Financial Capability: Clinicians' Assessment of Beneficiaries With Dual Diagnoses.
Financial Capability: Clinicians' Assessment of Beneficiaries With Dual Diagnoses.
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DOI：
10.1080/15504263.2018.1436732
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发表时间：
2018-04
影响因子：
2.2
通讯作者：
Rosen MI
中科院分区：
文献类型：
--
作者：
Thornhill Iv TA;Black AC;Rosen MI
患有精神疾病的成年人，如果其工作能力受到严重阻碍，有权获得社会保障管理局的财政支助。如果受益人被确定没有能力管理这些资金，则应指定一名代表收款人，协助受益人满足其需要。然而，收款人分配的模式表明，收款人分配的影响因素以外的社会保障局指示临床医生考虑。在这项研究中，我们测试了临床医生对其客户财务能力的判断与假设的预测因素（人口统计学特征，精神病诊断，最近的酒精和其他物质使用，自我资金管理不善，最近无家可归和提供者特征）之间的关联。我们假设，预测者可能会间接作用于能力判断，通过他们对受益人的资金管理的影响。总共有261名接受强化精神卫生保健的人在提供书面知情同意书后，没有收款人或受托人。这些受益人完成了面对面的评估访谈，报告人口特征，治疗史，物质使用和无家可归。由受益人确定的心理健康临床医生参加了这项研究，并要求他们根据标准的社会保障说明来判断客户的经济能力。假设的预测因素和临床医生确定的无行为能力之间的双变量关联进行了测试。在多变量概率单位回归模型中，无行为能力的确定被建模为所有受益人和临床医生特征的函数，这些特征与结果有显著的双变量关联。提供者确定他们的客户中有24%是经济上没有能力的。财务能力的确定与任何受益人或提供者的人口统计学特征无关，但与资金管理不善，无家可归和精神障碍呈正相关。酒精和其他物质的使用仅通过其对金钱管理不善的影响间接与能力测定显著相关。提供者对受益人管理资金能力的判断与符合社会保障管理局指导方针的因素有关，重要的是，与个人特征无关。这一发现表明，指导方针可以公平地应用于临床医生，并报告不一致的收款人分配占其他因素。社会保障管理局目前正在考虑其他方法来标准化能力确定。
Adults with mental health disorders whose ability to work is sufficiently impeded are entitled to financial supports from the Social Security Administration. Beneficiaries determined to be incapable of managing these funds are supposed to be assigned a representative payee to assist beneficiaries in meeting their needs. However, patterns of payee assignment suggest that payee assignment is impacted by factors other than those the Social Security Administration instructs clinicians to consider. In this study, we tested the association between clinicians’ judgments of their clients’ financial capability and hypothesized predictors (demographic characteristics, psychiatric diagnosis, recent alcohol and other substance use, selfrated money mismanagement, recent homelessness, and provider characteristics). We posited that predictors might act indirectly on capability judgment, via their impact on beneficiaries’ money management. Altogether, 261 people receiving intensive mental health care who did not have payees or fiduciaries were enrolled after providing written informed consent. These beneficiaries completed in-person assessment interviews, reporting demographic characteristics, treatment history, substance use, and homelessness. Mental health clinicians identified by the beneficiaries were enrolled in the study and asked to judge their clients’ financial capability with standard Social Security instructions for determining capability. Bivariate associations between hypothesized predictors and clinicians’ determinations of incapability were tested. In multivariate probit regression models, incapability determination was modeled as a function of all beneficiary and clinician characteristics that had significant bivariate associations with the outcome. Providers identified 24% of their clients as financially incapable. Determinations of financial incapability were unrelated to any beneficiary or provider demographic characteristics, but were positively associated with money mismanagement, homelessness and having a psychotic disorder. Alcohol and other substance use were only significantly associated with capability determinations indirectly, through their effects on money mismanagement. Providers’ judgments of beneficiaries’ capability to manage their funds were associated with factors that were consistent with Social Security Administration guidelines, and were, importantly, not associated with personal characteristics. This finding suggests that guidelines can be fairly applied by clinicians, and that reported inconsistencies in payee assignment are accounted for by other factors. Social Security Administration is currently considering other approaches to standardize capability determinations.
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影响因子：
3.8
作者：
Hanrahan, P;Luchins, DJ;Conrad, KJ
通讯作者：
Conrad, KJ
影响因子：
1.9
作者：
Appelbaum, PS;Redlich, A
通讯作者：
Redlich, A
影响因子：
11.3
作者：
Black, Anne C.;McMahon, Thomas J.;Rosen, Marc I.
通讯作者：
Rosen, Marc I.
影响因子：
4.2
作者：
Carey, KB;Roberts, LJ;Neal, DJ
通讯作者：
Neal, DJ
影响因子：
3.6
作者：
Carey, KB;Cocco, KM;Correia, CJ
通讯作者：
Correia, CJ