“I always wanted to practise clinically, but nagging questions kept coming up at the clinic,” she remembers. “I’d see some colleagues go home at night and leave those questions behind, but I couldn’t.”

Finally, a question about a patient’s ability to manage personal finances changed her career.

“I realized that we just didn’t have enough information on this. So I decided to do a PhD.”

After earning her doctorate at the University of Toronto, Engel moved to Winnipeg with her family in 2019 to join the College of Rehabilitation Sciences as an assistant professor.

Today, her research is focused on the financial capability and well-being of adults living with health conditions or disabilities.

“I believe I’m the only person researching this in Canada,” she says.

In 2020, she received more than $380,000 from the Government of Canada’s Social Development Partnerships Program (disability component) for a project with the Manitoba Brain Injury Association.

The project consists of four interrelated studies, including focus groups and a “photovoice” study that has participants who live with brain injury documenting their financial activities using digital cameras.

The photos will be used in a gallery that could persuade financial institutions and other groups to address how to help those with an “invisible disability.”

“One man took a picture of his bank and explained how he’s not able to function with the bright lights and the noise,” Engel says.

“He could have all the skills in the world, but the environment is preventing him from doing his banking.”

The focus groups have generated strong, practical ideas from participants. One is a double-sided wallet card that people with brain injury could carry to help them navigate financial situations.

“If they are not knowing what to say and in a trusting situation, the card could provide ideas to staff at a financial institution on how to work with them better. On the other side of the card would be reminders to themselves.

“It’s an amazing idea that came directly from talking to people living with brain injury.”

Engel says interest in financial wellbeing for people with disabilities is growing, in Canada and internationally. Canada’s financial literacy strategy was updated last year and now mentions people living with disabilities.

“I’ve had contact from researchers and groups across Canada, the U.S. and Australia to collaborate,” she says.

While about 80 per cent of Engel’s research focuses on financial well-being, she recently became co-lead on a national project looking at the effects of the pandemic on brain injury associations.

Funded by the Canadian Institutes of Health Research, the project aims to design a pandemic preparedness resource for people with brain injury in future pandemics or further waves of COVID-19.

“These associations have built a lot of amazing resources since the pandemic started,” she says.

“But there’s often a high staff turnover with these community groups and funding is precarious, so we want to make sure this information isn’t lost.”

Occupational Therapy assistant professor Lisa Engel, who joined the college in 2019, specializes in research on the financial well-being of people living with chronic health conditions. She and her team received $382,204 for three years for the project, funded in part by Government of Canada’s Social Development Partnerships Program – Disability component, in partnership with the Manitoba Brain Injury Association (MBIA).

“We have a three-year plan of four interrelated studies, the first year exploring people living with brain injury in Manitoba, what’s facilitating their ability to be financially capable and what the barriers are,” Engel said.

Part of the first year involves a photovoice study, in which up to 20 participants who live with brain injury will document their financial activities using digital cameras.

Lisa Engel (2019)

Engel said COVID-19 has led to some challenges for the project such as safely delivering cameras to participants who don’t already have one, participants who are not able to complete interviews online, or providing adaptive equipment if needed.

“That could require us to use full PPE and do very quick set-ups and teach participants from a social distance, showing them how the equipment works and assessing if it meets their needs,” she said. “We also have to be aware that our financial lives have changed with COVID, and we don’t know how permanent those changes are.”

Recruitment for the project, she said, will be done through MBIA.

“The association’s executive director contacted me and said some of their members struggle because there’s not a lot of financial empowerment programs that are tailored to meeting the informational and learning or cognitive needs of people living with brain injury,” Engel said.

“It’s about using photos as a medium to gain information, but also to share that information later. The plan is to wrap up this stage of the project with a public photo viewing event, hopefully in-person next year depending on COVID.”

Engel hopes that participants will have improved savings goals and financial well-being measures by the end of the three-year project, which will include the development of a financial empowerment program, analysis and evaluation.

While at Nanaimo Regional General Hospital she often worked with patients with cognitive disabilities and was frequently asked the same question, “can this patient manage his or her own finances?” When trying to find an answer, she found she was faced with more questions.

“I kept thinking, ‘How do I know if someone can handle their finances, and what does it actually mean to handle your finances?’” said Engel.

These questions led the Saskatchewan-born Engel, who has a bachelor’s degree in kinesiology and health studies from the University of Regina, to pursue a PhD from the University of Toronto in the area of cognitive rehabilitation and financial management, a new field in which very few in Canada were specializing.

In January 2019, she joined the University of Manitoba as assistant professor in the department of occupational therapy in the College of Rehabilitation Sciences, Rady Faculty of Health Sciences, where her research focuses on the financial management and financial well-being of adults living with cognitive impairment.

She said part of the reason this has been largely ignored in academia could be that money is such a taboo subject for many people, regardless of area of study or practice.

“As an OT, I did assessments on people on how to shower or get dressed, and I found that most people had a harder time with me asking finance questions than with these very personal tasks,” she said. “Money is so important to everything that we do in our lives, but for many reasons we don’t want to talk about it.”

What complicates the issue further, she said, is that so many Canadians have a hard time with their finances even when health is not an issue.

“Many Canadians perceive meeting financial obligations to be difficult, especially in the case of an unexpected cost or emergency. This can become more challenging when health and disability issues arise,” she said.

In her PhD research, Engel and her team interviewed 10 people living with an acquired brain injury. Of those that were more successful, she said a strategic approach was beneficial.

Her study, which will be published later this year by the Canadian Journal of Occupational Therapy, identified six financial management strategies to help individuals with cognitive impairments: recording and checking records; simplifying and organizing; scheduling; setting financial management “policies” or “rules of thumb”; obtaining advice or knowledge; and using and directing assistance.

“A lot of families are noticing that they can’t afford the things they need. It gets harder when you’re living in a low economic status, because not being able to afford your food and other necessities can happen fast,” she said.

But she noted that people with larger incomes can also have difficulties managing money while dealing with a cognitive impairment.

“It can get pretty complex if you’re of a higher socioeconomic status and have many larger investments. That is really hard for your family or others to notice,” Engel said.

The goal of her research, she noted, is to better understand the experience of living with a disability and managing one’s finances, including interactions with financial institutions.

“We need to define what supports are available for people with disabilities to learn how to manage their finances better. Once we have that understanding, we can determine how we can better assess and address these issues that people are facing.”