Critical Time Intervention for Homelessness

Overseen By Sean Kidd, PhD

Age: < 65

Sex: Any

Trial Phase: Phase 2 & 3

Sponsor: Centre for Addiction and Mental Health

Disqualifiers: Residence outside Toronto

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

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 12

Duration: 52 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to assist young people who have recently secured stable housing after experiencing homelessness. It evaluates the Housing Outreach Project Collaboration (HOP-C), which integrates case management, peer support, and mental health services, against standard community support. The goal is to determine if HOP-C improves housing stability, employment, education, and mental health outcomes more effectively than standard support. Young people who have been homeless for at least six months and have been in stable housing for up to six months may qualify for this trial. As a Phase 2 trial, this research measures HOP-C's effectiveness in an initial, smaller group, allowing participants to contribute to potentially impactful findings.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on providing support for youth transitioning out of homelessness, so it's best to discuss your medications with the trial coordinators.

What prior data suggests that this intervention is safe for youth transitioning out of homelessness?

Research has shown that the Housing Outreach Project Collaboration (HOP-C) effectively supports young people transitioning out of homelessness. Previous studies found that this program, which includes assistance from case managers, peer support, and mental health services, is practical and has helped participants secure stable housing. Although detailed safety information is unavailable, the successful completion of earlier trials suggests no major safety issues. Thus, past research and testing generally consider HOP-C safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Housing Outreach Project Collaboration (HOP-C) because it combines personalized case management with traditional support services, offering a more intensive and structured approach to tackling homelessness among transitional youth. Unlike the standard care options, which often involve sporadic access to support and primarily crisis-driven interventions, HOP-C provides consistent engagement and collaboration with dedicated youth workers, potentially leading to more sustainable housing stability and better overall outcomes. This approach not only addresses immediate housing needs but also aims to build long-term skills and connections, offering a more holistic solution to a complex problem.

What evidence suggests that the Housing Outreach Project Collaboration (HOP-C) is effective for youth transitioning out of homelessness?

Studies have shown that the Housing Outreach Project Collaboration (HOP-C), which participants in this trial may receive, helps young people leaving homelessness find stable housing. Research indicates that HOP-C not only improves housing stability but also aids in finding jobs and supporting mental health. Previous participants experienced positive results, suggesting this approach works better than standard services alone. The program includes case management, peer support, and mental health services, creating a supportive environment for young people. Overall, HOP-C offers promising outcomes for youth seeking stable housing and improved quality of life. ^{1 2 4 5 6}

Are You a Good Fit for This Trial?

This trial is for young people aged 16-25 in Toronto who have been homeless for at least 6 months but recently found stable housing (from 1 day to 6 months ago). They must speak English well. It's not for those planning to move out of Toronto within a year.

Inclusion Criteria

Proficiency in English

Participants will have been in stable housing for between 1 day and 6 months

I am between 16 and 25 years old.

Exclusion Criteria

Has transitioned to a residence outside of Toronto or plans to do so within the coming year.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the critical time intervention HOP-C for 1 year, including integrated case management, peer support, and mental health supports

52 weeks

Baseline, mid-point (6 months), post-intervention (1 year)

Follow-up

Participants are monitored for housing stability, quality of life, and mental health outcomes

6 months

6 months follow-up

What Are the Treatments Tested in This Trial?

Interventions

• Housing Outreach Project Collaboration (HOP-C)

Trial Overview

The study tests the HOP-C program, which includes team-based case management, peer support, and mental health services. The goal is to see if it helps youth stay housed and improve their life outcomes compared to usual community supports.

How Is the Trial Designed?

Group I: Housing Outreach Project - Collaboration (HOP-C) + Treatment as Usual Experimental Treatment 1 Intervention

The treatment condition is HOP-C plus treatment as usual (TAU).

Group II: Treatment As Usual Active Control 1 Intervention

TAU for this population reflects the standard array of services accessed by transitional youth populations. Most will have some contact with a youth worker with ranging focus and intensity (none likely to receive case management at HOP-C intensity), and very few will have any routine contact with other professionals or peer support. They may have some sporadic access to skills development programs and primary healthcare providers with mental health and addictions needs addressed primarily through emergency services at times of crisis.

Housing Outreach Project Collaboration (HOP-C) is already approved in Canada for the following indications:

Approved in Canada as HOP-C for:

• Youth homelessness stabilization
• Mental health support

Who Is Running the Clinical Trial?

Centre for Addiction and Mental Health

Lead Sponsor

Trials

388

Recruited

84,200+

LOFT Community Services

Collaborator

Wellesley Institute

Collaborator

Trials

1

Recruited

210+

LOFT Community Services

Collaborator

Trials

4

Recruited

490+

Covenant House Toronto

Collaborator

Trials

5

Recruited

330+

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]

Patients experiencing homelessness face significant health challenges and high hospital utilization, indicating a need for better housing coordination within healthcare systems.

Implementing a housing coordination framework that connects hospital-based and outpatient housing navigators could improve health outcomes and reduce healthcare costs for this vulnerable population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health system-based housing navigation for patients experiencing homelessness: A new care coordination framework. Velasquez, DE., Mecklai, K., Plevyak, S., et al.[2022]

The study aims to develop and test a distance-based implementation strategy for the Housing First model (HFM), which has been shown to significantly improve outcomes for chronically homeless individuals.

By involving ten housing providers in Chicago and Central Indiana, the research will gather both qualitative and quantitative data to refine the implementation strategy, potentially enhancing the scalability and effectiveness of HFM in diverse settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and testing of an implementation strategy for a complex housing intervention: protocol for a mixed methods study. Watson, DP., Young, J., Ahonen, E., et al.[2022]

The Housing Outreach Program-Collaboration (HOP-C) was a 6-month intervention for homeless youth that successfully engaged 31 participants, with 28 completing the program, indicating strong feasibility for this multiagency approach.

Participants showed modest improvements in self-reported metrics, but significant gains were noted in employment, education, and mental health service connections, highlighting the potential effectiveness of a flexible, comprehensive support system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

More than four walls and a roof needed: A complex tertiary prevention approach for recently homeless youth. Kidd, SA., Vitopoulos, N., Frederick, T., et al.[2020]

A local initiative called Project H3 successfully housed 47 medically vulnerable homeless individuals, with 98% of participants remaining in their homes after 12 months.

Participants reported significant improvements in healthcare access, quality of life, and a decrease in criminal justice involvement, highlighting the effectiveness of housing first, harm reduction, and peer support models in supporting homeless populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of housing first and peer support on people who are medically vulnerable and homeless. Bean, KF., Shafer, MS., Glennon, M.[2022]

The Housing Outreach Program-Collaboration (HOP-C) is a promising intervention for youth transitioning out of homelessness, showing feasibility and improved outcomes in mental health, employment or education, and housing stability in a pilot study of 65 participants.

Participants receiving HOP-C had significantly better subjective housing stability and higher odds of positive outcomes compared to those receiving standard transitional case management, suggesting the need for further testing in a larger trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trialing the feasibility of a critical time intervention for youth transitioning out of homelessness. Kidd, SA., Vitopoulos, N., Frederick, T., et al.[2021]

The Copenhagen Hospital Corporation successfully implemented a reporting system for adverse events, resulting in 6011 reported incidents over three years, indicating a strong safety culture among staff.

The organization conducted 92 root cause analyses during this period, focusing on both optional and mandatory reports, which highlights their commitment to understanding and preventing future adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adverse events management. Methods and results of a development project]. Rabøl, LI., Jensen, EB., Hellebek, AH., et al.[2006]

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 HEALing Communities Study (HCS) is testing a community-based intervention called Communities That HEAL (CTH) in 67 communities across four states to enhance the implementation of evidence-based practices (EBPs) aimed at reducing opioid-involved overdose deaths.

Coalitions in these communities will select at least five strategies to implement EBPs, including overdose education and naloxone distribution, and access to medications for opioid use disorder, ensuring a tailored approach to local needs and contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio. Young, AM., Brown, JL., Hunt, T., et al.[2022]

Both Critical Time Intervention (CTI) and Assertive Community Treatment (ACT) models were effective in helping individuals with co-occurring disorders transition from homelessness to stable housing, with significant reductions in homelessness observed after 6 months (30% for ACT and 44.3% for CTI).

Participants in the CTI program experienced notable improvements in their mental health and substance use, indicating that this model not only aids in housing stability but also supports recovery from psychiatric symptoms and substance use issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case Management Models in Permanent Supported Housing Programs for People With Complex Behavioral Issues Who Are Homeless. Clark, C., Guenther, CC., Mitchell, JN.[2022]

The HOP-C North program, adapted for Indigenous youth in Thunder Bay, showed promising preliminary effectiveness, with participants reporting improvements in educational enrollment, employment, and mental health service engagement after the program.

Key aspects of the program that contributed to its success included flexibility, accessibility, strong relationships, and a focus on participant autonomy, highlighting the importance of tailoring interventions to meet the unique needs of Indigenous youth experiencing homelessness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaption and implementation of the Housing Outreach Program Collaborative (HOP-C) North for Indigenous youth. Toombs, E., Mushquash, CJ., Lund, J., et al.[2022]

Citations

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clinicaltrials.gov

clinicaltrials.gov/study/NCT04755361

Examining the Effectiveness of a Critical Time Intervention ...

Examining the Effectiveness of a Critical Time Intervention to Stabilize Trajectories Out of Homelessness for Youth. ClinicalTrials.gov ID NCT04755361.

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pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/32309974/

Trialing the feasibility of a critical time intervention for youth ...

This study was a pilot randomized controlled trial of one such critical time intervention, called the Housing Outreach Program-Collaboration (HOP-C).

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sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0190740918301403

Development of a complex tertiary prevention intervention ...

Youth homelessness is a complex social problem · HOP-C is a tertiary prevention complex intervention for youth transitioning from homelessness · HOP-C represents ...

4.

ovid.com

ovid.com/journals/ajorp/pdf/10.1037/ort0000454~trialing-the-feasibility-of-a-critical-time-intervention-for

Trialing the Feasibility of a Critical Time Intervention for Youth ...

This study was a pilot randomized controlled trial of one such critical time intervention, called the Housing Outreach Pro- ... Transitional housing for youth in ...

5.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8427990/

Effectiveness of interventions to reduce homelessness

A range of housing programs and case management interventions appear to reduce homelessness and improve housing stability, compared to usual services.

6.

consensus.app

consensus.app/search/what-are-the-outcomes-of-the-housing-outreach-prog/qmCjlTzCTo2-QKf4U3XUEg/

The Housing Outreach Program—Collaboration (HOP-C) ...

The Housing Outreach Program—Collaboration (HOP-C) shows promising outcomes for youth transitioning out of homelessness, including improved housing ...