Critical Time Intervention for Mental Health Challenges

(CTI-YAMH Trial)

Overseen By Yadira Cortez

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Houston

Disqualifiers: Age 25+, Non-English, others

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

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

Compensation: Varies

Number of Visits: 15

60 Participants Needed

Trial Summary

What is the purpose of this trial?

Young adults experiencing homelessness have high rates of mental health conditions but low rates of service utilization and the point of transition from homelessness to supported housing provides a window of opportunity for intervention. The goal of this study is to adapt the evidenced-based intervention, Critical Time Intervention, for young adults with mental health conditions who are entering a rapid rehousing program and test the adapted intervention in a randomized feasibility pilot trial. Participants in the pilot trial will be asked to participate in the CTI-YAMH intervention that involves structured case management and supports from a mental health liaison and a peer support specialist. After a pilot feasibility phase (n=8), we will test the intervention by randomly assigning young adults on the housing wait list to a housing program with CTI-YAMH (n=26) or to get housing supports from another agency that does not provide CTI-YAMH (treatment as usual, n=26).

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 is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Critical Time Intervention for Young Adults with Mental Health conditions?

Critical Time Intervention (CTI) has been shown to help people with serious mental illnesses by improving their social skills and family relationships, which can reduce the chances of being rehospitalized. It also helps prevent homelessness by providing support during transitions from hospitals to community living. ^{1 2 3 4 5}

How is the Critical Time Intervention for Young Adults with Mental Health conditions treatment different from other treatments?

Critical Time Intervention (CTI) is unique because it focuses on providing support during critical transition periods in a young adult's life, such as moving from child to adult mental health services, which is often a challenging time for maintaining mental health care. ^{6 7 8 9 10}

Eligibility Criteria

This trial is for young adults aged 18-24 who are on a housing list, experiencing mental health challenges like depression, anxiety, bipolar or psychotic disorders with ongoing symptoms. They must speak English and be eligible for rapid rehousing based on their priority score.

Inclusion Criteria

You have exhibited psychological distress on the Kessler-6 scale, or have been diagnosed with depression, anxiety, bipolar disorder or a psychotic disorder and are still experiencing symptoms.

Exclusion Criteria

I am 25 years old or older.

Not eligible for rapid rehousing based on housing priority score

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pilot Feasibility Phase

Recruit and enroll a sample of 8 participants to refine enrollment and intervention procedures

3 months

Baseline interview via Zoom or phone

Intervention Phase

Participants receive the CTI-YAMH intervention in conjunction with rapid rehousing supports

6 months

Baseline, midpoint (3 months), and end of intervention (6 months) surveys

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Follow-up survey at 12 months

Treatment Details

Interventions

• Critical Time Intervention for Young Adults with Mental Health conditions

Trial Overview The study tests an intervention called Critical Time Intervention (CTI-YAMH), which provides structured case management and support from mental health professionals to young adults transitioning into supported housing. Participants will either receive CTI-YAMH or standard housing supports.

Participant Groups

Group I: Intervention Condition, CTI-YAMH Experimental Treatment 1 Intervention

Participants receive the CTI-YAMH intervention in conjunction with rapid rehousing supports for the 6 month intervention

Group II: Treatment as Usual Condition Active Control 1 Intervention

Participants will be assigned to a housing program at another agency that provides rapid rehousing with usual supports

Critical Time Intervention for Young Adults with Mental Health conditions is already approved in United States for the following indications:

Approved in United States as Critical Time Intervention for:

• Homelessness prevention and support for individuals with mental health conditions

Who Is Running the Clinical Trial?

University of Houston

Lead Sponsor

Trials

155

Recruited

48,600+

Findings from Research

The Critical Time Intervention (CTI-BR) did not show significant advantages over regular care in improving social performance and quality of life for individuals transitioning from long-term psychiatric hospitalization.

Despite the lack of overall benefit from CTI-BR, participants reported improvements in social functioning and self-perception of mental health, suggesting that elderly patients can successfully reintegrate into community living with appropriate support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deinstitutionalization of long stay patients in a psychiatric hospital in Rio de Janeiro. Silva, PRFD., Carvalho, MCA., Cavalcanti, MT., et al.[2018]

Critical Time Intervention (CTI) is an effective case management approach that provides intensive, time-limited support to patients with serious mental illness, helping them connect to long-term care systems.

CTI is particularly beneficial for patients who are new to psychiatric care and may struggle to engage with services due to complex issues like homelessness or social skills deficits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Engaging patients with serious mental illness in care services by Critical Time Intervention]. van der Plas, AG., Abdoelbasier, S., van Hemert, AM.[2010]

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]

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]

The brief three-month critical time intervention (B-CTI) significantly improved continuity of psychiatric outpatient care for 135 veterans with serious mental illness after discharge from inpatient treatment, leading to fewer days until their first outpatient service visit.

Participants in the B-CTI group had more outpatient visits and reported better support in managing appointments and community connections, indicating that this intervention effectively enhances postdischarge care continuity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Dixon, L., Goldberg, R., Iannone, V., et al.[2022]

Early identification and treatment of serious mental illnesses, which often begin before age 20, is crucial for reducing long-term impacts on youth.

Despite advancements in understanding and treating children's behavioral health, significant barriers such as insurance gaps and public misconceptions still hinder timely access to necessary services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reflection health means hope: 2013 is the year of the children. Rosenberg, L.[2021]

Adolescence is a critical period for mental health, with 50% of adult mental disorders starting before age 16, highlighting the need for effective early intervention services.

Current youth mental health services, which separate care between child and adult systems at ages 16-18, are inadequate; a pilot program in Birmingham, Youthspace, demonstrates that a redesign of these services is both necessary and achievable to improve young people's experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Youth services: meeting the mental health needs of adolescents. Vyas, NS., Birchwood, M., Singh, SP.[2022]

A study involving 1,062 youth and young adults aged 11 to 25 showed significant reductions in depression symptoms after participating in remote intensive outpatient programming, with over half of the participants crossing below the clinical cutoff for major depressive disorder by discharge.

The remote treatment model was effective across diverse subgroups, including those defined by gender identity and sexual orientation, indicating it may help address mental health disparities among marginalized youth who often face greater barriers to care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment. Evans-Chase, M., Solomon, P., Peralta, B., et al.[2023]

Young men aged around 18.8 years face significant barriers to seeking mental health care, including societal expectations of masculinity and unfamiliarity with talk therapy, as identified in interviews with 25 young males and 4 service providers.

Facilitators that could improve help-seeking behaviors include positive initial contact with services, partnerships between different sectors, the presence of male practitioners, and targeted messaging that resonates with young men.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Young men's access to community-based mental health care: qualitative analysis of barriers and facilitators. Rice, SM., Telford, NR., Rickwood, DJ., et al.[2018]

The Youth Mental Health First Aid Program significantly improved adults' ability to recognize mental health issues like schizophrenia and depression, as well as their confidence in providing help, based on an evaluation of 246 participants over six months.

The program has successfully trained 318 instructors who have taught over 10,686 individuals across Australia, and it has expanded internationally to countries like Canada and Singapore, indicating its effectiveness and broad acceptance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Youth mental health first aid: a description of the program and an initial evaluation. Kelly, CM., Mithen, JM., Fischer, JA., et al.[2023]

References

1. Brazil pubmed.ncbi.nlm.nih.gov

Deinstitutionalization of long stay patients in a psychiatric hospital in Rio de Janeiro. [2018]

2. Netherlands pubmed.ncbi.nlm.nih.gov

[Engaging patients with serious mental illness in care services by Critical Time Intervention]. [2010]

3. 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]

4. Netherlands pubmed.ncbi.nlm.nih.gov

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

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

Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. [2022]

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

Reflection health means hope: 2013 is the year of the children. [2021]

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

Youth services: meeting the mental health needs of adolescents. [2022]

8. Canada pubmed.ncbi.nlm.nih.gov

Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Young men's access to community-based mental health care: qualitative analysis of barriers and facilitators. [2018]

10. England pubmed.ncbi.nlm.nih.gov

Youth mental health first aid: a description of the program and an initial evaluation. [2023]