Evidence of financial competence may be needed to inform capability determinations when evidence of a beneficiary’s real-world financial performance is very limited or unavailable, either because the person has had no funds to manage recently or because no reliable informant with such knowledge can be identified. Bias can be reflected, for example, in the instrument’s cut-off scores. Annex Table 5-1 at the end of this chapter summarizes information about each of these instruments, including its psychometric properties. The Kohlman evaluation of living skills, 3rd ed. For example, the Financial Capacity Instrument (FCI) (Griffith et al., 2003; Marson et al., 2000) can take 40 to 50 minutes or longer to administer in a person with Alzheimer’s disease. Lai, J. M., T. M. Gill, L. M. Cooney, E. H. Bradley, K. A. Hawkins, and J. H. Karlawish. You should also be able to show that you have made every effort to encourage and support the person to make the decision themselves (principle 2 ). The assessment of financial judgment, in particular, can be affected by value judgments embedded in the design and scoring of the instrument being used. Its focus is on (a) how 0000657023 00000 n For further information on each test and how to apply it to an assessment of capacity see Section 5 'Assessing capacity in each area of life' on page 72. 2013. Medical decision-making capacity is the ability of a patient to understand the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment). MyNAP members SAVE 10% off online. Some informants lack the opportunity to observe financial performance, while others spend insufficient time with the individual to assess his or her performance accurately. Lazar, C. M., A. C. Black, T. J. McMahon, R. A. Rosenheck, R. Ries, D. Ames, and M. I. Rosen. As screening criteria or other systematic methods for identifying people at high risk for financial incapability were developed, they might be used to broaden the target population for periodic reassessment. TABLE 5-1 Components of Financial Capability Measured by Assessment Instruments, In contrast to financial knowledge and financial judgment, which can be measured in an office or clinical setting, financial performance represents the actual, real-world performance (or success) of an individual in handling financial demands in the context of the stresses, supports, contextual cues, and resources in his or her actual environment. For instance, an individual may value setting aside a weekly allotment for a hair appointment even if it means having less money with which to buy food, while the assessor may deem weekly hair appointments excessive and unnecessary if they mean the person will not have enough food. 0000006715 00000 n For this reason, formal instruments that provide valid and reliable information about an individual’s financial capability could be useful in helping to inform the U.S. Social Security Administration’s (SSA’s) capability determinations. However, it is difficult to determine how well this instrument can detect people’s ability to protect their own best interests if they do not report any problems with their spending. 2007. You should always start from the assumption that the person has the capacity to make the decision in question (principle 1 ). �x������- �����[��� 0����}��y)7ta�����>j���T�7���@���tܛ�`q�2��ʀ��&���6�Z�L�Ą?�_��yxg)˔z���çL�U���*�u�Sk�Se�O4?׸�c����.� � �� R� ߁��-��2�5������ ��S�>ӣV����d�`r��n~��Y�&�+`��;�A4�� ���A9� =�-�t��l�`;��~p���� �Gp| ��[`L��`� "A�YA�+��Cb(��R�,� *�T�2B-� The importance of creating as accurate a process as possible for incapability determinations is underscored by the consequences of incorrectly identifying recipients either as incapable when they can manage their benefits or as capable when they cannot. As described in Chapter 4, financial knowledge is possession of the declarative and procedural knowledge required to manage one’s finances, including, for example, the concept of money, values of currency, making change, check writing, use of ATMs (automated teller machines), and online banking procedures. As described in Chapters 1 and 4, the committee’s conceptualization of financial capability distinguishes between financial competence (i.e., the financial knowledge and financial judgment one possesses, demonstrated in a controlled [e.g., office or clinical] setting) and financial performance (i.e., one’s degree of success in handling financial demands in the context of the stresses, supports, contextual cues, resources, and opportunities in one’s actual environment). The Mental Capacity Act is a visionary piece of legislation which legislates the rights of all of us, but in particular people who may lack capacity whether it be permanently or temporarily. As a professional, you are going to be faced with this on quite a lot of occasions so making sure that you are assessing with integrity and adhering to the individual’s human rights is a must. An assessment of mental capacity for anything other than what is in the Substitute Decisions Act does not need to be performed by a designated capacity assessor. Instruments whose administration requires trained individuals need to have clear scoring guidelines; the degree of structure of the scoring is another administration property. In addition, some collateral informants may under- or overestimate the individual’s financial abilities. Another characteristic of assessment instruments is susceptibility to reporter biases. Depression is a serious medical illness that often goes unrecognized and untreated among older adults, according to the National Institute of Mental Health.It’s normal for an older person to feel sad every once in a while or frustrated by health problems or financial concerns. ؆��( n�a:no��F���ek��\ ϊ�k]�E��u&�~�0�瘣[ʼ��G�J@�Ϲ4�S�F�Gf��>�ΐ������3f3��ܙ6OxC̴M�E,�n�S�0]u�]LZ�!��%&�a�����8��k��:��Q������eDM}��ޗ�j����lqb2[qE�A�� 0000066435 00000 n For some disorders, neuropsychological impairments that are characteristic of the disorder itself may mean that administration of even a relatively straightforward instrument may take a substantial amount of time. Psychological testing in the service of disability determination. Show this book's table of contents, where you can jump to any chapter by name. Legal capacity is a legal determination, not a medical determination. a����RZ=��3��/e8A�j�+d0wC�����"��o����8Uc}�,Ʈ��}��������7�ӟ���V�/X*f���������0;ie��(:�pm�K�p��Y�����]Q29/,�YRy��w��Ĉl���E���>ŏN:�Me�oI��G��"e������5Y}d�q+)�w]V��r�Dc�Bq�~^^��LJ���Λ*�W����U����]u��~uNO��v|mގ,�p����'O�-�:����V��� �,O�I�k��؁����~u��"_��D|:�-n��_@��b��|����*/g��=�� h���">�˟o[°lI>�a��i��Ef�� ��m��hC��ق5����4��_�$��T�g�D N�=�"���߱ &�)�EJ�XW��W�U(�-�,St&j�߾j���eQ����f9�srt��0dɎ�D|vBi�k���)R�"�)���j���lLk���g�����w2]p@�2C�=����Y۹l���{���-�_�)���t�����hp#�}N֗�?�2��M�E�W�Y^bi'����r���V߸��E���Q��>�v�L�w��J��� 0000006602 00000 n A number of existing instruments are designed to assess functional capacity across a broad range of domains in adults with such conditions as schizophrenia, bipolar disorder, schizoaffective disorder, and major neurocognitive disorders (attributable to such conditions as Alzheimer’s disease, Parkinson’s dementia, diffuse Lewy body disease, frontotemporal dementia, head trauma, and vascular dementia)—conditions that may be present in Social Security beneficiaries being evaluated for capability. The GP was happy to perform the assessment (despite not being contractually obliged to do so), but was concerned about what questions should actually be asked and wanted advice on a list of questions … Though not exhaustive, it will help to determine in general the mental capacity assessment … Given the conceptual framework of financial capability described in Chapter 4, the committee examined each instrument in terms of the components of financial capability it is used to evaluate (as summarized in Table 5-1).1 It should be noted that the committee is unaware of any instruments designed to assess individuals’ ability to direct someone else to manage their funds. Rachel has huge experience and knowledge in the area of Mental Capacity, including how to recognise deprivation of liberty, when and how to assess capacity and how to go about making decisions in someone’s best interests. Heaton, R. K., T. D. Marcotte, M. Rivera Mindt, J. Sadek, D. J. Moore, H. Bentley, J. 4 Abilities Required to Manage and Direct the Management of Benefits, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, The National Academies of Sciences, Engineering, and Medicine, Informing Social Security's Process for Financial Capability Determination, OVERVIEW OF ASSESSMENT OF FINANCIAL CAPABILITY, INSTRUMENTS DESIGNED TO ASSESS FINANCIAL CAPABILITY, USES AND LIMITATIONS OF AVAILABLE ASSESSMENT INSTRUMENTS, CONSIDERATIONS AND CHALLENGES IN ASSESSMENT OF FINANCIAL COMPETENCE AND PERFORMANCE, 2 Review of the Social Security Administration and Other Selected Capability Determination Processes, 3 Effects of Appointment of Representative Payees on Beneficiaries, 5 Methods and Measures for Assessing Financial Competence and Performance, Appendix D: Biographical Sketches of Committee Members, Clinician Assessment of Financial Incapability (CAFI) (, Financial Incapability Structured Clinical Assessment done Longitudinally (FISCAL) (, Timeline Historical Review of Income and Financial Transactions (THRIFT) (, Financial Capacity Assessment Instrument (FCAI) (, Financial Capacity Instrument-Short Form (FCI-SF) (, Assessment of Capacity for Everyday Decision-making (ACED) (, Component of Financial Capability Measured. The outcome of a capacity assessment is sometimes challenged. Abstract This booklet gives you information about the Mental Capacity Act 2005, which affects anyone who is unable to make some or all decisions for themselves. 2015. Financial performance in real-world situations can best be captured by informants who have current knowledge of and experience with how the individual functions in his or her actual environment and have sufficient opportunities to observe the individual in that environment. %PDF-1.7 %���� Although these instruments were not designed specifically to assess financial performance and competence, several of them have validated financial knowledge subscales that can be used to assess such skills as identifying and counting currency, writing a check, and balancing a checkbook. Specific items include making change, filling out bank forms, and paying bills. Validating the measurement of real-world functional outcomes: Phase I results of the VALERO study. characterized by progressive or fluctuating changes over time in the presence, severity, and nature of symptoms. Wallace, C. J., R. P. Liberman, R. Tauber, and J. Wallace. Psychosocial assessment generally is conducted in a question-answer format, where a medical expert asks a series of questions and the patient is expected to answer them truthfully. SSA recognizes that a face-to-face interview with the beneficiary is valuable for. Pp. 2013. h��XkXSg�^;7"rKZ��Q�5@���$\�����T�����M֊����,"(�Or�U�"���R�x��ҙ�̜op�3?�ϳ$��e�w��]��� @`��x`�xh��δ��m G4$Հ Ll�i��X�T��� P���$>��T�k��CW��챙����h_���1�J��!�3�� 3�J�$��7�P5�V��R�D��/�P���j���a�Cp��ૢu��nFD To determine the utility of an instrument, one needs to assess its true positive predictive value, which depends on its sensitivity and the actual base rate of impairment in the population, as well as its negative predictive value, which depends on its specificity and the population base rate. ASSESSMENT OF CAPACITY Examples of Impairment Conditions that are associated with Mental Capacity are: Dementia Learning Disabilities, long term affects of brain damage, physical or mental conditions that cause confusion, drowsiness or loss of consciousness, delirium, confusion, symptoms of drug or … Caregivers’ judgments of the functional abilities of the Alzheimer’s disease patient: A comparison of proxy reports and objective measures. 0000094117 00000 n 2006. Because capacity is a given, ok so let us consider the complexities of fluctuating capacity. This report evaluates SSA’s capability determination process for adult beneficiaries and provides recommendations for improving the accuracy and efficiency of the agency’s policy and procedures for making these determinations. The assessment does not yield scores. 1) All staff providing care should be comfortable with assessing capacity. This guide is designed to offer some help. Both have established reliability and validity. Social workers are employed in various service settings, such as primary care, specialty mental health care, community clinics, rehabilitation and recovery services, subsidized housing programs, and skilled nursing. Bipolar Disorders 12(1):45-55. Everyday decision-making ability in older persons with cognitive impairment. These include the time elapsed between two administrations of the test, which. Most of us just make do with what our parents taught us — and for many people, that’s not enough. Can you weigh up or use the information to reach a decision? 2015. Washington, DC: The National Academies Press. All rights reserved. Questions vary according to the state of the patient, and the problems he may be facing at the time. Development of the Clinician Assessment of Financial Incapability (CAFI). He is widowed and lives in an assisted living facility. You should always start from the assumption that the person has the capacity to make the decision in question (principle 1 ). Author Office of the Public Guardian. This chapter provides an outline for conducting an interview to assess the capacity of a person with mental disorder or inability to communicate in relation to the management of his/her money and any other assets. Step 17, “Assess Capacity to Execute Contracts, Conveyances, and Agency Appointments,” has a helpful discussion of practical questions to ask to evaluate how well someone can manage their affairs. 2015. Mental Capacity Assessment Forms. Good general knowledge about what is happening to his or her money and investments? For this reason, it is important for SSA to distinguish between the weight given to “lay evidence” that comes from professionals (e.g., social workers, professional counselors, clergy) and that acquired from relatives, friends, landlords, and other untrained individuals. Because all of the above instruments were designed to assess functional capacity across a broad range of domains, none permits the comprehensive assessment of financial competence and performance enabled by instruments designed specifically for that purpose, despite having validated financial subscales. Capacity always needs to be presumed unless proven otherwise. 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