5.13 Critical Time Intervention in Action: Serving Homeless Families (Morris)
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This session offers more advanced content on the Critical Time Intervention model and how it applies to families. Speakers will discuss the practical application of the model for families with varying barriers to housing and services. Participants will walk away from this session with an in-depth understanding of how the model can improve outcomes for families in their community.
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5.13 Critical Time Intervention in Action: Serving Homeless Families (Morris)
- 1. Background, Description and Evidence
- 2. Fort Washington Armory Men’s Shelter, 1990s
- 3. Transitions can result in discontinuity of support multiple complex needs loss of supportive relationships fragmented community services
- 4. CTI aims to solidify supports as it spans the period of transition CTI
- 5. CTI differs from traditional case management Time limited Three phases Focused
- 6. Implement transition plan while providing emotional support Phase One: Transition Pre-discharge connection
- 8. Phase Two: Try-Out Facilitate and test client’s problem-solving skills and capacity of the support system
- 10. Phase 1 Phase Three: Transfer of Care Terminate CTI services with support network safely in place
- 16. Percent of subjects who were homeless over follow-up period (ITT) 18 months 9 months
- 17. Percent of subjects who were homeless over follow-up period (as treated)
- 22. Critical Time Intervention Montgomery County, PA
- 27. Participants in CTI Phases
Notas del editor
- Our story begins here at the Fort Washington Armory in upper Manhattan in the early 1990s. This large men’s shelter was among many that opened around this time, as New York City was struggling under the weight of the homelessness crisis. Up to 1000 men would sleep on cots on drill floor, many with SMI and substance abuse, untreated medical problems including HIV and TB. After a while, onsite MH and case management services were added to provide outreach, treatment and stabilization----and NY/NY led to placement into housing for many.
- What we found, unfortunately, was that many became homeless again despite strong discharge plans and referrals to community services So why didn’t their tenure in housing last? One reason is that transitions are especially challenging for mentally ill individuals, especially those who have a combination of the risk factors – these who are poor, lack social support and struggle with other disabilities such as substance abuse and physical health problems Further compounding this was the loss of supportive relationships they had in the shelter and neighborhood, one more set of losses for people who have experienced many throughout their lives Moreover, the community services that existed for this population were fragmented, poorly integrated, difficult to access and not always welcoming of these individuals. These factors combined to result in discontinuity of care and support.
- We developed CTI as a way to augment our services so that support and continuity of care would be enhanced during the critical time of transition from shelter to community housing. We thought that a time-limited intervention might have a durable impact if it helped to strengthen a network of community support. CTI emphasizes maintaining continuity of care while gradually passing primary responsibility to supports in the community.
- CTI is a time-limited model delivered by a case manager who has existing relationship with the service recipient. It was designed to provide emotional & practical support during a period of transition for the client, for instance, during the transition from living in a shelter to placement in housing in the community. It is highly focused on a small number of service areas that place the individual at risk of becoming homeless again. Thus, it is very individualized. Gradually, the case manager begins to transfer responsibility to community caregivers over a nine-month period that is divided into three specific phases. The case manager’s primary role is to strengthen ties to services, family, friends, creating a community network that will continue to provide support to the client long after the CTI intervention is over.
- During the Transition phase, the CTI worker has a high level of contact with clients. He escorts them to their new residence and visits them regularly to evaluate their adjustment to community living. He also accompanies clients to the first community mental health appointment to help smooth this experience. Mediate conflicts between client and prospective network of support (formal and informal) The CTI worker also works with clients to strengthen their ability to advocate for themselves. Continuing assessment of needs in community
- By the time the Try-Out phase begins, the basics should be in place. The CTI specialist steps back a bit and observes how study the new community linkages are. He encourages the client and members of the support network to handle more on their own. If the system seems to be operating smoothly, the CTI worker can become less active. Most likely, however, problems arise which will require continued mediation, advocacy and sometimes development of new support arrangements
- During Phase 3, the CTI specialist, the client and community linkages hold a meeting to discuss transfer of care and go over long-term goals. Ideally, this discussion should take place 1-2 months before the end of CTI to allow time to work through any snags. Key issue at this phase is dealing with the end of the CTI relationship. The client and CTI worker need to review and reflect on the work they have done together – where the client was at the beginning, where he moved during the intervention and what possibilities lie ahead. The two should discuss the client’s strengths, new skills, vulnerabilities and “safety net” that is in place should the client need it. A celebration is a nice way to mark the end of the CTI relationship.