safety day: an application of disaster psychology...
TRANSCRIPT
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.
1ye
ar
2ye
ar
3ye
ar
4ye
ar
5ye
ar
6ye
ar
7ye
ar
8ye
ar
9ye
ar
10yea
rClea
nout
1mon
th
3mon
th
6mon
th
TheProblemAsWeSeeIt…
Ê Cleanouts:Ê Arenoteffectiveorsustainable
Ê Theycanbetraumatizing
Ê Theyoverlookthecrisis/disasternatureofacleanouteventonahomeowner
Ê BUT,sometimestheyarenecessaryinordertopreservepublicsafety
Ê HistoryÊ UMMedicalReserveCorps&
PsychologicalFirstAid
Ê Hoardingclean-outs
Copyright2016.Allrightsreserved.
CleanoutsasTraumaticCrisis???
DiffusePhysiological
Arousal
DisasterSurvivors
HoardingCleanouts
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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.
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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)
Copyright2016.Allrightsreserved.
WhatisImportanttoKnowaboutDisaster/CrisisEvents?(continued)
Ê Caplan(1964)proposedthatacrisisisaturningpoint.Individualsincrisiscaneither:
Ê Copesuccessfullyandtherebyenhancetheirabilitytocope,or
Ê Makemaladaptiveattemptstocope,andtherebydeclineintheirpsychologicalfunctioning
Ê Availabilityofresourcesandstressreductioniscriticaltopostdisasteradjustment(Caplan,1964)
Copyright2016.Allrightsreserved.
PreventionApproachestoCrisisIntervention
Ê Caplan(1964):modelofpreventionofnegativepsychologicalsymptoms(psychopathology)
SecondaryPrevention
IdentifyPeopleatRisk,conductrapidscreeningafterdisasters,andtobegininterventionsassoonaspossible
PrimaryPrevention
ReduceStressoftheEnvironment
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
CriticalIncidentStressDebriefing
Mustbeofferedasanoptionforteammembers,notarequirement
1. Introductionsanddescription
2. Reviewoffactualmaterial
3. Sharingofinitialthoughtsandfeelings
4. Sharingofemotionalreactionstoincident
5. Instructionaboutnormalstressreactions
6. Reviewofsymptoms
7. Closingandfurtherneedsassessment
AdaptedfromCERTBasicTraining,2011PreparatoryPhase
CriticalPhase
InventoryPhase
RecoveryPhase
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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
Copyright2016.Allrightsreserved.
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.