Services Effectiveness Research Program (SERP)

Duke University School of Medicine
Department of Psychiatry and Behavioral Sciences

Current and Recent Projects

Title: Improving Representative Payeeship for People with Psychiatric Disabilities and their Families

Sponsor: NIDRR through UNC-CH

Principal Investigator(s): Eric Elbogen, PhD; Jeffrey Swanson, PhD

SERP Investigators & Collaborators: Marvin Swartz, MD

Project Description: Representative payees, mostly family members, manage Social Security Administration funds of more than one million people with psychiatric disabilities. Although studies show payeeship can be used coercively, foster dependency, reduce work incentives, lead to family conflict and even violence, there has been little systematic research on how to lower these significant barriers to community integration.

Our long term goal is to promote recovery among adults with psychiatric disabilities who have payees by reducing downsides associated with what has been called “the nation's largest guardianship system.” Our objective in the current application is to evaluate a pilot-tested, stakeholder-informed intervention that is grounded in principles of psychiatric rehabilitation and encourages consumers with psychiatric disabilities and their family members to collaborate within the representative payee arrangement.

To do this, we will test the Collaborative Representative Payeeship (Co-RP) intervention by randomly assigning N=200 consumer-family payee dyads into one of two groups: (a) the Co-RP intervention ( n =100); or (b) a “usual care” control ( n =100). The Co-RP is a brief, 4-session intervention that aims to facilitate a cooperative consumer-payee relationship, increase accurate knowledge about representative payeeship, promote collaborative money management and effective budgeting, and prepare mutually developed plans for carrying out the payeeship in the future.

We will interview people with psychiatric disabilities and their family payees at baseline and six-months. This study aims to examine the effects of the Co-RP intervention on community participation, employment, and family support of adults with psychiatric disabilities who have family representative payees. Our central hypothesis, based on strong preliminary data, is that the Co-RP will benefit consumers by enhancing autonomy, boosting motivation to work, and reducing family conflict.

We are well prepared to pursue this study because of our peer-reviewed research in this area and our success completing large scale empirical studies examining the impact of laws and policies on people with psychiatric disabilities and their families. The current research is innovative because it will lead to a brief, targeted, cost-effective, and feasible method for helping disability beneficiaries potentially become less reliant on disability funds and more likely to work and become independent in the community.

At the end of this project, we expect to establish that a systematic, evidence-based approach can greatly bolster self-determination and empowerment for a substantial number of people with psychiatric disabilities. We plan to construct a user-friendly, transportable manual so that mental health clinicians can readily implement the Co-RP intervention when serving consumers who have family payees. We anticipate that the primary impact of this proposal will be the evaluation of a novel and effective procedure to maximize full inclusion and integration into society and to promote independent living and family support for individuals with psychiatric disabilities.