Randomized Trial of Critical Time Intervention to Prevent Homelessness After Hospital Discharge

Abstract

OBJECTIVES This study assessed the effectiveness of a previously tested model, Critical Time Intervention (CTI), in producing an enduring reduction in homelessness for persons with severe mental illness who were discharged from inpatient psychiatric treatment facilities. METHODS A total of 150 previously homeless men and women who were diagnosed with severe mental illness and were discharged from inpatient psychiatric hospitalization were randomly assigned to receive either usual care or usual care plus CTI. The nine-month CTI intervention aims to gradually pass responsibility for providing ongoing support to community sources that will remain in place after the intervention ends, thereby leading to a durable reduction in the risk of future homelessness. Participants’ housing status was assessed every six weeks for eighteen months via participant self-report collected by interviewers blind to condition. RESULTS In an intent-to-treat analysis, participants assigned to the CTI group had significantly less homelessness at the end of the follow-up period (the final three six-week intervals) than did those assigned to the control group (OR=0.22, 95% CI=.06--.88). CONCLUSIONS We have shown that a relatively brief, focused intervention for persons with severe mental illness led to a reduction in homelessness that was evident nine months after the end of the intervention. This work suggests that targeted, relatively short interventions applied at critical transition points may enhance the efficacy of long-term supports for persons with severe mental illness living in the community.

RedeAmericas

“…Esse efeito duradouro tem sido demonstrado em ensaios clínicos randomizados 3,4 . O ensaio da RA de CTI-TS será o primeiro a adaptar o modelo de CTI para a América Latina.…”

How Feasible is Multiple Time Point Web-Based Data Collection with Individuals Experiencing Street Homelessness?

“…Many investigators have examined prevention and intervention strategies for use with this vulnerable population [4][5][6][7][8][9]. Three barriers investigators often encounter when conducting longitudinal work with homeless or other marginalized populations are difficulty tracking participants, high rates of noshows for follow-up interviews, and high rates of loss to follow-up [10][11][12][13].…”

Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale, Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Intervention

“…Strategies that bridge hospital and community-based services for this population are therefore urgently needed. One such model, Critical Time Intervention (CTI), was originally developed as a time-limited case management intervention to reduce the 4 risk of homelessness among people leaving shelters; it has since been implemented in a variety of settings, including hospitals (Herman et al 2011). The CTI model connects individuals with mental illness to a case manager at the point of discharge from institutional to community settings.…”

“…The CTI model has been shown to successfully reduce homelessness (Susser et al 1997;Herman et al 2011;Lennon et al 2005) and improve a variety of other outcomes. Randomized controlled trials (RCTs) have identified reductions among CTI participants, compared to usual care participants, in negative psychiatric symptoms (Herman et al 2000), alcohol and drug use problems, costs (Jones et al 2003) and psychiatric hospitalizations (Tomita & Herman 2012).…”