A significant portion of Veterans who apply for disability benefits have difficulty finding and sustaining employment, and are concerned that working for pay will jeopardize their receipt of service-connection benefits. Too frequently, the process of applying for disability fails to include reminders of opportunities for rehabilitation.
Benefits Counseling is an Motivational Interview-formatted counseling intervention designed to help people who are applying for disability benefits learn about opportunities to work and receive service-connection, manage their time productively, manage their money so it furthers their goals, and avail themselves of treatment. In a completed clinical trial, Veterans who received the Benefits Counseling intervention went on to work for pay significantly more often than controls.
A computer-delivered version of the Benefits Counseling intervention tailored to help Veterans applying for service-connection engage in work-related activities was developed and pilot tested. A current clinical trial is testing this counseling's efficacy.
- SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an approach to identifying and treating patients with substance abuse issues who are presenting for purposes other than substance abuse treatment. SBIRT was developed for use in settings such as emergency rooms, and primary care clinics where patients were not seeking substance abuse treatment but had issues potentially related to substance abuse. It involves Motivational Interviewing, which has been a remarkably consistently effective approach to facilitating engagement in substance abuse treatment in Veterans and other populations. Length of time in treatment is arguably the most important predictor of good substance abuse outcomes and Motivational Interviewing that fosters attendance at VA facilities is an efficient way to target substance use. SBIRT-PM’s efficacy is supported by a completed clinical trial of 101 Veterans applying for service-connection for Musculoskeletal Disorders (MSD). A telephone version of SBIRT-PM is currently being tested in a two phase, randomized controlled trial
Interventions are available for clients with psychiatric disabilities who mismanage their funds but there are few validated measures of money mismanagement.
A widely-used intervention, the involuntary assignment of a representative payee, depends on a clinical judgment that the client is incapable of managing funds but there are no validated measures of capability for this population.
Several measures of money mismanagement are being tested.
Structured Clinical Interview for Money Mismanagement (S.C.I.M.M.)
- The S.C.I.M.M. is a semi-structured clinical interview designed to rate the extent of a client’s mismanagement of funds, and can also be scored to rate whether he/she is incapable of managing funds. It involves an assessment of the last year’s expenditures, living situations and costs, and any periods when there was not enough money for housing.
- S.C.I.M.M. Manual
- The client-rated assessment consists of items that address substance use, ability to meet basic needs and spending habits.
- Client-Rated Assessment
Clinician Assessment of Financial Incapability (C.A.F.I.)
- The CAFI is a clinician-rated assessment in the pilot phase of development.
- Black AC, McMahon TJ, Rosenheck RA, Ball SA, Ries RK, Ames D, Rosen MI. Development of the Clinician Assessment of Financial Incapability (CAFI). Psychiatry Res. 2014; 215(3):784-9.
- CAFI Instrument (Phase II)
Financial Incapability Structured Clinical Assessment done Longitudinally (F.I.S.C.A.L)
- The FISCAL measure of financial capability was developed to be a more effective, reliable, and evidence-based method to assess the ability of disabled persons to manage federal disability payments without a representative payee or other fiduciary. It was presented in a poster session at the American Psychiatric Association's 167th Annual Meeting, May 3-7 in New York, New York. Poster: "An All-Data Approach to Assessing Financial Capability in People with Psychiatric Disabilities"
- New Tool May Help Psych Patients Manage Finances. Medscape. May 12, 2014.
- FISCAL Version 7.31.14
Clients who have substance use and/or psychiatric problems often have difficulty managing their funds. ATM therapy was developed to help people stop using drugs and/or alcohol, manage their money better, and improve their quality of life.
The behavioral treatments involve helping people align their money management with their values. For example, ATM (Advisor Teller Money Manager) helps people addicted to drugs or alcohol spend money on abstinence-promoting activities by:
- Storing money so it's not available for impulsive substance use
- Budgeting money so it's designated for the client's abstinence-related goals
- Contracting to spend the client's money if he/she meets weekly goals
ATM Materials available
- To start delivering ATM, download the ATM Therapist Manual.
- To start a program to store client funds, download Managing Program Accounts.
- To train therapists to conduct ATM, download the ATM Training Materials. The manual contains interactive exercises to make learning ATM interesting. It also contains nuts-and-bolts information about how to deliver ATM.
- To get an overview of ATM for clients or therapists, view the ATM film. In this fifteen-minute film, Drs. Rosen and Rosenheck speak about how ATM was developed, therapists describe how to conduct ATM, and Delores describes her experience in ATM.
Black AC, McMahon TJ, Potenza MN, Fiellin LE, Rosen MI: Gender moderates the relationship between impulsivity and sexual risk-taking in a cocaine-using psychiatric outpatient population. Personality and Individual Differences 2015;75:190-194. PMC4278375
Black AC, Serowik KL, Ablondi KM, Rosen MI. Timeline historical review of income and financial transactions: A reliable assessment of personal finances. Journal of Nervous and Mental Disease 2013;201(1):56-9. PMC3535442.
Rowe, M, Serowik KL, Ablondi, K, Wilber C, Rosen MI: Recovery and money management. Psychiatric Rehabilitation Journal 2013; 36 (2): 116-118. PMC3992283
Serowik LK, Bellamy CD, Rowe M, Rosen MI. Subjective experiences of clients in a voluntary money management program. American Journal of Psychiatric Rehabilitation 2013;16(2):136-153. PMC3942091.
McQuaid JR, Marx BP, Rosen MI, Bufka LF, Tenhula W, Cook H, Keane TM: Mental Health Assessment in Rehabilitation Research. Journal of Rehabilitation Research and Development 2012; 49: 121-138.
Rosen MI. Overview of special sub-section on money management articles: cross-disciplinary perspectives on money management by addicts. American Journal of Drug and Alcohol Abuse 2012; 38(1):2-7. PMC3320213.
Rosen MI: Cross-Disciplinary Perspectives on Money Management by Addicts. American Journal of Drug and Alcohol Abuse 2012; 38(1):2-7. PMC3320213
Black AC, Rosen MI: A Money Management-Based Substance Use Treatment Increases Valuation of Future Rewards. Addictive Behaviors 2011; 36: 125-128. PMC2981645
Fries HP, Rosen MI. The efficacy of assertive community treatment to treat substance use. Journal of the American Psychiatric Nurses Association 2011;17(1):45-50..PMC3082444
Rosen MI. The ‘check effect’ reconsidered. Addiction 2011; 106(6):1071-7. PMC3094507
Rosen MI, Rounsaville BJ, Ablondi K, Black AC, Rosenheck RA: Advisor-Teller Money Manager (ATM) Therapy for Substance Use Disorders. Psychiatric Services 2010; 61(7): 707-713. PMC3064073
- This study developed and piloted an intervention program delivered by phone and supported information technology that combined contingency management for medication adherence and a cognitive-behavioral approach to both adherence to antiretroviral therapy and abstinence from substances of abuse. The intervention, CARE (Centralized Off-site Adherence Enhancement Program), builds on the published finding that adherence was robustly improved and viral load was significantly reduced among patients who received cash-reinforcement for opening MEMS-capped bottles to take prescribed medication on time.
Benefits Management is designed for people who are "at risk" for needing a payee because of a disabling psychiatric illness. It is important to determine whether a client who is mismanaging money can be helped with a brief intervention or should be assigned a representative payee to manage the funds. If a payee is needed, therapists should inform their client, and assist the client in selecting and training a payee to manage funds therapeutically. In Benefits Management, therapists help clients make a budget for the month, track the clients' success at adhering to the budget and if necessary, discuss with the client whether a payee is needed.
Benefits Management Materials Available
- The Benefits Management Therapist Manual is being developed.
- References about Benefits Management will be made available.
G.I.F.T. is a time-limited psycho-education curriculum for people with psychiatric illnesses. It is designed to help disabled people manage their money better, and provides basic training in setting financial goals, budgeting, and avoiding common financial traps.
- To start delivering G.I.F.T., download the G.I.F.T. Therapy Manual