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Critical Time Intervention: how our journey began

Alex Smith is FLNG’s former Operational Lead who played a major role in setting up our Critical Time Intervention pilot. Before she moved on to pastures new with Homeless Link in August 2019 we asked her to share her experiences of how our CTI journey began and its early impact on the people we support which she has done in this series of blogs – thank you Alex! We’ll follow up these blogs with a piece from our Programme Manager Lindsay Henderson reflecting on our current experiences and next steps.

Critical Time Intervention – how our journey began
Alex Smith

Since the beginning of the Fulfilling Lives programme, we have known that transitions are tough for people experiencing multiple and complex needs.  Endlessly moving through health and social care, criminal justice and housing systems mean support is inconsistent, disjointed and contributes toward the re-traumatisation of people with extensive past trauma.

Critical Time Intervention (CTI) helps vulnerable people during times of transition in their lives by strengthening their network of support in the community and we were keen to learn from this approach and understand more about how we could use it.

I was given the opportunity to experience CTI first hand in 2017 when I participated in the Homeless Link Transatlantic Exchange then started working alongside colleagues in FLNG and at CACTI (Centre for the Advancement of Critical Time Intervention) to develop an initial implementation plan to pilot CTI.

Implementing CTI at FLNG

We began by developing some bespoke training for our frontline system change practitioners.  It’s true that the team were sceptical and that it felt like a risk to change our approach with people who had come to understand our previous way of working; a navigation model, with no-time limit and the flexibility to meet all and every need.  CTI is more like navigation than not with its focus on small caseloads, a harm reduction and person-centred approach, but there are some key differences.

The training included a groan-inducing role play, but an incredibly important exercise of trying out a conversation on introducing CTI.  How do you describe CTI to someone who never really understood the navigation model?  The main interest from the people we support is that we are caring, reliable and offer help when it’s needed; the name of the model means very little.  With this in mind, we wanted to try our best to get our communication right.  We do not want to ‘do’ to people, but to work collaboratively; inform people about our role, how our relationships would change and most importantly, what our ending would look like.  So role play it was!  It went pretty well and we agreed that we would introduce CTI to a small cohort of seven people and in June 2018 we started in Pre-CTI/Phase One.

CTI phases

Managing the roll-out

As each phase is a period of three months (nine months in total) we agreed to introduce a new cohort to CTI each quarter.  This was firstly to ensure we were allowing time for reflective learning but to also balance caseloads across the phases taking into account CTI caseload formula:

CTI formula

The difficulty we had was around the timing of transitions and not having direct control over a person’s transition (such as their prison release or accommodation move) meant we were often ready to start CTI but waiting for weeks or months for the transition to happen.  For others, their transition happened before we had anticipated and risked having caseloads that were too high in Phase One.

Timing is crucial for CTI; knowing when a phase is due to end and begin, managing a pause and planning for the ending are all crucial to the fidelity of the model. This proved to be difficult to manage and has required intensive monitoring and coordination – a consideration for anyone embarking on a CTI pilot.

By March 2019 we had a full caseload working in the CTI model, with all practitioners supporting people across the three phases: managing the transition, try-out and transfer of care and during this time it was increasingly important to check-in with the fidelity self-assessment tool – we were ‘well implemented!’

In my next blog (available here) I share what I learned about some of the impacts of CTI on the people we support. In the meantime, please get in touch with FLNG Programme Manager Lindsay.henderson@fulfillinglives-ng.org.uk if you have any questions about our pilot.  We’ve also recently published an interim evaluation of the pilot which you can read at Latest reports.