Payees, Disability Payments and Dual Diagnosis

描述（由申请人提供）： 这是一项R21赠款申请，用于进行3项二级数据分析研究，涉及ACCESS研究（获得社区护理和有效服务和支持）参与者之间的收款人分配需求。在这项耗资1亿美元的独特研究中，9个不同州18个地点的社区机构为患有严重精神疾病的无家可归者提供了积极的社区治疗（ACT）。7229名参与者中的大多数伴有药物滥用障碍。值得注意的是，对于那些众所周知难以跟踪的患者，90.5%的患者，共计7055人，在随后的12个月内完成了随访评估。此外，社会保障管理局同意提供详细资料，说明参与者每月领取社会保险补助金的确切数额、社会保障保险倡议补助金和受款人身份。研究1：根据广为宣传的残疾津贴用于滥用药物的例子，但很少对实际风险进行经验性检查，人们普遍认为，向没有收款人的病人支付残疾津贴有助于药物滥用。第一项研究将探讨的问题是：领取残疾补助金与随后滥用药物之间有什么联系？残疾支付和其他临床结果之间的关联，如精神病学，生活质量，无家可归，监禁和住院治疗也将被考虑。多水平分层线性模型将代表随时间推移的结局嵌套在受试者内，受试者嵌套在研究中心内的事实。研究2：为了减少资金的滥用，社会保障管理局和退伍军人福利管理局可以指定一个代表收款人或受托人来管理受益人的付款。 双重诊断受者的受款人分配标准是模糊的，我们小组根据对法律的和政策问题的审查，定义了使用药物的患者无法管理自己资金的标准（罗森和Rosenheck，1999）。目前还不清楚实际上是否使用这些收款人分配标准或其他隐含标准。研究2将解决的问题：什么样的物质使用和其他特征区分残疾津贴谁是指定的收款人从那些谁没有？研究3：受款人分配涉及相当大的削减受助人的自由作出支出决定，但鲜为人知的是，payeeship的疗效，改善药物滥用和其他临床困难。研究3解决了这个问题：药物使用和其他结果之间的受益人谁被指定为收款人来管理他们的资金和那些支票直接邮寄给他们的不同？倾向缩放将用于创建匹配的样本。这些研究将解决有关残疾付款的分配和双重诊断受益人的收款人的分配的基本问题，这些问题不能通过前瞻性试验在伦理上解决。

DESCRIPTION (provided by applicant): This is an R21 grant application to conduct 3 secondary data analysis studies concerning the need for payee assignment among participants in the ACCESS study (Access to Community Care and Effective Services and Supports). In this unique 100 million dollar study, community agencies in 18 locations in 9 different states provided Assertive Community Treatment (ACT) to homeless persons with severe mental illness. Most of the 7229 participants had concomitant substance abuse disorders. Remarkably for patients who are notoriously difficult to track, 90.5 percent of patients, a total of 7055, completed a follow-up assessment during the subsequent 12 months. In addition, the Social Security Administration has agreed to provide detailed information describing participants' exact month-by-month amount of SSI benefits, SSDI benefits and payee status. STUDY 1: Based upon highly publicized instances of disability payments being spent for drugs of abuse but few empirical examinations of the actual risk, it is widely believed that disability payments to patients without payees contribute to substance abuse. The first study will address the question: What is the association between receipt of disability payments and subsequent substance abuse? The association between disability payments and other clinical outcomes such as psychiatric symptomatology, quality of life, homelessness, incarceration, and hospitalization will also be considered. Multi-level hierarchical linear models will represent the fact that outcomes over time are nested within subjects, and subjects are nested within sites. STUDY 2: In order to curtail misuse of funds, the Social Security Administration and Veterans Benefits Administration may assign a representative payee or fiduciary to manage a beneficiary's payments. The criteria for payee assignment to dually diagnosed recipients are vague, and our group has defined criteria for when patients who use drugs are incapable of managing their own funds, based on a review of legal and policy concerns (Rosen and Rosenheck, 1999). It is unclear whether these criteria for payee assignment or other implicit criteria are used in practice. Study 2 will address the question: What substance use and other characteristics distinguish those recipients of disability payments who were assigned payees from those who were not? STUDY 3: Payee assignment involves considerable curtailment of a recipients' liberty to make spending decisions but little is known about payeeship's efficacy in ameliorating substance abuse and other clinical difficulties. Study 3 addresses the question: Do substance use and other outcomes differ between beneficiaries who were assigned payees to manage their funds and those whose checks were mailed directly to them? Propensity scaling will be used to create matched samples. These studies will address fundamental questions about dispensing of disability payments and assignment of payees to dually diagnosed beneficiaries, questions that cannot be ethically addressed by prospective trials.