Outcomes of critical time intervention case management of homeless veterans after psychiatric hospitalization.
OBJECTIVE
This study evaluated a modification of the critical time intervention (CTI) community case management model for homeless veterans with mental illness who were leaving Department of Veterans Affairs (VA) inpatient care. CTI offers time-limited intensive case management designed to negotiate transitions from institutional settings to community living.


METHODS
CTI was implemented at eight VA medical centers through a training program that used primarily teleconference-based case review. A comparison cohort (phase 1) of 278 participants was recruited before CTI was implemented, and a treatment cohort (phase 2) of 206 participants was recruited after implementation and offered CTI. Mixed-regression models were used to compare outcomes in phase 1 and phase 2 and controlled for baseline differences between participants in the two phases.


RESULTS
Measures of client service delivery show that CTI was successfully implemented at most sites. Phase 1 veterans had a better work history and more drug use at baseline than phase 2 clients had. Controlling for these differences, veterans in phase 2 on average had 19% more days housed in each 90-day reporting period over the one-year follow-up (p<.002) and 14% fewer days in institutional settings (p=.041). Veterans in phase 2 also had 19% lower Addiction Severity Index (ASI) alcohol use scores (p<.001), 14% lower ASI drug use scores (p=.003), and 8% lower ASI psychiatric problem scores (p=.001).


CONCLUSIONS
A sustained training program can be used to implement CTI in systems that have little past experience with this approach and can yield improved housing and mental health outcomes.
Kasprow
Wesley J
WJ
Northeast Program Evaluation Center 182, Department of Veterans Affairs, Connecticut Health Care System, 950 Campbell Ave., West Haven, CT 06516, USA. wesley.kasprow@yale.edu
Rosenheck
Robert A
RA
D000328:Adult; D019090:Case Management / Q000458:organization & administration*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006778:Hospitals, Psychiatric; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D012917:Social Adjustment; D014481:United States; D014728:Veterans / Q000523:psychology*