Managing Severe Hoarding in Non-voluntary Clients: A 2-years Follow-up Comparative Study of Three Different Approaches

Abstract The management of severe hoarding is often highly challenging due to lack of collaboration and the need to coordinate a large team of professionals. Although numerous strategies have been developed to manage severe hoarding, the most effective approach has not been established. To evaluate and compare three different approaches to the management of severe hoarding in non-voluntary clients. Naturalistic study of clients treated involuntarily by a Crisis Resolution Home Treatment (CRHT) team for severe hoarding. Three management strategies were compared: (1) case management approach with full and part-time staff (HLH), (2) case management approach based on interprofessional networking collaboration (ICN), and (3) routine social service care with non-specific hoarding management led by a social worker (RSW). The Clutter Image Rating scale (CIR) was used to assess hoarding severity at baseline and at 6-, 12-, and 24-months. The main outcome measure was “case resolution” (CIR score < 4). Of the 271 cases referred to the CRHT, 214 completed all follow-up measures. Resolution was achieved in 84.5%, 36.6%, and 36.4% of cases managed by the HLH, RSW, and ICN strategies, respectively ( p < 0.001). The HLH strategy resulted in the greatest improvement in hoarding behaviour. In this study, the most effective strategy to resolve severe hoarding in non-voluntary clients was the case management approach with a full-time team. These findings suggest that centralizing case management in a team of specialized, highly autonomous professionals using a collaborative approach involving motivational interviewing could be the best strategy to resolve severe hoarding.