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Premium member Presentation Transcript : April 5, 2010 “You can’t have everything, where would you put it?” -Steven Wright Presented by Michael Golub Email: email@example.com Working with People Who Compulsively Hoard What is it & How to Deal with it Supportive Housing Network of NY Bed Bug Workshop Wednesday, May 24, 2010 Center for Urban Community Services : 2 Center for Urban Community Services CUCS offers a range of programs & services to more than 20,000 individuals and families in NYC. Permanent Housing Transitional Housing Single Stop Street Outreach ACT Team PPOH Housing Consultation Case Management Consultation CUCS shares knowledge with several thousand direct care staff annually through Training & Consulting Services. Training Consultation Slide 3: 3 The Bed Bug - Hoarding Nexus : 4 The Bed Bug - Hoarding Nexus Compulsive hoarders should not be blamed for the new bed-bug epidemic Compulsive hoarding does not help the bed-bug issue Difficult for property management and social services to engage these individuals making it difficult to coordinate a building’s effort to reduce bed bugs—reporting about bed bugs will be unlikely Inspections and pest management and other procedures are typically not welcomed by these individuals Bringing in clothing, furniture, other things from unknown is the largest issue The inability to clean, organize, and reduce clutter are the symptoms of hoarding, which is problematic for treating bed bug infestation Discarding infested things may also be extremely difficult Once apt is cleared, cleaned and organized, relapse is very likely Visualizing Hoarding : 5 Visualizing Hoarding Slide 6: 6 Slide 7: 7 Slide 8: 8 Slide 9: 9 Slide 10: 10 Framing the Issue : 11 Framing the Issue Hoarding is a new field, still many unknowns Difficult behavior to stop Use the term “Collector” over “People Who Compulsive Hoard” Estimated that there are 3-6 million Americans that compulsively hoard Veblen coins the phrase “conspicuous consumption” First became know with the Collyer Brothers who’s apt. had 180 tons of “stuff” Widely popular topic: Grey Gardens on Broadway, Oprah, TLC & A &E Collecting vs. Hoarding : 12 Collecting vs. Hoarding We all save things for the following reasons: Sentimental Value: emotional attachments to things Utility Value: the item is, or could be, useful Aesthetic Value: the item looks pretty to us Collecting vs. Hoarding : 13 Collecting vs. Hoarding The Collector: Brings joy Show off their collections Save $$$ to purchase more items Sense of pride Does not impair daily functioning or cause emotional distress Collecting vs. Hoarding : 14 Collecting vs. Hoarding Person Who Compulsively Hoards: Ashamed of their “stuff” Embarrassed by their possessions Impairs daily functioning (emotionally & occupationally distress) How does it impair their functionality? Fire hazard Safety hazard Health hazard Clinical DefinitionNote: compulsive hoarding is not yet its own DSM IV diagnosis : 15 Clinical DefinitionNote: compulsive hoarding is not yet its own DSM IV diagnosis The acquisition and failure to discard a large number of possessions that appear to be useless or of limited value Living spaces are cluttered enough that they can't be used for the activities for which they were designed Causes significant impairment in functioning Three Components : 16 Three Components Compulsive Acquisition: buying and/or acquiring free things Compulsive Saving: Sentimental saving: “This is a part of me.” Instrumental saving: “I have a need for this.” Intrinsic saving: “This is too pretty to discard.” Clutter and Disorganization: Random piles Fear of putting things out of sight Indecisiveness Churning: meaning that piles are worked over but nothing is ever done about the piles themselves Quote from an on-line person who hoards : 17 Quote from an on-line person who hoards “I feel that if I FINALLY get rid of my piles that fill rooms in my house and garage, I will die. I know it's not true, but I feel that way. It's my safety pile and significant other.” Zeigarnik Effect Gestalt Psychology (the whole is greater than sum of its parts) : 18 Zeigarnik Effect Gestalt Psychology (the whole is greater than sum of its parts) People remember uncompleted tasks BETTER than completed ones. Hoarders report significantly less confidence in their memory and usually have catastrophic beliefs about forgetting things Compulsive hoarders like to leave tasks UNDONE so that they can REMEMBER it better Three Types of Hoarding : 19 Three Types of Hoarding Common Hoarding: the hoarding of items most people save, just extremely exaggerated Diogenes Syndrome: the hoarding of trash and living in squalor; associated with self-neglect Animal Hoarding: the accumulation of large number of animals together with a failure to care for the animals in terms of nutrition, sanitation and veterinarian care Demographics & Features : 20 Demographics & Features Little evidence of history of material deprivation Education ranges widely Marital Status: tend to be single, high divorce rates Tend to live alone Family history of hoarding is common Insight tends to be low Saving usually begins at childhood (13), are mild during teen years, moderate in 20s and worsen in 30s, recognition begins only in late 30s and 40s Hoarding may be worsened by loss Populations Affected : 21 Populations Affected Traumatic Brain Disorders & Organic Brain Disorders The Elderly Individuals with Serious & Persistent Mental Illness Homeless Individuals Attention-deficit Hyperactivity Disorder (ADHD) Individuals with Eating Disorders, ADHD, Physical Illnesses, or those who are Blind or Deaf Warning Signs : 22 Warning Signs Odor!!! Critters crawling out of apt. Unkempt appearance Hesitation at the mention of visiting their apartment Statements such as “My place is kind of a mess. I haven’t been up to cleaning it lately” or “I’m not a very good housekeeper.” Complaints by neighbors Negative behaviors and/or population affected Slide 23: 23 Typical Issues : 24 Typical Issues Attention Decision Making Elaborative Processing (prepare for every imaginable contigency + artistry) Memory Perfectionism Procrastination (Difficulty completing tasks) Avoidance Usually late for appointments Common Cognitive Difficulties : 25 Common Cognitive Difficulties Multi-Tasking: looking at bills and categorizing them into ‘need to pay’ vs. ‘junk mail’ while looking at a letter from management regarding their compulsive hoarding behavior… dealing with all of these items at once may overwhelm individuals Following Verbal Directions: case manager may have explained a week ago about cleaning up his/her apartment. The case manager may need to explain these directions several times before the person really gets it Reading Comprehension Sorting Crucial From Non-Crucial Information Difficulty Problem Solving Short Term Memory Problems Unhelpful Beliefs : 26 Unhelpful Beliefs Problems with: Attention Categorization Decision Making Elaborative Processing Memory Perfectionism Slide 27: 27 Stages of Change for Individuals Who Compulsive Hoard PRE-CONTEMPLATION: unaware that they have a problem Built trust, use empathy & engage through simple activities Connect with what they like about collecting and the things they collect CONTEMPLATION: starting to be aware that a problem exists, but not ready to stop acquiring new things or discard any Continue to build the relationship, continue to engage Discuss personal goals & how CH may impede the achievement of personal goals Help person envision life without clutter, etc. via role playing, achieving goals PREPARATION: getting ready to make changes, but not there yet… Help person make decisions about what they will keep & what they may discard Try out discarding less meaningful items, try not bring home items ACTION/RELAPSE MAINTENANCE “Stuff Reduction” : 28 “Stuff Reduction” A client “collects” broken pianos. When you ask him why he collects them, he tells you that he plans on fixing them up and selling them, but he has yet to do that in the last 5 years you’ve known him. Stuff reduction would be to… General Best Practices : 29 General Best Practices Dealing with CH will take time, effort, coordination, patience and persistence to resolve the problem Effective interventions are going to involve many staff members working in cooperation with each other and the tenant Involve the family and structure daily living activities Staff should anticipate strong resistance, particularly when the tenant’s belongings are removed during a deep cleaning. This will be felt as a real loss and a violation of their privacy A deep cleaning should be seen as a LAST RESORT! On Deep Cleaning : 30 On Deep Cleaning -Dr. Randy Frost “A number of people have asked about the effect of just going into someone's home and cleaning it out without their knowledge. While this may solve a short-term problem, it will not get rid of the hoarding behavior. Before a change in behavior can occur, the person must learn to make the discarding decisions themselves. I would not advise such a strategy unless the person's health or safety was imminently threatened…” - Dr. Randy Frost Effective Case Management Services : 31 Effective Case Management Services Understand that short interventions are unlikely to be as effective as long-term strategies Follow up with collaterals Expect a lot of ups and downs in terms of the therapeutic relationship Help with access to care Think about rep-payee benefits payments Speak clearly and calmly Be realistic about what is possible Encourage clients and case managers to slow down and take their time Helpful Tips for Cleaning Up : 32 Helpful Tips for Cleaning Up Put a halt on acquiring new things! Work on one target area at a time Use lists to breakdown cleaning and organizing tasks Use reminder notes and other types of reminders Pick areas that are highly visible so that once it is de-cluttered you can see the reward of the work. Begin by choosing areas that are highly functional (stove, oven, chairs, bed) Develop daily and weekly cleaning goals Clothing: If you have not worn it in the past year: discard it! Helpful Tips for Cleaning Up : 33 Helpful Tips for Cleaning Up Newspapers and magazines: anything with a date of 6 months or older: discard it! Multiple things: you can keep an original + 1 backup: everything else is discarded! Use boxes or storage bins, separate the clutter from the things that are necessary items Use the 3 ½ box technique 1st box: save box 2nd box: display box (things that will be on display) 3rd box: discard box or trash bag ½ box: to-do-immediately like bills, taxes, etc. Slide 34: 34 Bed Bugs Are Back & They’re Everyone’s Problem! We All Have to Do Our Part. Don’t Bring Things In From the Street If You Suspect You Have Bed Bugs, Call Management Keep Your Apartments Clean & Clutter Free To Learn More, Pick Up A Brochure In the Social Services Office. For Training on Compulsive Hoarding : 35 For Training on Compulsive Hoarding Working with People Who Compulsively Hoard Mike Golub, Trainer/Consultant 212.801.3377 <> firstname.lastname@example.org Training & Consulting Services Center for Urban Community Services www.cucs.org You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.