Enforced Harm Reduction
The Hoarding Connection of Cuyahoga County recommends that municipalities adopt the Enforced Harm Reduction model used by the Orange County, CA Hoarding Task Force. This model relies on a team of housing enforcement and social, health and mental health services personnel to work with the person who hoards. The goal is long-term management of the situation; not elimination. The Cuyahoga County Hoarding Connection recommends a goal of achieving Level III or lower on the Institute for Challenging Disorganization (ICD) Clutter Hoarding Scale. Any progress is beneficial. It includes the person who hoards in the decision-making to the extent he/she is able.
Benefits of Enforced Harm Reduction
The Enforced Harm Reduction model:
- Can help restore the resistant person who hoards to a level of safety and health that has been absent while living with too much stuff.
- Can be the first step toward influencing treatment resistant older adults who hoard toward considering alternative and addressing the underlying problems which lead to hoarding.
- Benefits the community by removing health and safety hazards and maintaining housing values.
Elements of the Enforced Harm Reduction Model
Enforced Harm Reduction Includes:
- Reasonable, clearly written housing codes and regulations that address the accumulation of debris inside a private residence.
- Collaboration among a team of stakeholders who are willing and able to work outside their “silos” to effect change with the individual who hoards and within their own system as well.
- A long-term perspective that sees management rather than complete resolution of the situation as the goal.
- An integrated plan to proceed.
- Use of the NSGCD Clutter Hoarding Scale to rate the amount of clutter. (RECOMMENDED)
- Coordination with trash pick-up or volunteers to collect the items that the person is willing to discard. It must be removed from the premises and taken away or people who hoard will put them back in the house. (RECOMMENDED)
The Enforced Harm Reduction Team
Members of the team include:
- The consumer to the degree that he/she is capable. The consumer must be involved with identifying items to be discarded. If not, it could lead to more severe psychological damage.
- A housing safety inspector who has the willingness and ability to enforce the codes if necessary.
- A helper/supporter who can establish an unconditional relationship with the person who hoards. The goal is to engage the consumer and helper to work a program.
- Community resources including mental health services, health department and animal control if needed. This would also include a faith-based resource as well as any established cleaning service or organizing service.
- The housing court, if necessary.
Some notes about the housing safety and the helper role:
- Generally, individuals respond better with both a mandate to comply with health and safety codes and positive support for their actions to manage the situation.
- The housing safety and helper roles work best when they are two different individuals or agencies.
- It is critical that team members communicate with one another.
- Clients may tend to split people into good and bad people.
- No one is truly the bad or good guy.
- Roles need to maintain a united front.
- Clarification of goals and roles is critical.
Our special thanks to the Orange CA Hoarding Task Force for their pioneering work in developing the Enforced Harm Reduction Model and training and consultation for this project. We also thank the Older Ohioans Behavioral Health Network for their start-up support of the Cuyahoga County Hoarding Connection.