Managing the Harm Reduction Plan

  • Michael A. Tompkins


At this point in the harm reduction (HR) process, the clinician has completed a harm potential assessment, engaged the client in the HR approach, created a HR team, and the team and client have created and agreed upon an agreement to guide the HR process. The next step is to manage the plan over time and in the face of the inevitable difficulties that arise when managing a problem as complicated and as difficult as severe hoarding. This chapter describes the process of managing the HR plan, which depends largely on the ability of the clinician to engage and re-engage the client and other team members in managing the harm potential of the client. The chapter begins by describing guidelines for effective in-home visits. The primary objectives of in-home visits are to monitor harm potential, to monitor progress toward implementing the HR plan, particularly keeping HR environmental targets clear, and to work with the client to clear these targets when he has cluttered them. Effective in-home visits make this possible.

The chapter then presents HR strategies to manage the harm potential of the client and focuses primarily on HR strategies to manage environmental targets but describes strategies to manage other HR targets that influence harm potential, such as acquisition targets and physical, social, and psychological capacity targets. The chapter then describes other key skills, such as problem solving and decision-making, that clinicians can teach clients to improve their effectiveness when working collaboratively with team members or independently between in-home visits. This chapter presents the important topic of agreement failures—when the client or other team members fail to honor the HR agreement. The chapter describes common reasons for agreement failures and strategies to correct these failures when they occur.


Team Member Harm Reduction Harm Potential Team Meeting Environmental Target 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Michael A. Tompkins
    • 1
  1. 1.San Francisco Bay Area Center for Cognitive Therapy and University of CaliforniaOaklandUSA

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