Rk. Ries et Dg. Dyck, REPRESENTATIVE PAYEE PRACTICES OF COMMUNITY-MENTAL-HEALTH-CENTERS IN WASHINGTON-STATE, Psychiatric services, 48(6), 1997, pp. 811-814
Objective: A survey was conducted to evaluate the representative payee
practices of community mental health centers (CMHCs) in Washington St
ate, with emphasis on whether and how benefit disbursement practices w
ere 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 4
1 responding agencies, 30 (73 percent) reported providing payee servic
es for at least some of their patients, approximately one-third of who
m had a dual diagnosis of a mental illness plus an alcohol or drug dis
order The frequency of benefit disbursement, but not the overall amoun
t of funds disbursed, was moderately to highly linked by contingency m
anagement to patients' money management skills, substance use, and lev
el 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 smalle
r programs. Responses also indicated a significant need for more clear
ly articulated guidelines for payee benefit management. Conclusions: D
espite a lack of studies demonstrating the effectiveness of representa
tive 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 ne
eded.