CTI Implementation FAQs
Understanding the CTI Model
- What is the CTI Model?
For a complete overview of the CTI model and its core components, please click HERE.
- Does a CTI worker fulfill the same responsibilities as a case manager?
No. CTI is not meant to be a substitute for comprehensive, long-term case management. The CTI worker is responsible for linking the client to the appropriate community supports (including permanent case management) and assisting them over time with making use of such supports independently.
- How often should a CTI worker meet with the client throughout the intervention?
During Phase 1, the worker meets often with clients and their supports. However, the CTI model does not specify the exact frequency because one principle of CTI is that the worker must tailor the approach to the needs and context of each client. The worker then should aim to decrease frequency of contact over the next two phases while gradually transitioning clients to community supports. Many programs have asked for guidelines that would help them make staffing and other funding projections. We have provided them with this general guide for frequency of client visits by phase: weekly during Phase 1, bi-weekly during Phase 2, and monthly during Phase 3. Keep in mind that specific numbers of visits per phase can and should be adapted to the context of your program.
- Where should CTI visits take place?
A key component of the model is that it is community-based. The worker needs to directly observe clients within their environment in order to make an informative assessment of the types of community supports they are going to need. As a general rule, during Phase 1, at least four meetings should take place in the community. The worker needs to be sensitive to the clients’ preferences, by discussing with them the best timing and location of visits. Additional contacts with clients and supports may take place either in person or by telephone.
- How many and what types of linkages should occur for each client?
There are no specific guideless regarding the number or types of linkages that should take place during the CTI process; they should be tailored to the particular needs, strengths, and aspirations of each client. Additionally, linkages will depend upon the program’s specific pre-determined focus areas and types of supports available in the community.
- Is CTI effective among chronically homeless populations?
Yes. Randomized trials provide evidence that CTI is effective in reducing recurrent homelessness and other adverse outcomes among chronically homeless populations. For more information and links to specific publications on CTI, please see visit CACTI’s Evidence for Effectiveness page.
Questions About Phase Duration
- Under which circumstances may CTI phases be extended?
The CTI phases should not be extended. A grace period of two weeks is permitted to terminate the intervention after the originally planned closing date. In the event that a client is continuously out of contact for more 25 percent of the intervention’s total duration (which may vary among programs), the CTI worker may re-start the intervention upon the client’s return. Otherwise, the CTI worker works with the client along the originally planned timeline.
- Should the CTI period be extended if a client has not met their long-term goals (e.g. finding a job, enrolling in school, maintaining medication compliance) within the CTI timeframe?
One should not expect clients to meet their long-term goals within the short timeframe of CTI. Instead, the goals of the CTI phases are related to successful linking of clients to supports who will eventually take over helping clients meet their long-term goals.
- If a client has disengaged for an extended period of time after multiple attempts by the CTI worker to make contact, at what point can the worker discharge the client from the program while still maintaining fidelity to the model?
If the client makes clear after multiple attempts at engagement that they are not interested in receiving CTI services (with adequate documentation), discharge is appropriate so long as approved by the supervisor. Any standards around the number of attempts to make contact by the CTI worker in this circumstance may be decided upon by the program.
10. Should a CTI worker extend Phase 3 if the client has not been linked to sufficient supports/services?
Although each case presents its own unique challenges, it is generally recommended that under such circumstances the client still BE discharged at the originally planned closing date of the intervention. However, an extension of the CTI phases may be appropriate if specific services/supports are likely to become available in the near future and the client is willing to be linked to such services/supports.
- If a client loses housing during Pre-CTI, Phase 1, 2 or 3, should the CTI worker continue working with this client?
Ideally, clients remain in the CTI program until the end of the intervention, but this may not be permissible due to their organization’s regulations. Some CTI programs make a back-up plan to refer these clients to a long-term case manager in a different program run by their organization.
- If a client contacts a CTI worker post-termination requesting assistance during a crisis, what should the worker do?
A CTI worker should not be the ongoing contact for crisis intervention. The worker should remind the former client that CTI is over, offer some limited advice and re-direct the client to the supports and sources of help to which he or she was hopefully connected during the intervention. Do not re-open the case unless there is another major life event where CTI might help with the transition.
- If a client is successfully making use of their support network on their own, can they be discharged early in order to make room for others in need of the CTI services?
One of the core components of the model is “no early discharge.” A grace period is permitted for closing CTI two weeks prior to the originally planned closing date. If by Phase 2 the links to supports are already strong, then the CTI worker may begin to significantly limit contacts at that time (still maintaining monthly contacts, at minimum). The CTI worker should still hold the “final transfer-of-care” meeting with the client and supports, as well as the closing meeting with the client alone at the end of Phase 3.
Addressing Other Implementation Issues
- What are some ways of coping with a mismatch between agency tradition and/or expectations and CTI model?
Sometimes a conflict emerges between agency expectations and fidelity to the CTI model. It is essential that prior to implementing CTI, administrators are oriented to the model and have a thorough understanding of how it can be properly executed within their agency. Some core components of the model should always be adapted to the particular context of the agency, but most are non-negotiable (i.e. substantial changes may threaten fidelity to the model).
- How can CTI programs best collaborate with and educate their partnering organizations (agencies to which clients are linked) about CTI?
The head of the CTI program should consider convening meetings with administrators and top clinical staff of partnering agencies to educate them about the model and discuss potential concerns and conflicts. This should be followed by a meeting with their front line staff to provide an overview of the model and answer any remaining questions. Some organizations have found it useful to host a CTI “kick-off” event, which can provide a platform for many partnering organizations to come together to learn about what the model is and is not.
- Can CTI be implemented in a rural context?
Yes – and it has been already. One of the major challenges of implementing CTI in such settings is the large geographic distances that CTI workers have to travel to visit clients and their supports. Because of this challenge, organizations may have to be especially thoughtful about about where, when and for how long their CTI meetings take place. Another common challenge encountered by CTI programs in rural areas is the limited number of support networks and resources. If you are a provider hoping to implement CTI in a rural context, you may find our Member Map and Directory useful for finding and contacting other providers with experience implementing CTI in a rural area. In order to access our Member Map and Directory, you must be a member of our CTI Global Network. Please click HERE in order to join.
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