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
CAFI (Clinical Assessment of Financial Incapability)
The goal of this study is to improve upon the current procedure for determining when patients with psychiatric and/or substance use disorders are incapable of managing their funds by validating a brief clinician-rated instrument to “diagnose” incapability. Disabled people are harmed when their Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits are misspent, often on drugs and alcohol, leaving them without money for housing and other essentials. A representative payee may be assigned to patients who are incapable of managing their funds but the Social Security Administration (SSA) largely decides on payee assignment based on a single question answered by the patient’s clinician. Clinicians are given no instruction to consider substance use, despite its importance in managing funds.
This study involves two phases- an instrument development phase and an instrument validation phase. In Phase One, candidate items for the instrument will be developed by the research team and pre-piloted with 15 clinicians. Then, three sets of assessments will be conducted: (a) clinicians treating 120 acutely ill patients (inpatients and those in outpatient day hospitals) will complete questionnaires with the candidate items and rate their patients’ capability to manage their funds, and sixty clinicians will repeat the assessments 1 week later to identify items with adequate test-retest reliability, (b) independent third-party experts will conduct alldata assessments of patients’ capability to manage their funds using the L.E.A.D. procedure (Longitudinal Expert Evaluation Using All Available Data) applied to pre-defined criteria, and (c) a research assistant will administer clinical rating scales to patients. Individual item analysis, test-retest reliability, exploratory factor analysis and backwards stepwise logistic regression will be used to cull a brief questionnaire from the candidate questionnaire with items that best identify beneficiaries incapable of managing their funds (as determined by the all data approach). In Phase Two, the clinician questionnaire culled from Phase One and a similar series of assessments (all-data evaluation, and research assistant ratings) will be collected for 160 acutely ill patients at baseline. The sensitivity and specificity of each of the clinician assessments (brief questionnaire and single SSA question) vis a vis the concurrent all-data assessment will be determined and the accuracy of the single SSA question and the brief questionnaire will be compared using a z-test of differences between coefficients. The convergent validity of each of the clinician assessments will be determined by comparing the agreement of each assessment with clinical measures collected by the research assistant. Twenty-four weeks later, follow-up assessments will be collected by the research assistant and third-party experts to determine the predictive validity of the initial clinician untutored judgment and brief clinician instrument. Secondary analyses will be conducted of the role of substance use in capability determination.
Lazar MC, Black AC, McMahon TJ, Rosenheck RA, Ries R, Ames D, Rosen MI. All-data approach to assessing financial capability in people with psychiatric disabilities. Psychological Assessment. 2016; 28(4):362-71. PMC4703571. https://www.ncbi.nlm.nih.gov/pubmed/26146947
Moore BA, Black AC, Rosen MI: Factors Associated with Money Mismanagement Among Adults with Severe Mental Illness and Substance Abuse. International Journal of Mental Health and Addiction. 2016;4(4):400-9. doi: 10.1007/s11469-015-9625-3.
Lazar CM, Black AC, McMahon TJ, O’Shea K, Rosen MI. Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities. Psychiatric Services 2015; 66(3):279-84. PMC4402222. https://www.ncbi.nlm.nih.gov/pubmed/25727116
Black AC, McMahon TJ, Rosenheck RA, Ball SA,Ries RK, Ames D, Rosen MI. Development of the Clinician Assessment of Financial Incapability (CAFI). Psychiatry Research 2014; 215(3):784-9. PMC3959734. https://www.ncbi.nlm.nih.gov/pubmed/24495575
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.
Claycomb M, Black AC, Wilber C, Brocke S, Lazar CM, Rosen MI. Financial victimization of adults with severe mental illness. Psychiatric Services 2013; 64(9):918-20. PMC4276043. https://www.ncbi.nlm.nih.gov/pubmed/24026837
Rosen MI, Afshartous D, Nwosu S, Scott MD, Jackson JC, Marx BP, Murdoch MM, Sinnot PL, Speroff T: Racial Differences in Veterans’ Satisfaction with Examination of Disability from Posttraumatic Stress Disorder. Psychiatric Services. 2013; 64 (4): 354–359. doi: 10.1176/appi.ps.201100526 PMID: 23318842.
- Clinicial Assessment of Financial Incapaibility (CAFI): http://medicine.yale.edu/psychiatry/behaviorchange/assess/CAFI%20Instrument%20Phase%20II%209-27-12_tcm363-190358_tcm363-284-32.pdf
- Financial Incapability Structured Clinical Assessment Done Longitudinally (FISCAL): http://medicine.yale.edu/psychiatry/behaviorchange/assess/FISCAL%20Version%207.31.14_tcm363-194718_tcm363-284-32.pdf
- Structured Clinical Interview for Money Management (SCIMM): http://www.behaviorchange.yale.edu/assess/SCIMM-2008_tcm363-37206_tcm363-284-32.pdf
- Timeline Historical Review of Income and Financial Transactions (THRIFT): http://www.behaviorchange.yale.edu/addresources/THRIFT%20Manual_tcm363-120537_tcm363-284-32.pdf