. For beneficiaries identified as incapable of managing their funds, representative payee assignment is mandated. However, studies indicate that the current SSA method of determining capability leads to idiosyncratic payee assignment, with a tendency to under-identify beneficiaries needing payees. Over two phases with data from 78 mental health clinicians treating 134 patient-beneficiaries, we describe the development of a new assessment, the Clinician Assessment of Financial Incapability (CAFI). Item generation, subscale construction, and preliminary assessments of validity are described. We also describe the simultaneous development of a criterion measure of capability, a comprehensive review of all data. Experts identified four subscales mapping to four criteria of incapability; factor analysis provided support for this item structure. Close to one-half of patients were determined to be incapable by review of all data. CAFI and SSA methods correctly classified 73% of cases, but errors with CAFI were more evenly distributed between false negatives and false positives. The implications of classification error are considered, and advantages of CAFI over the SSA method are enumerated. Plans for future instrument revision are briefly described.

show abstract

“…Substance use is frequently the reason for payee assignment (11,12). Studies suggest that properly implemented payee programs can reduce substance use (13,14), but retrospective cohort studies in which payeeship practice was not specified have had more modest or no benefits (12,15).…”

Section: Nih Public Accessmentioning

confidence: 99%

Advisor-Teller Money Manager (ATM) Therapy for Substance Use Disorders

Rosen¹,

Rounsaville²,

Ablondi³

et al. 2010

Psychiatric Services

View full text Add to dashboard Cite

Objective-Patients with concomitant psychiatric and substance use disorders are commonly assigned representative payees or case managers to help manage their funds, but money management has not been conceptualized as a theory-based treatment. This randomized clinical trial was conducted to determine the effect of a money management-based therapy, advisor-teller money manager (ATM), on substance abuse or dependence.Methods-Ninety patients at a community mental health center who had a history of cocaine or alcohol abuse or dependence were assessed after random assignment to 36 weeks of ATM (N=47) or a control condition in which use of a financial workbook was reviewed (N=43). Patients assigned to ATM were encouraged to deposit their funds into a third-party account, plan weekly expenditures, and negotiate monthly budgets. Substance use calendars and urine toxicology tests were collected every other week for 36 weeks and again 52 weeks after randomization.Results-Patients assigned to ATM had significantly more negative toxicologies for cocaine metabolite over time than patients in the control group, and treating clinicians rated ATM patients as significantly more likely to be abstinent from illicit drugs. Self-reported abstinence from alcohol did not significantly differ between groups. Unexpectedly, patients assigned to ATM were more likely to be assigned a representative payee or a conservator than control participants during the follow-up period (ten of 47 versus two of 43). One patient in ATM assaulted the therapist when his check had not arrived.Conclusions-ATM is an efficacious therapy for the treatment of cocaine abuse or dependence among people with concomitant psychiatric illness but requires protection of patient autonomy and staff safety.People with severe psychiatric illnesses commonly use alcohol, cocaine, or both (1,2). Because of their substance use and disabling psychiatric illnesses, patients with co-occurring disorders are frequently poor and need to make the most of their limited income to avoid abject poverty. Unfortunately, high proportions of psychiatric patients report difficulty managing their money and have made poor financial decisions under the influence of drugs (3). Patients' desire to have money is a potentially powerful motivation to stop buying alcohol and cocaine, and people who are poor and mentally ill indicate a desire for help with concrete financial concerns (4). DisclosuresThe authors report no competing interests. Advisor-teller money manager therapy (ATM) is a money management-based intervention that targets substance use. ATM attempts to break the linkage between a patient's money and cued associations with drug use by storing the patient's funds and training him or her to budget funds for things other than substances of abuse (5). Patients in the ATM program work with their therapists to make budgets, thus mentally associating their money with planned nondrug expenditures that in turn are linked to long-term goals. Behavioral economists have described how such "men...

show abstract

Characteristics of Persons With Mental Illness in a Representative Payee Program

Cited by 24 publications

References 3 publications

Overview of Special Sub-section on Money Management Articles: Cross-Disciplinary Perspectives on Money Management by Addicts

Overview of Special Sub-section on Money Management Articles: Cross-Disciplinary Perspectives on Money Management by Addicts

Development of the Clinician Assessment of Financial Incapability (CAFI)

Advisor-Teller Money Manager (ATM) Therapy for Substance Use Disorders

Contact Info

Product

Resources

About