The effectiveness of critical time intervention for abused women leaving women’s shelters: a randomized controlled trial

Abstract

ObjectivesTo examine the effectiveness of critical time intervention (CTI)—an evidence-based intervention—for abused women transitioning from women’s shelters to community living.MethodsA randomized controlled trial was conducted in nine women’s shelters across the Netherlands. 136 women were assigned to CTI (n = 70) or care-as-usual (n = 66). Data were analyzed using intention-to-treat three-level mixed-effects models.ResultsWomen in the CTI group had significant fewer symptoms of post-traumatic stress (secondary outcome) (adjusted mean difference − 7.27, 95% CI − 14.31 to − 0.22) and a significant fourfold reduction in unmet care needs (intermediate outcome) (95% CI 0.06–0.94) compared to women in the care-as-usual group. No differences were found for quality of life (primary outcome), re-abuse, symptoms of depression, psychological distress, self-esteem (secondary outcomes), family support, and social support (intermediate outcomes).ConclusionsThis study shows that CTI is effective in a population of abused women in terms of a reduction of post-traumatic stress symptoms and unmet care needs. Because follow-up ended after the prescribed intervention period, further research is needed to determine the full long-term effects of CTI in this population.Electronic supplementary materialThe online version of this article (10.1007/s00038-017-1067-1) contains supplementary material, which is available to authorized users.

The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review

“…CTI showed little effect on mental health outcomes. However, a trial conducted among abused women reported significantly fewer symptoms of PTSD during follow-up (Adjusted MD -7.27, 95% CI -14.31 to -0.22, p = 0.04), but no effect on symptoms of depression or psychological distress [84]. In another RCT [85], families who received CTI showed mixed results on the frequency of children's internalizing and externalizing problems.…”

“…Two RCTs examined quality of life outcomes and found no significant impact of CTI over usual services at 9 months [81,84]. As well, when looking at substance-use outcomes, CTI was associated with non-significant reductions in cannabis and alcohol use [81].…”

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

“…90 However, findings for children's mental health were mixed: children aged 1.5-5 years showed improvements in internalizing (β coefficient -3.65, 95% CI -5.61 to -1.68) and externalizing behaviours (β coefficient -3.12, 95% CI -5.37 to -0.86), whereas changes for children aged 6-10 years and 11-16 years were not significant. 93 There were no significant effects of critical time intervention on substance-use, 90 quality-of-life 90,92 or income-related outcomes. 96 Two trials reported mixed findings on hospital admission outcomes; in 1 study, allocation to critical time intervention was associated with reduced odds of hospital admission (OR 0.11, 95% CI 0.01 to 0.96) and total number of nights in hospital (p < 0.05) in the final 18 weeks of the trial.…”

“…A scoping review of the literature on interventions for homeless women (Christine Mathew, Bruyère Research Institute, Ottawa, Ont. : unpublished data, 2020) yielded 4 systematic reviews [153][154][155][156] and 9 randomized controlled trials (RCTs) 36,60,92,95,[157][158][159][160][161] that focused specifically on homeless and vulnerably housed women. Findings showed that PSH was effective in reducing the risk of intimate partner violence and improving psychological symptoms.…”

“…158 As well, Housing First programs for families, critical time interventions during times of crisis, and therapeutic communities are associated with lower levels of psychological distress, increased self-esteem and improved quality of life for women and their families. 92,155 A gender-based analysis highlighted the importance of safety, service accessibility and empowerment among homeless women. We suggest that providers focus on patient safety, empowerment among women who have faced genderbased violence, and improve access to resources, including income, child care and other social support services.…”