Benefits Management for People with Psychiatric Disabilities

描述（由申请人提供）：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、心理和社会方面的挑战，这使得他们很难将支出与自己的利益结合起来。补充保障收入（SSI）和社会保障残疾保险（SSDI）的受助人可能会被指派代表收款人来管理他们的资金。由于收款人分配不一致，很大比例的精神残疾受益人在管理资金方面有困难，但没有分配收款人。对于因精神疾病致残的客户，自愿援助可能足以改善资金管理。在其他情况下，不指定收款人可能意味着错过了一个机会，因为数据表明，指定收款人与提高治疗依从性有关，如果实施得当，还会带来其他临床效益。第一阶段研究的目的是描述提供资金管理援助的干预措施的可行性和初步效果，并在需要时促进收款人分配。正在接受精神科治疗、接受SSI和/或SSDI并有需要收款人风险的人将被随机分配到福利管理组或控制组，对他们的收入和支出进行审查。利益管理包括以下部分：(a)评估-审查受益人的收入、支出和资金管理习惯；(b)教育及建立关系-协助客户厘清理财目标，并提供意见，协助客户更妥善地理财；(c)技能培养——教客户如何计划一个月的预算。如果资金管理不善持续存在并且有害，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，例如指定代表收款人。如果临床医生指出需要收款人，咨询师将协助收款人分配。福利管理的目的是评估，简短的治疗和分类。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人员、可用收款人和与客户处理金融交易的商家联系的人。根据专家顾问的意见和反复编写和修订，将编写一本描述福利管理的手册。120名参与者将被随机分配到福利管理组或控制组，从疾病管理和康复计划中抽取5个疗程。主要结果将是由观察者评价的生活质量。福利管理的可行性和客户可接受性将以与咨询师会面的次数、客户对干预的满意度、收款人申请的启动、包括感知强制在内的厌恶效果和客户观点的定性分析为特征。

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.