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Case Management / Critical Time Intervention

strength of evidence

Some reliable evidence

Cost effectiveness

Insufficient evidence available

Impact

Multiple studies show a positive impact

What is this intervention?

Critical time intervention is a model of case management common in the US that provides a person (or family) in transition between types of accommodation and at risk of homelessness with a period of intensive support from a caseworker. The caseworker will have established a relationship with the client before the transition – for example, before discharge from hospital or prison.

Critical time intervention involves three stages: (1) direct support to the client and assessing what resources exist to support them, (2) trying out and adjusting the systems of support as necessary, and (3) completing the transfer of care to existing community resources.


What is its goal?

By providing intensive support followed by a gradual and supported transition to community resources, critical time intervention is expected to reduce the likelihood that discharged people will end up back on the streets, as well as supporting their mental health and other needs.

What does the evidence tell us?

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Critical time intervention has a positive impact on housing stability in the US but may not do so elsewhere.

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It may improve the mental health status of people in accommodation transition who have a prior history of mental health issues.

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Where does the evidence come from?

There are nine studies reporting the effects of five interventions. Four of these interventions were evaluated using RCTs and one using a regression-based approach. Four of the interventions took place in the US (seven studies) and one in the Netherlands (two studies).

Which groups does it affect?

People with history of mental illness

The intervention beneficiaries are commonly people with a history of mental illness and include those being discharged from mental health institutions. In such cases critical time intervention has often been found to improve people’s mental health status.

Ex-services

The programme beneficiaries are commonly people with a history of mental illness and include military veterans. In such cases this intervention has often been found to improve people’s mental health status.

Which outcomes does it affect? 

Health and Wellbeing

Three studies (two from the US and one from the Netherlands) found positive effects on mental health. One study from the US found no effect on mental health. One study found a reduction in psychosocial problems in school children with an attendant reduction in problems at school. The evidence suggests that critical time intervention may have a positive effect on mental health among people with prior mental health issues.

Housing Stability

The three studies from the US that consider housing stability report a significant positive effect. No significant effect was found in the study in the Netherlands. The evidence suggests that the intervention may be effective in the US, but may not work elsewhere if existing services are more comprehensive.

Relationships

One study from the US found no effect and one other reported a positive effect. The study from the Netherlands found positive effects on family support, and on social support only for those with low prior support. No clear conclusion is possible from the current evidence.

considerations for IMPLEMENTATION

Invest in maintaining a skilled workforce

If you are implementing a case management service, ensure your team are:

  • Prioritising building open, positive relationships with their service users
  • Being patient and respectful towards service users
  • Taking a proactive and flexible approach to finding effective strategies.

Experiment with engagement retention approaches

Encourage staff to use a range of means to contact service users, including text, email and phone for those who find face-to-face meetings hard. This will help you and your team identify which strategies might work best.  

Set realistic caseloads

Enable staff to spend sufficient time on each service user to ensure each person gets the support they need. Unrealistic caseloads will impact on service quality.

Design procedures with the user in mind

Ensure that all procedures are designed with the user journey in mind. The service users’ perspective should guide the set up of all processes, systems, case recording etc.

Collaborate with other agencies

Working together with other agencies enables service users outcomes that would not be possible working independently. Multidisciplinary and partnership working is critical to identifying and engaging service users, sustaining tenancies, retaining contact and supporting service users after they have left the project. Consider carefully how data will be collected and shared.

Provide access to appropriate support

Ensure service users have access to support for non-housing issues, such as employment, parenting, and health (including addiction and mental ill health). Addressing these needs increases the chances that the intervention will succeed, through improving trust and engagement in the programme.

Ensure suitable, affordable housing is available

An important consideration is the availability of suitable, affordable housing. Many private landlords will initially be reluctant to rent to case management service users but some can be persuaded; compare different communication approaches and evaluate what works. If there are no suitable options for longer-term accommodation, your team will need to consider the most appropriate interim short-term housing plan for each service user.

Manage service user expectations

Ensure staff manage the expectations of service users around housing; the housing that is likely to be available and affordable to them will often be of poorer quality. One strategy can be to encourage them to think of their housing as a ‘stepping stone’ to improved life chances.

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