Managing severe hoarding in non-adherent clients: a 2-years follow-up comparative study of three different approaches

Background: 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. Aims: To evaluate and compare three different approaches to the management of severe hoarding in nonvoluntary clients. Methods: 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). Results: 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. Conclusions: 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.