The purpose of this application is to determine, in a randomized clinical trial, whether a community-based representative payee program coordinated with VA psychiatric community care (CO-RP) can be more clinically effective and less costly than customary treatment for veterans who have no representative payee (RP) or RP that is not coordinated with their care.

Two hundred and forty study subjects would: 1) meet the criteria for enrollment in the CO-RP program, i.e., chiefly, at risk for homelessness due to money management problems; 2) have a serious mental illness, possibly with a co-occurring substance use disorder; and 3) be engaged with the VA mental health treatment system. The study would assess utilization of services to examine the appropriateness of causal inferences as well to enable cost comparisons. It would also describe and document the implementation of CO-RP versus customary care. The implementation measures will assess dosage and enable replicability if outcomes are positive or recommendations for improvement if outcomes are negative or equivocal. The hypotheses to be tested are listed below with the measures of the constructs in parentheses.

The hypotheses are that, relative to customary care control group participants, the CO-RP participants will experience: 1) improved housing stability (Residential Follow Back Calendar and American Housing Survey, adapted), 2) improved financial stability (Money Management and Financial Victimization Questionnaire), 3) improved health-related quality of life, including less mental illness symptomatology (SF-36V, Colorado Symptom Index), 4) less substance abuse and dependence (Drug and Alcohol Follow Back Calendar, Addiction Severity Index (ASI), Drug and Alcohol Use Scales), and 5) reduced hospitalization and ER use with increased social and outpatient services for a net reduced cost (VA data bases and Treatment Services Review). To enable testing of treatment group by subgroup status interaction effects, the sample will be blocked on: substance abuse versus non-substance abuse using ASI criterion; low or high (IPCC) level of case management; low or high income split at the current mean income of $717. The outcomes will be analyzed with random effects analysis of covariance using data from a baseline pretest and six and twelve month posttests. The intervention is relevant to the VA since it involves an enhancement to current treatment that is rarely used but is potentially available nationwide, e.g., through agencies such as those used by the Social Security Administration. Also, CO-RP requires modest additional resources while having the potential to promote the more appropriate use of benefits, improve the outcomes of care, and reduce utilization of more expensive services for a possible net reduction in costs.

Genders Eligible for Study:  Both

Accepts Healthy Volunteers

Criteria

Inclusion Criteria:

• Severe mental illness
• Inability to manage money
• VA patient