Safe Steps Program Application

Please use this form to apply for the Hoarding Disorder Foundation of Alberta's Safe Steps Program. To be eligible, you must be an adult residing within Edmonton coping with hoarding behaviour. Participants for the program will be decided on a case by case basis; individual circumstance, barriers to access, and readiness for change will all be considered.

There is no cost to participate in the program.

Applicants must participate in an interview and in-home assessment before being approved for the program. Those chosen for interviews will be contacted within 2 weeks of submitting their application.

More information about the program can be found here.

If you require accommodations or assistance to fill this form, please email us at info@hdfa.ca.

Thank you for taking the time to apply.

Personal Information

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthdate

Month

Day

Year

Emergency Contact Name

Emergency Contact Number

How many people do you live with? Describe your relationship with them.

Hoarding and Current Support

Do you believe you struggle with hoarding behaviour?

Yes

Do you have any concurrent mental or physical health challenges?

Describe the current state of your home

Does your hoarding behaviour impact the safety or functionality of your home? (i.e. limits how much doors can open, limits access to kitchen sink, creates "avalanche" risk, impacts plumbing/heating, creates tripping hazards, etc)

Yes

Unsure

Are you currently under external pressure to improve your living conditions (from family, landlord, condo board, Child and Family Services, etc)?

Yes

Have you accessed any support for hoarding behaviour?

Yes

If you didn't receive support through Safe Steps, would you be able to access other support without financial hardship?

Yes

Other

Assessing "Readiness"

Participants of Safe Steps will receive in-home counselling and decluttering support. Their perceptions of their belongings will be challenged and they will be asked to be thoughtful about the items they keep vs. let go. They will discuss and explore their acquiring behaviour, their beliefs about their belongings, and emotions that may come up throughout this process.

Does that sound like something you're ready to work on?

Yes

With support, are you ready to let go of some items?

Yes

Are you prepared and able to dedicate at least 3-4 hours a week to the program?

Yes

Are you at a place in your life where your participation in this program can be a priority?

Yes

Are you able to attend our weekly support group meetings on Wednesdays from 3:30-5:30 PM?

Yes

Only virtual sessions

Only in-person sessions

Yes, I allow HDFA to contact me via email