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Co-Occurring Disorders and Homelessness

Using Critical Time Intervention With People With Co-Occurring Disorders Who Are Homeless

Critical time intervention is an evidence-based practice designed to reduce the risk of homelessness and other adverse outcomes. People with co-occurring mental and substance use disorders can benefit from this practice — specifically when transitioning from institutions such as hospitals, psychiatric or substance abuse facilities, jails, or shelters.

People with co-occurring disorders leaving institutions may be at risk for homelessness.

After being discharged from an institutional setting, people with co-occurring disorders may be at risk for homelessness. Intensified support for people transitioning out of institutions has been found to decrease the number of days the person experiences homelessness.

Transitional periods are often challenging for people with co-occurring disorders. Typically, when a person moves from an institution to the community, the individual abruptly loses key relationships with practitioners he or she relied on during the institutional stay. The transition from an institution to community living can create gaps in services and supports.

The transition period can also be a difficult for the individual's relationship with family and friends. Individuals may need to mend relationships that may have been strained as a result of experiences occurring when they were ill and re-establish positive supports. Families and friends may need information to fully understand the individual's co-occurring disorder.

Critical time intervention works in two ways:

1. It strengthens a person's long-term ties to services, family, and friends.

2. It provides emotional and practical support during transition periods—the "critical time".

Critical time intervention prioritizes continuity of care, which means the same practitioners work with the same individuals during and after their stay in an institution. The practitioners' primary role is to strengthen the individual's ties to services, family, and friends, which helps create a support network that will endure long after the critical time intervention is over. When successful, this network of support is maintained and support is gradually passed from the critical time intervention team to existing community supports and services.

Critical time intervention needs an effective, creative workforce.

Critical time intervention relies on effective outreach and engagement and is flexible enough to meet the needs of different people. Practitioners are typically bachelor's- or master's-level prepared, operating under the supervision of an experienced, clinically trained professional. Practitioners need to be flexible, creative, and comfortable working in the community.

In New York City, Project Connect is using critical time intervention in a pilot program serving men who are homeless after hospital release. An innovative feature of this program is the use of peer specialists to build the primary relationship with the person, a key to critical time intervention. Peer specialists are able to quickly engage individuals, and they have unique resources to share from their own experiences about what has worked for them. Peer specialists help individuals with co-occurring disorders see how they can change their lives and work toward those goals in a powerful way. The peer specialist personifies recovery, giving people hope and motivation to live a different life.

Critical time intervention differs from traditional case management.

Critical time intervention is essentially case management, but it differs from traditional case management in three ways. Critical time intervention is:

  • Implemented in three distinct phases
  • Time-limited
  • Focused

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Resources and Links

  • On March, 22, 2011, Daniel Herman, DSW, Associate Professor of Clinical Epidemiology at Columbia University's Mailman School of Public Health, gave a guest lecture entitled "Critical Time Intervention: An Empirically Supported Model for Preventing Homelessness in High Risk Groups." Dr. Herman leads research and dissemination activities pertaining to critical time intervention, a time-limited psychosocial intervention intended to prevent homelessness and other adverse outcomes among adults with severe mental disorders.

  • This web-based training offers basic knowledge and explores the phases of critical time intervention, the role of the team, and the research that supports this evidence-based practice. The course, which users complete at their own pace, features illustrated slides, background readings, audio and video clips, activities, and quiz questions. Continuing education credits are available.

  • This site is a portal to current research, publications, and in-person and online training in the critical time intervention model.