Critical Time Intervention: Mobilizing Supports for People During Perilous Transitions

Critical time intervention (CTI) is a time-limited, evidence-based model of care coordination for people that is delivered during a critical period of transition in their lives, such as the transition from shelters, hospitals, jails, and prisons into the community. This, in turn, places them at risk of ongoing instability and return to homelessness, re-institutionalization and other adverse outcomes. CTI provides direct emotional and practical assistance and strengthens individuals' ties to their community and support systems during the critical time. On the strength of numerous tests of its impact (including several randomized trials) the model has been widely implemented in the US, Europe, and Latin America as many communities struggle to devise effective responses to homelessness and dislocation among their most vulnerable citizens.

The book recounts CTI's initial development by a creative team of mental health and social service providers working in large homeless shelters in New York City during the early years of the city's contemporary homelessness crisis, describes the main components of the model, emphasizing how it differs from standard forms of case management, summarizes research evidence supporting the effectiveness of CTI, describes how the model has been adapted for use with different high-need populations in a variety of settings in the US an elsewhere, and considers strategies and challenges related to broader implementation of CTI including workforce training, funding, fidelity assurance, and program drift. It concludes with a consideration of the implications of CTI for the design of new "time-sensitive" intervention models in social work and allied fields.

Daniel Herman is Professor Emeritus and former Associate Dean for Research at the Hunter College Silberman School of Social Work and the Graduate Center of the City University of New York. He previously served on the faculty of Columbia University's Mailman School of Public Health and its Department of Psychiatry. Dr. Herman is the founding director of the Center for the Advancement of Critical Time Intervention which promotes international dissemination of the CTI model. He began his academic career following a dozen years working as a social worker in New York City's public mental health and homeless services systems.

Ezra S. Susser is Professor of Epidemiology and Psychiatry at the Mailman School of Public Health at Columbia University, and at New York State Psychiatric Institute. At Columbia University, his roles have included Chair of Epidemiology, Director of the Psychiatric Epidemiology Training Program, and co-founder of the Columbia University Global Mental Health Program. His work includes the initial development and testing of Critical Time Intervention (CTI) to prevent recurrent homelessness, and its adaptation to settings in Latin America, alongside Sarah A. Conover. Under the leadership of Daniel Herman, as well as Sarah A. Conover, he has contributed to the ongoing evolution of CTI in the Center for Advancement of CTI.

Sarah A. Conover directs the Global Network of the Center for the Advancement of Critical Time Intervention at Hunter College, which promotes fidelity to the model through collaboration on international adaptations. She co-developed the CTI model while at the New York State Psychiatric Institute, where her focus was on developing and evaluating services for people with schizophrenia who are homeless.