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.

1. FAMILY CRITICAL TIME INTERVENTION Clinical Principles Stages of Change Motivational Interviewing Harm Reduction Psychodynamic Approach

2. Stages of Change 1. Pre-contemplation Stage 2. Contemplation Stage 3. Determination Stage 4. Action Stage 5. Maintenance Stage

3. 3 MOTIVATIONAL INTERVIEWING Mobilize Client’s Desire to Change Non-confrontational Minimize Defensiveness Do No Harm

4. Stage of Change/Goal Precontemplation/Raise doubt, awareness of risk Contemplation/Evoke reasons to change, self-efficacy Determination/Find best course of action Action/Aid client in taking steps toward change Maintenance/Develop strategies to prevent relapse Relapse/Renew process of recovery without losing hope

5. CTI STAGE/STAGE OF CHANGE Pre-CTI/Pre-Contemplation Housing Application/Contemplation Transition to Community/Determination Practicing/Action Transfer of Care/Action to Maintenance 5

6. 6 Harm Reduction Prevent Disease/Injury Prevent Incarceration Prevent Hospitalization Prevent Homelessness Prevent Unplanned Pregnancies Housing First

7. Psychodynamic Principles in CTI History Repeats Itself Holding Environment Transference/Countertransference “Good Enough” Case Management Separation/Individuation 7

8. Team Supervision Presentation of Client’s History Dynamic Formulation-- What are the key issues/risk factors? What can be predicted? Management of Transference and Countertransference Maintain Fidelity to CTI Model Meet the Client/Family Termination 8

9. 9 Transference/Countertransference Paradigms Damsel in Distress/Savior Complex The Bottomless Pit/Sucked Dry Help Rejecting Complainer/Helpless and Frustrated The Neutron Bomb/Hatred & Criticism, or Fear & Rejection The “Good Case”/Separation Anxiety

10. Case Example- Ms. PPre-CTI 25 y.o. mother of 5 escaping an abusive boyfriend. Parents used IV drugs, father was violent, mother died of AIDS when Ms. P was a teen. Physically and sexually abused in foster care. 2 teen pregnancies with older boys who abandoned her. Help from Group Home leads to GED, improved parenting skills, and maintenance of child custody. Series of relationships with abusive men and 3 more children between age 22-26. 10

11. Case Example- Ms. PCTI – Stage 1 Positive engagement with CTI worker. Rapid re-housing. Seen in CTI team meeting, diagnosed with post-partum depression. Enters treatment with CTI worker’s encouragement. Mother’s depression seen as key aspect of difficulty meeting goal of stable housing Substance abuse: self medicating seen as secondary yet important concern 11

12. Case Example- Ms. PCTI– Stage 2 While CTI worker is on vacation, Ms. P becomes angry and refuses to meet with covering worker. Ms. P stops taking her medication and relapses into marijuana and alcohol use. CTI worker returns, feeling disappointed, guilty, and frustrated with Ms. P. Voices her feelings at team meeting. CTI worker is able to frame Ms. P’s self-destructive reaction to her vacation as a repetition of her chaotic and rejecting past. Ms. P confirms the interpretation by responding, “I never thought you’d come back.” Ms. P’s strengths that led her to housing, a GED, and better parenting are re-affirmed by CTI worker and they re-focus on moving towards a productive termination, guided by greater independence and self-esteem for Ms. P. 12

13. 13 Case Example- Ms. PCTI-- Continued At termination, Ms. P breaks down crying, but avoids self-destructive behavior. She has joined a dual diagnosis therapy group and turns to it for support. She thanks her CTI worker for helping her and proudly looks forward to her greater independence and autonomy

14. Additions to the Model for Special Populations Very young mothers: Supervising clinician is Pediatrician/Child Psychiatrist Baby care, Infant/child development Reduction in risky behaviors Positive parenting Youth transitioning from foster care: Supervising clinician is Child and Adolescent Psychiatrist Complex trauma recovery Education/ Job coaching Developing life skills

15. CONTACT US: Judith Samuels, PhD samuels@nki.rfmh.org Web Site: www.criticaltime.org