HELP In-Home/In-Facility/In-Office Mental Health and Counseling Services since 1993. By Annette Conway, Psy.D. Licensed Clinical Psychologist CA 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: • • A symptom of Obsessive Compulsive Disorder

(OCD and OCDP). • 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

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

1. Lives alone 2. Above average intelligence 3. Reclusive, suspicious, obstinate, isolated from potential sources of support. 4. Men and women are equally at risk

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 h lth d ll b i

Presenter

Presentation Notes

Bird Hoarding is common because they are less costly to feed and maintain,and multiply quickly

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

Sil Phbi

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 resident o Risk to the other residents o Risk to the "responders"

STEP: 2 Hoarding situations need a team

1. 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: 4 1. 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

DISCARDING 6. 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"

HOARDING Self- 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.

HOARDING KEYS 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-based Effective Living Professionals

(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-based Effective Living Professionals

What is HELP?

• HELP (in-Home Effective Living Professionals) • 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-based Effective Living Professionals

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-based Effective Living Professionals

Clinicians

• Services are provided by: • Licensed Clinical Psychologists • Licensed Clinical Social Workers • Marriage and Family Therapists • Bilingual therapists

HELPHome-based Effective Living Professionals

Biopsychosocial Assessments

• In-home assessments • More thorough assessments possible • Access to important information about living conditions

HELPHome-based Effective Living Professionals

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-based Effective Living Professionals

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-based Effective Living Professionals

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-based Effective Living Professionals

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