A Winning Team: The Clinician and the Payee

October 2005
Treating substance abuse and mental illness is much more complicated than treating a physical ailment. Identifying the problem may be simple, but coming up with a care and treatment plan can become quite complex. Complexity can be addressed by utilizing a multi-disciplinary treatment team creating an integrated system of care.

This team, analogous to a sports team, needs a quarterback. The quarterback calls the plays. That quarterback is the clinician. The clinician is trained in the complex issues associated with the service need and best trained to determine the needs of the client. At times the clinician is faced with the daunting task of developing a budgeting strategy so that the client will have enough money left over at the end of the month for food and other necessities and to relieve the client of the stresses associated with daily money management decisions. This means adding a representative payee to the treatment team.

The representative payee is responsible for the food/shelter and clothing needs of the client. Representative payees fall into three categories. The simplest is a relative or trusted associate of the client who takes over the responsibility of money management. There is no need for extra staff, but the clinician is required to monitor closely to insure that funds are being used according to the treatment plan. The next level is a program-based representative payee. This works as long as the client remains in the program, but breaks down should the client leave the program for any reason. Finally we have representative payee services from an independent community-based non-profit organi-zation. This representative payee is a service multiplier able to highlight the therapeutic alliance required to meet all treatment goals.

The benefits of this latter representative payee may go well beyond money manage-ment for basic living needs. The independent payee is in frequent communication with the treatment team to ensure coordination of services. The payee also reduces inpatient and emergency hospitalizations, increases treatment compliance, improves quality of life, reduces victimization related to money and leads to an efficient use of other com-munity services.

As with the sports analogy, the clinician directs the treatment plan and the representa-tive payee provides fiscal stability are thereby creating a winning team.

Artilce provided by Ed Doonan, Living in Familiar Environments (L.I.F.E.) (916)718-5603 Ed@webpayee.com