Improving Money Management Skills for Veterans With Psychiatric Disabilities

Veterans with psychiatric disabilities face unique challenges concerning money management. Financial strain, money mismanagement, and homelessness have been well documented among veterans with psychiatric disabilities and linked to poor outcomes. The investigators' long-term goal is to promote recovery among veterans with psychiatric disabilities by addressing an 'unmet need' of developing basic money skills necessary for independent functioning in living, working, and social environments. The investigators' objective in the current application is to rigorously evaluate a pilot-tested, stakeholder-informed intervention grounded in principles of psychiatric rehabilitation designed to help develop money management skills and informed financial judgment among veterans with psychiatric disabilities. $teps for Achieving Financial Empowerment ($AFE) is an individualized, psycho-educational intervention that aims to teach veterans with psychiatric disabilities how to save money, create a viable budget, avoid money scams and financial exploitation, and access vocational and mental health resources. To evaluate the $AFE, the investigators will randomly assign N=200 veterans with psychiatric disabilities to either (a) the $AFE intervention (n=100); or (b) a "usual care" control (n=100). The investigators will interview veterans with psychiatric disabilities at baseline and six months. The investigators' central hypothesis, based on strong preliminary data, is that by fostering financial skills and judgment, the $AFE will concurrently increase employment, boost work motivation, and reduce disablement. If these outcomes are met, the investigators hypothesize the intervention will also lead to reduced psychiatric symptoms and homelessness among veterans with psychiatric disabilities.

Study Overview

• Status: Completed
• Conditions: Psychiatric Problem
• Intervention / Treatment: Behavioral: $AFE

Detailed Description

Veterans with psychiatric disabilities face unique challenges concerning money management. Not only do they encounter problems as do non-veterans with psychiatric disabilities; for example, they may possess limited financial experience due to longstanding dependence on family or have limited money skills related to cognitive deficits. But since veterans can receive disability benefits from both the Veteran's Administration (VA) and the Social Security Administration (SSA), the added income paradoxically exposes veterans to greater risk of severe debt and financial exploitation. To compound this problem, VA and SSA policies for working while disabled differ, often change, and thus can be misunderstood in ways that potentially reduce incentives to seek employment.

Financial strain, money mismanagement, and homelessness have been well documented among veterans with psychiatric disabilities and linked to poor outcomes. Hundreds of thousands of veterans have psychiatric disabilities - a number likely to grow as a substantial proportion of troops return from Iraq and Afghanistan. Yet little systematic research has examined how to help veterans with psychiatric disabilities learn tangible skills needed to maintain financial stability in the community. Our long-term goal is to promote recovery among veterans with psychiatric disabilities by addressing an 'unmet need' of developing basic money skills necessary for independent functioning in living, working, and social environments.

Our objective in the current application is to rigorously evaluate a pilot-tested, stakeholder-informed intervention grounded in principles of psychiatric rehabilitation designed to help develop money management skills and informed financial judgment among veterans with psychiatric disabilities. $teps for Achieving Financial Empowerment ($AFE) is an individualized, psycho-educational intervention that aims to teach veterans with psychiatric disabilities how to save money, create a viable budget, avoid money scams and financial exploitation, and access vocational and mental health resources.

To evaluate the $AFE, the investigators will randomly assign N=200 veterans with psychiatric disabilities to either (a) the $AFE intervention (n=100); or (b) a "usual care" control (n=100). The investigators will interview veterans with psychiatric disabilities at baseline and six months. Our central hypothesis, based on strong preliminary data, is that by fostering financial skills and judgment, the $AFE will concurrently increase employment, boost work motivation, and reduce disablement. If these outcomes are met, the investigators hypothesize the intervention will also lead to reduced psychiatric symptoms and homelessness among veterans with psychiatric disabilities.

The investigators are well prepared to pursue this study because of our peer-reviewed research in this area and success in completing large-scale empirical studies of veterans and non-veterans with psychiatric disabilities. The current research is innovative because it will lead to a brief, targeted, cost-effective, feasible procedure for helping veterans potentially become less reliant on disability funds and more likely to work, gaining independence in the community.

At the end of this project, the investigators expect to show that a systematic, evidence-based approach can greatly bolster self-determination and empowerment for veterans with psychiatric disabilities. The investigators plan to construct a user-friendly, transportable manual so clinicians can readily implement the $AFE intervention. The investigators anticipate the primary impact of this study will be evaluation of a novel and effective method to promote independent living and employment and maximize full society integration among veterans with psychiatric disabilities.

• Study Type: Interventional
• Enrollment (Actual): 183
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27701
      • Duke University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age 18-65 years
• Veteran
• Receives disability for psychiatric or cognitive condition from either the VA or SSA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental; $teps for Achieving Financial Empowerment ($AFE)	Behavioral: $AFE; $teps for Achieving Financial Empowerment ($AFE) is an individualized, psycho-educational intervention that aims to teach veterans with psychiatric disabilities how to save money, create a viable budget, avoid money scams and financial exploitation, and access vocational and mental health resources.
No Intervention: Usual Care; Veterans in control arm will receive usual care at VA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Employment	Any part time or full time employment between baseline interview and follow-up interview	Past six months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Financial savings	Amount of money saved between baseline and follow-up interview	Past Six months
Financial Debt	Amount of unsecured debt incurred between baseline and follow-up interviews	Past six months
Homelessness	Homeless and/or living in a homeless shelter for at least one day between baseline and follow-up	Past Six Months

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Collaborators: Duke University; Durham VA Medical Center
• Investigators: Principal Investigator: Eric Elbogen, Ph.D., UNC-Chapel Hill; Principal Investigator: Eric Elbogen, Ph.D., UNC Chapel Hill

Publications and helpful links

General Publications

• Elbogen EB, Hamer RM, Swanson JW, Swartz MS. A Randomized Clinical Trial of a Money Management Intervention for Veterans With Psychiatric Disabilities. Psychiatr Serv. 2016 Oct 1;67(10):1142-1145. doi: 10.1176/appi.ps.201500203. Epub 2016 May 16.

Study record dates

Study Major Dates

• Study Start: April 1, 2011
• Primary Completion (Actual): September 1, 2014
• Study Completion (Actual): September 1, 2014

Study Registration Dates

• First Submitted: May 10, 2011
• First Submitted That Met QC Criteria: May 11, 2011
• First Posted (Estimate): May 12, 2011

Study Record Updates

• Last Update Posted (Actual): June 15, 2018
• Last Update Submitted That Met QC Criteria: June 13, 2018
• Last Verified: September 1, 2014

More Information

Terms related to this study

• Other Study ID Numbers: H133G100145