Topic: Alcohol/Drugs/Tobacco, Intimate Partner Violence, PTSD, Trauma
Target Population: Adults
Sector: Community-Based
Military Sector: Veterans Affairs
This program is for adults who are transitioning into the community after discharge from shelters, hospitals, or correctional institutions.
Critical Time Intervention (CTI), a community-based program, is designed to prevent homelessness and provide support for participants as they transition from institutional to community living.
This program has been evaluated in several randomized controlled trials. One study demonstrated that CTI participants experienced a significantly lower average number of homeless nights over the 18-month follow-up period and significantly fewer homeless nights during the last month of the follow-up compared to control participants. Additionally, extended homelessness, but not intermediate or transient homelessness, was significantly lower in the treatment group compared to the control group. Another study found that CTI participants experienced significantly less homelessness during the final three follow-up intervals and fewer total homeless nights over the 18-month follow-up compared to the control group. Results from a study, which tested a 6-month version of CTI in veterans, indicated that intervention participants experienced more days housed and fewer days in institutional settings over a 1-year follow-up period and had lower alcohol and drug use and psychiatric problem scores compared to a control group. However, a study among adults in the Netherlands, in which participants were assigned to CTI or care as usual, indicated no difference between groups in the number of days rehoused at 3-, 6-, or 9-month follow-ups. Recurrent homelessness was rare in both groups, and authors speculate this may be due to the higher intensity of care as usual and an extensive social housing system in the Netherlands as compared to in the United States.
The CTI program is designed to help participants successfully transition and reintegrate into their communities and intends to increase participants' connections to resources and support. The program is delivered in three main phases, by CTI workers, who form a trusting relationship with participants prior to implementing the program:
Since 1991, the CTI program has been implemented at approximately 130 sites in 30 states in the United States. CTI has reached more than 500 individuals, including homeless veterans with mental illness who were leaving the Department of Veterans Affairs inpatient care. This program has also been implemented in Argentina, Australia, Brazil, Canada, Chile, the Netherlands, and the United Kingdom.
CTI workers should have a bachelor’s degree in social work or a related field. In-person and online training options are available. In-person training is provided by the Center for Urban Community Services and Housing Innovations. Online training is provided by the Center for Social Innovation. Certification for CTI practitioners is also available. Please visit https://www.criticaltime.org/training-consultation/ for more information.
Considerations for implementing this program include acquiring participant buy-in; finding facilitators who have a suitable educational background and the time and personal commitment to form relationships with participants; ensuring facilitators receive training, which could require funding; developing relationships with community organizations; and understanding implementation costs could be expensive.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing CTI, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
The program is delivered in three 3-month phases over 9 months.
Implementation materials are free. Please visit https://www.criticaltime.org/cti-model/manuals/ for more information.
To move the CTI program to the Effective category on the Clearinghouse Continuum of Evidence, at least two evaluations should be performed demonstrating positive effects lasting at least two years from the beginning of the program or at least one year from program completion. At least one of these studies must be conducted independently of program developers.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact the Center for the Advancement of Critical Time Intervention by visiting https://www.criticaltime.org/contact/
Clark, C., Guenther, C. C., & Mitchell, J. N. (2016). Case management models in permanent supported housing programs for people with complex behavioral issues who are homeless. Journal of Dual Diagnosis, 12(2), 185-192. https://doi.org/10.1080/15504263.2016.1176852
de Vet, R., Beijersbergen, M. D., Jonker, I. E., Lako, D. A., van Hemert, A. M., Herman, D. B., & Wolf, J. R. (2017). Critical time intervention for homeless people making the transition to community living: A randomized controlled trial. American Journal of Community Psychology, 60(1-2), 175-186. https://doi.org/10.1002/ajcp.12150
Herman, D. B., Conover, S., Gorroochurn, P., Hinterland, K., Hoepner, L., & Susser, E. S. (2011). Randomized trial of critical time intervention to prevent homelessness after hospital discharge. Psychiatric Services, 62(7), 713-719. https://doi.org/10.1176/appi.ps.62.7.713
Herman, D., Opler, L., Felix, A., Valencia, E., Wyatt, R. J., & Susser, E. (2000). A critical time intervention with mentally ill homeless men: Impact on psychiatric symptoms. Journal of Nervous and Mental Disease, 188(3), 135-140. https://doi.org/10.1097/00005053-200003000-00002
Jones, K., Colson, P. W., Holter, M. C., Lin, S., Valencia, E., Susser, E., & Wyatt, R. J. (2003). Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness. Psychiatric Services, 54(6), 884-890. https://doi.org/10.1176/appi.ps.54.6.884
Kasprow, W. J., & Rosenheck, R. A. (2007). Outcomes of critical time intervention case management of homeless veterans after psychiatric hospitalization. Psychiatric Services, 58(7), 929-935. https://doi.org/10.1176/appi.ps.58.7.929
Lako, D. A., Beijersbergen, M. D., Jonker, I. E., Vet, R., Herman, D. B., Hemert, A. M., & Wolf, J. R. (2018). The effectiveness of critical time intervention for abused women leaving women’s shelters: A randomized controlled trial. International Journal of Public Health, 63(4), 513-523. https://doi.org/10.1007/s00038-017-1067-1
Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W., & Wyatt, R. J. (1997). Preventing recurrent homelessness among mentally ill men: A "critical time" intervention after discharge from a shelter. *American Journal of Public Health, 87(*2), 256-262. https://doi.org/10.2105/AJPH.87.2.256
Tomita, A., & Herman, D. B. (2012). The impact of critical time intervention in reducing psychiatric rehospitalization after hospital discharge. Psychiatric Services, 63(9), 935-937. https://doi.org/10.1176/appi.ps.201100468
Agrest, M., Le, P. D., Yang, L. H., Mascayano, F., Alves-Nishioka, S., Dev, S., … Susser, E. S. (2019). Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users. International Journal of Social Psychiatry, 65(1), 38-45. https://doi.org/10.1177/0020764018815204
Bai, R., Collins, C., Fischer, R., & Crampton, D. (2020). Family critical time intervention with housing unstable, child welfare-involved families: Service providers’ and families’ experiences with the phases. Children and Youth Services Review, 119, 9. https://doi.org/10.1016/j.childyouth.2020.105592
Barrenger, S. L., Draine, J., Angell, B., & Herman, D. (2017). Reincarceration risk among men with mental illnesses leaving prison: A risk environment analysis. Community Mental Health Journal, 53(8), 883-892. https://doi.org/10.1007/s10597-017-0113-z
Barrenger, S. L., Kriegel, L. S., Angell, B., & Draine, J. (2016). Role of context, resources, and target population in the fidelity of critical time intervention. Psychiatric Services, 67(1), 115-118. https://doi.org/10.1176/appi.ps.201400108
Baumgartner, J. N., & Herman, D. B. (2012). Community integration of formerly homeless men and women with severe mental illness after hospital discharge. Psychiatric Services, 63(5), 435-437. https://doi.org/10.1176/appi.ps.201100392
Collins, C. C., Bai, R., Fischer, R., Crampton, D., Lalich, N., Liu, C., & Chan, T. (2020). Housing instability and child welfare: Examining the delivery of innovative services in the context of a randomized controlled trial. Children and Youth Services Review, 108, 11. https://doi.org/10.1016/j.childyouth.2019.104578
de Vet, R., Lako, D. A. M., Beijersbergen, M. D., van den Dries, L., Conover, S., Hemert, A. M., … Wolf, J. R. (2017). Critical time intervention for people leaving shelters in the Netherlands: Assessing fidelity and exploring facilitators and barriers. Administration and Policy in Mental Health and Mental Health Services Research, 44(1), 67-80. https://doi.org/10.1007/s10488-015-0699-9
Dixon, L., Goldberg, R., Iannone, V., Lucksted, A., Brown, C., Kreyenbuhl, J., … Potts, W. (2009). Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Services, 60(4), 451-458. https://doi.org/10.1176/appi.ps.60.4.451
Draine, J., & Herman, D. B. (2007). Critical time intervention for reentry from prison for persons with mental illness. Psychiatric Services, 58(12), 1577-1581. https://doi.org/10.1176/appi.ps.58.12.1577
Herman, D. B. (2014). Transitional support for adults with severe mental illness: Critical time intervention and its roots in assertive community treatment. Research on Social Work Practice, 24(5), 556-563. https://doi.org/10.1177/1049731513510976
Herman, D., Conover, S., Felix, A., Nakagawa, A., & Mills, D. (2007). Critical time intervention: An empirically supported model for preventing homelessness in high risk groups. The Journal of Primary Prevention, 28(3-4), 295-312. https://doi.org/10.1007/s10935-007-0099-3
Herman, D. B., & Mandiberg, J. M. (2010). Critical time intervention: Model description and implications for the significance of timing in social work interventions. Research on Social Work Practice, 20(5), 502-508.
Jarrett, M., Thornicroft, G., Forrester, A., Harty, M., Senior, J., King, C., … Shaw, J. (2012). Continuity of care for recently released prisoners with mental illness: A pilot randomised controlled trial testing the feasibility of a critical time intervention. Epidemiology and Psychiatric Sciences, 21(2), 187-193. https://doi.org/10.1017/S2045796011000783
Jenson, J. M. (2014). Science, social work, and intervention research: The case of critical time intervention. Research on Social Work Practice, 24(5), 564-570. https://doi.org/10.1177/1049731513517144
Kahn, L. S., Vest, B. M., Kulak, J. A., Berdine, D. E., & Granfield, R. (2019). Barriers and facilitators to recovery capital among justice-involved community members. Journal of Offender Rehabilitation, https://doi.org/10.1080/10509674.2019.1621414
Kim, D., & Gayadeen, S. M. (2020). Use of critical time intervention (CTI) to promote continuity of reintegration after incarceration. Criminal Justice Review, 73401682095813. https://doi.org/10.1177/0734016820958139
Lako, D. A., de Vet, R., Beijersbergen, M. D., Herman, D. B., van Hemert, A. M., & Wolf, J. R. (2013). The effectiveness of critical time intervention for abused women and homeless people leaving Dutch shelters: Study protocol of two randomised controlled trials. BMC Public Health, 13(1), 1-12.
Le, P. D., Agrest, M., Mascayano, F., Dev, S., Kankan, T., Dishy, G., … Susser, E. S. (2021). Understanding users’ perspectives of psychosocial mechanisms underpinning peer support work in Chile. Community Mental Health Journal, https://doi.org/10.1007/s10597-021-00800-1
Lennon, M. C., McAllister, W., Kuang, L., & Herman, D. B. (2005). Capturing intervention effects over time: Reanalysis of a critical time intervention for homeless mentally ill men. American Journal of Public Health, 95(10), 1760-1766. https://doi.org/10.2105/AJPH.2005.064402
Lennox, C., Stevenson, C., Edge, D., Hopkins, G., Thornicroft, G., Susser, E., … Shaw, J. (2019). Critical time intervention: A qualitative study of the perspectives of prisoners and staff. Journal of Forensic Psychiatry & Psychology, https://doi.org/10.1080/14789949.2019.1665699
Millen, A. M., Levinson, A., Linkovski, O., Shuer, L., Thaler, T., Nick, G. A., … Rodriguez, C. I. (2020). Pilot study evaluating critical time intervention for individuals with hoarding disorder at risk for eviction. Psychiatric Services, 71(4), 405-408. https://doi.org/10.1176/appi.ps.201900447
Olivet, J., Zerger, S., Greene, R. N., Kenney, R. R., & Herman, D. B. (2016). Online versus face-to-face training of critical time intervention: A matching cluster randomized trial. The American Journal of Distance Education, 30(4), 237-249. https://doi.org/10.1080/08923647.2016.1232107
Shaw, J., Conover, S., Herman, D., Jarrett, M., Leese, M., McCrone, P., … Stevenson, C. (2017). Critical time intervention for severely mentally ill prisoners (CrISP): A randomised controlled trial. Health Services and Delivery Research, 5(8), 1-138. https://doi.org/10.3310/hsdr05080
Shinn, M., Samuels, J., Fischer, S. N., Thompkins, A., & Fowler, P. J. (2015). Longitudinal impact of a family critical time intervention on children in high-risk families experiencing homelessness: A randomized trial. American Journal of Community Psychology, 56(3-4), 205-216. https://doi.org/10.1007/s10464-015-9742-y
Tomita, A., & Herman, D. B. (2015). The role of a critical time intervention on the experience of continuity of care among persons with severe mental illness following hospital discharge. The Journal of Nervous and Mental Disease, 203(1), 65-70.
Tomita, A., Lukens, E. P., & Herman, D. B. (2014). Mediation analysis of critical time intervention for persons living with serious mental illnesses: Assessing the role of family relations in reducing psychiatric rehospitalization. Psychiatric Rehabilitation Journal, 37(1), 4-10. https://doi.org/10.1037/prj0000015
