12/1/2017 1 INTRODUCTION TO EFFECTIVE HOARDING INTERVENTION Erika Woods Environmental Specialist/ Sanitarian Barnstable County Department of Health & Environment Chair: Cape Cod Hoarding Task Force (CCHTF) [email protected]508-375-6620 Mission Statement The Cape Cod Hoarding Task Force’s mission is to raise awareness of compulsive hoarding and to provide education and support for those affected by hoarding through accessible tools, referrals and resources. The Cape Cod Hoarding Task Force (CCHTF) seeks to develop a coordinated response among community agencies to the problem of hoarding in a sensitive and responsible fashion. ► Hoarding Disorder (HD) ► Definition ► Attributes ► Hoarding vs squalor ► Animal hoarding ► Examine the challenges in addressing hoarding ► Explore tools for assessing hoarding ► Promising programs ► Strategies to address hoarding Today’s Overview: Hoarding is a Mental Health Disorder as defined in the DSM V (Diagnostic and Statistical Manual of Mental Disorders) Experts Define Hoarding as: ► The acquisition of, and inability to discard items regardless of the perceived value put on them by others ► Living spaces (are) sufficiently cluttered so as to preclude activities for which those spaces were designed ► Significant distress or impairment in functioning caused by the hoarding (to tenant, others in building, owner, etc). " This definition distinguished hoarding from the collecting of objects generally considered interesting and valuable” 2013 American Psychiatric Association In order for a diagnosis of hoarding to be given, these symptoms cannot be from another illness/ injury such as: a traumatic brain injury Definition The hallmark of hoarding behavior is not being able to let go of things. Individuals tend to want to make sure items go to a “good home” but won’t let go. Research shows that brain is signaling that they have made the wrong decision even before they make a decision. Is there a failure to discard a large volume of items? Does the clutter make it hard to use rooms for their intended use? Is there stress or impaired functioning caused by the stress? Is it Hoarding?
Transcript
12/1/2017
1
INTRODUCTION TO
EFFECTIVE HOARDING
INTERVENTION
Erika Woods
Environmental Specialist/ Sanitarian
Barnstable County Department of Health & Environment
The Cape Cod Hoarding Task Force’s mission is to raise awareness of compulsive hoarding and to
provide education and support for those affected by hoarding through accessible tools, referrals and
resources. The Cape Cod Hoarding Task Force
(CCHTF) seeks to develop a coordinated response among community agencies to the problem of
hoarding in a sensitive and responsible fashion.
► Hoarding Disorder (HD)
► Definition
► Attributes
► Hoarding vs squalor
► Animal hoarding
► Examine the challenges in addressing hoarding
► Explore tools for assessing hoarding
► Promising programs
► Strategies to address hoarding
Today’s Overview:Hoarding is a Mental Health Disorder as defined in the DSM V (Diagnostic and Statistical Manual of Mental Disorders)
Experts Define Hoarding as:
► The acquisition of, and inability to discard items regardless of the perceived value put on them by others
► Living spaces (are) sufficiently cluttered so as to preclude activities for which those spaces were designed
► Significant distress or impairment in functioning caused by the hoarding (to tenant, others in building, owner, etc). " This definition distinguished hoarding from the collecting of objects generally considered interesting and valuable”
2013 American Psychiatric Association
In order for a diagnosis of hoarding to be given, these symptoms cannot be from another illness/ injury such as:
a traumatic brain injury
Definition
The hallmark of hoarding behavior is
not being able to let go of things.
Individuals tend to want to make sure
items go to a “good home” but won’t
let go.
Research shows that brain is signaling
that they have made the wrong decision even before they make a
decision.
Is there a failure to discard a large volume of items?
Does the clutter make it hard to use rooms for their intended use?
Is there stress or impaired functioning caused by the stress?
The pathological accumulation of animals was first described in 1981 and animal hoarding was formally defined in the public health literature in 1999 using the following criteria:
► Having more than the typical number of companion animals.
► Failing to provide even minimal standards of nutrition, sanitation, shelter, and veterinary care, with this neglect often resulting in illness and death from starvation, spread of infectious disease, and untreated injury or medical condition.
► Denial of the inability to provide this minimum care and the impact of that failure on the animals, the household, and human occupants of the dwelling.
► Persistence, despite this failure, in accumulating and controlling animals.
Hoarding of Animals Research Consortium
Animal Hoarding
► Air Quality► Ammonia
► Bio-aerosols;
► Fungal spores► Dust particles
► Zoonotic diseases
► Elder, child abuse/
neglect
► Squalor
Animal Hoarding
Animal cruelty laws
Each state in the US has laws prohibiting cruelty to animals and imposing upon caretakers a duty of providing minimal care. Although the laws may differ
somewhat in each state, all states require that owners or caretakers of animals do
the following:
► Provide adequate food and clean, potable water
daily in sufficient quantities to maintain an
animal’s normal body weight.► Provide shelter from the elements that will allow
the animal to stay dry and maintain a
normal body temperature.► Provide a clean, sanitary environment free of animal
feces, urine, and trash.
► Provide veterinary care necessary to relieve
suffering from disease, injury, or illness.
In hoarding situations, some or all of these provisions are likely to be violated
because animal cruelty statutes prohibit keeping animals in squalid situations. This is despite the fact that a competent adult might often be
allowed to live in these conditions unless in violation of a public health or safety
code. Therefore, these animal welfare statutes may provide an additional mode of
intervention for an adult living in squalor.
► Proper Food & Water
► Proper Sanitation
► Proper Comfort► Grooming
► Safety► Proper shelter and protection from the weather
► Proper veterinary care
For help, call local animal control, MSPCA or other local animal welfare agency.
► Use visual cues for where items belong (or don’t belong)
► Set sorting “guidelines”
► Find out what will help the individual relax-music, tea etc.
Imminent Risk
•Clear egress path 24”
•Remove items from top of stove
•Remove items from near heating system
Must be corrected to
pass inspection
• Reduce clutter by 25%
• Egress paths 36”
• Stacks no higher than 4’
Not required but may improve
quality of life
•Clear bed for sleeping
•Put sheets/ towels in linen closet
Tiered Approach
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Room Mapping
Helpful Tools
Let’s Practice
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Mary is a 44-year-old, single woman with a history of depression
and anxiety. Her home is filled with books, newspapers, and other items collected over the past 28 years. She saves things just in
case she will need them later; they may become important. The
piles have become so stacked and unstable that she has trouble opening the door to her bedroom. Lately, Mary sleeps on a chair
in the living room because her bed has become cluttered with
miscellaneous books, newspapers and years’ worth of mail. She
has failed the Section 8 housing inspection due to egress violations and fire hazards in her home. In order to pass inspection, she has
been told that she will need to significantly reduce the number of
books, papers, and other items in her home. Mary is angry about the need to downsize and does not see any problem with owning
books and newspapers since they possess valuable information.
However, Mary does fear the potential for homelessness if she continues to fail inspection.
CASE ONE
Daniel is a 53-year-old man and he lives alone with a physical disability. His family is very concerned because he has fallen while walking with a cane several times in recent months. His last fall resulted in hospitalization for a broken leg. His home has become filled with canned food, computer parts and other items. Daniel plans to use these items when his health improves. Despite these piles getting significantly worse since his divorce 7 years ago. The majority of the food in the refrigerator has spoiled and begun to attract flies. The computer parts are obsolete and rendered useless. The hospital social worker made a recommendation for him to move to a rehabilitation center until his home is cleaned and de-cluttered. Daniel refused the rehabilitation placement and insisted on returning home. Although, he does not think it is necessary, as a compromise, a referral was made for hoarding intervention services.
CASE TWO
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CASE THREE
Elizabeth is a 79-year-old, frail elder who walks with a cane and has begun to have memory-related issues. The inside of the small home that she owns is filled with clothing, old photographs, knick-knacks, and food. Although, she no longer wears the majority of the clothing, the pieces hold sentimental value, as do the photographs that she has collected throughout her life. Elder Protective Services was called because a neighbor is concerned about her safety due to the appearance of her home from the outside. The roof is missing shingles and presents a potential problem for a leak. Items have begun to pile up on her front porch making it a challenge for any possible repairman or visitor to enter her home. Elder Services have offered to pay for Elizabeth’s home to be “cleaned-out” but she is unwilling to let strangers come in to make decisions about what will be thrown away. Each of these items has significant meaning and if they did not then she would not have held on to them.
