FAMILY CRITICAL TIME INTERVENTION<br />Clinical Principles<br />Stages of Change<br />Motivational Interviewing<br />Harm ...
Stages of Change<br />1. Pre-contemplation Stage<br />2. Contemplation Stage<br />3. Determination Stage<br />4.  Action S...
3<br />MOTIVATIONAL INTERVIEWING<br />Mobilize Client’s Desire to Change<br />Non-confrontational <br />Minimize Defensive...
Stage of Change/Goal<br />Precontemplation/Raise doubt, awareness of risk<br />Contemplation/Evoke reasons to change, self...
CTI STAGE/STAGE OF CHANGE<br />Pre-CTI/Pre-Contemplation<br />Housing Application/Contemplation<br />Transition to Communi...
6<br />Harm Reduction<br />Prevent Disease/Injury<br />Prevent Incarceration<br />Prevent Hospitalization<br />Prevent Hom...
Psychodynamic Principles in CTI<br />History Repeats Itself<br />Holding Environment<br />Transference/Countertransference...
Team Supervision<br />Presentation of Client’s History<br />Dynamic Formulation-- What are the key issues/risk factors?  W...
9<br />Transference/Countertransference Paradigms<br />Damsel in Distress/Savior Complex<br />The Bottomless Pit/Sucked Dr...
Case Example- Ms. PPre-CTI<br />25 y.o. mother of 5 escaping an abusive boyfriend.<br />Parents used IV drugs, father was ...
Case Example- Ms. PCTI – Stage 1<br />Positive engagement with CTI worker.<br />Rapid re-housing.<br />Seen in CTI team me...
Case Example- Ms. PCTI– Stage 2<br />While CTI worker is on vacation, Ms. P becomes angry and refuses to meet with coverin...
13<br />Case Example- Ms. PCTI-- Continued<br />At termination, Ms. P breaks down crying, but avoids self-destructive beha...
Additions to the Model for Special Populations<br />Very young mothers:<br />Supervising clinician is Pediatrician/Child P...
CONTACT US:<br />Judith Samuels, PhD<br />samuels@nki.rfmh.org<br />Web Site:<br />www.criticaltime.org<br />
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5.13 Critical Time Intervention in Action: Serving Homeless Families (Samuels)

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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 (Samuels)

  1. 1. FAMILY CRITICAL TIME INTERVENTION<br />Clinical Principles<br />Stages of Change<br />Motivational Interviewing<br />Harm Reduction<br />Psychodynamic Approach<br />
  2. 2. Stages of Change<br />1. Pre-contemplation Stage<br />2. Contemplation Stage<br />3. Determination Stage<br />4. Action Stage<br />5. Maintenance Stage<br />
  3. 3. 3<br />MOTIVATIONAL INTERVIEWING<br />Mobilize Client’s Desire to Change<br />Non-confrontational <br />Minimize Defensiveness <br />Do No Harm<br />
  4. 4. Stage of Change/Goal<br />Precontemplation/Raise doubt, awareness of risk<br />Contemplation/Evoke reasons to change, self-efficacy<br />Determination/Find best course of action<br />Action/Aid client in taking steps toward change<br />Maintenance/Develop strategies to prevent relapse<br />Relapse/Renew process of recovery without losing hope<br />
  5. 5. CTI STAGE/STAGE OF CHANGE<br />Pre-CTI/Pre-Contemplation<br />Housing Application/Contemplation<br />Transition to Community/Determination<br />Practicing/Action<br />Transfer of Care/Action to Maintenance <br />5<br />
  6. 6. 6<br />Harm Reduction<br />Prevent Disease/Injury<br />Prevent Incarceration<br />Prevent Hospitalization<br />Prevent Homelessness<br />Prevent Unplanned Pregnancies <br />Housing First <br />
  7. 7. Psychodynamic Principles in CTI<br />History Repeats Itself<br />Holding Environment<br />Transference/Countertransference<br />“Good Enough” Case Management<br />Separation/Individuation<br />7<br />
  8. 8. Team Supervision<br />Presentation of Client’s History<br />Dynamic Formulation-- What are the key issues/risk factors? What can be predicted?<br />Management of Transference and Countertransference<br />Maintain Fidelity to CTI Model<br />Meet the Client/Family<br />Termination<br />8<br />
  9. 9. 9<br />Transference/Countertransference Paradigms<br />Damsel in Distress/Savior Complex<br />The Bottomless Pit/Sucked Dry<br />Help Rejecting Complainer/Helpless and Frustrated<br />The Neutron Bomb/Hatred & Criticism, or Fear & Rejection<br />The “Good Case”/Separation Anxiety<br />
  10. 10. Case Example- Ms. PPre-CTI<br />25 y.o. mother of 5 escaping an abusive boyfriend.<br />Parents used IV drugs, father was violent, mother died of AIDS when Ms. P was a teen.<br />Physically and sexually abused in foster care.<br />2 teen pregnancies with older boys who abandoned her.<br />Help from Group Home leads to GED, improved parenting skills, and maintenance of child custody.<br /> Series of relationships with abusive men and 3 more children between age 22-26.<br />10<br />
  11. 11. Case Example- Ms. PCTI – Stage 1<br />Positive engagement with CTI worker.<br />Rapid re-housing.<br />Seen in CTI team meeting, diagnosed with post-partum depression. Enters treatment with CTI worker’s encouragement.<br />Mother’s depression seen as key aspect of difficulty meeting goal of stable housing<br />Substance abuse: self medicating seen as secondary yet important concern<br />11<br />
  12. 12. Case Example- Ms. PCTI– Stage 2<br />While CTI worker is on vacation, Ms. P becomes angry and refuses to meet with covering worker.<br />Ms. P stops taking her medication and relapses into marijuana and alcohol use.<br />CTI worker returns, feeling disappointed, guilty, and frustrated with Ms. P. Voices her feelings at team meeting.<br />CTI worker is able to frame Ms. P’s self-destructive reaction to her vacation as a repetition of her chaotic and rejecting past. Ms. P confirms the interpretation by responding, “I never thought you’d come back.”<br />Ms. P’s strengths that led her to housing, a GED, and better parenting are re-affirmed by CTI worker and they re-focus on moving towards a productive termination, guided by greater independence and self-esteem for Ms. P.<br />12<br />
  13. 13. 13<br />Case Example- Ms. PCTI-- Continued<br />At termination, Ms. P breaks down crying, but avoids self-destructive behavior. <br />She has joined a dual diagnosis therapy group and turns to it for support. <br />She thanks her CTI worker for helping her and proudly looks forward to her greater independence and autonomy<br />
  14. 14. Additions to the Model for Special Populations<br />Very young mothers:<br />Supervising clinician is Pediatrician/Child Psychiatrist<br />Baby care, Infant/child development<br />Reduction in risky behaviors<br />Positive parenting<br />Youth transitioning from foster care:<br />Supervising clinician is Child and Adolescent Psychiatrist<br />Complex trauma recovery<br />Education/ Job coaching<br />Developing life skills<br />
  15. 15. CONTACT US:<br />Judith Samuels, PhD<br />samuels@nki.rfmh.org<br />Web Site:<br />www.criticaltime.org<br />

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