Buried in Too Many Treasures. An Introduction to De-Cluttering Techniques

Transcription

1 Buried in Too Many Treasures An Introduction to De-Cluttering Techniques

2 Introductions Jill Nielsen, LCSW Adult Protective Services Program Director City and County of San Francisco Mark Salazar Senior Projects Manager, ICHC Program, PCORI Research Manager Mental Health Association of San Francisco David Bain Peer Facilitator, PCORI Research Mental Health Association of San Francisco

3 Learning Objectives Hoarding behavior and who it affects Intersection of loneliness, clutter, and seniors Resources in San Francisco to provide support Providing support to seniors with HD directly Learn the fundamentals of de-cluttering techniques

4 Who does clutter affect?

5 Samuels, % 5%

6 9 15 Million People

7 Clutter issues affect approximately the same percentage of the population as Alzheimer s Disease. As with Alzheimer s, stigma around Hoarding Disorder can affect open discussion and willingness to seek treatment.

8 3% 5% Between 25,000 to 50,000 adults in San Francisco face hoarding and cluttering challenges and that estimate may be low.

9 Age of Onset

10 Most reported

11 Clutter issues disproportionately affect older adult populations. Why? Elders have lived long enough to accumulate more stuff. They have a greater likelihood of experiencing a life-altering event. Death of a loved one Health crisis Loss of a job or retirement They may have experienced downsizing, especially in conjunction with custodial care of items left behind by loved ones who have died.

12 Loneliness and clutter The vicious circle

13 Clutter Isolation Increased Acquiring Depression and Anxiety

14 Many people who seek treatment cite lapsed social connections as their primary motivation for wanting to beat clutter.

15 Many people who deal with clutter are exceptionally social and are greatly afflicted by loneliness and isolation.

16 What can we do to support elders on their journey of decluttering?

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18 Stigma Elimination Advocacy Public Policy Peer Support Education Consumer Driven Training

19 2007

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21 Annual Conference Support Groups Consultation Treatment Group Community Education / Trainings City Wide Task Force Information and Referral Peer Response Team Advocacy ICHC Research

22 CONTINUUM OF SERVICES Maintenance/ Continuation Action Group Un-Buried In Treasures Group WRAP for Clutter Commitment/ Structured Therapist-led Treatment Group Buried In Treasures Group Low Threshold/Low Commitment Drop-In Support Group PRT 1:1

23 We identify social connection as a key to recovery. We offer 1:1 In-Home Peer Support. Not sustainable in the long term due to travel and increased reliance on Peer Responders for alleviating social isolation We engage individuals and encourage them to join an increasing variety of groups. We provide opportunities for social connection and community building.

24 Group offerings at MHASF Drop-In Group Treatment Group Buried in Treasures Unburied from Treasures Action Group WRAP for Finders/Keepers Open House Group (LGBT Center)

25 Why groups? Groups, rather than individual therapy, are becoming the gold standard for treatment of clutter issues. Groups provide not only an optimum learning environment for new skills and strategies, but are also a way of addressing isolation. Groups provide individuals with a way to connect with clutter buddies another means of alleviating social isolation.

26 Group treatment program 16 to 26 - week group therapy program Works very well for some individuals Continued progress after the process for some while others have some degree of relapse CBT TREATMENT GROUP

27 What about individuals that we cannot reach?

28 San Francisco Adult Protective Services Hoarding Intervention and Tenancy Preservation Program Pilot DAAS DBI APS MHASF MBHP

29 Goals of the HITPP Pilot 1. Prevent Evictions 2. Resolve Health and Safety Violations 3. Reach Clients that are Reluctant to Access Clinic or Group Treatment 4. Improve Collaborations Across Programs 5. Learn More about Hoarding and Cluttering Disorder and Effective Treatment

30 APS Clients Adults with Disabilities or Elders over 65 At Risk of Eviction or Homelessness Experiencing Code Violations as a Result of Hoarding Conditions Co-Occurring Mental Health and Physical Health Problems No History of Participating in Hoarding Treatment

31 Intervention Techniques Home- Based Skill Building Hands-on Practice Supportive Counseling Motivational Interviewing Crisis Intervention

32 Findings Improved Insight 6 Months Evictions Prevented Weekly Visits Required Reduced Anxiety and Depression Small Caseload Critical

33 PCORI: Therapist vs. Peer Lead Group Funded by PCORI: Patient Center Outcomes Research Institute Partnership with University of California, San Francisco Carol Mathews, M.D. 3-years

34 BURIED IN TREASURES GROUP 15 week group over 20 sessions Peer-Led Group Step-by-Step textbook guide to understanding why we clutter and how to change our thinking and behaviors

35 DSM V: Diagnostic Criteria A. Persistent difficulty discarding possessions i. Regardless of the value others may attribute to these possessions B. Caused by strong urges to save items What do we mean by clutter? C. Accumulation of a large number of possessions that render the home or areas of the homes not useable D. Cause clinically significant distress or impairment E. Symptoms are not due to a general condition

36 What are our challenges? Mental functioning

37 What are our challenges? Mental functioning Attention Categorization Decision Making Memory

38 Overly Creative Thinking Perfectionism

39 Safety, security and control Sentimental attachments Identity

40 Perception Do you see what I see? Telling your story?

41 Non-acquiring shopping trips Non-acquiring hierarchy

42 Non-acquiring Help Card

43 I. Set your priorities II. Keep you eye on the prize III. Develop the right skills

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52 Identify the challenges Identify your goals Find a technique that works Choose a place to start Identify your categories Create your hierarchy list

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54 Would I buy it again if I did not already own it? Am I keeping it only because of the money I spent? Do I have enough space for it? Is it of good quality, accurate and / or reliable? When do I have time to read this/ fix this / finish this project? Am I keeping this just because I am looking at it now? Do I already have enough / too many of these?

55 If it doesn t fit, it must go If I have 5 of these, all others must go If I have not worn it in a year, it must go If it is badly stained, it must go If I don t have room for it, it must go If I have not read it in 6 months, it must go

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57 17 th Annual ICHC Conference November 5 6, 2015 Hilton San Francisco Financial District

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59 Mark Salazar Senior Projects Manager, ICHC Program, PCORI Research Manager Mental Health Association of San Francisco Jill Nielsen, LCSW Adult Protective Services Program Director City and County of San Francisco Thank you, and please stay in touch! David Bain Peer Facilitator, PCORI Research Mental Health Association of San Francisco