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IIR 98-154 – HSR&D Study

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IIR 98-154
Homelessness Prevention: Psychiatric Care with Representative Payeeship
Kendon J. Conrad MA PhD MSPH
Edward Hines Jr. VA Hospital, Hines, IL
Hines, IL
Funding Period: January 2001 - June 2004

BACKGROUND/RATIONALE:
Money management is a neglected issue in maintaining persons with mental illness in the community. This randomized controlled trial (RCT) assessed whether a community-based representative payee program, i.e., money management of Social Security and/or VA benefits, coordinated with VA psychiatric care (CO-RP) could be more effective than customary treatment for veterans who had no representative payee.

OBJECTIVE(S):
After 184 subjects were randomly assigned to CO-RP experimental group or customary care control group, hypotheses were that the CO-RP group would experience: 1) more frequent enrollment in the representative payee program, 2) improved residential status, 3) improved health-related quality of life, including less mental illness symptomatology, 4) less substance abuse, 5) improved money management.

METHODS:
Six-month interviews were completed on 152 of 184 possible subjects (83%) and 12-month interviews were completed on 149 of 184 possible subjects (81%). The six and twelve-month outcomes were analyzed with analysis of covariance using data from the baseline pretest.

FINDINGS/RESULTS:
Six-month findings indicated positive effects on quality of life and money management for the full “intention to treat” sample. Residential status approached significance at p=.07. At 12 months, only the measure of psychological symptoms was not affected at a level near p=.05. Positive effects of the experimental program were observed on residential status (p=.06), alcohol (p=.04) and drug use (p=.02), quality of life (p=.03), and money management (p=.001).

IMPACT:
This is the only existing randomized controlled trial on money management for serious mental illness. It indicates that encouraging patients with long-term severe mental illness to voluntarily enter an agency representative payee program can have positive effects on the proximal outcomes of better money management, improved quality of life, and reduced substance use, as well as on the more distal outcome of residential stability.

PUBLICATIONS:

Journal Articles

  1. Conrad KJ, Matters MD, Luchins DJ, Hanrahan P, Quasius DL, Lutz G. Development of a Money Mismanagement Measure and cross-validation due to suspected range restriction. Journal of Applied Measurement. 2006 May 1; 7(2):206-24.
  2. Conrad KJ, Lutz G, Matters MD, Donner L, Clark E, Lynch P. Randomized trial of psychiatric care with representative payeeship for persons with serious mental illness. Psychiatric services (Washington, D.C.). 2006 Feb 1; 57(2):197-204.
  3. Conrad KJ, Wright BD, McKnight P, McFall M, Fontana A, Rosenheck R. Comparing traditional and Rasch analyses of the Mississippi PTSD Scale: revealing limitations of reverse-scored items. Journal of Applied Measurement. 2004 Jan 1; 5(1):15-30.
HSR&D or QUERI Articles

  1. Conrad KJ, Mahableshwarkar A, Lutz G. Money Management for Mental Illness: The Missing Leg on the Table of Community Care. Federal Practitioner. 2003 Sep 1; 20(9): 32-54.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Epidemiology, Treatment - Observational
Keywords: Homeless
MeSH Terms: Mental Health Services

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