title: All-data approach to assessing financial capability in people with psychiatric disabilities.
abstract: The goal of this project was to develop an evidence-based method to assess the ability of disabled persons to manage federal disability payments. This article describes the development of the Financial Incapability Structured Clinical Assessment done Longitudinally (FISCAL) measure of financial capability. The FISCAL was developed by an iterative process of literature review, pilot testing, and expert consultation. Independent assessors used the FISCAL to rate the financial capability of 118 participants (57% female, 58% Caucasian) who received Social Security disability payments, had recently been treated in acute care facilities for psychiatric disorders, and who did not have representative payees or conservators. Altogether, 48% of participants were determined financially incapable by the FISCAL, of whom 60% were incapable because of unmet basic needs, 91% were incapable because of spending that harmed them (e.g., on illicit drugs or alcohol), 56% were incapable because of both unmet needs and harmful spending, and 5% were incapable because of contextual factors. As expected, incapable individuals scored higher on a measure of money mismanagement (p < .001) compared with capable individuals. Interrater reliability for FISCAL capability determinations was very good (κ = .77) and interrater agreement was 89%. In this population, the FISCAL had construct validity; ratings demonstrated good reliability and correlated with a related measure. Potentially, the FISCAL can be used to validate other measures of capability and to help understand how people on limited incomes manage their funds.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Lazar
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Black
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McMahon
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.affiliation: Addiction Psychiatry Residency Program, University of Washington School of Medicine.
authors.forename: Richard
authors.initials: R
authors.lastname: Ries
authors.affiliation: Psychosocial Rehabilitation and Recovery Center, University of California, Los Angeles School of Medicine.
authors.forename: Donna
authors.initials: D
authors.lastname: Ames
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Marc I
authors.initials: MI
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005376:Financial Management; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000523:psychology*; D008875:Middle Aged; D015588:Observer Variation; D011581:Psychological Tests; D015203:Reproducibility of Results; D012943:Social Security; D014481:United States; D055815:Young Adult