Help and hoarding by Annette Conway, Psy.D.

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  • Hello, Great crowd today. Thank you all for inviting me to speak on Hoarding. I hope you leave with some addiitonal knowledge about hoarding... as well, I hope to learn from you.
  • How many of you know someone who is a hoarder...a relative, friend, ? How many of you have clients who are or were hoarders?
  • There are universal messages about hoarders and hoarding that stay true. No gender difference. men and women equally share the hoarding pool. I have had clients as hoarders in small SRO's, and have also worked with clients who live in the Muirlands of La Jolla. You can move a hoarder out of his/her home across the city, and in no time, there new place will be just as cluttered.
  • I like this photo because I had a patient 12 years ago who saved all his empty boxes. When I asked him why would he do such a thing. His response was "You never know when you are going to move". And that seems to be the theme... "You never know when you are going to need that piece of blank paper or whatever again.
  • Compulsive behavior that the person feels driven to perform in response to an obsession (thought) or according to rules that must be applied rigidly. The behaviors are aimed at preventing or reducing distress or preventing some dreaded event or stituation: hoever, these behaviors are not connected in a realistic way and are clearly excessive... these behaviors cause marked distress, are time consuming (take more than one hour a day), or significantly interfere with the person's normal routine, occupational or academic functioning, or usual social activities or relationships
  • Compulsive hoarding has a different pattern of genetic heritance: 84% have first degree family member with a hoarding behavior; 37% have family history of OCD or OCDP
  • Day - Oh - Jeenz ?412--?323 bc , Greek Cynic philosopher, who rejected social conventions and advocated self-sufficiency and simplicity of life
  • Howard Hughes type; James Holmes might have
  • Bird Hoarding is common because they are less costly to feed and maintain,and multiply quickly
  • Similar to what you see on the tv show "The Hoarders"
  • Usually at HELP, the building manager will contact the social worker, then the social worker contacts HELP, and we meet meet and plan an approach based upon "How can we make it happen"
  • Ignore the negative and emphasize the positive. If the client is inclined to read, Create a reference library to promote Insight
  • Takes alot of energy. This is why a "Team Approach" is more successful. The problem with a team approach is that it is costly, time consuming. Discard through
  • Many hoarders have never been positively reinforced for their successes, so it may be difficult for them to accept support and positive regard for their efforts.
  • Help and hoarding by Annette Conway, Psy.D.

    1. 1. HELPIn-Home/In-Facility/In-OfficeMental Health and CounselingServices since 1993.By Annette Conway, Psy.D.Licensed Clinical PsychologistCA Lic.PSY 19997
    2. 2. HOARDING: OPTIONS FOR HELPING
    3. 3. 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
    4. 4. WHAT IS HOARDING?
    5. 5. 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 othersA symptom of Obsessive Compulsive Disorder (OCD and OCDP).
    6. 6. HOARDING vs. CLUTTERINGHoarding and cluttering are often usedinterchangeably. There are twodifferences:1. Clutterers can discard things moreeasily2. Their clutter does not debilitate theirlives to the same degree
    7. 7. 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
    8. 8. KEY PRESENTATION MESSAGE2 Essentials for Success:1. Getting people help with the reasons they hoard2. Cleaning up the property which is the by product of the untreated behavior
    9. 9. TYPES OF HOARDING• Common Hoarding - Generalist - Specialist• DiogenesSyndrome• Animal Hoarding
    10. 10. 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
    11. 11. 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
    12. 12. Characteristics of Diogenes Syndrome2. Above average intelligence3. Reclusive, suspicious, obstinate, isolated from potential sources of support.4. Men and women are equally at risk1. Lives alone
    13. 13. Characteristics contd• Approximately 40% of those affected also have significant psychopathology• Severe situations are often accompanied by physical health problems• Correlated with Age
    14. 14. 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.
    15. 15. ANIMAL HOARDINGAccumulation of animals to theextent that:•Failure to provide minimal nutrition,sanitation and veterinary care•Failure to act on the deteriorating conditionof the animals or the environment•Failure to act on or recognize the negativeimpact of the collection on their own healthand well-being
    16. 16. ANIMAL HOARDINGcontd• 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
    17. 17. Hoarding is associated with other Axis I Disorders• Depression• Anxiety Disorders• Eating Disorders• Addictions (drugs, alcohol, gambling)• Tics, Tourettes Syndrome• Autism• Schizophrenia• Dementia
    18. 18. What Works?• Medication alone has little effect on Hoarding• In-Home support• "Collaborative Intervention"• Multimodal--Combination of medication, therapy and increased social contact
    19. 19. Hoarding Cleanup InterventionsSTEP: 11. Assess the risk and respond accordingly: o Risk to the resident o Risk to the other residents o Risk to the "responders"
    20. 20. STEP: 2Hoarding situations need a team1. Who is your team2. Which organizations do you need on your team to get the job done on time?3. Whats the "Team Plan" -- "How can we make it happen" approach
    21. 21. STEP: 31. Control your reactions to the sight and smell of the unit2. Be aware of internal reactions and judgements--stay neutral and solution-focused3. Be patient. Ask client how things got to this stage and then Listen to what they tell you
    22. 22. STEP: 41. What type of fears are they expressing? What will they need to muster up their motivation?2. Acknowledge small successes3. Make appropriate referrals4. Encourage increased Social contact5. De-Emphasize punishment.
    23. 23. DISCARDING1. Do I need it?2. Have I used it in the last year?3. Select target areas and types of possessions4. Sort into "Yes" and "No" piles5. Work quickly and continuously until target area is clear
    24. 24. 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 patterns9. Always end the session on an "UP" reinforce success and "reward yourself"
    25. 25. HOARDING Self- Directed Program for Hoarding OCDStep 1. Set a Realistic Goal That You are Willing to Achieve – Start SmallStep 2. Make an Assessment of Your Hoarding ProblemStep 3. Put a Moratorium on All AccumulatingStep 4. Develop an Organization Plan for Your HomeStep 5. Decide Where to start FirstStep 6. Establish a Few Simple Rules for Placing, Storing, and Discarding, and Stick to ThemStep 7. Pace YourselfStep 8. When an Area is Clear, Decide How the Space if Going to be Used.
    26. 26. HOARDING KEYS TO BREAKING FREE1.All decisions about saving, discarding, andorganizing are to be made only by the personwith the hoarding problem2.Family members should involve themselvesonly to the extent that they are invited to do soby the hoarder3.During each uncluttering session, stay focusedon one small area until you have completed thearea you started.4.Play soothing, pleasing background music whileuncluttering.5.Severe hoarding should be evaluated by aqualified neurologist or psychiatrist
    27. 27. HOARDING: Animal Hoarding: Animal Hoarding- Birds Over PeoConfessions: Animal Hoarding - AnimalHoarding- Birds Over People ... Todays MostWatched Videos ... 3/4/11 1:29 ​www.bing.com/​videos/watch/video/animal- ​hoarding-birds-over-people/p0wbwi8 · Cached page
    28. 28. (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
    29. 29. 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
    30. 30. HELP Services•Wide array of services •assessment •individual, couples, family counseling andpsychotherapy •treatment coordination with case managers, primarycare physicians, and other health providers •referrals to community resources HELPHome-based Effective Living Professionals
    31. 31. Clinicians•Services are provided by: •Licensed Clinical Psychologists •Licensed Clinical Social Workers •Marriage and Family Therapists •Bilingual therapists HELPHome-based Effective Living Professionals
    32. 32. Biopsychosocial Assessments•In-home assessments •More thorough assessments possible •Access to important information about livingconditions HELPHome-based Effective Living Professionals
    33. 33. Persons Served •Ideal for home-bound patients who otherwiseunable to see a psychologist or physician •frail elderly •people with disabilities •home-bound •seriously ill •agoraphobic HELPHome-based Effective Living Professionals
    34. 34. Patient Characteristics•Treatment duration •usually brief treatment until client regainsfunctioning or transitions to higher level of care•Point-of-entry services •in-home therapists can provide the initial steps toreceiving additional community services HELPHome-based Effective Living Professionals
    35. 35. Conditions Treated•Depression • Phobias•Anxiety and Panic Disorder • Anger Management•Agoraphobia • Relationship Issues•Grief and Bereavement • Parenting•Adjustments to Major Life changes•Addictive Behaviors • Step-Family Issues•Mood Disorders • Couples Therapy•Divorce Issues • Family Therapy•Obsessive-Compulsive Disorder • Communication Problems HELPHome-based Effective Living Professionals
    36. 36. Payments • Medicare Part B • Medi-Cal when Medicare is present • Private insurance coverage • Contracts through various social services andprivate agencies • Reasonable private client rates HELPHome-based Effective Living Professionals

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