HEATH

The Home Environment Assessment Tool for Hoarding (HEATH©) is a tool created by the Centre to assess the most important health and safety risks in hoarded environments. Risk assessment in hoarded homes is not easy. Different service providers often have different priorities when working in the home, as well as different understandings of what risk means. With this in mind, the Centre has worked together with such providers, including fire inspectors, social workers, and more, to create the HEATH: a universal tool designed for professionals working with hoarding in any discipline. 

Home Environment Assessment Tool for Hoarding (HEATH)

Drs. Sheila Woody and Christiana Bratiotis, 2024

The HEATH is a one-page tool to guide assessment of the most important health and safety risks during an in-person visit in hoarded environments. It is designed for professionals in any discipline or area of community practice.

© 2024. The HEATH has a CC BY-ND license.

It may be downloaded, copied, or shared for free, as long as no changes are made to the assessment. The HEATH is licensed for commercial use and is available for download below.

Download the HEATH

Check out the HEATH – Traduction française (French Translation) here!

Overview
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How to Use the Tool

The HEATH covers five domains of risks that can occur with a high volume of clutter in the home. Each domain includes assessment or inspection items that were carefully selected by providers for their importance in home safety. (Hover your mouse over the icons below to see an explanation.) The HEATH is designed to assess only the most important health and safety risks in the home, to help people who have problems with severe clutter to meet most fire and building codes and be safe in their home.

As the service provider moves through the home with the resident, the provider systematically observes all the items in each domain of the HEATH. They use the checklist to keep track of items that meet the safety threshold (“ok”) and items that are of concern (““) as they represent some level of current or potential risk. After looking at all the items in a domain, the provider uses their professional judgement to assign a risk level – from low to high risk – for each domain. In this way, the HEATH helps providers communicate clearly with the resident about health and safety risks in their home, collaboratively set goals for improvement, and track progress in targeted risk areas.

Safe Pathways

Are pathways clear if emergency access or exit is needed? Are stacks or piles low enough to avoid avalanche or tripping?

Fire Safety

Are combustibles far enough away from heat sources?

Structural Integrity

Has the home received regular maintenance? Is the flooring stable? Does water damage present a structural risk to the people in the home?

Health and Wellness

Are basic utilities working? Can plumbing fixtures be used for personal hygiene? Can medical equipment be used if needed?

Sanitation

Is there spoiled food, human or animal waste, or pest infestations that could pose health problems? Is the air free of mold or mildew?

Your Questions: Answered

What gap does the HEATH fill?

We developed the Home Environment Assessment Tool for Hoarding (HEATH) in a multi-year collaboration between researchers and community partners who are frontline experts in different fields that get involved in cases of hoarding. We wanted to develop a tool that could be used to identify and prioritize health and safety risks in the home. Specifically, our goals were to:

  • Assess the most critical health and safety issues that commonly occur in hoarded environments
  • Be usable by anyone entering a hoarded environment (such as housing inspectors, fire prevention officers, service providers, mental health clinicians, and client support workers, as well as family members and clients themselves)
  • Allow the tracking of progress over time as the resident works toward a safer environment 
  • Facilitate clear communication about health and safety concerns with the resident and with other professionals

How did we develop the HEATH?

The items on the HEATH were developed by researchers in partnership with 34 frontline hoarding experts from the fields of mental and behavioural health, housing providers, first responders, fire and building code enforcement, professional organizers, and animal welfare. To make sure the items were clear, relevant to hoarding cases, and practical for service providers to evaluate in a home visit, we obtained feedback from 15 additional community-based hoarding experts. Finally, we tested and refined the HEATH over two years of field testing in rural and urban settings with agencies focused on fire prevention, older adult support services, and tenancy preservation.

A decorative flow chart describing the steps taken to develop the Home Environment Assessment Tool for Hoarding. Steps include: 1. Review of existing hoarding measures 2. Prototype Drafts 3. Delphi Survey 4. Pilot Testing 5. Content Validation 6. Field Trials and 7. HEATH rollout

Why use a structured assessment tool?

The HEATH is a structured tool, which offers a few advantages. Research has shown that different professionals often come to different conclusions when making judgments about the same person or home – generally because they notice different things about the situation. In a hoarded home, belongings are often disorganized and located in unexpected places, which can be distracting even to experienced professionals. Using a structured tool means that the assessor can be assured they are not missing key details. While some risks make themselves apparent quickly (such as blocked exits), other risks might be harder to notice. Something that isn’t there (such as working smoke alarms) can be a risk, and some risks require inquiry beyond just a visual inspection (such as whether the utilities are all functioning). A structured tool can require a little practice to use it smoothly, but it ensures that the assessor catches anything they might have missed in identifying health and safety risks.

Professional Resources and Training

What kind of research supports the HEATH?

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Title of: Research Study

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Title of: Research Study

This is the answer to the question. We will provide a little bit of a description to make sure that the viewer understands the content, even if it takes up multiple lines of text. Since this is a research study, it will probably need more space for all of the text.
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Where can I get a copy of the HEATH?

You can download the HEATH below!

© 2023. The HEATH has a CC BY-ND license.
The HEATH is licensed for commercial use. It may be downloaded, copied, or shared for free, as long as no changes are made to the assessment.

Learn how to prepare for a

home inspection with the HEATH!

Development of the HEATH was supported by funding from 

the Social Sciences and Humanities Research Council of Canada.

1. Setting Up the Visit
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Tips for a Successful Inspection

If you’re a professional who works with hoarding, the main thing you can do to ensure a successful inspection is to remember the resident in the home. This is their home you’re entering and assessing and talking about. Inspections might be a regular event in your working life, but they’re not a casual experience for the resident. Focus on building good rapport with the resident, and aim to help the resident to feel as comfortable as possible.

The lived experience advisors who consult with us in our research recommend letting the resident know what to expect ahead of time if you can. Tell the resident about how long you’ll be there, what you’ll be looking for, what the next steps are. Remind the resident that your primary interest and concern is for their safety. It can be helpful to invite the resident to have a supportive friend with them for the inspection. 

Be careful with the language you use, as some words that might be common among professionals can be hurtful to the resident. Using language like “junk”, “garbage”, or “smelly” can raise the resident’s anxiety and prevent them from being able to hear what you would like for them to understand about safety risks in their home.

If you’re using the HEATH, feel free to use the tool as an aid to talking with the resident about the risks in their home. The clear and specific language can help the resident understand what they need to do to make things safer.

Learn how to

administer the HEATH!

2. Using 
the HEATH
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Learn to Use the HEATH

You can easily learn the basics of using the HEATH during an in-home assessment by watching our series of short videos. After that, we recommend a couple of ways you can practice using the HEATH, especially if you don’t yet have a lot of experience evaluating environmental risks in hoarded homes.

Step-By-Step with the HEATH

Step One: Learn the Basics

To understand the basic structure of the tool, you can carefully read the instructions on the first page of the HEATH or watch this video, Introducing the HEATH, or do both!

Step Two: Learn About Each Domain

Below is a series of short videos about each of the five domains of health and safety covered by the HEATH. We especially recommend that you watch the videos for topic areas that are less familiar to you based on your previous experience. Note that these videos assume you have already learned the basics by reading the instructions on the first page of the HEATH or watching the Introducing the HEATH video in Step One.

Safe Pathways
Fire Safety
Structural Integrity
Health and Wellness
Sanitation

Case Study

This short video illustrates how the HEATH is completed for a specific case.

Step Three: Do a Dry Run

Conducting a risk assessment in any home goes room-by-room, usually starting in the room where you entered. The HEATH, however, is organized by safety topic rather than by room, because each home will have a different layout. Learning to use the HEATH involves keeping track of the various potential environmental risks as you tour the home. A good first step is to practice using the tool in your own home or the home of a friend.

Give it a try!

Step Four: Calibration

Two professionals talking with each other with a clipboard in hand.

If you want to feel really confident in your assessment skills, practice the HEATH with another professional. The idea is that you would both use the HEATH to make independent judgments of health and safety risks in the same home at the same time. Then share your ratings and discuss any discrepancies. Doing this with a colleague who is from a different discipline (for example a fire inspector paired with a social worker) is especially informative because you will each have different background knowledge and can learn from each other.

Check out some of the things you can do

with data from the HEATH!

3. Using the Results
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Once you’ve completed and scored the HEATH, the results can be used in several important ways: to conceptualize, communicate and collaborate, plan, and evaluate.

Conceptualize the Risk Profile

The results of the HEATH can help you conceptualize (think about) the risk profile for the resident using the following three steps:

1. Identify the specific health and safety risks in the home that are the most important for intervention.

2. Determine who is affected by the health and safety risks. If the risks impact only the resident, and if they are able to make competent decisions for themselves, then they can choose to live with the risks.

3. Prioritize interventions that address immediate threats to life safety of the resident, family members, neighbours or threats to the resident’s housing security.

Communicate Results and Collaborate with Others

HEATH assessment results can be used to communicate threats to safety or environmental risks in the home and to collaborate with the resident and other stakeholders for goal setting and intervention planning.

Communicate results to community providers

Refer to the HEATH checklist and your notes about areas of concern to provide clear and specific communication to other professionals about risks in the home and the need for services, supports and coordination of the hoarding intervention.

The purpose of sharing results with community providers:

  • specify the risks in concrete terms
  • identify needed supports that others can provide the resident
  • coordinate resident and provider goals and interventions among everyone involved
Communicate results to the resident

Share the HEATH assessment process and results as part of communication with the resident about areas of concern that may pose threats to their safety and well-being and others in close proximity.

The purpose of sharing results with the resident:

  • specify the risks in concrete terms
  • collaboratively set goals for intervention with the resident
  • track progress and celebrate improvement and achievement

Plan Next Steps

Consider the following three questions to help you plan the intervention:

What environmental risks and safety concerns can I address in my professional role and how will I do that?  

If I have the necessary professional skills, tools, supports, time, and mandate. And if I know how to organize, coordinate, implement and evaluate, then I can address the concerns.

What risks and safety concerns are outside of my professional scope and who can provide the needed help?

If I don’t have the professional training, perspective, know-how, support or mandate, then I will coordinate with other public, private, governmental and for-profit services that can help.

What risks and targets for intervention can be addressed by the resident and their support system?

If the resident and I can collaboratively identify that they (and their support system) have the awareness, skills, confidence and materials to make progress toward elimination of risk, then I will provide support to the resident in addressing the concern.

Communication and Evaluation

Through repeated use of the HEATH, targets for intervention can be assessed to determine if specific health and safety concerns in the home have changed over time with intervention.

Review

Review initial HEATH, the originally identified risks, goals and intervention activities

Readminister

Readminister HEATH and compare results to prior assessment

Determine

Determine specific health and safety risks that have improved.
Note any new areas of concern.

Celebrate

Celebrate the improvements and achievements of risk reduction.
Make plan for any new areas of concern.


Want to learn more about hoarding?

Check out some general resources!