A Systematic Review of Health Outcomes Associated With Provision of Representative Payee Services
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Results
Primary Outcomes
Population and location | Representative | Outcome | ||||
---|---|---|---|---|---|---|
Study | Intervention | payee | Primary | Secondary | Main findings | |
Angell et al., 2007 (14) | Individuals receiving services from a large, urban community mental health center | Case management services and representative payee services managed in a nonclinical department. Case managers served as fiduciary authority (“clinician payee”). Clients with a clinician payee (N=84) were compared with those with a noninstitutional payee (N=23) and those without a payee (N=94). | Mental health or other service agency | Client-provider relationship, financial leverage, perceived coercion | In bivariate analyses, having a clinician payee was associated with experiencing financial leverage (p<.001) and with client-provider conflict (p<.001) but not with client-provider bond. Client-reported experiences of financial leverage mediated the relationship between having a clinician payee and reporting client-provider conflict. | |
Conrad et al., 2006 (12) | Individuals receiving care from the VA in Chicago | Individuals were randomly assigned to receive representative payee services through a community agency that coordinated services with the VA (N=94) or general case management through the VA, where they could receive representative payee services through usual channels but not in a coordinated fashion (N=90). Individuals were followed for 12 months. | Mental health or other service agency | Housing stability, health-related quality of life, symptoms of mental illness, substance use | Money management | At 12 months, participants in the intervention arm reported significantly fewer drinks (β=–16.0, p=.04) and drug months (β=–.5, p=.02), higher quality of life (β=.5, p=.03), and lower money mismanagement (β=–.5, p<.001), compared with participants in the control arm. Intervention participants reported fewer days of homelessness, but results did not reach significance. Not all intervention participants and some control arm participants received representative payee services. |
Elbogen et al., 2003 (16) | Individuals with serious mental illness in nine counties in North Carolina | Individuals were randomly assigned to receive mandated involuntary outpatient commitment (OPC) to avoid hospitalization and followed for 12 months. Analyses compared those who received OPC and representative payee services (N=62), those who received representative payee services but not OPC (N=46), those who received OPC but not representative payee services (N=85), and those who received neither OPC nor representative payee services (N=65). | No detail provided. Study tracked only whether participants had representative payee assignment. | Treatment adherence | Financial leverage, perceived coercion | Compared with individuals who did not have a representative payee at any point in 12 months, those who added a new representative payee during the year had 3.85-higher odds of better treatment adherence (p=.003). Having a representative payee alone (odds ratio [OR]=3.44, p=.004) or in conjunction with OPC (OR=3.82, p<.001) was associated with perceived coercion. |
Elbogen et al., 2003 (33) | Individuals with serious mental illness in nine counties in North Carolina | Individuals were randomly assigned to receive mandated OPC to avoid hospitalization. Analyses used baseline assessment data and compared individuals who were receiving payee services at baseline (N=109) and those who were not (N=149). | No detail provided. Study tracked only whether participants had representative payee assignment. | Financial leverage, perceived coercion | Individuals with a representative payee had 5.14-higher adjusted odds of reporting perceived coercion (p<.001). | |
Elbogen et al., 2003 (28) | Individuals with serious mental illness in nine counties in North Carolina | Individuals who were awaiting discharge on outpatient commitment from one of four hospitals and receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) (N=240) were recruited into a randomized trial. Analyses used baseline data prior to randomization. Individuals receiving representative payee services (N=70) were compared with those who had another money management arrangement (N=33). | No detail provided. Study tracked only whether participants had representative payee assignment. | Substance use, insufficient funds for housing | Compared with individuals with informal money management arrangements, those receiving representative payee services had greater odds of comorbid substance use disorders (OR=4.28, p<.01) and lower odds of reporting insufficient funds for housing (OR=.13, p<.05). | |
Elbogen et al., 2005 (18) | Individuals with serious mental illness in nine counties in North Carolina | Individuals were randomly assigned to receive mandated OPC to avoid hospitalization and followed for 12 months. The study assessed 245 individuals who were followed through four follow-up time points (0, 4, 8, and 12 months). Those whose family member served as a payee (N=75) were compared with those with a nonfamily payee or no payee (N=170). | Family member or non–family member payee | Family violence | Having a family representative payee was associated with family violence (bivariate: OR=1.93, p=.05; multivariable: OR=2.11, p=.04). | |
Hawk et al., 2016 (17) | Individuals living with HIV and receiving supportive housing | Representative payee services were offered to individuals living in a supportive housing program for people living with HIV. Individuals (N=18) were followed for 6 months. | Mental health or other service agency | HIV viral load suppression | The number of individuals who were virally suppressed significantly increased 6 months after enrollment in representative payee services (p=.004). | |
Herbst et al., 1996 (31) | Individuals who received an initial SSI or SSDI check while in treatment in a methadone maintenance treatment program in San Francisco | An observational study of 26 individuals; of those for whom payee status could be ascertained (N=18), eight had a representative payee. They were compared with the ten without a payee. | No detail provided. Study tracked only whether participants had representative payee assignment. | Substance use, treatment adherence | No association was found between receipt of representative payee services and substance use outcomes, but individuals without a payee missed significantly more clinic attendance days after check receipt, compared with before check receipt (median increase of missed days from 4 to 14, p=.02). | |
Labrum, 2017 (36) | U.S. adults who reported having a relative with a psychiatric disorder and responded to an online survey | Respondents were included if they were age 55 or older (N=243). Whether the family member served as an official representative payee was assessed in a regression model predicting violence. | Family member | Physical, financial, or psychological abuse perpetration | Serving as a representative payee was associated with experiencing financial abuse (“In the past 6 months how many times has s/he [the relative with a psychiatric disorder] misused or stolen any of your funds, property, or assets?”; OR=2.76, p=.05) but was not associated with physical or psychological abuse. | |
Labrum, 2018 (30) | U.S. adults who reported having a relative with a psychiatric disorder and responded to an online survey | Respondents (N=573) were asked if they provided money management on behalf of their relative in the past 6 months. Those who provided “official” money management (representative payee) (N=101) were compared with those who provided “unofficial” money management (N=155). | Family member | Psychiatric hospitalization, treatment adherence, substance use, arrest history | Among relatives with a psychiatric disorder, 57% of those whose family member served as a representative payee had a psychiatric hospitalization in the past year, compared with 35% of those whose family member provided unofficial money management services (p<.001). Those receiving representative payee services were more likely to have attended regular mental health treatment in the past 6 months, compared with those receiving unofficial assistance (78% versus 61%, p=.005). No difference between the two groups was found in rates of substance use in the past 6 months or adulthood history of arrest. | |
Labrum and Solomon, 2016 (35) | U.S. adults who reported having a relative with a psychiatric disorder and responded to an online survey. | Respondents (N=573) were categorized by whether their family member with a psychiatric disorder had enacted any violence against them in the past 6 months (N=124). Whether the family member served as an official representative payee (N=101) was assessed in a regression model predicting violence. | Family member | Violence perpetration | In a multivariate model controlling for all factors significantly associated with family violence, family members who served as representative payees had 2.93-higher odds of experiencing violence perpetrated by their family member with a psychiatric disorder (p<.001). | |
Luchins et al., 1998 (10) | Individuals with serious mental illness receiving services at a community mental health center in Chicago | Services provided by the Community Counseling Center of Chicago included case management, day treatment, budgeting assistance, and assistance locating housing. Representative payee services were delivered at the agency. Analyses compared the 12 months before and 12 months after representative payee enrollment of center clients (N=56). | Mental health or other service agency | Health care utilization | A reduction was noted in the mean number of days of state hospitalization (length of stay reduced by 61.1 days, p<.001) and the frequency of admissions (reduced by .8, p<.001) after receipt of services that included representative payee services. Similar reductions were observed for a subsample of individuals for whom data were available on Medicaid-funded private hospitalizations. | |
Moore, et al., 2016 (34) | Adults receiving SSI or SSDI who were receiving services from one of five outpatient mental health programs in Connecticut | A secondary analysis of baseline data from a randomized trial that assessed money management–focused treatment (N=107) | No detail provided. Study tracked only whether participants had representative payee assignment. | Money management | Receipt of representative payee services was not associated with self-reported money mismanagement (measured by the problems with managing money scale from the Money Management Questionnaire). | |
Ries and Comtois, 1997 (13) | Individuals with co-occurring serious mental illness and an alcohol or drug use disorder receiving services in a large, urban, outpatient, and university-linked program for treatment of co-occurring disorders | The program included staff and treatment modalities from systems that provided alcohol and drug treatment and systems that provided treatment for persons with serious mental illness. Individuals (N=275) received care from case managers, nurses, and doctors, who used a harm reduction approach. Analyses compared those who received representative payee services from the program (N=116) and those without payee services (N=159). | Mental health or other service agency | Housing stability, health care utilization, substance use treatment, incarceration | Representative payee services were associated with higher outpatient service utilization; total hours of services used in the past 90 days was higher by an average of 30.3 hours for individuals with representative payee versus not (p<.002). There were no significant differences in housing stability measures, psychiatric hospitalization, addiction treatment, or days incarcerated in the past 90 days. | |
Rosen et al., 2007 (11) | Individuals from multiple locations with serious mental illness who were experiencing homelessness | As part of the Access to Community Care and Effective Services and Supports (ACCESS) demonstration project, individuals in 18 communities in 9 states received assertive outreach and case management services. A total of 1,457 received Social Security benefits and completed at least 1 follow-up assessment within 12 months after enrollment. The analysis compared those who did not receive representative payee services (N=969) with those who were newly assigned a payee between months 0 and 3 (N=174) and between months 4 and 12 (N=314). | No detail provided. Study tracked only whether participants had representative payee assignment. | Substance use, housing stability, health care utilization | Having a representative payee was not associated with housing measures or substance use outcomes. Individuals who obtained a representative payee between months 4 and 12 used significantly more days of psychiatric services (p=.07) and significantly higher numbers of health and social services (housing, mental health, substance abuse, general health, and vocational) in the past 60 days (p=.006), compared with individuals who were not assigned a representative payee and those who were assigned a payee between months 0–3. | |
Rosenheck et al.,1997 (27) | Individuals from multiple locations with serious mental illness who were experiencing homelessness | As part of the ACCESS demonstration project, individuals in 18 communities in 9 states received assertive outreach and case management services. Analyses compared data from individuals at baseline to 3-month follow-up (N=1,348). Those who obtained a payee during the 3 months (N=144) were compared with 3 other groups: public support beneficiaries who had a payee for the entire 3-month period (N=125), public support beneficiaries who were never assigned a payee (N=663), and those who received neither public support nor payee services (N=416). | No detail provided. Study tracked only whether participants had representative payee assignment. | Substance use, symptoms of mental illness, housing stability | The two groups that received representative payee services for at least part of the observation period reported a greater decrease in homeless days, compared with the other groups. Percentage changes in homeless days were as follows: newly started representative payee services (N=140), –56%; continued representative payee services (N=115), –58%; public support only (N=623), –48%; no public support and no payee (N=400), –51% (p=.001). Representative payee services were not associated with substance use outcomes or severity of mental illness symptoms. | |
Swartz et al., 2003 (32) | Individuals from Chicago, Los Angeles, and Seattle, whose SSI disability benefits for drug and alcohol dependence were terminated in January 1997 | An observational study of the effect of termination of SSI disability benefits for individuals with drug and alcohol addiction. Individuals (N=740) were randomly selected and interviewed between December 1996 and April 1997 and then followed for 12 months. Among those who requalified for SSI in the 12 months after termination (N=247), those who received representative payee services were compared with those who did not (Ns not reported). | No detail provided. Study tracked only whether participants had representative payee assignment. | Substance use | Representative payee services were not associated with substance use outcomes. | |
Weiser et al., 2006 (29) | Men who were homeless or marginally housed and living with HIV in San Francisco | Respondents (N=239) were surveyed every 2 years; data were from the 1999–2000 survey wave. Whether the person received representative payee services was assessed in a regression model predicting depressive symptoms. | No detail provided. Study tracked only whether participants had representative payee assignment. | Depression | Individuals receiving representative payee services had higher adjusted odds of reporting depressive symptoms on the Beck Depression Inventory, compared with those who did not receive representative payee services (adjusted OR=2.37, p<.05). |
Housing stability.
Mental health outcomes.
Substance use.
Other primary outcomes.
Secondary Outcomes
Therapeutic relationship.
Financial leverage.
Other outcomes.
Methodological Quality
Discussion
Conclusions
Acknowledgments
Supplementary Material
References
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