Improving Representative Payeeship for People With Psychiatric Disabilities and Their Families

Representative payees, mostly family members, manage Social Security Administration funds of more than one million people with psychiatric disabilities. Although studies show payeeship can be used coercively, foster dependency, reduce work incentives, lead to family conflict and even violence, there has been little systematic research on how to lower these significant barriers to community integration.

The investigators' long term goal is to promote recovery among adults with psychiatric disabilities who have payees by reducing downsides associated with what has been called "the nation's largest guardianship system." The investigators' objective in the current application is to evaluate a pilot-tested, stakeholder-informed intervention that is grounded in principles of psychiatric rehabilitation and encourages consumers with psychiatric disabilities and their family members to collaborate within the representative payee arrangement.

Study Overview

• Status: Completed
• Conditions: Schizophrenia; Bipolar Disorder; Major Depressive Disorder
• Intervention / Treatment: Behavioral: Steps for Achieving Financial Empowerment (SAFE)

Detailed Description

To do this, we will test the Steps for Achieving Financial Empowerment (SAFE) intervention by randomly assigning N=200 consumer-family payee dyads into one of two groups: (a) the SAFE intervention (n=100); or (b) a "usual care" control (n=100). The SAFE is a brief, 5 component educational intervention that aims to facilitate a cooperative consumer-payee relationship, increase accurate knowledge about representative payeeship, promote collaborative money management and effective budgeting, and prepare mutually developed plans for carrying out the payeeship in the future.

We will interview people with psychiatric disabilities and their family payees at baseline and six-months. This study aims to examine the effects of the SAFE intervention on community participation, employment, and family support of adults with psychiatric disabilities who have family representative payees. Our central hypothesis, based on strong preliminary data, is that the SAFE will benefit consumers by enhancing autonomy, boosting motivation to work, and reducing family conflict.

• Study Type: Interventional
• Enrollment (Actual): 303
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599
      • UNC-Chapel Hill

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• For disability recipients:

  1. Meets DSM-IV criteria for schizophrenia, schizoaffective disorder, bipolar disorder, or depressive disorder with psychotic features;
  2. age 18-65;
  3. Has a family member (parent or sibling) as a representative payee.

• For payees:

  1. Has family member (child or sibling) with schizophrenia, schizoaffective disorder, bipolar disorder, or depressive disorder with psychotic features; and
  2. Is the family member's representative payee.

Exclusion Criteria:

• None.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; Subjects will be offered the Steps for Achieving Financial Empowerment (SAFE) which helps facilitate a cooperative consumer-payee relationship, increase accurate knowledge about representative payeeship, promote collaborative money management and effective budgeting, and prepare mutually developed plans for carrying out the payeeship in the future.	Behavioral: Steps for Achieving Financial Empowerment (SAFE); The SAFE is a brief, 5-component intervention that aims to facilitate a cooperative consumer-payee relationship, increase accurate knowledge about representative payeeship, promote collaborative money management and effective budgeting, and prepare mutually developed plans for carrying out the payeeship in the future.
No Intervention: 2; Representative payeeship as usual

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
employment	six months
empowerment	six months
family support	six months

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: U.S. Department of Education
• Investigators: Principal Investigator: Eric B Elbogen, Ph.D., UNC-Chapel Hill

Publications and helpful links

General Publications

• Elbogen EB, Ferron JC, Swartz MS, Wilder CM, Swanson JW, Wagner HR. Characteristics of representative payeeship involving families of beneficiaries with psychiatric disabilities. Psychiatr Serv. 2007 Nov;58(11):1433-40. doi: 10.1176/ps.2007.58.11.1433.
• Elbogen EB, Wilder C, Swartz MS, Swanson JW. Caregivers as money managers for adults with severe mental illness: how treatment providers can help. Acad Psychiatry. 2008 Mar-Apr;32(2):104-10. doi: 10.1176/appi.ap.32.2.104.
• Elbogen EB, Tiegreen J, Vaughan C, Bradford DW. Money management, mental health, and psychiatric disability: a recovery-oriented model for improving financial skills. Psychiatr Rehabil J. 2011 Winter;34(3):223-31. doi: 10.2975/34.3.2011.223.231.

Study record dates

Study Major Dates

• Study Start: May 1, 2008
• Primary Completion (Actual): April 1, 2011
• Study Completion (Actual): April 1, 2011

Study Registration Dates

• First Submitted: June 17, 2009
• First Submitted That Met QC Criteria: June 18, 2009
• First Posted (Estimate): June 19, 2009

Study Record Updates

• Last Update Posted (Actual): June 15, 2018
• Last Update Submitted That Met QC Criteria: June 13, 2018
• Last Verified: May 1, 2011

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Mood Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Bipolar and Related Disorders; Depressive Disorder; Schizophrenia; Disease; Bipolar Disorder; Depressive Disorder, Major
• Other Study ID Numbers: H133G070058