Safety Day: An Application of Disaster Psychology to Hoarding Cleanouts Jennifer Sampson, PhD, LMFT The Hoarding Project Antioch University Seattle 2016 Hoarding Awareness Conference Tukwila, WA October 28. 2016 Copyright 2016. All rights reserved.
SafetyDay:AnApplicationofDisasterPsychologytoHoardingCleanouts
JenniferSampson,PhD,LMFTTheHoardingProject
AntiochUniversitySeattle
2016HoardingAwarenessConferenceTukwila,WA
October28.2016
Copyright2016.Allrightsreserved.
Outline
Ê ApplicationofDisasterPsychologytoHoardingCleanoutInterventions
Ê SafetyDayInterventionProcess
Ê Implications
Copyright2016.Allrightsreserved.
Cleanout….OrElse!!
• HoardingisamentalhealthissueANDcanresultinpublicsafetyconcerns
• 23%ofindividualsseekinghelp
forhousingproblems,includingeviction,metcriteriaforhoardingdisorder(Rodriguezetal.,2012)• 32%currentlythreatened
withimminenteviction
• Bythetimehoardingcasescometopublicattention,theylikely:
Requireintensive,lengthy,costly,strategicandcomplexresponses
Copyright2016.Allrightsreserved.
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TheProblemAsWeSeeIt…
Ê Cleanouts:Ê Arenoteffectiveorsustainable
Ê Theycanbetraumatizing
Ê Theyoverlookthecrisis/disasternatureofacleanouteventonahomeowner
Ê BUT,sometimestheyarenecessaryinordertopreservepublicsafety
Ê HistoryÊ UMMedicalReserveCorps&
PsychologicalFirstAid
Ê Hoardingclean-outs
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CleanoutsasTraumaticCrisis???
DiffusePhysiological
Arousal
DisasterSurvivors
HoardingCleanouts
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HoardingCleanoutsasDisasterEvents
Ê Thinkingabouthoardingcleanoutsthroughthelensofdisasterpsychologyallowsusto:Ê Makesenseofthestrongemotionalandpsychological
responsesexperiencedbypeoplewhohoardbefore,during,andafteraforcedcleanout
Ê Applyevidence-basedknowledgeandpracticesfromotherfieldstothisnew,developingfieldofinterventioninordertominimizethedamagewhenhoardingcleanoutsarenecessary
Copyright2016.Allrightsreserved.
BackgroundonDisasterorCrisisPsychology
DevelopmentofCrisisInterventionfollowingaTraumaticEvent
Ê 1942CoconutGrovenightclubfireinBoston(493peoplekilled)
Ê Lindemann-Generalandpredictableemotionalandphysicalpatternsofresponse->focusedonreactionstotheeventofthetragedy
Ê Certainclinicalstrategies(e.g.facilitationoftheexpressionofgrief)werehelpfulwithawiderangeofclientsincrisis
Ê Createdstandardproceduresforhelperstotreatandpreventproblemsfollowingacrisis
Trepper&Papay,1996
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Definitionofa“TraumaticCrisis”
Ê Aneventthatisexperiencedorwitnessedinwhichpeople’sabilitytocopeisoverwhelmedÊ ActualorpotentialdeathorinjurytoselforothersÊ SeriousinjuryÊ Lossofcontactwithfamilymembersorclosefriends
Ê Destructionoftheirhomes,neighborhood,orvaluedpossessions
AdaptedfromCERTBasicTraining,2011Copyright2016.Allrightsreserved.
PossibleSymptomsofTraumaticStress
PsychologicalSymptoms
Ê CognitivefunctioningdifficultiesÊ IrritabilityorangerÊ Self-blameorblamingofothersÊ IsolationandwithdrawalÊ FearofrecurrenceÊ Feelingstunned,numb,oroverwhelmedÊ FeelinghelplessÊ MoodswingsÊ Sadness,depression,andgriefÊ DenialÊ ConcentrationandmemoryproblemsÊ RelationshipconflictsÊ RigidthinkingÊ Difficultydecision-making
PhysicalSymptomsÊ Lossofappetite
Ê Headachesorchestpain
Ê Diarrhea,stomachpain,ornausea
Ê Hyperactivity
Ê Increaseinalcoholordrugconsumption
Ê Nightmares
Ê Inabilitytosleep
Ê Fatigueorlowenergy
AdaptedfromCERTBasicTraining,2011
Symptomsoftraumaticstressarenormalhumanresponsestoabnormalevents.
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WhathappenstoourbodyinCrisis:DiffusePhysiologicalArousal(DPA)
Ê AllpeopleexperienceDPAorflooding.
Ê Heartrateover90-100bpm:adrenalineentersbloodstream
Ê Flight,fight,orfreeze(intenseanxietyorfear)
Ê Wehearandseesignalsofdanger,nothingelse.
Ê IndividualsinDPAcannotmakebasicdecisions
Ê Limbicsystemonoverload
Ê Forphysiologicalreasons,whenwearefloodedweareunabletocommunicateeffectively.
Ê ProcessingcrisiseventswhileweareinDPAmayresultintraumatization
Ê SympatheticNervousSystem(SNS)responsetostress
Ê Fight,Flight,orFreeze
Diffuse
• Manypartsofthebodyareaffectedatonetime
Physiological
• “ofthebody”,aphysicalphenomenon
Arousal
• Stirringupoftheneurologicalsystem,makingreadyforaction
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MediatingFactors:Whysomepeopleresponddifferentlyto
particulareventsthanothers
Ê Thestrengthandtypeofpersonalreactiontoatraumaticeventvariesdependingonseveralfactors:Ê Person’spriorexperiencewithsameor
similarevent
Ê Intensityofdisruptioninperson’slife
Ê Meaningoftheeventtotheindividual
Ê Emotionalwell-beingandresourcesavailabletotheindividual
Ê Lengthoftimethathaselapsedsinceeventandpresent
AdaptedfromCERTBasicTraining,2011Copyright2016.Allrightsreserved.
WhatisImportanttoKnowaboutDisaster/CrisisEvents?
Ê Psychologicalresearchhasshownthatdisasterscancauseseriousmentalhealthconsequencesforvictims
Ê PTSD,Depression,Anxiety,HealthConcerns.(Norrisetal.,2002)
Ê Themorestress,definedinavarietyofways,withinthedisaster,themorelikelytherearetobeemotionalconsequences(Sundin&Horowitz,2003)
Ê FirstrespondersanddisasterworkersareatspecialriskforPTSDandothernegativeemotionalconsequencesofdisaster(Gibbs,Lachenmeyer,
Broska,&Deucher,1996;Norris,2002)
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WhatisImportanttoKnowaboutDisaster/CrisisEvents?(continued)
Ê Caplan(1964)proposedthatacrisisisaturningpoint.Individualsincrisiscaneither:
Ê Copesuccessfullyandtherebyenhancetheirabilitytocope,or
Ê Makemaladaptiveattemptstocope,andtherebydeclineintheirpsychologicalfunctioning
Ê Availabilityofresourcesandstressreductioniscriticaltopostdisasteradjustment(Caplan,1964)
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PreventionApproachestoCrisisIntervention
Ê Caplan(1964):modelofpreventionofnegativepsychologicalsymptoms(psychopathology)
SecondaryPrevention
IdentifyPeopleatRisk,conductrapidscreeningafterdisasters,andtobegininterventionsassoonaspossible
PrimaryPrevention
ReduceStressoftheEnvironment
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ApplicationofDisasterPsychologytoHoardingCleanouts
HoardingCleanoutsandTraumaticStress
Ê Wecan’tdotherapyinthemiddleof“atornado”
Ê IndividualsincrisiscannotmakebasicdecisionsorcommunicateeffectivelyÊ Limbicsystemonoverload:diffusephysiologicalarousal(DPA)
Ê Additionally,individualswhohoardalreadystrugglewith:Ê Decision-making
Ê Co-occurringdiagnoses
Ê Cognitivedifferences
Ê Partingwithitemsduetoemotionalattachment
Ê Approachingcleanoutsfromarational,confrontationalperspectivenotonlywillnotwork,butitcanactuallydomoredamagethangoodinthelongrunÊ Mayprovokeanincreaseinstress,whichinturnmayworseneffectsoftraumatic
event
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TranslatingPhasesofCrisistoHoardingCleanouts
ImpactPhase
Survivorsgenerallydonotpanicandmay,infact,shownoemotion
InventoryPhase
Immediatelyfollowsevent;survivorsassessdamageandtrytolocateothersurvivors;focuson
function
RescuePhase
Survivorswillingtotakedirectionfromgroupswithoutprotest;likelyto
behelpful
RecoveryPhase
Survivorsappeartoturnagainstrescuers(emergencypersonnel);
expressanger/blame
PreparationPhase
Participantsmayexperienceintenseanxietyattheanticipationoftheimpendingeventortheymay
experiencedenialaboutthedifficultyoftheupcomingday
AdaptedfromCERTBasicTraining,2011
DuringtheCleanout
Participantsgenerallydonotpanicandmay,infact,shownoemotion;howeverindividualsaretypicallyveryclosetoemotionalfloodingthreshold;similartoRescuePhase,maytakedirectionfromteamwithoutprotestandmay
behelpfulduringtheprocess
ImmediatelyFollowing
theCleanout
Participantsassessdamageandtrytolocatetheiritems;focusonfunction;maybeeagertousenew
space
HourstoDaysFollowingCleanout
Participantsbegintorealizetheoutcomesofthecleanoutandmaynotbeabletolocatepossessions;mayturnagainstteam,expressingangerandblame
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Phasesof“SafetyDay”Intervention:Trauma-InformedHoardingCleanoutInterventions
PreparatoryPhase
• AnticipatoryPlanning;logisticalplanningforcleanoutevent(harmreductionapproach)• Informedconsent• SpecificDecisionMakingrelatedtoHarmReductiontasks• TeachingStressmanagementtechniques• DevelopCrisisPlans
CriticalPhase
• Stressmanagement(keepclientoutofDPA)• Coordinateclean-outefforts/reachharmreductiongoals• Ifwecanattendtotheneedsofthehomeowners,weshouldbeabletocountoncooperation
InventoryPhase
• Anticipateparticipantconcernsre:locationofpossessions;makeplansandbeavailableforde-escalationasneeded
RecoveryPhase
• Processcleanoutascrisis;cananticipatestrongemotions(anger/blame)• Processclean-outasifrespondingtotraumaticevent• Transitiontomentalhealthcare
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Goalsof“SafetyDay”
Ê ProcessandApplicationofCriticalIncidentStressManagementÊ Adaptive,short-termpsychologicalhelping-
processthatfocusessolelyonanimmediateandidentifiableproblem.Itcanincludepre-incidentpreparednesstoacutecrisismanagementtopost-crisisfollow-up.
Ê Additionally,needtounderstandtheimportanceofpreservingteammemberspsychologicalwell-being
Ê Bringclient’shometosafetytoreducethreatofevictionandcomplywithhousingcodesusingaHarmReductionApproachÊ Mitigatenegativeeffectsof
stressfulandpotentiallytraumaticevent
Ê Onlydiscardwhatisnecessarytoreachgoals
Ê KeepclientoutofDiffusePhysiologicalArousal
Ê UsePsychologicalFirstAidÊ Recognizeandrespondto
symptomsofpsychologicalcrisis
Ê Mitigatethemediatingeffects
PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
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ProcessofSafetyDay
HarmReduction(Tompkins,2014)
Ê Setofpracticalstrategiesthatreducethenegativeconsequencesofaparticularhealthissue(HarmReductionCoalition,2010)
Ê Goal:nottoeliminatebehavioritselfbuttominimizenegative,unwantedconsequencesthataccompanybehavior
Ê Doesnotrequiretheindividualtohave“insight”intoreasonsforhoardingÊ Onlyrecognizethepotentialforharmtothem,others,orneighbors
andtoagreetominimizetheriskÊ Doesn’tpreventnewitemsfromcominginorincreasediscarding
Ê Helpfulforindividualwithcognitiveimpairmentsorforpeoplewhoareunwillingtoseektreatment
Copyright2016.Allrightsreserved.
Phasesof“SafetyDay”:Trauma-InformedHoardingCleanout
Interventions
PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
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PreparatoryPhaseforClient
Ê PrimaryFocus:Buildtrustingrelationshipwithclient
Ê Sessionwithclienttoreviewtheprocessoftheday:Ê Whatwillhappen
Ê Stress-managementteamwillbewithclientÊ Onlyitemsthatposethreattohealth/safetywillbediscarded
Ê Whatwon’thappenÊ Decision-makingrelatedtokeepingorgettingridofgeneralitems
Ê Feelingstheymayhaverelatedtovolunteersintheirhomeandwhatishappening
Ê Stressmanagementplan(similartoCrisisPlan)Ê Prepfor“hoardinghangover”(InventoryPhase:emotionalresponse
followingtheSafetyDay)-developanotherstressmanagementplan
PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
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PreparatoryPhaseforTeam
OrganizationalTeamÊ Clearideaofharmreductiontargets
Ê Makeaplanforcategorization,labeling,discarding,etc.
Ê Gathervolunteers
Ê Trainnewvolunteers
Ê Schedulepre-meetingandpost-debriefing
Ê Reviewexpectationsfortheday
Ê Gatherneededitemsfortheday:
Ê Boxes,packingtape,sharpiesforlabeling
StressManagementTeam
Ê PsychologicalFirstAidÊ Supportresilience:
Ê PromoteSafety
Ê Calm&Comfort
Ê Connectedness
Ê Self-Empowerment
Ê PreventionStrategies
Ê Self-Care
Ê KeepclientoutofDiffusePhysiologicalArousal
PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
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CriticalPhase–DayofSafetyDay
Ê Pre-meetingwithvolunteers
Ê Coordinationofefforts–teamsoftwoworkingtogetherinspecificareasofthehome
Ê OrganizationalTeam
Ê CarryoutHarmReductionGoals
Ê Onlyitemsindirectviolationofhealth/safetyshouldleave/bediscarded
Ê Anyitemsthatneedtobedecideduponshouldnotleavethehomethatday(ideally)inordertominimizestress
Ê Developre-organizationstrategyforsortingintoboxes(e.g.labeling,categorizing,etc)
Ê StressManagementTeam
Ê KeepclientoutofDPAthroughouttheday
Ê Reducepotentialofstressors
Ê Debriefwithvolunteerteam(provideanoption)
Ê Howdiditgo?
Ê Whatdidyounotice?Preparatory
PhaseCriticalPhase
InventoryPhase
RecoveryPhase
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CriticalIncidentStressDebriefing
Mustbeofferedasanoptionforteammembers,notarequirement
1. Introductionsanddescription
2. Reviewoffactualmaterial
3. Sharingofinitialthoughtsandfeelings
4. Sharingofemotionalreactionstoincident
5. Instructionaboutnormalstressreactions
6. Reviewofsymptoms
7. Closingandfurtherneedsassessment
AdaptedfromCERTBasicTraining,2011PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
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InventoryPhase
Ê DayOf/After:Ê Providea“visualmap”ofnewlocationofpossessionsinhome
Ê Workwithorganizationteamtocreateeasilyvisiblelabelsthroughoutthehome
Ê Implementpre-setCrisisPlanasneeded
Ê Follow-upwithclientbyphoneÊ Feelings
Ê Concernsrelatedtotheday
Ê Whatarenextsteps?Ê SetHarmReductionCheck-inScheduletopromotemaintenance
Ê Ifnotalreadyinlong-termmentalhealthcare,connectclienttodounderlyingworkaswellasaddressbehavioralissues
Ê Possiblereferraltoaprofessionalorganizer
PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
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RecoveryPhase–Days/Weeks/MonthsFollowingSafetyDay
Ê ProcessEventwithClientwiththeunderstandingthattheclienthasgonethroughatraumaticeventÊ CreatespaceforunderstandingandprocessingÊ Donottrytorationalizeclient’sstrongfeelingsaway
Ê Thiswilltakeaslongasitneedstotake
Ê Mayrequiresometraumaprocessinginterventions
Ê WorkwithteamtodevelopHarmReductionandMaintenancePlantocontinueprogressbeyondSafetyDay
Ê Consult,consult,consult
PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
Copyright2016.Allrightsreserved.
Implications
Implications
Ê Weneedamajorre-haulofinterventionapproachesforseverehoardingsituationsÊ Wecan’tdotherapyinthemiddleofastorm
Ê ApplyingdisasterpsychologytohoardingcleanoutswillhelpustodevelopstrategiestoworkingwithindividualswhohoardÊ Helptoavoidordecreasetheintensityoftraumaticoutcomesforthe
homeowner
Ê ReframingthiseventwillhelpprofessionalsandfamilymembersdevelopcompassionforindividualswhohoardinanewwayÊ Recoveryprocessesareexpectedandaccommodatedinotherareasof
traumaticcrises
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Questions?
www.thehoardingproject.org
Weoffernationalphoneconsultationservicesforprofessionals,familymembers,
andpeoplewhohoard.
Contactusbyemailtoscheduleaconsultationtoday!
References
Ê Caplan,G.(1964).Principlesofpreventivepsychiatry.NewYork:BasicBooks.
Ê CERTBasicTraining,2011
Ê Gibbs,M,Lachenmeyer,J.R.,Broska,A.andDeucher,R.(1996).EffectsoftheAVIANCAAircrashonDisasterWorkers.InternationalJournalofMassEmergenciesandDisasters14(1):23-32.
Ê Lindemann,E.(1944).Symptomatologyandmanagementofacutegrief.AmericanJournalofPsychiatry,101,141-148.
Ê Norris,F.H.,Friedman,M.J.,Watson,P.J.,Byrne,C.M.,Diaz,E.,&Kaniasty,K.(2002a).60,000disastervictimsspeak:Part1.Anempiricalreviewoftheempiricalliterature,1981-2001.Psychiatry,65,207-239.
Ê Rodriguez,C.I.,Herman,D.,Alcon,J.,Chen,S.,Tannen,A.,Essock,S.,&Simpson,H.B.(2012).PrevalenceofHoardingDisorderinIndividualsatPotentialRiskofEvictioninNewYorkCity:APilotStudy.TheJournalofNervousandMentalDisease,200(1),10.1097/NMD.0b013e31823f678b.http://doi.org/10.1097/NMD.0b013e31823f678b
Ê Sundin,E.C.&Horowitz,M.J.(2003).Horowitz'sImpactofEventsScale:Evaluationof20yearsofuse.PsychosomaticMedicine,65,870-876.
Ê Tompkins,M.(2014).Clinician'sGuidetoSevereHoarding:AHarmReductionApproach.Springer.