Implementation and evaluation of a community-based treatment for late-life hoarding.

Abstract

The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science. Program activities took place in San Diego County, mainly within clients' homes or community, with some activities in-office. Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD. A manualized, mobile protocol that incorporated CREST was utilized. The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation. Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.