Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention

Abstract

Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse outcomes by providing support to individuals during challenging life course transitions. While several narrative reviews suggest the benefit of CTI, the evidence on the model’s effectiveness has not been systematically reviewed. This article systematically reviews studies of CTI applied to a variety of populations and transition types. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) guidelines, we reviewed 13 eligible experimental and quasi-experimental studies. Findings were summarized by individual outcome domains, including housing, service engagement use, hospitalization or emergency services, mental health, substance use, family and social support, and quality of life. CTI had a consistent positive impact on two primary outcomes—reduced homelessness and increased service engagement use—among different populations and contexts. Despite the effectiveness of CTI, the specific mechanisms of the model’s positive impacts remain unclear. Implications for practice, policy and research are addressed.

Prevalence of Mental Health Disorders Among Individuals Experiencing Homelessness

“…9 We used the generalized linear mixed effects model pooling method as recommended for meta-analysis of proportions. 10,11 The primary meta-analysis synthesized the current prevalence of mental health disorders among people experiencing homelessness, generating a pooled estimate of prevalence and an accompanying 95% CI. Secondary meta-analyses examined the lifetime prevalence of mental health disorders and sex-and diagnosis-specific mental health disorder categories.…”

Supporting Women Exit Sex Work: A Contribution Analysis of the Exit Doors Here Integrated Care Program in Toronto, Canada

“…The effectiveness of CTI has been evaluated in relation to mental health (i.e., moving from institutions to community living) [8] and housing (i.e., transitioning from shelters to independent housing) [9]. In a systematic review of CTI applied to marginalized populations dealing with mental health, homelessness or intimate partner violence, Manuel et al (2023) documented positive impacts on reduced homelessness and increased use of health care services. Results were more equivocal for mental health, substance use, quality of life and social support [10].…”

“…In a systematic review of CTI applied to marginalized populations dealing with mental health, homelessness or intimate partner violence, Manuel et al (2023) documented positive impacts on reduced homelessness and increased use of health care services. Results were more equivocal for mental health, substance use, quality of life and social support [10]. To our knowledge only one evaluation study has been conducted with regards CTI and exiting sex work, which documented improvements in mental health and reduced involvement in sex work at the end of the program [7].…”

A practical risk calculator for suicidal behavior among transitioning U.S. Army soldiers: results from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS)

“…In addition, the finding that the lasso model is as accurate as more complex ML models shows that it is possible to combine this information into a simple risk calculator. Based on these results, the 17 survey questions in our lasso model have been added to the SFL survey and a pilot is underway to evaluate the effects of providing an intensive case management intervention to high-risk TSMs focused on SA prevention (Manuel et al, 2022) based on this risk targeting scheme. Future intervention work will examine the accuracy of the model (among soldiers in the control group of the intervention evaluation) and investigate opportunities for model refinement.…”