Family Critical Time Intervention for Successful Transitions to Stable Housing<br />July 12, 2010<br />NAEH<br />Judith Sa...
Homeless Families: Current Environment<br />Economic <br />“Crisis”<br />Foreclosures <br />impact renter as well<br />Une...
How Family CTI Fits<br />Time-limited<br />Evidence base<br />Increases continuity of care: from homeless to housed<br />F...
Why CTI ???<br />People in multiple systems, multiple situations, often transitioning<br />From homeless to housing<br />F...
The CTI Clinical Trial (1990-94)<br />Prevention of Homelessness Among Individuals with Mental Illness<br />Elie Valencia,...
CTI originally used for homeless single adults, NYC<br />From long homelessness <br />				 housing<br />
Staying Housed N=2,937 <br />Lipton, F. R., Siegel, C., Hannigan, A., Samuels, J., & Baker, S. (2000). <br />Tenure in sup...
Why don’t people “survive?”<br />Multiple complex needs<br />Need for supportive relationships<br />Fragmented service sys...
 Program/Intervention Process:Critical Time Intervention<br />Time-limited (9-month) case management <br />Titrated, 3 sta...
 Program/Intervention Process:Critical Time Intervention<br />Practices Employed<br />       - motivational interviewing<b...
Stages of CTI<br />
Flexibility of CTI Model<br />Designed to meet the individual’s needs.  This increases cost-effectiveness and maximizes nu...
Family CTI (FCTI) Over-arching Philosophy of Approach<br />comprehensive assessment of the homeless family, but does not a...
Figure 5-2. Model Program: Critical Time Intervention with Homeless Families<br />Program<br />Family Critical Time Interv...
Research:Westchester Families First<br />Randomized trial<br />Family Critical Time Intervention (FCTI) with rapid re-hous...
Research:CTI for Homeless Families<br />Target Population<br />Single Female Headed Households<br />Children Under 18<br /...
Research:CTI for Homeless Families<br />SAMHSA funding for “parent” study<br />NIMH funding for children study<br />Interv...
Family CTI Features<br />Strengthens ties to services, family, friends<br />Provides emotional and practical support<br />...
Stages of Family CTI<br />0-3 Months: Transition to the Community<br />4-6 Months: Practicing Phase<br />7-9 Months: Trans...
Stage 1: Transition to the Community<br />Much of this work was done in shelter<br />This stage may be longer while securi...
Stage 2:Practicing Phase<br />Solidify linkages to community resources<br />This includes schools, TANF workers, food pant...
Stage 3: Transfer of Care<br />Fine tuning of linkages<br />Higher level skills training (employment, education, social sk...
What Makes FCTI Different?<br />Continuity of assistance<br />From shelter to housing<br />Focus on mother’s strengths/ass...
MODEL COMPONENT:Continuity of Assistance<br />From shelter to new home<br />FCTI work begins shelter entry<br />Intake/ass...
MODEL COMPONENT:Intensive Clinical Support<br />Does not replace case work supervisor<br />Can be part time<br />Supports ...
MODEL COMPONENT:Intensive Time Limited – 9 months<br />Many case work models are much longer<br />Until family is “ready”<...
MODEL COMPONENT:Titrated Model – 3 stages<br />Allows for uneven case load<br />12 cases: 4 stage 1, 4 stage 2, 4 stage 3<...
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5.13 Critical Time Intervention in Action: Serving Homeless Families (Felix)

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This session offers more advanced content on the Critical Time Intervention model and how it applies to families. Speakers will discuss the practical application of the model for families with varying barriers to housing and services. Participants will walk away from this session with an in-depth understanding of how the model can improve outcomes for families in their community.

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5.13 Critical Time Intervention in Action: Serving Homeless Families (Felix)

  1. 1. Family Critical Time Intervention for Successful Transitions to Stable Housing<br />July 12, 2010<br />NAEH<br />Judith Samuels, PhD<br />Alan Felix, MD<br />
  2. 2. Homeless Families: Current Environment<br />Economic <br />“Crisis”<br />Foreclosures <br />impact renter as well<br />Unemployment<br />Stress can increase domestic violence<br />Reinvestment funds (ARRA)<br />Homeless Prevention & Rapid Re-housing (HPRP)<br />
  3. 3. How Family CTI Fits<br />Time-limited<br />Evidence base<br />Increases continuity of care: from homeless to housed<br />Flexible to meet varying needs of heterogeneous population<br />Recovery oriented<br />
  4. 4. Why CTI ???<br />People in multiple systems, multiple situations, often transitioning<br />From homeless to housing<br />From hospital to home<br />From residential treatment program to home<br />From prison to community<br />From foster care to independence<br />What is the critical time?<br />
  5. 5. The CTI Clinical Trial (1990-94)<br />Prevention of Homelessness Among Individuals with Mental Illness<br />Elie Valencia, JD, MA<br />Ezra Susser, MD, DrPH<br />Alan Felix, MD<br />NY Presbyterian Hospital<br />Department of Psychiatry<br />5<br />
  6. 6. CTI originally used for homeless single adults, NYC<br />From long homelessness <br /> housing<br />
  7. 7.
  8. 8. Staying Housed N=2,937 <br />Lipton, F. R., Siegel, C., Hannigan, A., Samuels, J., & Baker, S. (2000). <br />Tenure in supportive housing for homeless persons with severe mental illness. <br />Psychiatric Services 51, 479-486.<br />
  9. 9. Why don’t people “survive?”<br />Multiple complex needs<br />Need for supportive relationships<br />Fragmented service systems<br />Lack of continuity of care<br />RESULTS<br />Recidivism to:<br /> Homelessness<br />Prison<br />Hospital<br />Substance Abuse<br />
  10. 10. Program/Intervention Process:Critical Time Intervention<br />Time-limited (9-month) case management <br />Titrated, 3 stages<br />Focused team approach with aim of reducing recurrent homelessness<br />Continuity of care<br />Starts before transition takes place<br />
  11. 11. Program/Intervention Process:Critical Time Intervention<br />Practices Employed<br /> - motivational interviewing<br /> - harm reduction<br />Clinical Interventions<br />Mental Health Treatment Compliance<br />Substance Abuse Services<br />Money Management<br />Prevention of Housing-Related Crises<br />Family Psychoeducation<br />Skills Training<br />
  12. 12. Stages of CTI<br />
  13. 13. Flexibility of CTI Model<br />Designed to meet the individual’s needs. This increases cost-effectiveness and maximizes number of individuals served.<br />Services may be direct and assertive AND/OR maximize linkage to community resources. <br />Services aim to increase autonomy, self-care, and recovery.<br />
  14. 14. Family CTI (FCTI) Over-arching Philosophy of Approach<br />comprehensive assessment of the homeless family, but does not assume the complex psychosocial problems of the family are the cause of homelessness<br />emphasizes that lack of affordable housing is the most important factor causing family homelessness<br />in some cases, problems arise out of homelessness and poverty, in other cases they merely co-exist<br />for some families, psychiatric disorders, substance abuse, and an array of psychosocial stressors may be contributing factors to the family’s homelessness<br />other economic factors contribute, such as the job market and accessibility of entitlements <br /> once a family becomes homeless, any combination of the areas of need may serve to hinder progress into stable community living <br />intervention should target those problems and needs of the family that are most closely linked to persistent homelessness. <br />
  15. 15. Figure 5-2. Model Program: Critical Time Intervention with Homeless Families<br />Program<br />Family Critical Time Intervention model (FCTI). The program is jointly funded by NIMH and the Center for Mental Health Services/Center for Substance Abuse Treatment Homeless Families Program.<br />Goal<br />To apply effective, time-limited, and intensive intervention strategies to provide mental health and substance abuse treatment, trauma recovery, housing, support, and family preservation services to homeless mothers with mental illnesses and substance use disorders who are caring for their dependent children.<br />Features<br />The Critical Time Intervention model (CTI) was developed in New York City as a program to increase housing stability for persons with severe mental illnesses and long-term histories of homelessness. Its principle components are rapid placement in transitional housing, fidelity to a Critical Time Intervention CTI model for families (i.e., provision of an intensive, 9-month case management intervention, with mental health and substance use treatments), a focused team approach to service delivery, with the aim of reducing homelessness, and brokering and monitoring the appropriate support arrangements to ensure continuity of care.<br />
  16. 16. Research:Westchester Families First<br />Randomized trial<br />Family Critical Time Intervention (FCTI) with rapid re-housing<br />Vs. services/system as usual<br />Baseline interview, 3, 9,15,24 month follow-up<br />Targets homeless families, singles moms w/mental illness and/or substance abuse<br />Challenges “housing readiness” criteria<br />RAPID RE-HOUSING<br />Housing is SCATTER SITE<br />
  17. 17. Research:CTI for Homeless Families<br />Target Population<br />Single Female Headed Households<br />Children Under 18<br />Literally Homeless<br />Mental Health and/or Substance Abuse Problem<br />High prevalence of:<br />Trauma history (abuse, separation)<br />Low education<br />Poor work history<br />Health problems<br />Unstable housing history<br />
  18. 18. Research:CTI for Homeless Families<br />SAMHSA funding for “parent” study<br />NIMH funding for children study<br />Intervention program funded by State of NY<br />Housing funded by HUD and Westchester County<br />Random assignment:<br />100 families CTI, <br />123 families in control group<br />No differences between groups at baseline<br />Outcomes: <br />CTI families have less time homeless<br />Children have better school and mental health outcomes<br />
  19. 19. Family CTI Features<br />Strengthens ties to services, family, friends<br />Provides emotional and practical support<br />Time-limited<br />Limited goals<br />Simple and adaptable<br />
  20. 20. Stages of Family CTI<br />0-3 Months: Transition to the Community<br />4-6 Months: Practicing Phase<br />7-9 Months: Transfer of Care<br />
  21. 21. Stage 1: Transition to the Community<br />Much of this work was done in shelter<br />This stage may be longer while securing housing<br />Intensive, assertive outreach-- Develop linkages to community resources, evaluate and build living skills <br />This stage is more complex for families as children’s needs are also addressed<br />Provide direct services when needed<br />Psychiatist/psychologist meets weekly with CTI workers and consumers<br />Visit at least weekly<br />More intensive while in shelter<br />
  22. 22. Stage 2:Practicing Phase<br />Solidify linkages to community resources<br />This includes schools, TANF workers, food pantries, religious/spiritual resources<br />Promote independent living skills<br />Includes family resources assessment and plans<br />Observe and test current plan<br />Develop long-term plan<br />Less frequent visits, more phone follow-up<br />
  23. 23. Stage 3: Transfer of Care<br />Fine tuning of linkages<br />Higher level skills training (employment, education, social skills)<br />Termination with the client<br />
  24. 24. What Makes FCTI Different?<br />Continuity of assistance<br />From shelter to housing<br />Focus on mother’s strengths/assets<br />Time limited<br />Although a safety net is recommended<br />Intensive clinical support<br />Harm reduction<br />Motivational Interviewing<br />Titrated model<br />CTI is an EBP<br />
  25. 25. MODEL COMPONENT:Continuity of Assistance<br />From shelter to new home<br />FCTI work begins shelter entry<br />Intake/assessment<br />Building relationship through Motivational Interviewing<br />Service plan based on mom’s goals<br />Connections to community providers<br />Support during move back to community<br />
  26. 26. MODEL COMPONENT:Intensive Clinical Support<br />Does not replace case work supervisor<br />Can be part time<br />Supports team<br />Provides indirect and direct care<br />Opportunity for staff to increase knowledge<br />Can help ensure model fidelity<br />
  27. 27. MODEL COMPONENT:Intensive Time Limited – 9 months<br />Many case work models are much longer<br />Until family is “ready”<br />Can foster dependence<br />Many families have more strengths than we think<br />“survival” rate is very high<br />Allows for more families to be service<br />
  28. 28. MODEL COMPONENT:Titrated Model – 3 stages<br />Allows for uneven case load<br />12 cases: 4 stage 1, 4 stage 2, 4 stage 3<br />Forces case worker to move family toward discharge<br />Forces family to move toward discharge<br />Reinforces strengths<br />Reinforces “housing first” goal<br />

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