Critical Time Intervention for Homelessness

Age: Any Age

Sex: Any

Trial Phase: Phase 1

Sponsor: VA Office of Research and Development

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

153 Participants Needed

Trial Summary

What is the purpose of this trial?

The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Critical Time Intervention for preventing homelessness?

Research shows that Critical Time Intervention (CTI) consistently helps reduce homelessness and increase engagement with services for people transitioning from institutions to community living, especially those with severe mental illness. It has been effective in various settings and populations, although the exact reasons for its success are not fully understood. ^{1 2 3 4 5}

Is Critical Time Intervention safe for humans?

The research on Critical Time Intervention (CTI) does not specifically address safety concerns, but it is generally used to support people during difficult life transitions, like moving from shelters to housing, without reports of harm. ^{1 2 4 5 6}

How does the treatment Critical Time Intervention differ from other treatments for homelessness?

Critical Time Intervention (CTI) is unique because it focuses on providing support during critical transition periods, such as moving from shelters to housing, to prevent homelessness. It emphasizes building community connections and enhancing family support, which helps improve service engagement and reduce psychological distress. ^{1 2 5 7 8}

Research Team

Sonya Emi Gabrielian, MD MPH

Principal Investigator

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Eligibility Criteria

This trial is for Veterans who have experienced homelessness and are part of the Grant and Per Diem (GPD) case management aftercare program in 7 Veterans Integrated Service Networks. It's designed to help them as they transition into housing by providing six months of specialized case management.

Inclusion Criteria

Grant and Per Diem (GPD) case management aftercare grantees in 7 Veterans Integrated Service Networks (VISN), all of whom provide 6-months of case management to Veterans who have experienced homelessness.

Exclusion Criteria

N/A

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation of Critical Time Intervention (CTI) at 32 VA GPD-CM sites using the Replicating Effective Programs (REP) implementation bundle

6 months

Ongoing site visits and facilitation

Enhanced Implementation

Half of the sites receive additional 9 months of external facilitation to support CTI implementation

9 months

Weekly facilitation sessions

Follow-up

Participants are monitored for outcomes such as hospitalization rates, outpatient service use, and housing stability

12 months

Treatment Details

Interventions

• Critical Time Intervention
• External Facilitation
• Replicating Effective Programs

Trial Overview The study is testing Critical Time Intervention (CTI), a time-limited support strategy, along with External Facilitation and Replicating Effective Programs, to improve the housing stability of homeless-experienced Veterans in the GPD program.

Participant Groups

Group I: Replicating Effective Programs (REP) Experimental Treatment 2 Interventions

A stakeholder-informed training and technical assistance implementation strategy

Group II: REP + External Facilitation (Enhanced REP) Active Control 3 Interventions

REP plus site specific weekly facilitation to support CTI implementation.

Group III: Control Group Active Control 1 Intervention

No CTI implementation

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

University of California, Los Angeles

Collaborator

Trials

1,594

Recruited

10,430,000+

Center for the Advancement of Critical Time Intervention

Collaborator

Trials

2

Recruited

15,300+

University of Southern California

Collaborator

Trials

956

Recruited

1,609,000+

Findings from Research

Critical Time Intervention (CTI) effectively helps prevent recurrent homelessness in individuals with severe mental illness by improving continuity of care during their transition from institutional settings to community living.

The model has shown promise in real-world applications, as illustrated by a case example of a homeless woman successfully transitioning from a shelter to stable housing, highlighting its potential for broader adaptation and implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Critical Time Intervention: an empirically supported model for preventing homelessness in high risk groups. Herman, D., Conover, S., Felix, A., et al.[2022]

Critical Time Intervention (CTI) has been shown to significantly reduce homelessness and increase service engagement among various populations, based on a systematic review of 13 studies.

While CTI demonstrates effectiveness in improving outcomes during life transitions, the exact mechanisms behind its positive impacts are still not well understood.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention. Manuel, JI., Nizza, M., Herman, DB., et al.[2023]

The Critical Time Intervention (CTI) significantly improved family contact and satisfaction with family relationships among 150 individuals with serious mental illness over an 18-month follow-up period after hospital discharge.

Improvements in family relationship quality were found to modestly mediate the reduction in psychiatric rehospitalization, suggesting that strengthening family ties can be beneficial during the transition from hospital to community living.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization. Tomita, A., Lukens, EP., Herman, DB.[2022]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Critical Time Intervention: an empirically supported model for preventing homelessness in high risk groups. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

The impact of critical time intervention in reducing psychiatric rehospitalization after hospital discharge. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Randomized trial of critical time intervention to prevent homelessness after hospital discharge. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization. [2022]

6. England pubmed.ncbi.nlm.nih.gov

The effectiveness of critical time intervention for abused women and homeless people leaving Dutch shelters: study protocol of two randomised controlled trials. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Critical time intervention for reentry from prison for persons with mental illness. [2007]