1. Regional Conference to End Homelessness Norfolk, VA March 2012 Prepared by: Housing Innovations

2.  What is CTI? ◦ Overview  Why CTI? ◦ The Evidence  How to CTI? ◦ Fidelity - the Principles ◦ Implementation Tips www.criticaltime.org 2

3.  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 3

4.  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 4

5.  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 ◦ Housing Selection and Planning 5

6.  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” 6

7.  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 7

8.  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

9.  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 9

10.  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 10

11.  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 11

12.  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 12

13.  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 13

14.  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 14

15.  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 15

16.  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 16

17.  Maintaining housing  Increase Income  Network of supports  Less emergency interventions: ER visits, hospitalization, incarceration, removal of children  Structure and Purpose in each persons life 17

18. Contact info: Suzanne Wagner swagner@housinginnovations.us (917) 612-5469 18