1. 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

2. HOARDING:
OPTIONS FOR HELPING

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. WHAT IS HOARDING?

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

7. 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

8. 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

9. 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

10. TYPES OF HOARDING
• Common Hoarding
- Generalist
- Specialist
• Diogenes'Syndrome
• Animal Hoarding

11. 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

13. 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

15. 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 risk
1. Lives alone

16. Characteristics cont'd
• Approximately 40% of those affected
also have significant psychopathology
• Severe situations are often
accompanied by physical health
problems
• Correlated with Age

17. 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.

18. 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

20. 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

21. Hoarding is associated with
other Axis I Disorders
• Depression
• Anxiety Disorders
• Eating Disorders
• Addictions (drugs, alcohol, gambling)
• Tics, Tourette's Syndrome
• Autism
• Schizophrenia
• Dementia

22. What Works?
• Medication alone has little effect on Hoarding
• In-Home support
• "Collaborative Intervention"
• Multimodal--Combination of medication,
therapy and increased social contact

23. 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"

24. 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

25. 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

26. 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.

27. 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

28. 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"

29. 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.

30. 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

31. HOARDING
: Animal Hoarding: Animal Hoarding- Birds Over Peo
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

32. (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

33. 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

34. 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

35. Clinicians
•Services are provided by:
•Licensed Clinical Psychologists
•Licensed Clinical Social Workers
•Marriage and Family Therapists
•Bilingual therapists
HELPHome-based Effective Living Professionals

36. Biopsychosocial Assessments
•In-home assessments
•More thorough assessments possible
•Access to important information about living
conditions
HELPHome-based Effective Living Professionals

37. 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

38. 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

39. 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

40. 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
HELPHome-based Effective Living Professionals