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Transitions are tough: could CTI be the solution?

The people we work with have Multiple Complex Needs, which sees them journeying around health, social care, and criminal justice systems constantly. Throughout these journeys, there are numerous points of transition. The more complex and chaotic a person’s life, the more likely it is that they will experience a greater number of transitions and with that a greater number of chances of ‘falling through the gaps.’

We’re now piloting a new way of supporting people through transitions - Critical Time Intervention (CTI) – which was included as a solution to homelessness in Crisis’ recent ‘Everybody In’ report. In this blog, our Operational Lead Alex Smith talks about the difficulties faced during transitions and how CTI can support our existing caseload.

I moved house last year, months in the planning with hundreds of different tasks and dates to juggle, not to mention the wrench of leaving a neighbourhood I loved and neighbours who had become friends.  The move went well; my new house is great, my neighbours are amazing, my transition was a success.  But this is rarely the story for the people we work with here in Newcastle and Gateshead, in the north east of England.

Since 2014, the Fulfilling Lives Newcastle Gateshead (FLNG) programme have worked with 267 people who have multiple complex needs, which we understand to mean a person who has multiple different support needs and challenges happening at the same time around, but not limited to; substance use, mental health difficulties, homelessness and offending.  The people we work with are often both high risk and highly vulnerable, with an above average history of trauma and adverse childhood experiences with a below average amount of interpersonal skills to manage day-to-day life challenges, relationships and emotions.  The people we support are chaotic and have very messy complex lives, with multiple points of transition around homelessness, incarceration and hospital admissions.

Life in transition is tough

Over 50 people we have worked with through the FLNG have been in prison, with many people experiencing unstable housing or homelessness on release.  Of this cohort, 42% have reoffended or have been recalled to custody, with 87% of people serving short-term sentences of 6 months or less.  This pattern is also repeated within housing services and over an 18 month period the people we support have an average of 4 different housing placements, with an average of 2 evictions.

Engagement is a key challenge for both the people we work with and the systems we work within.  Due to the complexities of thoughts, emotions and actions it is difficult to meet the requirements of different services to be at a specific place on a specific day and at a specific time and this often leads to transitions being periods of great vulnerability, missed opportunity and almost an inevitability that it is going to fail and people will continue in a cycle of chaos and further transition.

Critical time intervention – a better transition?

The Fulfilling Lives programme, funded through the Big Lottery Fund, operates 12 pilot areas across England and has an overall aim of improving the lives of the people we work with, change and improve the systems supporting the people we work with and ensuring that we work collaboratively to ensure their voice is heard.  Our learning programme is creative and innovative and looking for ways to ensure we meet our broad aims for change; we are keen to learn, to pilot and to evidence our findings.

In 2016 I applied to the Homeless Link Transatlantic Exchange, attracted by one of the key learning areas around improving transitions; Critical Time Intervention.  Following the application process I travelled to Los Angeles and spent two weeks with Brilliant Corners and the team who have been implementing CTI since 2015. You can read about my trip in a series of blogs.

On my return to the UK and with a growing interest in CTI as a possible way to support our FLNG caseload, I completed a course in understanding CTI and really started to appreciate the potential for making a difference to the way we support people through transition.

CTI for Newcastle and Gateshead

At the beginning of the year, we decided to implement CTI across FLNG for those clients experiencing a transition, which equates to around two-thirds of our overall caseload.  Following training with our team, we have now selected our first 7 CTI cases – people who have experienced a transition around leaving prison or moving accommodation – and discussed what CTI means and how our support offer will look over the next 9 months.

Phase 1 started in June for our first 7 CTI cases, close to or just after their transition took place.  We have discussed person-centred goal setting which has already opened up new and exciting conversations with people about what they are interested in, where their motivations lie and what they really care about.  We have started to move away from simply focusing on the person’s support need and deficits, to actually listening to where they want to start – just because someone doesn’t have stable accommodation doesn’t mean they necessarily want to focus on housing, maybe building a relationship with their granddaughter is what they care about, so that’s where we will be, working alongside our clients as partners, in collaboration.

From September we will be moving our first 7 cases into phase 2 of CTI, continuing to focus on maximum of 3 goals, whilst building the person’s network of support and decreasing the intensity of work we do.  By January we will move into phase 3, where we will ensure the support network around the person is robust and able to meet ongoing support needs to build stability in the community. Part of phase 3 will be developing the links between our current caseloads and our Experts By Experience Network. We are excited to see how our implementation develops and will be sharing our full evaluation by 2019 to explore the impact of CTI both for our caseload and in the context of the UK.

CTI for the UK

In their latest report, ‘Everybody In: How to end homelessness in Great Britain’, national charity Crisis pinpointed CTI as being critical to ending homelessness in the UK. We are proud to be pioneering this approach in the UK, as one of the first organisations to pilot CTI.

I am going to be talking about the implementation of CTI for our programme at the forthcoming Homeless Link’s Under One Roof conference and in September, we are lucky to be joined by Sally Conover, who leads the CTI Global Network at Center for the Advancement of Critical Time Intervention (CACTI), for a full day’s training session here in Newcastle upon Tyne.

In addition to our team and close partners, we hope local and national colleagues will join us to learn more about CTI and its critical role in supporting people with multiple and complex needs and ending homelessness.

If you are interested in coming along to the full-day CTI training session in September 2018, or would like to find out more about our pilot, please get in touch: info@fulfillinglives-ng.org.uk