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.