1. DISCUSSION continued (WSCHT) combines the resources of county and community agencies to provide a coordinated response to hoarding behavior when it affects the safety of individuals and the community.  Complexity of Issue: Because hoarding cases are complex, an appropriate response is likely to be prolonged, expensive and require strong and well defined inter-agency collaboration. (Figure 1.)  Limitations of Enforcement: The response of behavioral health agencies may be limited by laws requiring evidence of danger to the hoarder or other people before an intervention can be made. Hoarding and Public Health: a case report Deborah B. Fromer, MT(ASCP), MPH¹, John W. Kephart, MSPH¹, Suzanne R. Hawley, PhD, MPH², Krista Lovette, BA³ The Sedgwick County Health Department, Health Protection, Wichita, Kansas¹, The University of Kansas School of Medicine-Wichita, Preventive Medicine and Public Health ², The Sedgwick County Department on Aging, Wichita, Kansas³ __________________________________________________________________________________________ BACKGROUND Behavioral health experts have indicated that compulsive hoarding is the acquisition and failure to discard an excessive number of possessions that appear to be useless or of limited value.¹ While this condition is not new, recently it has come to the forefront as communities began recognizing it as a disorder that impacts the health, welfare, and safety of the public. Each case of hoarding has a unique set of circumstances. Signs of hoarding include the following:²  Extreme collection and storage of items in home and yard  Accumulation of combustible materials  Blocked exits, narrow pathways  Rat and/or insect infestations  Rotting food and/or used food containers  Human and/or animal waste  Long-term neglect of home maintenance  Non-working utilities  Limited or no social interactions OBJECTIVE Epidemiologists at the Sedgwick County Health Department (SCHD) were asked by the SC Department of Code Enforcement to prepare a public health assessment of a 2.5 acre property, owned by the same individual, for 15 years. The purpose of this assessment was to determine the public health risk to the community from this property. RESULTS At the conclusion of the inspection of the property, six primary public health concerns to the surrounding community were identified: 1.Risk of zoonotic vector-borne diseases due to standing water in old tires and garbage and food stored in cars and trailers 2. In case of fire, risk of toxic inhalation hazards due to burning tires 3. In case of fire, risk of explosion and possible hazardous waste exposure due to multiple gas tanks and containers and 55-gallon drums 4. Increased fire risk due to large quantities of lumber and scrap wood, paper and cardboard boxes 5. Risk of multiple physical hazards due to nails, glass, and rusted metal found on the ground throughout the site 6. Unrestricted access to trespassers or nearby residents, especially children DISCUSSION  Support for Community Education/Awareness: Although community members may generally understand that the accumulation of large amounts of “personally collected items” may place neighborhoods at risk due to unsanitary and dangerous conditions, such risks may not be clearly understood or prioritized by residents.  Additional Concerns for Residents: Additionally, illegal “dumping” becomes blight to the surrounding properties and has the potential to decrease property values, making communities unattractive to commercial and residential developers.³  Local Efforts: Locally, procedures for intervention have only been implemented recently.⁴ Formed in 2006, the Wichita/Sedgwick County Hoarding Taskforce CONCLUSIONS/IMPLICATIONS  Further studies documenting the health related dangers involved in hoarding are needed to provide reason for more rapid action.  Literature describing the prevalence and relationship of hoarding behavior and its potential impact on public health is limited.  The authors undertook the present investigation to stimulate greater awareness of this under-recognized and complex issue.  Awareness, understanding and consideration, along with education of hoarding and its effects on the community, could lead to closing existing gaps and advocacy of policy changes in city codes that could better support reduction of health risks. REFERENCES 1.Frost, R; Hartl, T. (1996). A cognitive –behavioral model of compulsive hoarding. Behavior Research and Therapy, 34 (4), 341-50. 2. http://www.fairfaxcounty.gov/dpwes/trash/hoarding/signs.htm 3. USEPA. 1998. Illegal Dumping Prevention Guidebook. EPA 905B- 97- 001. March 1998. 4. http://www.sedgwickcounty.org/hoarding/ Case Residential Complaint(s) Law Enforcement Mental Health Public Health Other Agencies (as needed) Code Enforcement Hoarding Task Force Figure 1. Inter-agency collaboration