Veterans Who May Need a Payee to Prevent Misuse of Funds for Drugs

Rosen, Marc I.; Rosenheck, Robert A.; Shaner, Andrew; Eckman, Thad A.; Gamache, Gail; Krebs, Christopher

doi:10.1176/appi.ps.53.8.995

Cited by 23 publications

(21 citation statements)

References 12 publications

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“…The disproportionate assignment of payees to clients assigned to ATM suggests that the well-documented inconsistency in payee assignment (Ries & Comtois, 1997; Hanrahan et al, 2002; Rosen et al, 2002) is mutable and responsive to intervention. This is remarkable in that payee assignment was not a goal of the ATM intervention and had not been conceived as part of it.…”

Section: Discussionmentioning

confidence: 99%

Pathways to Assignment of Payees

Rosen

Ablondi

Black

et al. 2013

Community Ment Health J

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How clients come to be assigned representative payees and/or conservators to manage their funds is not well understood. We compared clients assigned a payee during a clinical trial of a money management-based intervention to those not assigned payees and examined antecedents to payee assignment. One year after randomization, significantly more clients assigned to the ATM money management intervention were assigned payees than participants in the control condition (10 of 47 vs. 2 of 43; p=.02); those assigned payees had lower baseline GAF scores and participated more in study therapies. Several ATM clients were assigned payees after third parties paid more attention to clients’ finances, and others after having negotiated storage of their funds with the ATM money manager during the study. Assignment of payees appears to be influenced by whether third parties critically attend to how clients’ manage funds and by clients’ receptiveness to having a payee.

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Section: Discussionmentioning

confidence: 99%

Pathways to Assignment of Payees

Rosen

Ablondi

Black

et al. 2013

Community Ment Health J

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“…Patients assigned to ATM who participated in it extensively to receive financial counseling likely diluted the relationship between session attendance and reduced cocaine use. It has been noted that patients with psychiatric illnesses frequently desire help with financial matters but may be ambivalent about substance abuse treatment (3,35). The sample was too small and payee assignment was too sporadically implemented to determine its impact on outcomes, but a descriptive review of patients who were assigned payees during the study showed no consistent change in patterns of cocaine use after the payee was assigned.…”

Section: Discussionmentioning

confidence: 99%

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

Rosen¹,

Rounsaville²,

Ablondi³

et al. 2010

Psychiatric Services

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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...

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“…Broad SSA guidelines for determining capability status are subject to idiosyncratic interpretation, and clinicians have reported considering a range of factors, some of which were unrelated to the beneficiary's financial functioning (Luchins et al, 1998; Luchins et al, 2004; Marson et al, 2006; Rosen et al, 2002). For example, clinicians indicate more willingness to assign representative payees when beneficiaries are inclined to accept them (Rosen et al, 2002). Other studies have highlighted a tendency to under-identify beneficiaries who needed payee assignment.…”

Section: Introductionmentioning

confidence: 99%

“…Other studies have highlighted a tendency to under-identify beneficiaries who needed payee assignment. In several studies of adults with mental illness, as many as a quarter of beneficiaries were not assigned a representative payee despite their apparent need for one (Black et al, 2008; Rosen et al, 2002). An audit conducted by the Office of the Inspector General of SSA benefits paid to adults with mental impairments concluded that 23% of the beneficiaries reviewed were likely incapable of managing their income, but had not been assigned a payee (SSA, 2012c).…”

Section: Introductionmentioning

confidence: 99%

Development of the Clinician Assessment of Financial Incapability (CAFI)

Black

McMahon

Rosenheck

et al. 2014

Psychiatry Research

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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.

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Veterans Who May Need a Payee to Prevent Misuse of Funds for Drugs

Abstract: A substantial proportion of veterans who have not been assigned a payee may need one. More effective approaches to money management in this population are needed.

Cited by 23 publications

References 12 publications

Pathways to Assignment of Payees

Pathways to Assignment of Payees

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

Development of the Clinician Assessment of Financial Incapability (CAFI)

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