Implementing and Sustaining Critical Time Intervention (CTI) in Case Management Programs for Homeless-experienced Veterans (PII 21-285)
Trial Snapshot
- Phase
- Phase 1
- Status
- Recruiting
- Enrollment
- 153
- Locations
- 2
- Primary Endpoint
- Sustainment of CTI
Study Overview
Brief Summary
The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.
Detailed Description
The VA Grant and Per Diem case management (GPD-CM) program provides six months of case management for homeless-experienced Veterans (HEVs) undergoing housing transitions. At present, no specific case management paradigm is required in the GPD-CM program, resulting in practice variation across sites. This Partnered Implementation Initiative (PII) implements Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-at 32 VA GPD-CM sites. The investigators will use the Replicating Effective Programs (REP) implementation bundle to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external facilitation (enhanced REP) as additional support for CTI implementation. In a type 3 hybrid trial, the investigators will use mixed methods to examine the impacts of REP versus enhanced REP. Using trial data, the investigators will develop a business case analysis and implementation playbook for the investigators' program partners to support continued CTI spread and sustainment in the GPD-CM program.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Grant and Per Diem (GPD) case management aftercare grantees in 7 Veterans Integrated Service Networks (VISN), all of whom provide 6-months of case management to Veterans who have experienced homelessness.
Exclusion Criteria
- Not provided
Arms & Interventions
Replicating Effective Programs (REP)
A stakeholder-informed training and technical assistance implementation strategy
Intervention: Critical Time Intervention (Behavioral)
REP + External Facilitation (Enhanced REP)
REP plus site specific weekly facilitation to support CTI implementation.
Intervention: External Facilitation (Other)
REP + External Facilitation (Enhanced REP)
REP plus site specific weekly facilitation to support CTI implementation.
Intervention: Replicating Effective Programs (Other)
Control Group
No CTI implementation
Replicating Effective Programs (REP)
A stakeholder-informed training and technical assistance implementation strategy
Intervention: Replicating Effective Programs (Other)
REP + External Facilitation (Enhanced REP)
REP plus site specific weekly facilitation to support CTI implementation.
Intervention: Critical Time Intervention (Behavioral)
Outcomes
Primary Outcomes
Sustainment of CTI
Time Frame: 18 months after implementation start
% of Sites with adequate fidelity to CTI at 18 months, as measured by the CTI fidelity scale
Dollars spent delivering CTI at each site
Time Frame: Between 6 and 18 months after implementation start
Case manager salary and benefits
Fidelity to CTI
Time Frame: 12 months after implementation start
% of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale
Secondary Outcomes
- Cost of CTI as Implemented(Between 6 and 18 months after implementation start)
- Return on Investment (ROI) of CTI(6-, 12-, and 18-months after GPD case management program enrollment)
- Outpatient service use(Between 6 and 18 months after implementation start)
- Cost of Implementation Strategies(Through study completion, 4 years)
- Housing stability(Between 6 and 18 months after implementation start)
- Hospitalization rates(Between 6 and 18 months after implementation start)