Using IM-Adapt to Implement CREST in Spanish-speaking Rural Communities for Hoarding Disorder

Join us as this presenter discusses this poster live on May 25, 2021 | Track A at 1:00 PM Mountain

PRESENTER
JAMES PITTMAN
University of California San Diego, VA San Diego Center of Excellence for Stress and Mental Health
BACKGROUND
Hoarding disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and community consequences. HD is defined by persistent difficulty discarding or parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. As a result, clutter accumulates and fills active living areas, preventing the normal use of space resulting in distress and disability. The accumulation of clutter places individuals at risks of falls, fires, infestation, food contamination, medication mismanagement, social isolation, and nutritional deprivation. HD starts early in life and progresses in severity with age and does not remit if left untreated. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) provides training in compensatory cognitive strategies to address the executive dysfunction typical of individuals with HD, then uses exposure therapy to reduce the distress associated with discarding items. CREST improves hoarding symptoms and functioning in older adults with HD, but there has been little focus on the implementation and dissemination of evidence-based treatment for hoarding in community settings.
SETTING/POPULATION
Spanish-speaking adults with HD who reside in rural communities, including East San Diego County and Imperial County, which reliably have worse outcomes and access to evidenced-based mental care compared to more urban communities.
METHODS
To address the lack of evidence-based interventions for HD in the rural heavily Spanish speaking East San Diego and Imperial Counties, we plan to use the IM-Adapt (Intervention Mapping – Analyze, Discover, Adapt, Practice, Test) model to tailor an implementation strategy. The tailored implementation strategy will be used to scale-out CREST to these communities, focused on Spanish-speaking adults with HD. This project will work with a diverse group of stakeholders to analyze the needs and goals of these regions via focus groups and interviews to provide evidence-based services to residents with HD, adapt a strategy, and develop a practice plan for implementing CREST in these communities.
CONCLUSIONS
Preliminary results demonstrate the feasibility of using the Practical Robust Implementation and Sustainability Model (PRISM) to implement the CREST intervention in a community setting to effectively treat hoarding disorder in low income older adults. The current project will generate additional knowledge and innovations to inform larger implementation efforts. The overall goal of this project is to reduce mental healthcare disparities in these regions related to HD.
POSTER

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Posted in 2021 Poster Session, Implementation Strategies.