Hoarding Workshop Presentation

transcript

7/23/2019 Hoarding Workshop Presentation

1/38

1

Hoarding Disorder:

A Brief Overview


2/38

Denition

Compulsive hoarding:

the acquisition of, and failure to discard, alarge numer of possessions that appear

to e useless or of limited value living spaces are su!cientl" cluttered so

as to preclude activities for which thosespaces were designed

signicant distress or impairment infunctioning caused " the hoarding

#$rost % Hartl, 1&&'(

)


3/38

Hoarding, *qualor andAnimal Hoarding

Hoarding and squalor are not the same

*qualor is dened as lthiness or degradation fromneglect: +wo forms domestic and personal

Hoarding is related to the volume of clutter in thehome, not the cleanliness

Animal hoarding: involves the failure to provideadequate facilities for animals overcrowded or

unsanitar" living conditions, inadequate veterinar"care, poor nutrition, etc - Contact the .*/CA or+ufts 0niversit" Hoarding of Animals ResearchConsortium for information aout animal hoarding


4/38

Demographics % /revalence

*aving egins in childhood 2 age 1

Average age in treatment 3 45

.arital *tatus: tend to e single

6ow marriage rate, high divorce rate, tend to livealone

7ducation: ranges widel"

$amil" histor" of hoarding is common

*qualid conditions uncommon among treatment

see8ers 7stimates 94 of 0* /opulation #14 million Americans(

Occurs cross9culturall": ;apan, 0


5/38

.ore on Hoarding

Hoarding is a mental health disorder not adecision

Hoarding is not a moral issue@ t is not caused" lainess, lac8 of standards, lac8 of

responsiilit" Clutter is onl" a s"mptom of the prolem t is often characteried " low insight: others

are often more aware of>othered " the clutterthan the individual

&) of individuals with hoarding have 1 ormore other mental health #e-g-, depression,generalied aniet", osessive9compulsivedisorder, social phoia(

4


6/38

Course of Hoarding Disorder

6ittle evidence for histor" of materialdeprivation

Hoarding ma" e precipitated " loss Chronic or worsening course

nsight uctuates

*everit" range from mild to life9ta8ing

'


7/38

Hoarding Behaviors

*aving: *entimental, instrumental, intrinsic

Acquisition: Bu"ing, acquisition of free things

Clutter>Disorganiation: Eandom piles,churning

Di!cult" Discarding: ndecision, attachment

F


8/38

n ers an ng eChallenges of Gor8ing with

/eople who Hoard Beliefs and 7motions associated with

oects

Beliefs aout self in relation to world Iulnerailities #+ime, $amil" Histor", 6oss, etc-(

Co9morid Conditions #.ental and /h"sical Health(

Cognitive Distortions #/rolematic +hin8ing( .otivation

J


9/38

Hoarding and nsight

/eople with hoarding prolems havevar"ing levels of insight aout the

etent of their prolem and the wa"sthat it impacts them % those aroundthem

Kon9insightful

nsightful ut unmotivated

nsightful, motivated, ut noncompliant

&


10/38

Assessing Hoarding

HO.7* .ulti9disciplinar" Hoarding Eis8Assessment

nstructions for 0se

HOMES.ulti9disciplinar" Hoarding Eis8 Assessment provides a structural measure throughwhich the level of ris8 in a hoarded environment can e conceptualied-

t is intended as an initialand briefassessment to aid in determining the nature and parameters

of the hoarding prolem and organiing a plan from which further action ma" e ta8en99 including

immediate intervention, additional assessment or referral-

HOMEScan e used in a variet" of wa"s, depending on needs and resources- t is

recommended that a visual scan of the environment in comination with a conversation with theperson#s( in the home e used to determine the eMect of clutter>hoarding on Health, Ostacles,Mental Health, Endangerment and Structure in the setting-

+he $amil" Composition, mminent Eis8, Capacit", Kotes and /ost9Assessment sections areintended for additional information aout the hoarded environment, the occupants and their

capacit">strength to address the prolem-

15


11/38

neMective ntervention *trategies

.a8e decisions #aout a plan ofaction( for a tenant

Argue or /ersuade /ressure the tenant to discard

+ell the tenant how to feel

=ive veral and non9veral cues thatare udgmental or negative in nature

11


12/38

7Mective ntervention *trategies

Be clear aout epectations andlimitations

As8 open9ended questions Eeectivel" listen

0se respectful, non9udgmental language

.irror the language used " the tenant

NGor8 with the tenant instead of Ndoingfor

1)


13/38

$ocus on nternal .otivation:+he P.agicQ Bullet

Ghat ma8es people motivated to changeR

Condence mportance

$actors nuencing .otivationHow much social support?

Are there any home visitors?

Can anyone monitor homework?How depressed is the tenant?

Can tenant tolerate discomfort?

1


14/38

7nhancing .otivation

Suestions to start dialogue:

How has hoarding aMected "our famil"R

How does the clutter t with the things"ou value in lifeR

Ghat successes have "ou had that ma8e"ou thin8 "ou address "our hoarding

prolemR

Gh" would "ou want to change if itmeans giving up part of "ourselfR


15/38

14

HOAEDK=:

+H7 67=A6$EA.7GOE


16/38

67=A6 S07*+OK*

GH7K DO7* HO0*7


17/38

/AE+ 1

GH7K DO7* HOAEDK=B7CO.7 A 67=A6

/EOB67.R

1F


18/38

HOAEDK= * A 67=A6 /EOB67.GH7KU

t violates applicale housing health andsafet" standards, including those foranimals

t endangers vulnerale people as dened" state law

Children

7lders

/ersons with Disailities

1J


19/38

HOAEDK= * A HO0*K= /EOB67.

Ghen it violates or progresses towardviolating:

+he 6ease

H0D>DHCD *tandards

6ocal or state health and safet" codes

Animal cruelt" standards

1&


20/38

)5

7**7K+A6 HO0*7 neighors,

staM

.AK+AK 0K+, Common Areas

KO *7EO0* COD7 IO6A+OK*

$ollow E7A*OKAB67 HO0*7 E067*


21/38

H0D HO0*7 E067* #1(

.a" include requirements for: =arage disposal, including disposal of

=rease

*mo8ing materials 0sed s"ringes or other iohaards


22/38

H0D HO0*7 E067* #)(

.a" prohiit

*torage of haardous materials

Bloc8ing of eits Bloc8ing of heating vents

Overloading circuits and haardous

use of etension cords =arage or clutter that attracts insects

or rodents or produces foul odors

))


23/38

H0D HO0*7 E067* #(

.a" prescrie repair>maintenancestandards

/rompt reporting of repair needs

Clear access to repair area

/rompt reporting of infestation

Cooperation with necessar"etermination

)


24/38

)?

H0D *AK+AET *+AKDAED*

CA+

.a" require changing of cat litter, ut nomore than twice>wee8

.a" require removing waste from litter,

ut no more than once>da"

CA+* % DO=*

.a" prescrie disposal of litter and waste Eequire control of noise and odor


25/38

H0D AKD DHCD*+AKDAED*

H0D

*ection J Housing Sualit" *tandards

#HS*( Ch 15

/et /olic"

DHCD

)?C$E &J) and HS* Ch J #/ulic Housing

and Certicates( *tate *anitar" Code 154 C.E ?15 #all

Housing(

)4


26/38

AK.A6 CE076+TE7S0E7.7K+*

.=6 chapter )F): *ec FF forids

unnecessaril" fail#ing( to provide #ananimal( with proper food, drin8U #and(sanitary environment

)'


27/38

HOAEDK= * A *7EIC7/EOID7E 67=A6 /EOB67.

Ghen it endangers:

Children

7lders #over '4(

/ersons with Disailities #an" age( Animals

)F


28/38

GHA+ s"stems haards

)J


29/38

/AE+ )

)&

GH7K DO7* E7A*OKAB67ACCO..ODA+OK CO.7

K+O /6AT


30/38

5

/7E*OK G> A D*AB6+T 9CI6 E=H+* D7$K+OK

A /HT*CA6 or .7K+A6 ./AE.7K+

which *=K$CAK+6T K+7$7E7* withone or more .A;OE 6$7 AC+I+7*

n this case, the maor life activit" ofhouse8eeping #and possil" otheractivities(


31/38

HOAEDK= A* A D*AB6+T

Civil Eights Denition is$0KC+OKA6, not diagnostic #D*.(

0* *upreme Court: the person isNunale or Nver" restricted in theailit" to do some Ndail" life activit"#house8eeping(

1


32/38

E7A*OKAB67ACCO..ODA+OK #1(

Applicale when:

Eesident has a disailit"

Disailit" is cause of house8eepingprolem

Eesident wants an accommodation

)


33/38

E7A*OKAB67ACCO..ODA+OK #)(

Applicale when:

Disailit" is ovious or there is relevantverication including ailit" and

willingness of resident to cooperate

Accommodation does not

pose undue urden or require a fundamental change in nature of

program


34/38

?

0KD07 B0ED7K

$inancial urden Ko set formula

Cost of accommodation vs- sie % nancial

condition of ownerQs overall housing usiness

Administrative urden #staM time(

How much timeR

7Mect on ailit" to carr" out otherresponsiilities


35/38

$0KDA.7K+A6 CHAK=7K +H7 KA+0E7 O$ +H7 /EO=EA.

4


36/38

Accommodation /lan ncludes#1(

1- *pecic standards in specic areas

)- +he timeline for each step and the deadline

- Gho will do the clean up and trash removal

?- Gho will chec8 and how often

Continued'

Accommodation /lan ncludes


37/38

Accommodation /lan ncludes#)(

4- *ervices resident will accept

'- Eelevant releases

F- Consequences for failure to follow plan

J- Ongoing monitoring

F


38/38

J

*77< CO0E+ EAA=E77.7K+ $U

+here is potential dangerto others

Eesident is in denialaout seriousviolation

Kecessar" to involve serviceproviders and/or family (TenancyPreservation Program)

Hoarding Workshop Presentation

Documents