Critical Time Intervention in Los Angeles’ Skid Row: Learning from the Downtown Women’s Center Pilot Intervention

About the Evaluation

The goal of this evaluation was to understand how CTI can be used to support formerly chronically homeless people during the rapid transition to permanent supportive housing. This report highlights implementation successes and challenges, impact of CTI on clients, and lessons learned and recommendations for providers who are considering adopting this model.

Evaluation data from several sources (clients, CTI Case Managers, DWC staff) was collected at different points in time coinciding with the phases of CTI. Interviews and focus groups were also conducted with clients and providers during the period of October-December 2013 when most clients had completed CTI services. The evaluation used measures and interviews that captured changes in independent living skills, self-sufficiency, quality of life, and satisfaction to document the efficacy of CTI at DWC.

CTI Impact: Key Findings

CTI is a nine-month evidence-based approach to case management that has been shown to increase the likelihood that chronically homeless individuals remain stably housed, decrease negative psychiatric symptoms, and prevent psychiatric re-hospitalization. The current evaluation found that CTI significantly impacted women in three main areas:

Housing Stability and Independence

Findings suggest that CTI was particularly effective at helping clients develop skills to manage everyday life which, in turn, supported their ability to remain stably housed:

• At intake, 60% of clients required assistance with living skills “most of the time”; by twelve month follow up, 53% required only “occasional” assistance.
• At intake 8% of clients reported being employed; by six months into CTI, 21% reported having some form of paid employment.
• At nine months into CTI, 87% of clients reported improved ability to deal with their own needs.
• All 80 clients successfully completed the CTI program, and 100% were stably housed at the end of the evaluation period (i.e., 3 months after termination of CTI services).
• 99% of women continued to be stably housed one year post-CTI.

“She helped me get to a point where I could do most of the stuff that I needed myself…But the door was always open if I needed to knock.”
-CTI client

Mental and Physical health

The constant attention that CTI provides during transition into housing allows clients experiencing acute psychiatric episodes to be connected to care immediately so that the situation does not destabilize housing. Additionally, clients felt that CTI Case Managers helped connect them to physical health care resources. Findings suggest that clients experienced a significant reduction in mental health symptoms and better management of health care needs:

• At 9 months into CTI, 54% of clients agreed or strongly agreed with the statement, “my mental health symptoms are not bothering me as much.”
• At 12 months, 10.4% of clients were rated as having recurrent mental health symptoms and persistent problems with functioning due to a mental health problem – a significant drop from 32% at intake.
• 70% agreed or strongly agreed with the statement,“I am better able to manage my health care.”

Connections to Family and Community

One of the major goals of CTI is to connect clients to their communities so that they can secure resources and social support in times of need. Data from both clinician and client report suggests meaningful increases in connections to the community throughout CTI participation:

• 94% of clients knew where to get help when they need it.
• 80% of clients reported feeling a sense of belonging to their community

“I was a person [to my Case Manager], I was not a case file”
-CTI client