Toward Workforce Capacity Building for Addressing Hoarding Among Older Adults: The Evaluation of an Online Training Program

Background and Purpose:

Hoarding disorder (HD) is a challenging and prevalent mental health and public health problem characterized by difficulty discarding possessions, excessive clutter, and impaired functioning. HD can pose significant health risks and housing instability. Few community providers are trained in HD assessments and interventions, and a coordinated community approach. An online course on HD in older adults was developed by a university-based center specializing in education and research on aging and disability, to increase providers’ knowledge and skills. The purpose of this study was to evaluate the online training program, delivered to health providers and human service personnel from community-based agencies.

Methods:

This online course included multiple scenarios, information and practice exercises on assessments, interventions, and ethical and legal considerations. Personnel (N=107) from community-based organizations and municipality departments completed the training and pre-test and post-test surveys. Participants were 78% women, 65% white, 22% Black/African American, and 42% were 25-40 and 32% were 41-55 years-old. Most participants were employed at housing (48%) or aging specific organizations (43%). Case Manager was the most frequent role (42%). Regarding education, 26% had a high school diploma/associate’s degree/some college, 42% had a bachelor’s degree, and 32% had a master’s degree or higher. Paired samples t-tests examined pre- and post-test scores. ANOVAs and post-hoc tests (Tukey) were conducted to examine the effect of the training on pre-test/post-test scores by key participant characteristics: job title, education level, agency type, and agency state.

Results:

About 96% of participants strongly agreed that the training expanded their knowledge and understanding and 93% reported that this training will help them to apply new practice skills. Across all competencies, pre-test to post-test competency scores significantly improved, with the greatest improvement in: identifying key agency/community organizations for assistance with hoarding problems, t(94)=-14.92, p<.001; developing and understanding HD intervention strategies, t(94)=-14.650, p<.001; identifying intervention options and current treatment approaches with hoarding, t(95)=-14.554, p<.001; and understanding intervention implementation as it relates specifically to hoarding, t(94)=-14.172, p<.001.

Pre-test competency scores were not statistically different across job title, education level, agency type, and agency state. Mean change scores revealed statistically greater improvement in pre- to post-test competency scores for those with a Bachelor’s Degree compared to those with a High School diploma/Some college/Associates Degree for six of nine competencies. For the competency, summarize current literature describing the prevalence, course, and features of HD in older adults, the mean pre-post change scores significantly improved for those with a Bachelor’s Degree (M=1.22, SD=.85) than a High School diploma/Some College/Associates Degree (M=.48, SD=1.04) (F(2,92)=5.401, p=.006).

Conclusions:

This online HD training program can serve as a model to improve the attitudes, knowledge, and practice behaviors of personnel working with older adults. Personnels’ increased competencies to assess and intervene with older adults with HD may enhance HD outcomes and mitigate health and public health risks. This online training provides a vehicle for social change, encouraging providers to partner, develop a shared understanding of HD, adopt evidence-based HD assessment and intervention approaches, and positively impact those experiencing HD and their communities.