Help and hoarding by Annette Conway, Psy.D

HELP

In-Home/In-Facility/In-OfficeMental Health and Counseling Services since 1993.

By Annette Conway, Psy.D.Licensed Clinical PsychologistCA Lic.PSY 19997

HOARDING: OPTIONS FOR HELPING

KEY HOARDING MESSAGES• Hoarding is found in all cultures, genders,

income and education levels and for different reasons.

• Hoarding interventions are usually complicated, costly and time consuming

• Hoarding situations continue to deteriorate until the health and safety of the individual and community are put at risk

WHAT IS HOARDING?

HOARDING IS:•

• Defined as the acquisition of, and failure to discard, possessions that appear to be useless or of limited value (Frost and Gross, 1993)

• Activities of daily life are impaired by spaces which cannot be used for intended use.

• Distress or impairment in functioning to the person hoarding or others

A symptom of Obsessive Compulsive Disorder (OCD and OCDP).

HOARDING vs. CLUTTERING

Hoarding and cluttering are often used interchangeably. There are two differences:

1. Clutterers can discard things more easily

2. Their clutter does not debilitate their lives to the same degree

CHARACTERISTICS OF HOARDERS

• Need for control, no one can move possessions

• Discarding is laborious and distressing; so it is avoided

• Categorization Problems- difficulty differentiating between what is valuable and what is not

KEY PRESENTATION MESSAGE

2 Essentials for Success:

1. Getting people help with the reasons they hoard

2. Cleaning up the property which is the by product of the untreated behavior

TYPES OF HOARDING

• Common Hoarding

- Generalist

- Specialist

• Diogenes'Syndrome

• Animal Hoarding

COMMON HOARDING

• Anything can be Hoarded; most often items are what most people save

• Insight is limited- they ignore the impact their behavior has on themselves and others

• Generalists-- save everything from human waste to valuable items

• Specialists-- save one or more specific categories of items

DIOGENES SYNDROME

• Self-Neglect-- lack of clothing, poor nutrition, medical and dental care even when they can afford it

• Domestic Squalor-- makes residence unhealthy

• Hoarding-- makes residence unsafe

Characteristics of Diogenes Syndrome

2. Above average intelligence

3. Reclusive, suspicious, obstinate,

isolated from potential sources of

support.

4. Men and women are equally at risk1. Lives alone

Characteristics cont'd

• Approximately 40% of those affected also have significant psychopathology

• Severe situations are often accompanied by physical health problems

• Correlated with Age

Better Outcomes

• Day Programs supplemented by Community Care services

• Have support of a "trusting relationship" such as a caregiver, social worker, psychologist or case manager.

ANIMAL HOARDING

Accumulation of animals to the extent that:•Failure to provide minimal nutrition, sanitation and veterinary care

•Failure to act on the deteriorating condition of the animals or the environment

•Failure to act on or recognize the negative impact of the collection on their own health and well-being

ANIMAL HOARDING cont'd• Prevalence is estimated at 88/100,000 GP

• The most difficult to treat usually claiming to be pet rescuers

• Where animal neglect and abuse are suspected, also assess for child & elder neglect and abuse if either co-reside

Hoarding is associated with other Axis I Disorders

• Depression

• Anxiety Disorders

• Eating Disorders

• Addictions (drugs, alcohol, gambling)

• Tics, Tourette's Syndrome

• Autism

• Schizophrenia

• Dementia

• Social Phobia

• Posttraumatic Stress Disorder

What Works?

• Medication alone has little effect on Hoarding

• In-Home support

• "Collaborative Intervention"

• Multimodal--Combination of medication, therapy and increased social contact

Hoarding Cleanup Interventions

STEP: 1

1. Assess the risk and respond

accordingly:

o Risk to the residento Risk to the other residentso Risk to the "responders"

STEP: 2Hoarding situations need a team1. Who is your team

2. Which organizations do you need

on your team to get the job

done on time?

3. What's the "Team Plan" -- "How

can we make it happen" approach

STEP: 3

1. Control your reactions to the sight

and smell of the unit

2. Be aware of internal reactions and

judgements--stay neutral and

solution-focused

3. Be patient. Ask client how things

got to this stage and then Listen to

what they tell you

STEP: 41. What type of fears are they

expressing? What will they need

to muster up their motivation?

2. Acknowledge small successes

3. Make appropriate referrals

4. Encourage increased Social

contact

5. De-Emphasize punishment.

DISCARDING

1. Do I need it?

2. Have I used it in the last year?

3. Select target areas and types of

possessions

4. Sort into "Yes" and "No" piles

5. Work quickly and continuously

until target area is clear

DISCARDING6. Most important, plan appropriate use

of the cleared area.

7. Plan for preventing new clutter to

area.

8. Cognitive-Behavioral Therapy:

Identify self-talk, automatic thoughts

and recognize thought patterns

9. Always end the session on an "UP"

reinforce success and "reward yourself"

HOARDINGSelf- Directed Program for Hoarding OCD

Step 1. Set a Realistic Goal That You are Willing to Achieve – Start Small

Step 2. Make an Assessment of Your Hoarding Problem

Step 3. Put a Moratorium on All Accumulating

Step 4. Develop an Organization Plan for Your Home

Step 5. Decide Where to start First

Step 6. Establish a Few Simple Rules for Placing, Storing, and Discarding,

and Stick to Them

Step 7. Pace Yourself

Step 8. When an Area is Clear, Decide How the Space if Going to be Used.

HOARDINGKEYS TO BREAKING FREE

1.All decisions about saving, discarding, and organizing are to be made only by the person with the hoarding problem

2.Family members should involve themselves only to the extent that they are invited to do so by the hoarder

3.During each uncluttering session, stay focused on one small area until you have completed the area you started.

4.Play soothing, pleasing background music while uncluttering.

5.Severe hoarding should be evaluated by a qualified neurologist or psychiatrist

HOARDING

: Animal Hoarding: Animal Hoarding- Birds Over People ...

Confessions: Animal Hoarding - Animal Hoarding- Birds Over People ... Today's Most Watched Videos ... 3/4/11 1:29

www.bing.com/videos/watch/video/animal-hoarding-birds-over-people/p0wbwi8 · Cached page

HELPHome-basedEffectiveLivingProfessionals

(Brief) History of In-Home Counseling

•Between 1987 and 1997:

•Medicare spending for home care rose at an annual rate of 21 percent

•The number of home care agencies certified by Medicare and the number of patients has doubled

•The older adult population in the U.S. is increasing annually

•“Baby Boomers”

HELPHome-basedEffectiveLivingProfessionals

What is HELP?

•HELP(in-HomeEffectiveLivingProfessionals)

•clinical services

•county-wide organization

•services delivered in homes, offices, or care facilities

•especially useful for homebound individuals

•services available to individuals of all ages

HELPHome-basedEffectiveLivingProfessionals

HELP Services

•Wide array of services

•assessment

•individual, couples, family counseling and psychotherapy

•treatment coordination with case managers, primary care physicians, and other health providers

•referrals to community resources

HELPHome-basedEffectiveLivingProfessionals

Clinicians

•Services are provided by:

•Licensed Clinical Psychologists

•Licensed Clinical Social Workers

•Marriage and Family Therapists

•Bilingual therapists

HELPHome-basedEffectiveLivingProfessionals

Biopsychosocial Assessments

•In-home assessments

•More thorough assessments possible

•Access to important information about living conditions

HELPHome-basedEffectiveLivingProfessionals

Persons Served

•Ideal for home-bound patients who otherwise unable to see a psychologist or physician

•frail elderly

•people with disabilities

•home-bound

•seriously ill

•agoraphobic

HELPHome-basedEffectiveLivingProfessionals

Patient Characteristics

•Treatment duration

•usually brief treatment until client regains functioning or transitions to higher level of care

•Point-of-entry services

•in-home therapists can provide the initial steps to receiving additional community services

HELPHome-basedEffectiveLivingProfessionals

Conditions Treated

•Phobias

•Anger Management

•Relationship Issues

•Parenting

•Step-Family Issues

•Couples Therapy

•Family Therapy

•Communication Problems

•Depression

•Anxiety and Panic Disorder

•Agoraphobia

•Grief and Bereavement

•Adjustments to Major Life changes

•Addictive Behaviors

•Mood Disorders

•Divorce Issues

•Obsessive-Compulsive Disorder

HELPHome-basedEffectiveLivingProfessionals

Payments

•Medicare Part B

•Medi-Cal when Medicare is present

•Private insurance coverage

•Contracts through various social services and private agencies

•Reasonable private client rates