critical time intervention - erie county · 2012-09-13 · transitions (homeless to housed,...
TRANSCRIPT
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© 2011, Center for Urban Community Services, Inc.
September 12, 2012
Critical Time Intervention
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Ready?
LEARNING OBJECTIVES
Understand the three distinct phases of CTI
Understand the core components of CTI
Understand how CTI is different from traditional Case Management Programs and how CTI is working in Erie County
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WHY IS ERIE COUNTY FOCUSING ON TRANSITIONS?
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SOME OF THE PROBLEMS
transitions (homeless to housed, hospitals to community, prison to community or from fragmented care to integrated care) can be difficult
persons can easily fall between the cracks without support (especially from one system to another)
many individuals don’t know how to access community services
it is costly for persons to be using emergency services when they can be set up to effective community services to get their needs met
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CTI BRIDGES THE GAP
Shelter
Prison
Hosp.
Trans.
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CRITICAL TIME INTERVENTION
Critical Time Intervention (CTI) is specialized intervention provided at a “critical time” [from institutional to community care]
CTI connects people with formal and informal community supports in this critical period
CTI is a time-limited intervention (6 months for the Erie County Model), divided into 3 specific phases that focuses on a limited number of focus areas that promote community stability
CTI is a well-researched and cost effective Evidence Based Practice (EBP) proven to assist people with mental illness with transitions
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•
Intense Period of Engagement
Assessment
Choose Focus Areas
Begin Linkages
Less Frequent Meetings
Adjusting & Monitoring the
Linkages
Finalizing Linkages
Adjusting & Monitoring the
Linkages
Termination
Phase I
Transition to
Community
Phase II
Try Out
Phase III
Transfer
Of Care
DIAGRAM OF CTI
6 MONTH PERIOD OF TIME
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OVERARCHING TASKS OF EACH PHASE
PHASE I: TRANSITION TO THE COMMUNITY
engagement/assessment of client and developing linkages
PHASE II: TRY OUT
developing linkages, negotiating, mediating
PHASE III: TRANSFER OF CARE
solidifying and terminating
CTI Care Coordinators continue to engage, assess, negotiate and link to services throughout phases ending in termination w/client
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How Do You Access CTI?
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CTI Starts with the Single Point of Access
CTI access starts with a referral to the Adult Single Point of ACCESS (SPOA). The SPOA evaluates referrals to CTI based on the following questions:
Is the person high risk?
Is the person undergoing a transition?
Are there supports that need to be in functioning in order to help address the person’s risks?
The SPOA referral website is https://familyfirst.secure.force.com/spoa/apex/spoa2_home
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CTI Overview
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CRITICAL TIME INTERVENTION (CTI)
CTI is an intervention that assists persons in their transition from homeless shelters, psychiatric hospitals or the criminal justice system into the community or from fragmented care to integrated care
transitional care coordination is provided to clients starting when the person is assigned to the CTI Care Coordinator’s caseload
is a time-limited intervention lasting 6 months, divided into 3 specific phases that focuses on a limited number of focus areas to promote a successful transition
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CTI APPROACH
Critical Time Intervention is focused on:
strengthening community linkages
limiting areas of focus to 2-3 areas essential to making the transition successful
gradually transferring care from CTI Care Coordinator to community
Presents an alternative to the traditional case management approach of building skills, by instead linking the person to community supports that can do so.
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GOAL OF CTI
The principle goal of CTI is to ensure successful transitions and prevent re-institutionalization, recurrent homelessness and other adverse outcomes during the period following placement into the community from shelters, hospitals, correctional facilities and other institutions.
CTI does this in two main ways:
by strengthening the individual's long-term ties to community services, family, and friends
by providing emotional and practical support during the critical time of transition
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CTI CORE PRINCIPLES
Time-limited around a transition period
identify and strengthen community support so that these supports can continue once the CTI intervention ends
work with existing services – don’t duplicate
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WHAT IS THE “CRITICAL TIME”?
“Critical Time” is when an adult transitions to community living. At this time, clients can fall through the cracks, but also this time creates a “window of opportunity”:
typically categorized by energy & renewed sense of hope
person is more amenable to trying new things
barriers to community stability can be identified and removed
opportunity to start establishing life-long connections to the community
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CTI CHARACTERISTICS
is time limited [6 months]
occurs in 3 phases w/decreasing services intensity over time
focused on a few areas of focus at one time
maintains small caseloads
team based [weekly team supervision w/case reviews]
utilizes community linkages
Uses a harm-reduction and motivational interviewing approach to behavior change
no drop-out policy
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SEVEN FOCUS AREAS
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NON-CTI FOCUSED ROLE OF THE CASE MANAGER
Client & Case Manager
Mental Health Services
Integration to the
Community
Entitlements
Health & Medical Services
Employment
Housing
Family
Spiritual Needs
Substance Abuse
Leisure Issues
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7 FOCUS AREAS
CTI Care Coordinator & client choose only a couple to work on to help ensure a successful transition: Housing and Housing Crisis Management
Psychiatric Treatment & Medication Management
Financial
Medical Treatment
Substance Abuse Treatment
Social Support
Legal
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CTI FOCUSED ROLE OF THE Care Coordinator
client & CTI Case Manager
Psychiatric
Health Substance Abuse
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AREAS OF TREATMENT OUTSIDE THE FOCUS?
The CTI worker Coordinator handles any crises until he/she able to transfer them to the appropriate person or
agency in the community
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3 PHASES of CRITICAL TIME INTERVENTION
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PHASE I: TRANSITION TO THE COMMUNITY
Time Frame: Months 1-2
begins day of discharge from institution and/or first day of transition to community
This is most intense period of CTI where bulk of the work is:
engaging client
addressing crises
assessing for potential long-term support systems
goal setting
beginning linking with formal and informal supports
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PHASE I: TRANSITION TO THE COMMUNITY cont.
CTI Care Coordinator Role:
engage client
develop CTI Plan based on no more than three of the 7 focus areas
meet with community caregivers
assess potential long-term support systems
provide direct service as needed
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PHASE II: TRY-OUT
Time Frame: Months 3-4
meet less frequent with client while testing how linkages made in Phase I are working
CTI Care Coordinator Role:
adjust systems of support for the client
monitor effectiveness of supports & intervening as needed
Try-Out phase is about adjusting systems of support for client & locating gaps in services that need further adjustment
Often involves negotiation and mediation
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PHASE III: TRANSFER OF CARE
Time Frame: Months 5-6 The final phase focuses on completing transfer of care to community resources providing long-term support to person. Work leading up to transfer has been done throughout the previous phases
CTI Care Coordinator Role:
monitor & fine tuning systems that have been established
finalizing long-term supports
transfer care (includes final transfer of care meetings w/client and all primary supports)
terminate from client (includes a final meeting)
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CTI Research
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Design
• randomized trial
• 9-month intervention/ 18-month follow-up
• n=100
Results • 3-fold reduction in risk of homelessness • Effect persisted beyond 9 months
Fort Washington Armory Susser, Valencia, et. al. 1997
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Design • “effectiveness” trial
• non-randomized pre-post design • men & women with SMI following hospital care • multiple sites nationally • n=484
Results
• 19% more days housed over one year • lower drug, alcohol & psychiatric problems
US Veterans Homelessness Program Kasprow et. al., 2009
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Design
• randomized trial
• homelessness primary outcome
• 9-month intervention / 18-month follow-up
• 150 men & women with SMI following discharge
CTI in the Transition from Hospital to Community
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Percent of subjects who were hospitalized over follow-up period
0
5
10
15
20
25
30
35
Control
Experimental
OR = 0.11 (.03, .35)
9 months 18 months
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EVIDENCE BASED PRACTICE
is tested with SCIENTIFIC METHODS
is shown to be SAFE
is proven EFFECTIVE
is employed in a REPLICABLE STANDARDIZED MANNER
outcomes are MEASURABLE AND UNDERSTANDABLE
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CTI IS AN EVIDENCE BASED PRACTICE
CTI has been recognized an Evidence-Based Practice by both the federal Substance Abuse and Mental Heath Services Administration (SAMHSA) and the President’s New Freedom Commission on Mental Health [2008]
http://nrepp.samhsa.gov/index.htm
http://www.criticaltime.org/
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Thank you Center for Urban Community Services
Erie County Department of Mental Health