Benefits Management for People with Psychiatric Disabilities

精神障碍人士的福利管理

• 批准号: 7788322
• 负责人: Marc I Rosen
• 金额: $ 21.65万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-15 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7788322
• 关键词: Accounting; Adverse effects; Adverse event; Budgets; Businesses; Client; Clinical; Coercion; Cognitive; Community Mental Health Centers; Counseling; Data; Disability Insurance; Disabled Persons; Education; Educational process of instructing; Evaluation; Expenditure; Face; Feedback; Frequencies; Funding; Goals; Guidelines; Habits; Homelessness; Hospitalization; Impairment; Income; Institution; Intervention; Interview; Legal; Manuals; Measures; Mental disorders; Monitor; Participant; Persons; Process; Professional counselor; Psyche structure; Psychiatric therapeutic procedure; Quality of life; Randomized; Recovery; Risk; Security; Social Security; Staging; Stress; Supplemental Security Income; Time; Transact; Treatment Efficacy; Triage; United States Social Security Administration; Writing; base; beneficiary; brief intervention; compare effectiveness; compliance behavior; design; disability payment; follow-up; improved; information gathering; interest; meetings; mental state; payment; primary outcome; programs; psychiatric disability; psychologic; public health relevance; satisfaction; skills; social

DESCRIPTION (provided by applicant): In addition to the cognitive distortions inherent in Mental Accounting, people with psychiatric illnesses face cognitive, psychological and social challenges that make it difficult to align their expenditures with their interests. Recipients of Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) may be assigned representative payees to manage their funds. Because of inconsistencies in the assignment of payees, high proportions of beneficiaries with psychiatric disabilities have difficulty managing their funds but have not been assigned a payee. In clients disabled by psychiatric illness, voluntary assistance may be sufficient to improve funds management. In others, not assigning a payee may represent a missed opportunity because data suggests that payee assignment is associated with improved treatment compliance and, when properly implemented, other clinical benefits too. The purpose of this Stage 1 study is to describe feasibility and preliminary efficacy of an intervention to provide money management assistance and to facilitate payee assignment when it is indicated. People who are in psychiatric treatment, receiving SSI and/or SSDI and at risk for needing a payee will be randomly assigned to Benefits Management or the control condition, a review of their income and expenses. Benefits Management involves the following components: (a) evaluation- reviewing the beneficiary's income, expenses and money management habits; (b) education and rapport building- helping clients identify their money management goals and providing advice to help clients manage their money better; and (c) skill-building - teaching clients how to plan a budget for the month. If funds mismanagement persists and is harmful, the Benefits Management counselor will talk to clients and their clinicians about alternatives to having the client manage their own money such as assignment of a representative payee. The counselor will facilitate payee assignment if the clinician indicates that a payee is needed. Benefits Management is designed to be an assessment, brief treatment and triage. In practice, the person providing Benefits Management to a large number of clients will be the person designated by the CMHC or other agency to liaison with the local Social Security Administration staff, available payees, and merchants who process financial transactions with clients. With input from expert consultants and iterative writing and revisions, a manual will be developed describing Benefits Management. One hundred twenty participants will be randomized to Benefits Management or the control condition, five sessions extracted from an Illness Management and Recovery program. The primary outcome will be observer-rated quality of life. The feasibility and client acceptability of Benefits Management will be characterized by the number of times meeting with the counselor, client-rated satisfaction with the intervention, initiation of payee application, aversive effects including perceived coercion and qualitative analyses of client perspectives. PUBLIC HEALTH RELEVANCE: People who misspend disability payments often do not have money to meet basic needs and may be harmed when benefit checks are spent on things other than basic needs. Benefits Management has the potential to help beneficiaries spend their money well and thus, improve their quality of life.

描述(申请人提供)：除了心理会计固有的认知扭曲外，患有精神疾病的人还面临认知、心理和社会挑战，使他们的支出难以与他们的兴趣相匹配。补充保障收入(SSI)和社会保障残疾保险(SSDI)的接受者可以被指派代表受款人来管理他们的基金。由于受款人分配的不一致，很大比例的精神残疾受益人难以管理其资金，但没有分配到受款人。对于因精神疾病而致残的客户，自愿援助可能足以改善资金管理。在另一些情况下，不分配收款人可能代表错失了机会，因为数据表明，收款人分配与改善治疗依从性相关，如果实施得当，还与其他临床好处相关。这项第1阶段研究的目的是描述干预措施的可行性和初步效力，以提供资金管理援助，并在必要时促进受款人的分配。正在接受精神治疗、接受SSI和/或SSDI并面临需要受款人的风险的人将被随机分配到福利管理或控制条件，对他们的收入和支出进行审查。福利管理包括以下部分：(A)评估--审查受益人的收入、支出和理财习惯；(B)教育和建立融洽关系--帮助客户确定他们的理财目标，并提供建议，帮助客户更好地管理他们的资金；(C)技能建设--教客户如何规划当月的预算。如果资金管理不善的情况持续存在，并且是有害的，福利管理顾问将与客户及其临床医生讨论让客户管理自己的资金的替代方案，如指定代表收款人。如果临床医生指出需要受款人，咨询师将为受款人分配提供便利。福利管理旨在进行评估、简要治疗和分类。在实践中，为大量客户提供福利管理的人将是CMHC或其他机构指定的与当地社会保障管理局工作人员、可用受款人和处理与客户进行金融交易的商家联系的人。根据专家顾问的意见以及反复编写和修订的内容，将编写一份说明福利管理的手册。120名参与者将被随机分配到福利管理或对照条件下，从疾病管理和康复计划中提取五个疗程。主要结果将是观察者评定的生活质量。福利管理的可行性和客户可接受性的特征将包括与顾问会面的次数、客户对干预的满意度、受款人申请的启动、包括感知到的胁迫在内的厌恶效果以及对客户观点的定性分析。 与公共健康相关：滥用伤残抚恤金的人往往没有钱满足基本需求，当福利支票花在基本需求以外的东西上时，他们可能会受到伤害。福利管理有可能帮助受益人花好他们的钱，从而提高他们的生活质量。