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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a method called Critical Time Intervention (CTI), designed to help Veterans who have experienced homelessness transition into stable housing. It examines two approaches: one provides training and support for case managers, while the other includes additional weekly guidance to enhance CTI implementation. The trial aims to determine if these strategies improve outcomes for Veterans. Veterans who receive six months of case management after experiencing homelessness might be suitable candidates for this study. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering Veterans a chance to be among the first to benefit from this innovative approach.

Will I have to stop taking my current medications?

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

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Critical Time Intervention (CTI) is safe and well-received by participants. Studies have found that CTI helps reduce homelessness and encourages more frequent use of helpful services. Importantly, no major negative effects have been reported from this approach. CTI supports people during critical transition periods, stabilizing their living situations and improving overall well-being. For those considering participation, these findings suggest that CTI is a safe and supportive method to address homelessness. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Critical Time Intervention (CTI) for homelessness because it offers a structured, time-limited approach designed to support individuals during critical periods of transition, such as moving from shelters to independent living. Unlike typical services that may not focus on these transition phases, CTI emphasizes building a supportive network and strengthening an individual's ties to their community and resources. The trial explores two approaches: Replicating Effective Programs (REP) and an enhanced version with external facilitation, both aiming to improve implementation effectiveness. This could lead to more consistent and successful outcomes in reducing homelessness by ensuring individuals have the necessary support when they need it most.

What evidence suggests that this trial's treatments could be effective for homelessness?

Research has shown that Critical Time Intervention (CTI) reduces homelessness and encourages more frequent use of support services during housing transitions. One study found that CTI significantly lowered the risk of becoming homeless again after securing housing, with benefits lasting up to 18 months. Another study discovered that during this period, people receiving CTI spent fewer nights homeless compared to those receiving regular care (32 nights versus 90 nights). In this trial, participants will join different treatment arms, including the "Replicating Effective Programs (REP)" arm and the "REP + External Facilitation (Enhanced REP)" arm, which support CTI implementation. CTI's structured approach helps stabilize housing, making it a promising option for Veterans who have experienced homelessness. ^{1 5 6 7 8}

Who Is on the Research Team?

Sonya Emi Gabrielian, MD MPH

Principal Investigator

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

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9832072/

A Systematic Review of Critical Time Intervention - PMC CTI had a consistent positive impact on two primary outcomes—reduced homelessness and increased service engagement use—among different ...

2. criticaltime.org criticaltime.org/cti-model/evidence/

Evidence for Effectiveness CTI significantly reduced the risk of recurrent homelessness following placement into housing. Over the 18 month follow-up period, those assigned to CTI had ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3132151/

A Randomized Trial of Critical Time Intervention to Prevent ... In this study, a nine-month CTI produced a significant reduction in post-discharge homelessness which, crucially, remained evident up to the end of an eighteen ...

4. criticaltime.org criticaltime.org/2023/12/23/cti-evidence-review-released/

CTI Evidence Review Released Led by Dr. Jennifer Manuel of the University of Connecticut, the review concludes that CTI demonstrated a consistent positive impact on two ...

5. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ps.54.6.884

Cost-Effectiveness of Critical Time Intervention to Reduce ... During the same period, the critical time intervention group experienced significantly fewer homeless nights than the usual care group (32 nights versus 90 ...

6. criticaltime.org criticaltime.org/cti-model/research-hidden/

Research Hidden This first randomized trial of the nine-month CTI model assessed its effectiveness in preventing homelessness among 96 men with serious mental disorder being ...

7. continuum.militaryfamilies.psu.edu continuum.militaryfamilies.psu.edu/program/Critical%20Time%20Intervention%20(CTI)

Critical Time Intervention (CTI) - Continuum of Evidence Another study found that CTI participants experienced significantly less homelessness during the final three follow-up intervals and fewer total homeless nights ...

8. endhomelessness.org endhomelessness.org/wp-content/uploads/2024/10/CTI-RRH-Manual.pdf

Critical Time Intervention For Rapid Rehousing CTI-RRH is not designed to resolve poverty, and in many cases clients' housing will remain precarious, although most are expected not to return to homelessness.