Filed under: research
A newly published paper by Andrew Tomita of Columbia University and Dan Herman of Hunter College examines the impact CTI in reducing rehospitalization among formerly homeless individuals with severe and persistent mental illness after discharge from inpatient psychiatric treatment. In a randomized trial with 150 participants, psychiatric rehospitalization at the end of the 18-month followup period was significantly lower for the group assigned to CTI compared with the usual services group (odds ratio=.11, 95% confidence interval=.01–.96). The study is the first to demonstrate that CTI, primarily designed to prevent recurrent homelessness in high-risk individuals, also reduced the occurrence of rehospitalization after discharge.
July 21, 2012
A team from the United Kingdom have published results from a pilot randomized trial testing the feasibility of using a brief version of CTI with persons with mental illness following release from prison. Sixty prisoners were randomly assigned to receive either a brief CTI intervention or usual discharge planning services. The study aimed to see whether the intervention would effectively connect mentally ill prisoners with social, clinical, housing and welfare services during the first weeks following release. Results showed that a higher proportion of persons assigned to CTI were connected to services than were those assigned to usual services. In addition, those assigned to CTI were more likely to be receiving medication and to be registered with a general practitioner. The team is currently in the midst of a full-scale randomized trial that will more conclusively test the model with a larger number of research participants.
May 14, 2012
Professor Fang-Pei Chen
A newly-published study by Fang-Pei Chen of the Columbia University School of Social Work explores the ways in which service setting characteristics influence the implementation and practice of CTI. Results show service structure (e.g., the platform for relationship building, staff to manage housing applications, and organizational policy on substance abuse) and agency services (e.g., existing resources and modalities) influenced practitioners’ operationalization of shared CTI goals and fundamental practice strategies. Findings inform CTI fidelity elements and the assessment of service settings for CTI implementation. The study highlights the crucial role of practitioners in the implementation of evidence based practices and the importance of seeking practitioners’ feedback on their experiences with EBPs for enhancing their effective implementation.
February 29, 2012
The highly regarded Coalition for Evidence-Based Policy has announced that CTI meets the Congressional Top Tier evidence standard as an effective social program. This standard, identified in recent legislative language, is “well-designed randomized controlled trials [showing] sizeable, sustained effects on important…outcomes.” The Coalition is a nonprofit, nonpartisan organization that works closely with key Executive Branch and Congressional officials to help promote dissemination of the most promising social interventions.
November 15, 2011
Investigators from four countries gathered on September 22 to describe their current research at a symposium held at the World Congress of Psychiatry in Buenos Aries, Argentina, sponsored by the World Psychiatric Association. Participants included Dan Herman (US), Ezra Susser (US), Graham Thornicroft (UK), Elie Valencia (Brazil), Judith Wolff (Netherlands). Thornicroft and colleagues are conducting a randomized trial of CTI with persons with mental illness being released from correctional facilities in London and Manchester, while Valencia reported on work his group is carrying out using CTI in the favelas of Rio De Janeiro. Wolff leads a large multi-site randomized trial testing an adapted version of the model with homeless persons and women who have experienced interpersonal violence.
September 23, 2011
Psychiatric Services has published the findings of the most recent randomized trial of CTI with people with severe mental illness following discharge from psychiatric hospitals. 150 previously homeless men and women with severe mental illness and who were discharged from inpatient psychiatric hospitalization to transitional residences on the hospital grounds were randomly assigned to receive usual care or usual care plus CTI at the point of discharge to the community. Following discharge, participants’ housing status was assessed every six weeks for 18 months. An intent-to-treat analysis demonstrated that participants assigned to the CTI group had significantly less homelessness at the end of the follow-up period, supporting the idea that a targeted, relatively short intervention applied at a critical transition point can enhance the efficacy of long-term supports for persons with severe mental illness who are living in the community. A free full-text version of the article is available here.
July 6, 2011
The Netherlands Center for Social Care Research at Radboud University Nijmegen Medical Centre, with funding from the national government, has launched two randomized controlled trials to assess the effectiveness of CTI in Dutch services for homeless people and victims of domestic violence. The studies investigate whether combining Critical Time Intervention (CTI) with the typical strengths-based social work approach is more effective than the strengths-based methodology alone in improving housing and other outcomes. The homeless sector trial will include adult clients of 9 shelters, examining whether CTI leads to fewer days of homelessness (primary outcome measure). The trial in the women’s shelter sector targets adult female clients of 8 facilities who have experienced violent abuse and examines how CTI affects their quality of life (primary outcome measure). Teams have been trained in the interventions and data collection is set to begin shortly. The study is led by Dr. Judith Wolf with collaborators Renee de Vet, Danielle Lako, and Marielle Beijersbergen. A kickoff meeting (see photo), held on November 18 in Utrecht, was attended by service providers, researchers and CTI experts from the Netherlands and the US including Dan Herman of Columbia University.
December 3, 2010
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
August 26, 2010
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 findings 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.
March 17, 2010
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
December 3, 2009
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