OBJECTIVE: A survey was conducted to evaluate the representative payee
practices of community mental health centers (CMHCs) in Washington State,
with emphasis on whether and how benefit disbursement practices were linked
to patients' clinical behaviors, especially substance use. METHODS: A
survey was pilot tested with several clinicians and sent to all 80 licensed
CMHCs in Washington State. Data were analyzed using t tests, Pearson r
correlations, and regression analysis. RESULTS: Of 41 responding agencies,
30 (73 percent) reported providing payee services for at least some of
their patients, approximately one-third of whom had a dual diagnosis of a
mental illness plus an alcohol or drug disorder. The frequency of benefit
disbursement, but not the overall amount of funds disbursed, was moderately
to highly linked by contingency management to patients' money management
skills, substance use, and level of functioning; it was less tightly linked
to treatment attendance. Larger and more experienced programs reported
tighter linkage between benefit disbursement frequency and patients'
behavior than did smaller programs. Responses also indicated a significant
need for more clearly articulated guidelines for payee benefit management.
CONCLUSIONS: Despite a lack of studies demonstrating the effectiveness of
representative payee practices, CMHCs appear to be using contingency
techniques to link benefit disbursement to clinical behaviors. Further
studies of these practices, their outcomes, and associated ethical issues
are needed.
Abstract Teaser