SORTING THROUGH HOARDING

A Workshop for Professionals

APHAAMay 2nd, 2018

Stacy Walker, Certified Professional OrganizerTerri Bailey, M.A. Counselling, CCC

Stacy Terri

Living in St igmaSocietal Percept ions of Hoarding

The Impact of Language

◆ The language we use often reflects commonly held societal views

◆ Important to try and use language that reflects the person not the disorder◆ e.g. a person who hoards vs. a “hoarder”

Publ ic Percept ions

What is Hoarding?

Diagnosing Hoarding Disorder

◆ Persistent difficulty discarding or part ing with possessions

◆ Item accumulat ion prevents living spaces from being used for their intended purpose

◆ Associated with clinically significant distress or impairment

Diagnosing Hoarding Disorder

◆ Further specifiers:◆ With excessive acquisit ion – if difficulty

dis carding pos s es s ions is accompanied by exces s ive acquis ition of items that are not needed or for which there is no s pace

◆ Level of ins ight – good/fair, poor, abs ent

Hoarding Related Impairment

◆ Physical/ medical complicat ions◆ Missed work and/ or compromised employment◆ Financial problems◆ Housing instability◆ Social isolat ion◆ Emotional distress◆ Family stress

Demographics & Prevalence

◆ Current populat ion est imates of 2-6%◆ Hoarding influenced by genet ic and environmental

factors◆ Women tend to seek treatment more often than

men but prevalence may actually be greater in men◆ On average people enter t reatment at age 50 but

age of onset is often prior to age 20◆ Funct ional impairment and symptoms tend to

worsen with age

Comorbidity

Diagnosis Comorbidi ty Rates

Major Depressive Disorder 50.7%

Attent ion Deficit Disorder 27.8%

Generalized Anxiety Disorder 24.4%

Social Phobia 23.5%

Obsessive Compulsive Disorder 17.0%

Specific Phobia 14.3%

Kleptomania 9.9%

Post Traumatic Stress Disorder 6.9%

Substance Use Disorder 1.8%

Bipolar Disorder 1.4%

Animal Hoarding

The accumulat ion of a large number of animals and a failure to provide them with minimal standards of nutrit ion, sanitat ion , and veterinary care

What Hoarding is NOT

◆ Collect ing◆ Chronic disorganizat ion◆ Presence of pests◆ Squalor

Pests

◆ Check for evidence of pests regularly◆ Vacuum often◆ Check points of entry/ exit (e.g. adjoining units)◆ Be caut ious when acquiring used items but

know even new items can carry eggs◆ Use plast ic storage containers when possible◆ Ensure proper food storage

Bed Bugs

◆ Mattress & box spring covers available◆ Heat is the most effect ive method of t reatment◆ Best results when treatment prep sheets are

followed

Squalor

Assessment Tools

◆ Safe Visit Assessment and Plan (Alberta Health Services – Environmental Public Health)

◆ HOMES ® - Multidis ciplinary hoarding ris k as s es s ment

◆ Clutter Image Rating S cale (CIR)◆ S aving Cognitions Inventory (S CI)

“ProgressAccording toCapabilit ies andExpectations

P – A – C – E

The Hoarding Model

Personal Vulnerability Factors

Information Processing Difficulties

Thoughts & Beliefs

Emotional Response

Positive Reinforcement Negative Reinforcement

HOARDINGBEHAVIOURS

The Hoarding Model

Personal Vulnerabil ity Factors

◆ Genetics◆ Comorbid Disorders◆ Role Modeling◆ Physical Health Problems◆ Grief & Loss◆ Trauma History

◆ Categorizat ion◆ As s ociation◆ Perception◆ Decis ion Making

Informat ion Processing Dif f icul t ies

◆ Problem S olving◆ Attentional Ability◆ Complex Thinking◆ Pros pective Memory

◆ Ident ity/ Potent ial◆ Control◆ Mis takes◆ Res pons ibility/Was te◆ Completenes s◆ Validation of Worth◆ Perfectionis m◆ S ocialization

Thoughts & Bel iefs

◆ Beauty/Aes thetics◆ Memory◆ Utility/Opportunity◆ Uniquenes s◆ S entimentality◆ Comfort◆ S afety

Meaning of Possessions

The Brush

How Do We Help?

Why is Help Refused?

◆ Poor insight◆ Fear & shame◆ Differing views on solut ions◆ Hopelessness & burnout◆ Resentment & mistrust◆ Negative past experiences◆ Personal values◆ Over-valuat ion of possessions

“Harm Reduction ModelFocuses on managing &

mitigating the negative impact of hoarding behaviour NOT on eliminating the behaviour

entirely

Harm Reduct ion is not “Bet ter Homes & Gardens”

Harm Reduct ion In Act ion

Harm Reduct ion in Act ion

Harm Reduct ion At t itude

◆ No two hoarding situat ions are ident ical◆ The client is an essent ial member of the team◆ Recognize that change is a slow process◆ Not meet ing goals does not mean the approach

isn’t working◆ Consider other problems the client may be

dealing with besides hoarding

Safety Considerat ions

Egress Issues◆ Do windows and doors

open freely?◆ In sleeping areas are

windows unobstructed?◆ Are pathways clear of

obstruct ions?

Air & Environmental Hazards◆ Mold◆ Pests (e.g. rodents, bed

bugs, cockroaches)◆ Spoiled/ unsafe food

Safety Considerat ions

Avalanche & Tripping Hazards◆ Possessions piled

precariously or stacked too high

◆ Climbing over items◆ Possessions blocking

entries and/ or stairs

Other Considerat ions◆ Reluctance to seek support

for fear of being “reported to authorities ”

How Else Can You Help?

Set realist ic expectat ions◆ Harm reduction goals◆ Monitoring progres s and/or maintenance◆ Harm reduction contract

How Else Can You Help?

Communicate expectat ions specifically & sensit ively◆ Choos e language carefully (e.g. us ing terms like

“items ” ins tead of “garbage”)◆ Us e s pecific meas urements in goals (e.g. 3 foot

clearance radius around furnace)◆ Create fair expectations (e.g. windows acces s ible)◆ Be careful with abs olute language (e.g. “all items

mus t be removed from the bas ement”)

Trauma Informed Intervent ion

Physiology of Trauma

Trauma Informed Intervent ion Strategies

◆ Be sensit ive entering the home ◆ Educate the client on potent ial t rauma

responses◆ Use anxiety reduct ion strategies (e.g.

mindfulness exercises, redirect ion)◆ Encourage client to have a support person with

them when someone new is entering the home◆ Manage your own emotions

Communicat ion Strategies

Act ive Listening

Reflect ing/ Paraphrasing◆ Thoughtfully rephras e the individuals

s tatements – if they dis agree with your interpretation acknowledge that you may have mis unders tood

◆ Example: “I don’t s ee why I can’t live the way I want. I’m not bothering anybody.”“Okay, s o you’re thinking that you’re not bothering anyone and that you don’t like people nagging you about the way you live?”

Act ive Listening

Clarifying◆ As k ques tions to help you “get it”◆ Avoid pres s uring the client to s ee things the

way you do◆ Example: “You never tell me exactly what you want me to do.”“What parts are you confus ed about?”

Act ive Listening

Giving Feedback◆ Calmly, without judgement, s hare your own

relevant thoughts , feelings and opinions◆ Notice and give pos itive feedback◆ Example: “I’m frus trated you won’t let me help.” vs . “You are impos s ible to work with.”“I s ee how much work you did on the landing.”“What I’m concerned about is s afety… I notice that…”

Mot ivat ional Interviewing & Reflect ions

Reflect ions◆ Reflective lis tening is the s kill of empathy◆ Reflections are s tatements – you’re voice inflection

goes down at the end

Double S ided Reflection◆ Reflect “don’t change” talk firs t and then “change” talk◆ E.g. “on one hand you think… but on the other…”

“Reflection Exercise

“Step Forward Exercise

Pract ical ToolsTips & St rategies for Helping

Pract ical Tools –SMART Goals

Pract ical Tools – Systems List

NO “SYSTEM” “SYSTEM”

Pract ical Tools – Project Planning

Pract ical Tools – Non-Acquiring Strategies

◆ Determine acquiring triggers◆ Establish rules for acquiring◆ The Acquiring Form◆ Advantages/ Disadvantages Worksheet◆ Pract ice!

Pract ical Tools – Non-Acquiring Strategies

◆ Quest ions about possessions◆ Do I have something similar?◆ Do I have a specific place to put it?◆ Could I manage without it?◆ Am I buying this because I feel [upset, angry,

depressed]?

Value Vil lage

Pract ical Tools - Disposal

Provide opportunit ies for environmentally responsible disposal of items◆ Eco S tations◆ Acces s ible Blue Bin◆ Information

Pract ical Tools – Occupant Tip Sheet

◆ A t ip sheet can provide guidance with goals for declut tering and/ or disposal

Resources for Rural Communit ies

Creat ive Solut ions:◆ Create your own hoarding coalition◆ Bring in educators to train individuals

interes ted in helping (e.g. family members , friends , church volunteers etc.)

◆ AIS H◆ Income S upport

Art Therapy

Thanks!Any quest ions?You can find us at : Stacy Walker – info@ gettinaroundtoit.ca

Terri Bai ley, M.A. Counsell ing, CCC – terribaileycouns elling@ gmail.com

Resources

◆ Brat iot is, C., Sorrent ino Schmalisch, C., Steketee, G. (2011). The hoarding handbook: A guide for human service professionals. New York: Oxford.

◆ Steketee, G., Frost, R.O., (2014). Treatment for hoarding disorder: Therapist guide, 2nd Ed. New York: Oxford.

◆ Tolin, D. F., Frost, R.O., Steketee, G. (2014). Buried in t reasures: Help for compulsive acquiring, saving and hoarding, 2nd Ed. New York: Oxford.

◆ Tompkins, M.A., Hart le, T.L. (2009). Digging Out: Helping your loved one manage clut ter, hoarding and compulsive acquiring, Oakland, CA: New Harbinger Publicat ions.

◆ Internat ional OCD Foundat ion: www.iocdf.org