This is the first study to compare clinician summary judgment to a criteria-based, semi-structured interview to rate money mismanagement. The findings suggest that the semi-structured clinical interview was reliable and valid, but raised questions about whether clinician summary judgment was. The semi-structured clinical interview demonstrated excellent test-retest reliability and, as expected, was correlated with client-rated money mismanagement and with the GAF, providing evidence for its validity. One reason for its high reliability may be that the interview assessed two concrete measurable behaviors: homelessness and substance-related harm.
However, the SCIMM did not correlate with amount spent on substances in the last 28 days. This may reflect the interview’s review of substance purchases over a one-year time frame instead of a 28-day time frame or that the exact amount spent on drugs and alcohol may not necessarily relate to the extent of harm experienced by the beneficiary. There is evidence that people with disabling mental illnesses use relatively small amounts of drugs but incur substantial harm from this use (Lehman et al., 1996
Two limitations of this study were the small sample size (n = 46) and the convenience sample enrolled. The convenience sample in this study was selected from various settings, including substance detoxification units and psychiatric inpatient and outpatient units, and represents a heterogeneous population. Capability measures may have different psychometric characteristics in other client populations and clinicians at other institutions. Other limitations to be addressed in future research include a very short test-retest interval and a limited range of validity indicators.
It is a significant concern that the widely-used SSA question of capability, clinician judgment, was not correlated with any money mismanagement or clinical measure. Clinician judgments have far-reaching implications for clients’ autonomy to manage their funds. The lack of convergent validity is perhaps not surprising given that term “capable” in the SSA question is not defined, leaving its meaning open to different interpretations. One implication of these findings is that clinician summary judgment of capability to manage funds may be of limited value in determining the need for a payee when no guidelines are provided. For example, SSA might instruct clinicians to assess functional capability to meet basic needs and avoid harmful purchases, using guidelines like those from the SCIMM.