OBJECTIVE: Assignment of representative payees, third parties
responsible for managing clients' funds, has been proposed to counter
potential use of public support payments for abused substances by people
with severe mental illness and substance use disorders. This study examines
substance use outcomes in a sample of homeless persons with serious mental
illness and substance use disorders, some of whom were assigned
representative payees. METHODS: The subjects were participating in the
Access to Community Care and Effective Services and Supports (ACCESS)
program, a federally funded demonstration program on integrating service
systems. Clients were assessed at baseline and three months after case
management services were initiated. Factorial repeated-measures analysis of
covariance was used to examine substance use among four client subgroups,
two of which had payees and two of which did not. RESULTS: Clients in this
sample (N = 1,348) showed significant improvement on all measures of
substance use over the first three months in the program. Those with payees
showed no greater improvement in substance abuse than those without payees,
although they did have fewer days of homelessness. CONCLUSIONS: This study
failed to find evidence that merely adding external money management
services to existing services improves substance abuse outcomes among
clients who had dual diagnoses and were homeless. Besides assigning a
payee, structured behavioral interventions may be needed to produce
additional clinical benefits.
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