Download - Regional Conference to End Homelessness Norfolk, VA March 2012 Prepared by: Housing Innovations
Regional Conference to End HomelessnessNorfolk, VAMarch 2012
Prepared by: Housing Innovations
What is CTI? ◦Overview
Why CTI? ◦The Evidence
How to CTI?◦Fidelity - the Principles◦Implementation Tips
www.criticaltime.org
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Focused on Housing Retention and Life Goals Time-limited (6-9 months) 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
Focused on Housing Retention and Life Goals Time-limited (6-9 months) 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
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 Planning1. Housing stability barriers2. Income and financial literacy3. Life skills training 4. Family and friends5. Psychiatric and substance abuse services6. Health and medical services
Pre-CTI ◦ Housing Selection and Planning
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Focus on Self Sufficiency Goal setting Connection to high quality sustainable treatment and
supports and Empowerment
Focus on Long-Term Stability Use lease to structure the work Not symptom or crisis based services Goal includes sustainability as opposed to acute
interventions Strong Expectation that Person becomes Integral
Part of Community 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
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
Work with landlords and property managers◦ 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
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)◦ 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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