SORTING THROUGH HOARDING - APHAA...SORTING THROUGH HOARDING A Workshop for Professionals APHAA May 2...
Transcript of SORTING THROUGH HOARDING - APHAA...SORTING THROUGH HOARDING A Workshop for Professionals APHAA May 2...
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