Enforced Harm Reduction Model for Hoarding Situations: A Guide for Hoarding Professionals

By The Hoarding Connection of Cuyahoga CountyJanuary 1, 2025

The Hoarding Connection of Cuyahoga County strongly advocates for the adoption of the Enforced Harm Reduction model, as utilized by the Orange County, CA Hoarding Task Force. This approach emphasizes long-term management rather than complete elimination of hoarding behaviors. It leverages a collaborative team of housing enforcement professionals, social services, health, and mental health personnel to assist individuals who hoard.

The primary aim is to reduce safety risks and improve living conditions, with the goal of achieving Level III or lower on the Institute for Challenging Disorganization (ICD) Clutter Hoarding Scale. Any progress is considered valuable, and the person who hoards should be involved in decision-making to the extent possible.

Benefits of the Enforced Harm Reduction Model

The Enforced Harm Reduction model offers several key benefits:

  • Safety and Health Improvement: It can help restore individuals who hoard to a level of safety and health that has been compromised by excessive clutter and accumulated possessions.
  • Initial Step Toward Treatment: For treatment-resistant individuals, this model serves as a first step in encouraging older adults who hoard to consider treatment options and address the underlying issues contributing to the hoarding behavior.
  • Community Benefit: By removing health and safety hazards, the model helps maintain housing standards and property values, benefiting both the individual and the surrounding community.

Elements of the Enforced Harm Reduction Model

Key components of the Enforced Harm Reduction model include:

  • Clear Housing Codes and Regulations: These regulations address the accumulation of debris within private residences and provide a framework for enforcement when necessary.
  • Collaboration Across Stakeholders: Successful implementation requires cooperation among a diverse team of professionals who are willing to work outside their individual silos. This ensures that the individual who hoards receives comprehensive support from all relevant systems.
  • Long-Term Management Focus: The model prioritizes ongoing management over immediate resolution, acknowledging that change will take time and that progress is often gradual.
  • Integrated Action Plan: A coordinated plan of action should be developed, incorporating specific steps and strategies for addressing the hoarding behavior and improving the living conditions of the individual.
  • Clutter Assessment: The use of the NSGCD Clutter Hoarding Scale (recommended) to measure the extent of clutter and track progress over time.
  • Collaboration with Trash Removal Services: Coordination with trash pick-up services or volunteers to remove items the person is willing to discard. Ensuring that items are physically removed from the residence is critical, as individuals who hoard may otherwise bring them back into the home.

The Enforced Harm Reduction Team

The team involved in implementing the Enforced Harm Reduction model typically includes:

  • The Individual Who Hoards: To the extent that the individual is capable, they should be involved in identifying which items to discard. Involvement in decision-making is vital to avoid causing additional psychological harm.
  • A Housing Safety Inspector: A professional who is willing and able to enforce housing codes when necessary. This role ensures that the safety and health standards are met, helping to mitigate risks associated with hoarding.
  • A Helper/Supporter: An individual who can establish a trusting, unconditional relationship with the person who hoards. The goal is to build rapport and engage the individual in a program of support, helping them to manage their environment in the long term.
  • Community Resources: A network of professionals and organizations, including mental health services, health department, and animal control (if needed), as well as faith-based resources, cleaning services, and professional organizers.
  • Housing Court: If the situation necessitates legal action, housing court involvement may be required to ensure compliance with housing codes and safety regulations.

Key Considerations for Housing Safety and the Helper Role

  • Mandates and Support: Research suggests that individuals who hoard respond best when they are both mandated to comply with health and safety standards and offered positive support to help them manage the situation.
  • Separation of Roles: It is generally most effective for housing safety enforcement and supportive roles to be held by separate individuals or agencies. This ensures that both compliance and emotional support can be provided without conflict.
  • Communication and Unity: Clear, consistent communication among team members is crucial. Individuals who hoard may attempt to divide team members into “good” and “bad” categories, so it’s essential that all team members maintain a united front. A shared understanding of roles and goals is vital to achieving success.

The Enforced Harm Reduction model offers a structured and compassionate approach to addressing hoarding situations, focusing on long-term management and collaboration among professionals. By providing a balance of enforcement, support, and ongoing care, this model ensures that individuals who hoard can achieve a safer and healthier living environment while maintaining their dignity and autonomy.

The Hoarding Connection of Cuyahoga County thanks the Orange County, CA Hoarding Task Force for their pioneering work in developing this model and for their ongoing support and consultation. We also express our gratitude to the Older Ohioans Behavioral Health Network for their start-up assistance in establishing the Cuyahoga County Hoarding Connection.