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Transatlantic Exchange: An empirically supported model for preventing homelessness in high risk groups

Our System Broker Alex is currently in LA as part of Homeless Link's Transatlantic Exchange, and will be working with Brilliant Corners for the next two weeks to learn about Critical Time Intervention (CTI) and how this way of working can benefit multiple complex needs programmes back in the UK. Here, Alex explains a little bit more about how CTI works.

My Transatlantic Exchange host asked me to watch a video which is essential viewing for anyone interested in CTI. As I mentioned in my previous blog, CTI is designed to be a simple intervention to be used during a transition period, but which builds the foundations for lasting long-term support within the community.

The CTI model is based on moving through clear, time-limited phases that are agreed and appropriate for the model or programme of support. Ideally, a case manager (support worker) will start to build a relationship with their client whilst they are still in the institution, for example prison, hospital or emergency housing and at the point of transition into the community, there are three distinct phases which are followed:

Transition

This is the most intensive support phase, with the case manager implementing the transition plan and providing emotional support. The worker will often be a negotiator and smooth potential conflicts during transition.

Facilitate

At this stage, the worker takes a step back to observe how the person is settling into their community of support. The worker is available to step back in where there is a crisis point.

Transfer

The final stage is the transfer of care into the support systems that have been created. During this phase there will be an explicit set of activities which solidify the support system that is in place. Ideally there will be a final meeting with all parties for reflection and to ensure there is a planned ending to the client/worker relationship.

The initial model for CTI was laid out over a 9 month period but through my time with Brilliant Corners, I have learned that this is adaptable and CTI here is based on the 24 month rapid rehousing programme, Breaking Barriers:

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The Breaking Barriers caseload is not as complex or chaotic as the people we work with through the Fulfilling Lives programme and my first reflection is that the process seems linear and unlikely to work for our clients, but Lisa thinks CTI can work for everyone and here’s why.   

Some of the key difficulties we have in sustaining contact/support with our client group is around multiple periods of transition which constantly disjoints the care and support which is offered.  In Fulfilling Lives we see clients endlessly going through periods of disengagement or being sent back to prison, but the CTI model here at Brilliant Corners works these challenges in: 

Disengaged  

The support offer is intensified until the person re-engages  

Back to prison 

The programme, including housing is held for a period of 60 days.  If the sentence is longer then the person is referred back into the programme and crucially they start where the left off – they do not return to the beginning.  

The programme is not right 

Breaking Barriers will try everything, but where someone refuses to participate the last resort is to withdraw the programme.  However, the client will be transitioned to a higher support needs programme, with housing.  

The time-limited phases may seem unrealistic for more complex clients but Lisa has explained that case manager’s actually role-model a more structured way of working which helps set boundaries and also supports clients to accept the transition of care.   

Ultimately, no support is indefinite and CTI creates structure for organisations, workers and clients around what is possible during the given timeframe.  The model is focussed on relationships, flexible support, setting expectations/boundaries and ensuring all parts of the system work together; maybe this is a model which really could work to prevent homelessness in the UK.  

Alex