Improving Clinician Ratings of Money Mismanagement: Addiction's Impact.

提高临床医生对资金管理不善的评级：成瘾的影响。

• 批准号: 8261982
• 负责人: Marc I Rosen
• 金额: $ 30.92万
• 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: 2010-05-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8261982
• 关键词: Agreement; Alcohol or Other Drugs use; Alcohols; Beck depression inventory; Clinical; Data; Device or Instrument Development; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Diagnostic tests; Disability Insurance; Disabled Persons; Disease; Equation; Evaluation; Evaluation Research; Factor Analysis; Food; Funding; Goals; Gold; Homelessness; Housing; Individual; Inpatients; Instruction; Insurance Benefits; Interview; Judgment; Left; Length of Stay; Logistic Regressions; Measures; Modeling; Outpatients; Patients; Pharmaceutical Preparations; Phase; Procedures; Questionnaires; ROC Curve; Recording of previous events; Regression Analysis; Research; Role; Sensitivity and Specificity; Series; Shelter facility; Social Security; Structure; Substance abuse problem; Supplemental Security Income; Testing; United States Social Security Administration; Validation; Work; addiction; alcohol and other drug; base; beneficiary; design; disability; disability payment; follow-up; improved; instrument; meetings; public health relevance; response

DESCRIPTION (provided by applicant): The goal of this study is to improve upon the current procedure for determining when patients with psychiatric and/or substance abuse disorders are incapable of managing their funds by developing and validating the CAFI (Clinician Assessment of Financial Incapability), a brief clinician-rated instrument to "diagnose" incapability. Disabled people are harmed when their Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits are misspent, often on drugs and alcohol, leaving them without money for housing and other essentials. A representative payee may be assigned to patients who are incapable of managing their funds but the Social Security Administration (SSA) largely decides on payee assignment based on a single question answered by the patient's clinician. Clinicians are given no instruction to consider substance abuse, despite its importance in managing funds. This study involves a Pre-Pilot Phase during which candidate items will be developed and tested, an Instrument Development Phase and an Instrument Validation Phase. In the Pre-Pilot phase, candidate items for the CAFI will be developed by the research team and piloted with 15 clinicians. Then, in the Instrument Development Phase, three sets of assessments will be conducted: (a) questionnaires with the single SSA question and the candidate items for the CAFI will be completed by clinicians treating 120 inpatients and patients in day hospitals with histories of substance abuse, and will be completed again one week later to identify items with adequate test-retest reliability, (b) all-data assessments of patients' capability to manage their funds will be completed by independent third-party experts using the L.E.A.D. procedure (Longitudinal Expert Evaluation Using All Available Data) applied to pre-defined criteria, and (c) clinical rating scales administered to patients by a research assistant. Individual item analysis, test-retest reliability, exploratory factor analysis and backwards stepwise logistic regression will be used to cull a brief questionnaire (the CAFI) from the candidate questionnaire with items that best identify beneficiaries incapable of managing their funds (as determined by the all data approach). In the Instrument Validation Phase, the CAFI and the battery of assessments (all-data evaluation, and research assistant ratings) will be collected for 192 patients at baseline. The sensitivity and specificity of each of the clinician assessments (single SSA question and CAFI) vis a vis the concurrent all-data assessment will be determined and the accuracy of the single SSA question and the CAFI will be compared using a z-test of differences between coefficients. The convergent validity of the single SSA question and the CAFI will be determined by comparing the agreement of each with clinical measures collected by the research assistant. Twenty-four weeks later, follow-up assessments will be collected by the research assistant and third-party experts to determine the predictive validity of the single SSA question and the CAFI. Analyses of the role of substance abuse in money mismanagement will be conducted. PUBLIC HEALTH RELEVANCE: People who spend their disability payments on drugs, alcohol and other non-essentials may not have money left for food and shelter. This proposal will develop and test a measure to identify people who are incapable of managing their funds so that they get the money management help they need.

描述(由申请人提供)：这项研究的目标是通过开发和验证CAFI(临床医生财务能力评估)来改进目前确定患有精神和/或药物滥用障碍的患者何时没有能力管理他们的资金的程序，CAFI是一种简短的临床医生评级工具，用于“诊断”无能力。当残疾人的补充保障收入(SSI)和社会保障残疾保险(SSDI)福利被滥用时，他们会受到伤害，通常是在毒品和酒精上，导致他们没有钱购买住房和其他必需品。代表性受款人可能被分配给没有能力管理其资金的患者，但社会保障管理局(SSA)在很大程度上根据患者临床医生回答的单个问题来决定受款人的分配。临床医生没有得到任何关于考虑药物滥用的指示，尽管它在管理资金方面很重要。这项研究包括预试阶段，在此期间将开发和测试候选项目，包括仪器开发阶段和仪器验证阶段。在前期试验阶段，CAFI的候选项目将由研究团队开发，并与15名临床医生一起进行试点。然后，在仪器开发阶段，将进行三套评估：(A)带有单一SSA问题的问卷和CAFI的候选项目将由临床医生完成，治疗120名住院患者和在日间医院有药物滥用史的患者，并将在一周后再次完成，以确定具有足够的测试-重测可靠性的项目；(B)对患者管理资金能力的所有数据评估将由独立的第三方专家使用L.E.A.D.程序(使用所有可用数据的纵向专家评估)应用于预先定义的标准完成，以及(C)由研究助理对患者实施的临床评分表。将使用单独项目分析、重测信度、探索性因素分析和向后逐步Logistic回归从候选人问卷中挑选一份简短的问卷(CAFI)，其中的项目最好地确定受益人没有能力管理其资金(由所有数据方法确定)。在仪器验证阶段，将收集192名基线患者的CAFI和一组评估(所有数据评估和研究助理评级)。将确定每个临床医生评估(单一SSA问题和CAFI)相对于同时进行的所有数据评估的敏感性和特异性，并将使用系数差异的z检验来比较单一SSA问题和CAFI的准确性。单个SSA问题和CAFI的收敛效度将通过比较每个问题与研究助理收集的临床测量的一致性来确定。24周后，研究助理和第三方专家将收集后续评估，以确定单一SSA问题和CAFI的预测有效性。将对滥用药物在资金管理不善中的作用进行分析。 与公共健康相关：将伤残抚恤金花在药物、酒精和其他非必需品上的人可能没有钱买食物和住所。这项提案将制定和测试一项措施，以识别没有能力管理其资金的人，以便他们获得所需的资金管理帮助。