Kathryn Koller, Lindsay Woods, Lisa Engel, Carolina Bottari, Deirdre R. Dawson, Emily Nalder; Loss of Financial Management Independence After Brain Injury: Survivors’ Experiences. Am J Occup Ther 2016;70(3):7003180070. https://doi.org/10.5014/ajot.2016.020198
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© 2021 American Occupational Therapy Association
OBJECTIVE. This pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence.
METHOD. Using a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis.
RESULTS. Three themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM.
CONCLUSION. This study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients’ experiences when supporting them through a change in independence.
“Tell me about how you manage your finances currently and how you managed them prior to your injury.”
“Tell me about how this change [in your FM since the injury] occurred.”
“Can you describe what going through this change in your FM has been like for you?”
“How has this change in your ability to manage your finances impacted your functioning and participation in your day-to-day life?”
“What has been helpful for you in managing your finances since your injury?”
P2: No, it was more like seeing the problems that I had and having it up to here, like enough is enough, so [parent] kind of, um, overthrew me and took control of [FM].
P3: Like, I never ran short of food . . . just they [family] didn’t like my drinking.
P6: They came to test me on how I can manage my money now. . . . But I just want to tell you this . . . I can answer, but in action I am different.
P4: They approached me and said if I want to take control of my . . . finances . . . I have to see doctors, specialists, for everyone to get together and decide if it’s OK for me.
P6: So the cheque goes to the head office [of the community organization]. So when the cheque goes there my caseworker [and I,] we have an appointment. We go to the bank, we pay my bills, my rent, my phone, my whatever bills I have to pay, my metro pass.
P6: Like my mail goes to the office, we go to the bank to deposit, and to do anything I have to go with support or it’s not going to happen.
P5: I think down the road I would like to take more responsibility. . . . I would much rather be able to be employed somewhere and buy a house instead of renting.
P2: [They] just handled it [taking over FM] and that was that, I had no choice. I: How did it make you feel? P2: Well, I knew there was nothing I could do. There was some resentment there, too.
P5: I realize after I sit back and relax and think about it [that] they're doing the right thing. It's tough because brain injury is invisible, and this whole disability—it’s hard to admit to oneself that someone else is better suited to do something for you.
P2: But I do enjoy that because every Monday, me and the guy from here [support worker], we go grocery shopping, and we pick it up and devise the list, and so I do that and it is independent.
P2: I would like to say that my [parent] does all my banking . . . sometimes I think [he or she] is going too far, but I let it go because [he or she] is my [parent].
During assessment, occupational therapists should obtain comprehensive client-centered information, including (1) clients’ FM goals, (2) current and preinjury FM strategies, (3) whether supports are in place or needed, (4) areas of distress or priority related to FM, and (5) any change in roles or identity associated with change in FM.
Interventions should aim to find a balance between promoting autonomy and preventing harm from financial mismanagement. Techniques commonly used in cognitive rehabilitation include goal setting, graded cues, metacognitive strategy training, and use of feedback, which may support learning and enable more independent performance of FM tasks.
In addition, education should be provided to family members on how to optimize the FM independence of the person living with ABI, and alternative interventions (e.g., counseling) may be required to support the person’s emotional adjustment after an FM change.
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