Hoarding is a complex issue that requires a wide range of professional skills and resources to address – so many that collaboration across disciplines is often required. In many communities, community service providers (such as those in fire prevention, social housing, and older adult services) have formed coalitions or networks to work together to address the public health and safety challenges associated with severe hoarding. However, there is not yet much research to guide these groups in making decisions and creating policies. With this line of research, we have created partnerships between community agencies and university researchers. Together, we are developing research-based strategies to address safety risks associated with hoarding in the community. Specifically, we have created a new tool that researchers and community service providers can use to evaluate the urgency and severity of safety risks in hoarded homes. This tool, the Home Environment Assessment Tool for Hoarding, or HEATH, will enable hoarding service providers from diverse disciplines to communicate more effectively and plan interventions based on shared priorities.

Developing the HEATH has involved many steps. Throughout the spring and summer of 2021, we conducted an extensive consultation of our community partners’ expertise through a systematic series of surveys. Our partners’ extensive feedback from these surveys led to the development of the first draft of the tool. Each item on the tool can be meaningfully traced back to our partners’ input in these surveys. A second step, conducted in the spring of 2022, was to consult with more community partners to ensure the HEATH has the right content for their work with hoarding.

We are currently testing the HEATH in field trials with several community partners. This involves service providers who are using the HEATH in their work with clients and comparing the results of this tool with how they have previously done their assessments to be sure the HEATH leads to conclusions that are valid in real-life situations.

From development to testing, this work highlights the possibilities that can emerge through meaningful researcher-provider partnerships. To learn more about the HEATH and the progress we’ve made in its development, please visit our HEATH page.

Another area of our research aims to identify the harm reduction targets for hoarding intervention and the strategies that community agencies use to reduce personal and community-level risks associated with hoarding. Our research team developed a multi-year partnership with a US-based housing provider and called on our network of expert cross-sector service-providers to participate in two qualitative studies. Specifically, these studies allow us to better understand the ways that clients’ willingness to work with community agencies and the level of risk in their home contribute to the clutter reduction strategies used by community providers.

One project, When Cleaning Up is Hard to Do: Community Responsesand Outcomes for Hoarding Cases was done in partnership with Beacon Communities, a nonprofit housing agency located in the Northeastern region of the US. In this study, we conducted individual interviews with staff members at Beacon properties in the Massachusetts to understand their perspectives about hoarding in affordable housing and their approaches to working with hoarding in resident homes. Importantly, Beacon staff shared how they use the Beacon hoarding protocol to work with residents. Ultimately, we hope this research will promote the development of more intentional and feasible policies for use by affordable housing providers.

Another study involved interviewing cross-sector professionals with expertise in community-based hoarding interventions. We conducted 90-minute in-depth interviews with expert professionals, exploring the interventions they use to reduce the risks associated with hoarding as well as the factors and processes that influence the selection of these strategies. Our primary goal with this line of research is to use the practice wisdom held by experts to inform the development of evidence-based best practices for implementing harm reduction and case management approaches to hoarding.

Messy homes and the people who live in them are often stigmatized. Popular media portrays an oversimplified vision of hoarding as a straightforward problem with an easy solution: “Just clean it up”. Stereotypes depicting people who hoard as “lazy” or “dirty” are offensive and mask the difficulties connected to hoarding. We are interested in understanding stigmatizing attitudes towards hoarding and how these attitudes might impact people with lived experience of hoarding.

One current study aims to understand community service providers’ attitudes about hoarding. We are testing whether providers who know more about hoarding and have more professional experience with hoarding tend to hold less stigmatizing views. Understanding these providers’ attitudes about hoarding is important because they are often the first to encounter and intervene in severe hoarding situations. Their perspective can make a real difference in how a person with hoarding experiences a community-based intervention.

In other projects, we are conducting experiments to understand factors that add to stigma associated with clutter. For example, does it matter how the “root cause” of the problem is described? Are attitudes toward household clutter the same, regardless of how much clutter there is or what kinds of problems the clutter causes inside the home? These studies will help us to gain a clearer understanding of stigma related to hoarding.

Although hoarding is driven by psychological factors, such as difficulty deciding what to keep versus what to get rid of, the major risks associated with hoarding, such as fires, pest infestations, and tripping hazards, are caused by the accumulation of extreme amounts of clutter. Clean-outs, which involve a rapid removal of a large volume of stuff, are not recommended, but they are still used in many cases. Evictions are sometimes used as well, despite the obvious negative impact on the resident. Very little research has been done about what clean-outs actually are, how clean-outs or evictions are implemented in cases of hoarding, what outcomes they do and do not achieve, and how community-based service providers and clients regard these intervention strategies.

We have several current studies on these extreme interventions. Our first step has been to conduct a scoping review of both academic and internet-based literature on clean-outs and evictions. We have also conducted a set of structured interviews with a wide range of community service providers to hear their reports of clean-outs – what made them seem necessary at the time, how they were conducted, and what the outcomes were. We are also conducting a survey of people with lived experience of a clean-out related to hoarding, to understand aspects of these practices that make them more or less difficult for the person whose stuff is being removed. We understand from community-service providers that clean-outs are sometimes necessary to prevent even worse outcomes (such as eviction), and we are ultimately interested in developing guidelines for conducting such extreme interventions – when they are necessary – in a compassionate and more client-centred way.