Critical Time Intervention in the Transition From Hospital to Community in People With Severe Mental Illness
Condition: Psychotic Disorders
MeSH terms: Psychotic Disorders
Study type: Interventional

Summary: 
      This study will evaluate the effectiveness of a psychosocial treatment, Critical Time
      Intervention, in easing the transition from hospital to community in people with severe
      mental disorders.
    

Detailed description: 
      Severe mental illness (SMI) encompasses a wide range of mental disorders and disabilities,
      but commonly includes disorders that involve symptoms of psychosis. Psychotic symptoms may
      involve hallucinations, a lost sense of reality, or other distressing symptoms. About 6% of
      people experiencing psychotic symptoms seek inpatient treatment at a psychiatric hospital.
      Hospital treatment for a person with SMI often focuses on rapid improvement of negative
      symptoms and promotion of the necessary skills to successfully return to the community after
      leaving the hospital. Despite preparation for community integration, the transition from
      hospital to community remains a difficult time for many people with SMIs, with those affected
      having an increased chance for suicide, homelessness, and relapse. Critical Time Intervention
      (CTI), a psychosocial treatment program that aims to restore skills for community living and
      to assist in seeking service and support in the community, may be more effective than usual
      care in preventing these adverse outcomes after hospital discharge. This study will compare
      the effectiveness of CTI versus usual services in preventing homelessness and other adverse
      outcomes after leaving a psychiatric hospital among people with SMI and psychosis.

      Participation in this study will last 18 months. Potential participants will undergo an
      initial 15- to 30-minute interview that will include questions about current mental,
      physical, and living conditions; history of psychiatric services; and alcohol and drug use.
      Eligible participants will then undergo the first full interview, which will include a full
      review of medical records and will last between 2 and 3 hours. After this interview,
      participants will be assigned randomly to receive CTI or usual services. For participants
      assigned to CTI, a CTI specialist will visit participants in the hospital and in their homes
      and will stay in contact with participants for 9 months after hospital discharge. During
      visits with the CTI specialist, participants will receive training in community living skills
      and help finding service and support in the community. Participants assigned to usual
      services will receive the usual care and community services offered to people recently
      leaving a psychiatric hospital.

      After leaving the hospital, participants in both groups will be asked to participate in 15
      follow-up interviews, which will include repeat questions from the 2 initial interviews.
      Interviews will be conducted once every 6 weeks until 18 months after hospital discharge and
      will last between 60 and 90 minutes.
    

Intervention name(s): Critical Time Intervention (CTI); Usual care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): CTI is designed specifically to enhance the continuity and focus of care during the transition from psychiatric hospital to community care. CTI does not replace community treatment and support, but instead is meant to complement available services. CTI will provide training in community living skills and in team-managed transfer of caregiving from hospitals to services and supports in the community. Participants will receive CTI for 9 months after hospital discharge.; Usual care will include the standard aftercare and community care services.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Psychosis; Homelessness; Case Management; Severe Mental Illness