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

描述（由申请人提供）：本研究的目的是通过开发和验证CAFI（临床医生财务能力评估），一种简短的临床医生评估工具来“诊断”无能力，以改善当前用于确定精神病和/或药物滥用障碍患者何时无法管理其资金的程序。残疾人受到伤害时，他们的补充保障收入（SSI）和社会保障残疾保险（SSDI）的福利被滥用，往往在毒品和酒精，使他们没有钱住房和其他必需品。一个代表性的收款人可能会被分配给那些没有能力管理他们的资金的病人，但社会保障管理局（SSA）主要根据病人的临床医生回答的一个问题来决定收款人的分配。尽管药物滥用在管理资金方面很重要，但临床医生没有得到考虑药物滥用的指示。本研究包括一个预试验阶段，在此期间将开发和测试候选项目，一个仪器开发阶段和一个仪器验证阶段。在预试点阶段，CAFI的候选项目将由研究团队开发，并与15名临床医生进行试点。然后，在仪器开发阶段，将进行三组评估：（a）为120名有滥用药物纪录的住院病人及日间医院病人进行治疗的临床医生，会填写问卷，其中包括单一的社会服务满意度问题及CAFI的候选项目，并会在一星期后再次填写问卷，以找出有足够信度的项目，（B）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）按照预定义的标准完成对患者管理其资金能力的所有数据评估，以及（c）由研究助理向患者提供临床评级量表。将使用单项分析、重测信度、探索性因素分析和向后逐步逻辑回归从候选问卷中挑选出一份简短问卷（CAFI），其中包含最能识别无法管理其资金的受益人的项目（由所有数据方法确定）。在仪器确认阶段，将收集192例患者基线时的CAFI和一系列评估（所有数据评价和研究助理评级）。将确定每项临床医生评估（单一SSA问题和CAFI）相对于同期所有数据评估的灵敏度和特异性，并使用系数间差异的z检验比较单一SSA问题和CAFI的准确度。通过比较研究助理收集的临床指标与单一SSA问题和CAFI的一致性，确定其收敛效度。24周后，研究助理和第三方专家将收集随访评估，以确定单一SSA问题和CAFI的预测有效性。将对药物滥用在资金管理不善中的作用进行分析。

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.