Critical Time Intervention

New paper explores broader implications of CTI for timing of social service interventions

Relatively little attention has been paid to the dimension of time in the design of social work interventions. CTI is an example of an intervention that was explicitly developed to address a timing-specific need (enhancing continuity of care during transitions between institutional and community living). After describing the model and summarizing research that supports its effectiveness, this new article by Dan Herman and Jim Mandiberg of Columbia University considers examples of other time-sensitive interventions in social work and related fields and speculates on some potential advantages to such strategies. The authors conclude that further attention to various dimensions of timing in the design and evaluation of human service interventions is warranted

NIH conference features web-based training pilot

Jeffrey Olivet and Sam Johnston (both from the Center for Social Innovation) and Dan Herman (Columbia University & New York State Psychiatric Institute) led a panel presentation at the 3rd Annual NIH Conference on the Science of Dissemination and Implementation held in Bethesda on March 15 and 16, 2010. The team described finding from their recently completed pilot study of web-based CTI training for social workers and other staff working in homelessness service settings. This study, a collaborative project carried out with support from NIMH, tested a virtual community of practice approach to supporting providers as they developed needed skills and specific plans to implement CTI in their organizations.

Project ASPIRE presented at ABCT conference

Clinicians and researchers from the Institute for Community Living, Inc., presented a poster evaluating the effectiveness of Project ASPIRE at the annual meeting of the Association for Behavioral and Cognitive Therapies held last month in New York City. Project ASPIRE is an award-winning SAMHSA-funded demonstration program that applies CTI and other evidence based approaches to help women with mental health and substance use problems successfully transition from a homeless shelter to stable life in the community. For more information on the program or the evaluation, contact Dr. Elizabeth Cleek at elizabeth.cleek@iclinc.net

CTI symposium features international collaboration

The Institute on Psychiatric Services, an annual meeting of community-based psychiatrists organized by the American Psychiatric Association, was the site of a well-attended symposium on CTI held on October 11, 2009. The symposium, organized by Bert van Hemert of the ParnassiaBavo Group and Leiden University in the Netherlands and Dan Herman of New York State Psychiatric Institute & Columbia University, featured presentations by researchers studying adaptations of CTI in diverse settings including US prisons (Jeffrey Draine) and community-based mental health clinics in Rio De Janeiro (Elie Valencia). Other speakers included Lewis Opler, who reported on the impact of CTI on psychiatric symptoms in two US trials. Sarah Conover of New York State Psychiatric Institute & Columbia University served as discussant.

CTI informs pilot ACT transition model in New York State

act_logo For persons with severe mental illness, the transition from assertive community treatment (ACT) to less intensive services is a vulnerable period during which enhanced support is especially vital. The ACT Transitions Model, adapted in part from CTI, is a framework designed to enhance the coordination and continuity of care of service recipients who are moving from ACT to less intensive services. A workgroup of stakeholders developed the model to be delivered in the following three phases over a nine-month period: (1) Transition Planning, (2) Try-Out, and (3) Fine Tuning, Transfer of Care and Follow-up. The stakeholder workgroup included ACT staff and consumers as well as representatives of the New York State Office of Mental Health and the New York City Department of Health and Mental Hygiene. The model will be piloted and evaluated over the next two years. The project is a New York State Office of Mental Health initiative funded by the Bristol-Myers Squibb Foundation (PI, Molly Finnerty, M.D.) For further information, contact Jennifer Manuel at coevjim@omh.state.ny.us or 212.543.5164.

Using a brief CTI to promote continuity of care after inpatient hospitalization

psych-svscover Lisa Dixon of the University of Maryland and colleagues have published a new experimental study assessing the effectiveness of a brief three-month adaptation of CTI in enhancing continuity of outpatient psychiatric treatment for persons with serious mental illness following discharge from inpatient care. Among the findings were that, compared with the control group, persons assigned to receive the intervention had significantly fewer days between their hospital discharge and their first outpatient service. The authors conclude that the intervention successfully promoted post-discharge continuity of care, but caution that the limited association between improved continuity and improved patient outcomes requires further study.

Project Connect aims to improve outcomes for frequent users of hospital emergency services

old-presbhospital Conceptualizing discharge from psychiatric emergency rooms (ER) as a “critical time” of transition, researchers at New York State Psychiatric Institute have launched Project Connect, a pilot program that adapts CTI for frequent users at New York Presbyterian Hospital, home to one of New York City’s busiest psychiatric emergency departments. In evaluating Project Connect, the research team will compare outcomes of persons receiving CTI services with those receiving usual care in order to determine whether the model decreases psychiatric ER visits and increases engagement in outpatient care among participants. A particularly innovative aspect of the study is its use of specially trained peer workers to deliver the CTI intervention. The project is supported with a grant from the New York State Health Foundation. For further details, contact Dr. Ilana Nossel who heads the study at irn1@columbia.edu

NODPAM: effectiveness and cost-effectiveness of needs-oriented discharge planning and monitoring for high utilisers of psychiatric services

logo_nodpam_k German researchers based at Ulm University are conducting a multi-site randomized trial testing a brief intervention intended to ehance continuity of care for high utilizers of psychiatric services following discharge from inpatient treatment. Although the research team notes that the study was partially inspired by CTI, the model they are employing differs from CTI in its emphasis on discharge planning and follow-up monitoring rather than provision of direct staff support during the post-discharge period. The researchers hope that the intervention will lead to a reduction in future inpatient stays and better quality of life and clinical outcome. Details on the study design were reported recently in BMC Health Services Research.

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