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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.
Solid waste disposal is a significant problem. It has been estimated that almost a ton of solid waste is collected per year per capita in the United States. Solid waste disposal, especially in rural areas, is frequently done in an unsanitary, potentially dangerous and often unslightly manner. To cope with these solid waste problems, both state legislatures and the Environmental Protection Agency are now in the process of requiring communities which presently utilize unsanitary disposal practices to upgrade their facilities and management practices. A sanitary landfill operation1 is usually the least-cost method of accomplishing these requirements, especially in rural areas.2 Quality facilities and management practices are not costless, however. It is estimated that the U.S. spends more than $4.5 billion each year on solid waste management, and more than 80 percent of this amount is for collection.