Developing Community Support for Homeless People with Mental Illness in Transition

Abstract

To facilitate effective transitional services and enhance continuity of care among people with mental illness, this grounded theory study explored the practice of developing community support in critical time intervention (CTI), a time-limited, shortterm psychosocial rehabilitation program designed to facilitate the critical transition from institutional to community settings. Semi-structured, one-on-one interviews with twelve CTI workers were analyzed. Results show that CTI workers self-identified as an "extra support" to develop community ties that will help clients sustain stable housing. Their practice of community support development was represented by a transient triangular relationship model, involving three dyadic relationships (worker-client, worker-primary support, primary support-client) as the building blocks and specific strategies to facilitate the relational transition. Findings also detailed identification of community supports, collaboration and boundary issues in working with primary supports, and engagement with clients in this transitional process. Recommendations were drawn from findings to enhance broad discharge and transitional services.

Mobile Nurse Practitioner: A Pilot Program to Address Service Gaps Experienced by Homeless Individuals

“…Formulating a plan that not only takes into account patients' medical conditions but also their socioeconomic, social, and psychological factors is imperative to their successful integration into the community (Rooney & Arbaje, 2012-2013. This comprehensive approach to health care delivery considers the entire spectrum of health care needs.…”

“…Although the study by Herman et al (2011) supports the benefits in paving the way to connect patients with community services, there is also emphasis placed on CTI workers helping patients navigate through community programs. Chen (2013) explained the importance of the role of CTI workers in connecting individuals to community programs using existing services aimed at preventing rehospitalization. Emphasis is placed on the significance of these time-limited strategies being implemented shortly after discharge.…”

Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

“…One study employed brief CTI [26]; which delivered the same intervention in a shorter time period. Finally, qualitative interviews found that CTI workers self-identified as 'extra support' and stressed the importance of three dyadic relationships to the success of the intervention: worker-client, workerprimary support and primary-support-client [27]. In summary, the studies reviewed suggest that CTI could be an effective method of reducing homelessness post-discharge and reducing early readmissions.…”

“…There were two interventions included in this review that focused on a sub-population within an acute ward, homeless individuals [10,[25][26][27]67]. All of the interventions reported success in reducing homelessness [10,[25][26][27]67]. The interventions studied by Forchuk and colleagues looked at financial assistance and support in accessing housing, essentially providing resources that service users might not otherwise have [10,67].…”

“…The interventions studied by Forchuk and colleagues looked at financial assistance and support in accessing housing, essentially providing resources that service users might not otherwise have [10,67]. Whereas the other intervention, CTI, focused on therapeutic relationships, and helping service users access services [25][26][27]. Both interventions focused primarily on homelessness but also reported benefits in terms of other outcomes like readmission.…”