Assessment Questions

In conjunction with the post on assessment and case formulation. I've included some example question prompts that can be asked either to the client to a relevant person/family member. In keeping with the other post,  I have structured it using the MOHOST headings,  as a means of organising the information. Although there may be a more logical way of ordering/asking  them, I've tried my best to avoid too much overlap and repetition . Obviously not all questions apply to everyone  and there may be better ways of phrasing the questions.  The intention would be that a comprehensive assessment would take place over a series of sessions (I normally would allow 4-6 assessment sessions), so I hope you are not too daunted by the long list.
I've also indicated after each section other complementary assessments. The OT tools I suggest are based on MOHO (Model of Human Occupation). I have suggested these because I am most familiar with this model, but there may be other suitable tools out there so please let me know any other ideas.

The hoarding-specific assessments can all be found in "Treatment  for   Hoarding  Disorder" (2nd ed)  G. Steketee and RO Frost ,2014 -alternatively most can be downloaded for free from the OC Foundation website www.ocfoundation.org/hoarding

Please let me know your comments and suggestions for improvement.

MOTIVATION FOR OCCUPATION Appraisal ·         How do you feel about the situation in relation to acquiring /keeping/ organising /discarding  items? ·         Do you feel you have any difficulties  with    acquiring/ keeping/ organising/discarding    items? ·         Are any of these aspects (acquiring/ keeping/ organising/ discarding) any easier/ harder to deal with than others? ·         Do you notice anything different in how you see objects compared to  most other people ( i.e do you see beauty / utility or  potential in objects that others don’t see?) Do you think this is an advantage  or a hindrance? Expectation of success ·         How much control do you have over urges to get / save things ? What are the hardest/easiest aspects to control? ·         If you were to do something   to tackle the problems ,how easy would it be ? What do feel are the main challenges  to overcoming these difficulties? ·         What do you feel would help you to tackle these difficulties? ·         How do you feel when you think about changing behaviours related to keeping/ getting and organising items? How intense are these feelings on a scale of 0-10? ·         Do you see any problems or risks  with the situation remaining as it is? How would the situation be in 1, 5 ,10 years if you didn’t change? ·         If you don’t feel ready to tackle the situation now, what (if anything?) might make you want to tackle this in the future? ·         Have you tried to tackle these problems before? What was the outcome? How does this affect how you feel about your ability to  deal with the problem now? ·         How would your life be different , should you  make changes  to these behaviours? ·         What would be the advantages and disadvantages to changing behaviours? ·         How good are you at carrying out goals/plans? How do you make plans?( ie keep in head/ write down/tell others?) Do you ever have plans that you don’t fulfil? What stops you from carrying out these plans? How do you feel if you don’t achieve your plans? Interests ·         What are your main interests ? Do you have the opportunity to pursue these interests? How does getting/keeping items affect your interests (helps/hinders)? ·         What are the priorities/most important things in your  life  at present.?  How do your priorities fit in with getting /keeping/discarding items? ·         Is there anything you do that makes you feel better or helps you cope with problems? Choices ·         What are your reasons for acquiring/ and keeping items? ( eg, financial/ usefulness / beauty/creative /sentimental/ information) ·         Do you ever change your mind about getting something? What makes you change your mind? ·         Do you have any “rules” about acquiring/ discarding items? ·         How do you feel (emotionally) when you get an item you want? Does this feeling change over time? ( 1 day , I year after getting it) Do you ever regret getting/ not getting something? ·         What (if any) are your goals or priorities in relation to acquiring/ keeping/ discarding? Do you have any other goals in life? ·         How would you know if you were successful in  tackling these problems/achieving your goals? -If  you   had  to  leave  your home  in an  emergency what   would  you  take and   why? Additional Assessments Occupational Therapy OCAIRS VQ/ Interest Checklist Hoarding-Specific Saving inventory Revised  (See Steketee and Frost, 2014) Saving Cognitions Inventory (“        “)

PATTERN OF OCCUPATION Routine ·         Tell me about your daily routine? Do you have regular routine? ·         How does acquiring / organising / discarding impact on your routine? Do any of these form the focal point of the day? ·         Are there any situations or places you avoid because of hoarding and why (e.g avoid staying indoors/ going to certain shops/socialising with certain people/ inviting people round)? ·         Are there any activities you carry out to avoid dealing with clearing /discarding items? ·         How do you typically acquire and discard items?(e.g purchase  /pick up/steal/ recycle/give to others/ give to charity)? ·         Do you plan what  to get in advance, or do you make impulsive decisions? Do you use a shopping list? ·         Are there regular places that you go to  acquire items? ·         Are there any times of the day/ or days of the week when you are more likely to acquire/clear  or discard? What factors influence these routines (eg presence of others/ energy levels/local sales/pay day )? ·         When did you ( or someone else) first notice that you may have a problem with acquiring/hoarding items? ·         Have there been any changes in your routines/habits related to  acquiring/keeping over time? What  triggered these changes (eg financial/ moving home/retirement/ traumatic event)? ·         Are there any other triggers that influence likelihood of acquiring/discarding items (eg loneliness/ boredom/ stressful events/threats of legal action)? ·         Do you have any very important routines (rituals) related to the storage and placement of items? (e.g do  they have to be organised in a particular way/do  items have to be checked or touched a certain number of times). What (do you think) would happen if these routines are not followed? Adaptability ·         How do you feel about making any changes in your routine either in general or specific to hoarding behaviours? ·         If you want to change your home environment,  what would it ideally look like for you? Can you visualise this?  How does it make you feel when you imagine this? ·         How would( do/did) you feel if someone touches/moves/ removes your possessions? What would (did) you do if this occurred? ·         How do/did you feel if something does not go to plan? ·         Have you tried doing anything differently in the past  to tackle hoarding? How did it go? What did you learn from the experience? How would you feel about taking a different/new approach to manage hoarding? Roles/Responsibilities ·         What  are the  important roles/responsibilities in your life (domestic/educational/ vocational/ familial/community/cultural)? ·         How does acquiring and  keeping objects  impact on the fulfilment of self care/productivity and leisure roles (help/hinder)? ·         Have you had  to give up roles/  responsibilities because of hoarding? ·         How would your roles/ responsibilities be affected if you were to make changes related to hoarding? Would it create/prevent certain opportunities? ·         Are there any threats to particular roles or responsibilities should the situation remain unchanged( ie tenancy/ child care/pet care/ work)? ·         Do you feel  equipped or ready to undertake/fulfil  valued roles /responsibilities? What would need to happen for  you to feel ready? Additional  Assessments Occupational Therapy OCAIRS OPHI II (MOHO)-To assess role development over lifespan Other Obsessive- Compulsive Inventory-Revised –(If OCD symptoms indicated) Foa , 2002 (see also Steketee and Frost, 2014)

COMMUNICATION Conversation ·         Are you able to focus or concentrate on a topic of conversation? ·         Do you ever find it difficult to express your thoughts? ·         Do you ever find it difficult to express yourself because you have a lot of thoughts going through your mind at once? ·         How do you feel about talking about hoarding? Do you ever avoid talking about it or change the subject? Relationships ·         Are there any important relationships in your life? ·         How has hoarding affected your relationship with others (help/hinders)? ·          How would your relationships be affected should the situation continue/ change (advantage/disadvantages)? Additional Assessments OT-Specific ACIS (MOHO)

PROCESS SKILLS Knowledge ·         How is your memory/ concentration and attention? Do you remember some things better than others? How do you remember best? ·         Is there anything you do to compensate for any memory /concentration difficulties (e.g keep everything in sight/ write lots of lists/not throw anything away/cut out clippings)? How helpful are these strategies? What would happen if you did not use these techniques?       Timing ·         How easy is it for you to start and finish tasks a) In general b) When clearing and organising? ·         What helps or hinders starting and finishing off an activity? ·         Do you ever re-do something you have started or completed because it does  not seem “right”? ·         Are you generally able to meet deadlines? Do you find deadlines helpful? ·         How do you go about deciding  priorities for tasks ? Do you stick to these priorities or get distracted? What are the main distractions for you? Is there anything that helps you concentrate/keep focussed? ·         How do you feel about your speed completing tasks (too fast/too slow/ ok)? Organisation ·         How do you go about arranging /organising your possessions? ·         How satisfied are you with your ability to do this? ·         Are there any strategies that have helped/hindered your ability to organise your possessions ? ·         How easy is it for you to find /use things you need? How would you go about locating something? ·         Are there any risks related to the organisation of objects? Have you ever had any accidents due to organisation of objects? ( e.g too crowded/piled high) Problem Solving ·         How easy is it for you to make decisions about acquiring/organising/ discarding items? (Scale 0=10) Do you ever avoid or put off making a decision? Do you often change your mind when making decisions? ·         Tell me about a recent problem you encountered and how you tackled it? ·         What do you normally do if something does not go to plan or you come across an obstacle ?(consider a recent example) · Do you ever give up if something seems too challenging? ·         What ideas do you have about how to deal with these problems? If someone else were in a similar situation what would you suggest they could do? Additional Assessments OT –Specific AMPS

MOTOR SKILLS Are there any physical difficulties that affect your ability to  clear or organise your living space (i.e energy/ strength/posture/ balance/co-ordination/mobility)? Additional Assessments OT –Specific AMPS

ENVIRONMENT Physical Space ·         How easy is it for you to use areas of your home? (consider each  room area in turn-also include communal and outdoor areas if applicable) ·         How comfortable do you feel at home? ·         How important is it for you to use these areas (highest priority/lowest priority)? ·         How does clutter/overcrowding affect your ability to carry out tasks (self care /productivity /leisure)? ·         Do you use any other spaces outside the home environment due to the clutter ( eg local swimming pool for showers/eat out only/communal lounge)? Are there any problems related to this (i.e too expensive/leads to conflict with others)? ·         Do you use any storage areas outside the home environment (paid /unpaid)? Does this lead to any problems?(egfinancil/conflict) ·         How safe and secure do you feel at home? ·         Are there any risks due to overcrowding (e.g. falls/fire/vermin/hygiene)?  Do other people share your view about risks? ·         Is anyone else affected by the clutter in your home? In what way? Physical Resources ·         What kind of objects do you acquire/keep? Have you always kept these kind of objects or has it changed over time? ·         Do you get to use all the objects you keep for their  intended purpose ? If not approximately what percentage do you actually use? ·         Do you feel you have enough/ not enough /too many possessions? Do other people share your view? · How would you know if you had too much of something? Do you ever use any replacement objects because you cannot find or use the most  suitable object ? (eg clothes as blankets/ fork as a spoon/sofa as bed/bath as storage area)? ·         Do you ever worry about running out of something or being without? What would the consequences be? ·         Do you ever get something and then realise you already own something similar? ·         Are there additional resources that you need to tackle hoarding (e.g money/storage space/use of a car/van)? Social Groups? ·         How do other people feel about your possessions (family/friends /neighbours/authorities/cultural groups)? Do you share these views? ·         How has it affected your social life? ·         Does anybody help you get or store possessions? ·         Does anybody help you get rid of items? ·         Do you think there are any other reasons (apart from hoarding) that people may  act against you? ·         Did anyone in your family have a similar problem? ·         Did you ever live or grow up in a cluttered/over orderly environment? How did this affect you? ·         How do you think others can help you? Who would you want to help you? ·         How have others responded to this problem in the past? Has it been helpful or unhelpful? Additional Assessments Hoarding –Specific Clutter Image Rating scale (Steketee and Frost,2014) ADL Scale (Steketee and Frost,2014)