Critical Time Intervention: a qualitative study of the perspectives of prisoners and staff

Lennox, Charlotte; Stevenson, Caroline; Edge, Dawn; Hopkins, G.; Thornicroft, Graham; Süsser, Ezra; Conover, Sarah; Herman, Daniel B.; Senior, Jane; Shaw, Jenny

doi:10.1080/14789949.2019.1665699

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…This has included individuals who experience mental health illnesses, individuals exiting the criminal justice system, homeless mothers with children, and women who have experienced domestic violence. Other scholars have also documented that common areas of the model which have had to be adapted include its time-sensitive nature (23,25,30,36). Therefore we can see that although our study focuses on women who engage with and are attempting to exit sex work, the adaptations made to the original CTI model are consistent with other populations.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, keeping participants focused, supported, and on track during a period of transition, CTI, a nine-month program, promotes continuity of care while facilitating integration into a community network of services to support ongoing transition and stabilization after completing the program. CTI originated to facilitate the transition of individuals experiencing homelessness to housing but has recently been used in a variety of transitions for individuals facing multiple social challenges including the transition after release from prison (23), facilitating reduced use of emergency room visits (24), assisting women affected by domestic violence transitioning out of shelters (25), and stabilizing individuals who have hoarding disorders at risk of eviction (23)(24)(25)(26)29).…”

Section: Sex Work In Canadamentioning

confidence: 99%

“…In this context, assessing program delity might help program staff identify where improvements can be made to increase adherence to, or adapt, the core model. A few of the aforementioned programs focused on implementation evaluation and we add to that growing literature about challenges with adhering to program delity (23,29). CTI exists for a number of populations and issues, and since different programs and populations might harbor speci cities which may in uence key program components, existing delity tools must rst be adapted to t the population and types of transition they are aiming for.…”

Section: Sex Work In Canadamentioning

confidence: 99%

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Critical Time Intervention to Facilitate Exiting Sex Work: Lessons Learned From a Fidelity Assessment

Perri

Shareck

Buhariwala³

et al. 2021

Preprint

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IntroductionIndividuals who engage with sex work face barriers to maintaining overall health and well-being such as criminalization, stigmatization, and violence. An emerging approach to facilitating exiting sex work for individuals is through programs applying the Critical Time Intervention (CTI) model. CTI represents a time-limited practice that supports vulnerable individuals during periods of transition. The objectives of this study were to apply an existing CTI fidelity assessment to the sex work exiting program Exit Doors Here (EDH) to (1) report on the program’s fidelity and (2) discuss the effectiveness of CTI for supporting these groups. MethodsTo determine the applicability to the EDH of an existing fidelity assessment tool, we consulted with program staff through in person meetings. Staff highlighted areas for adaptation. We adapted the tool based on this feedback and used it to assess program fidelity by analyzing data from 8 participants’ CTI notes. Fidelity ratings were computed and interpreted according to established guidelines. ResultsConsultations with program staff resulted in adaptations to seven items out of the 12 comprising the fidelity assessment tool. The majority of adaptations surrounded the time-limited nature of CTI and unique needs of the program participants. In regards to the fidelity assessment using the adapted tool, half of the items were ideally implemented, one was well implemented, one was fairly implemented and two were respectively found to be poorly implemented and not implemented at all. Conclusions Difficulties in implementing selected program components with high fidelity can be attributed to specificities of the target population and to contextual factors, which are hard to control from a staff and program standpoint. This assessment reiterates the importance of considering such factors when developing and implementing programs aimed at improving the health and well-being of marginalized women such as those who engage in sex work.

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Section: Discussionmentioning

confidence: 99%

Section: Sex Work In Canadamentioning

confidence: 99%

Section: Sex Work In Canadamentioning

confidence: 99%

See 1 more Smart Citation

Critical Time Intervention to Facilitate Exiting Sex Work: Lessons Learned From a Fidelity Assessment

Perri

Shareck

Buhariwala³

et al. 2021

Preprint

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“…16 As well as reoffending, frequent transitions in and out of prison take a high toll on the individual, their family and their social tenure. 17 Comorbidity is high for this group, 18 as is the financial cost of failing to address these health and social care issues. 19 In the UK, although the NHS commissions all health services, it appoints a range of providers from NHS, private, and voluntary and community sectors.…”

Section: Synopsismentioning

confidence: 99%

“…27 RCTs within the CJS can be more complex than in other settings because of a range of factors, such as organisational difficulties, maintaining trial arm allocation, poor follow-up rates and difficulties selecting appropriate outcome measures. 1,17,[28][29][30] How to navigate the Engager research programme and report…”

Section: Synopsismentioning

confidence: 99%

Development and evaluation of a collaborative care intervention for male prison leavers with mental health problems: the Engager research programme

Byng

Lennox

Kirkpatrick

et al. 2022

Programme Grants Appl Res

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Background Many male prison leavers have significant mental health problems. Prison leavers often have a history of trauma, ongoing substance misuse and housing insecurity. Only a minority of prison leavers receive mental health care on release from prison. Objectives The aim of the Engager research programme was to develop and evaluate a theory- and evidence-informed complex intervention designed to support individuals with common mental health problems (e.g. anxiety, depression) and other complex needs, including mental health comorbidity, before and after release from prison. Methods In phase 1, the intervention was developed through a set of realist-informed substudies, including a realist review of psychosocial care for individuals with complex needs, case studies within services demonstrating promising intervention features, focus groups with individuals from under-represented groups, a rapid realist review of the intervention implementation literature and a formative process evaluation of the prototype intervention. In a parallel randomised trial, methodological development included selecting outcome measures through reviewing literature, piloting measures and a consensus process, developing ways to quantify intervention receipt, piloting trial procedures and modelling economic outcomes. In phase 2, we conducted an individually randomised superiority trial of the Engager intervention, cost-effectiveness and cost–consequence analyses and an in-depth mixed-methods process evaluation. Patient and public involvement influenced the programme throughout, primarily through a Peer Researcher Group. Results In phase 1, the Engager intervention included multiple components. A practitioner offered participants practical support, emotional help (including mentalisation-based approaches) and liaison with other services in prison on the day of the participant’s release and for 3–5 months post release. An intervention delivery platform (i.e. training, manual, supervision) supported implementation. Outcome measures were selected through testing and stakeholder consensus to represent a broad range of domains, with a general mental health outcome as the primary measure for the trial. Procedures for recruitment and follow-up were tested and included flexible approaches to engagement and retention. In phase 2, the trial was conducted in three prison settings, with 280 participants randomised in a 1 : 1 ratio to receive either Engager plus usual care (n = 140) or usual care only (n = 140). We achieved a follow-up rate of 65% at 6 months post release from prison. We found no difference between the two groups for the Clinical Outcomes in Routine Evaluation – Outcome Measure at 6 months. No differences in secondary measures and sensitivity analyses were found beyond those expected by chance. The cost-effectiveness analysis showed that Engager cost significantly more at £2133 (95% of iterations between £997 and £3374) with no difference in quality-adjusted life-years (–0.017, 95% of iterations between –0.042 and 0.007). The mixed-methods process evaluation demonstrated implementation barriers. These barriers included problems with retention of the intervention team, and the adverse health and criminal justice system context. Seventy-seven per cent (108/140) of individuals had at least one community contact. Significant proportions of participants engaging received day release work and practical support. In contrast, there was evidence that the psychological components, mentalisation and developing a shared understanding were used less consistently. When engagement was positive, these components were associated with positive achievement of goals for individuals. We were also able to identify how to improve the intervention programme theory, including how to support individuals who were unrealistic in their perception of their ability to cope with challenges post release. Strengths and limitations Our development work provides a worked example of the development of a complex intervention, particularly given little prior evidence or theory specific to male offenders to build on. Our trial methodological development enabled the completion of, to the best of our knowledge, the first fully powered trial of a mental health intervention for prison leavers with common mental health problems. There were potential weaknesses in the trial methodology in terms of follow-up rates and outcome measures, with the latter potentially being insufficiently sensitive to important but highly individual changes in participants who responded to the intervention. Conclusions Delivering a randomised controlled trial for prison leavers with acceptable levels of follow-up is possible, despite adverse conditions. Full intervention implementation was challenging, but this is to be expected. Some individuals did respond well to the intervention when both practical and psychological support were flexibly deployed as intended, with evidence that most components were experienced as helpful for some individuals. It is recommended that several key components be developed further and tested, along with improved training and supervision, to support delivery of the Engager intervention within existing teams working with prison leavers. Trial registration This trial is registered as ISRCTN11707331. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

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Addressing the complex substance use and mental health needs of people leaving prison: Insights from developing a national inventory of services in Canada

Watson

Benassi

Agic

et al. 2022

International Journal of Drug Policy

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Critical Time Intervention: a qualitative study of the perspectives of prisoners and staff

Cited by 6 publications

References 29 publications

Critical Time Intervention to Facilitate Exiting Sex Work: Lessons Learned From a Fidelity Assessment

Critical Time Intervention to Facilitate Exiting Sex Work: Lessons Learned From a Fidelity Assessment

Development and evaluation of a collaborative care intervention for male prison leavers with mental health problems: the Engager research programme

Addressing the complex substance use and mental health needs of people leaving prison: Insights from developing a national inventory of services in Canada

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