Regional Conference to End Homelessness
Norfolk, VA
March 2012
Prepared by: Housing Innovations
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What is CTI?
◦ Overview
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Why CTI?
◦ The Evidence
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How to CTI?
◦ Fidelity - the Principles
◦ Implementation Tips
www.criticaltime.org
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Focused on Housing Retention and Life Goals
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Time-limited (6-9 months)
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Three 3-month phases of decreasing intensity
that begin when the person is housed
1. Transition to the community
2. Try out
3. Termination or transition to lower level of
service
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Focused Services
◦ 1-3 areas from 6 service areas
◦ Based on threat to long-term housing stability
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Rent payment
Following rules re visitors, noise etc
Keeping unit healthy and safe
Only allowing those on lease to live there
Other lease requirements
AND
◦ Access to care and supports
 Lots of focus on linkages and making them work
 Think about natural supports
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Areas of Focus for Assessment and Planning
1. Housing stability barriers
2. Income and financial literacy
3. Life skills training
4. Family and friends
5. Psychiatric and substance abuse services
6. Health and medical services
Pre-CTI
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Housing Selection and Planning
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Focus on Self Sufficiency
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Focus on Long-Term Stability
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Strong Expectation that Person becomes Integral
Part of Community
 Goal setting
 Connection to high quality sustainable treatment and
supports and
 Empowerment
 Use lease to structure the work
 Not symptom or crisis based services
 Goal includes sustainability as opposed to acute
interventions
 Considers purpose and activity as part of life in housing
 Role and life transition from “homeless” to “housed”
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CTI has been recognized an Evidence-Based
Practice by the federal Substance Abuse and
Mental Heath Services Administration (SAMHSA)
and the President’s New Freedom Commission on
Mental Health
Based on the original research of Columbia
University’s Center for Homelessness Prevention
Studies work with the homeless single adults
with serious mental illness
Has been applied and researched in a variety of
setting and with different populations
www.criticaltime.org
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Components
Phases – worker steps back every 3 months
Focused service plans – only 1-3 goals
Engage, Outreach and Link Early – Pre CTI
Contact with Links – accompany to appts, ensure
link sticks, meet with links, maintain
communications
◦ Time Limited – 7-9 months but may vary with
population
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Structure and Context
◦ Caseload size – between 16 – 18 clients
per worker, varies by stage
◦ Team Meetings – weekly
◦ Case Review – weekly by supervisory staff
◦ Organizational Support – hiring and safety
protocols and resources to assist clients
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Quality and Competencies
◦ Staff Role with Client –
 provides direct service as needed, works on ADL skills,
probes about threats to housing, fosters autonomy while
remaining available, use Motivational Interviewing
◦ Staff Role in Community –
 Meets with clients and linkages, educates linkages about
CTI, maintains communication
◦ Initial Assessment –
 focus on strengths and barriers in terms of community living
skills and support network
◦ Phased Service Planning –
 based on client history, revised with community linkages
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Quality and Competencies (cont)
◦ Progress notes –
 content related to previous notes, specifies next steps
◦ Case Closing –
 final transfer of care meeting, identifies issues related
to long-term housing stability
◦ Clinical Supervision –
 presentations of new, ending and particularly difficult
cases
◦ Fieldwork coordination –
 ensures safety in the field, supervisor to model for new
staff, monitors movement through phases by dates
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Can apply in a range of settings
◦ Moving in to safe havens, transitional housing
◦ Moving into to permanent supportive housing
◦ Moving into affordable housing
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Work with landlords and property managers
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Need Assertive approach
Hold person to lease obligations
Coordinate interventions
May accept services if threatens housing
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Use Resources
www.criticaltime.org
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Challenges
◦ Staff letting go
◦ Getting others agencies to do their jobs
◦ Providing quality close supervision and clinical
consultation
◦ Caseload levels
◦ Billing/funder requirements
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Provide services in the home and the
community
Ongoing assessments of housing barriers to
prevent housing loss
Connect with other mainstream and
community-based services – benefits and
services
Connect with natural supports including
spiritual
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Focus on eviction prevention and use the
structure of the lease to guide your
interventions
Use Evidence-Based Practices (EBP’s)
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Motivational Interviewing
Person-centered Planning
Supported Employment
IDDT – Integrated Duel Disorder Treatment
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Basic Demographics (age, how long homeless, how long in housing)
Health, MH, SA issues and connection to treatment
Engagement in Case Management: how the tenant is connecting to the worker, shared
tasks
CTI Phase and Focus Areas in the Housing Plan
What does the person do during a normal day?
Tenant strengths and successes
Tenant’s goals
Progress on adjusting to new housing
Any current challenges and reason case was selected for conference
◦ Any tenancy/lease violations?
◦ Efforts made to address these challenges and/or expand on the strengths
◦ How does tenant see these challenges, what is their response, is this consistent with
their priorities?
Resources being used and/or needed (include communication with the resource)
Involvement of friends/social supports
Is the person ready to move to the next phase?
Feedback, questions and discussion with the group
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Maintaining housing
Increase Income
Network of supports
Less emergency interventions: ER visits,
hospitalization, incarceration, removal of children
Structure and Purpose in each persons life
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Contact info:
Suzanne Wagner
swagner@housinginnovations.us
(917) 612-5469
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