critical time intervention for people experiencing complex disadvantage - learning from the fulfilling lives Newcastle Gateshead pilot
There is a growing interest in Critical Time Intervention (CTI) as a potential approach to support people experiencing multiple and complex disadvantage* – but my recent research for Fulfilling Lives Newcastle Gateshead (FLNG) showed that the model works better for some people than others, and suggests that we should be cautious about how and when we use this approach.
Critical Time Intervention originated in the United States, where robust evidence shows that it has been effective in supporting people during times of transition. The model meets the Coalition for Evidence-based Policy’s rigorous “Top Tier” standard. It is an asset-based approach that aims to support people to develop their independence and work towards self-defined person-centred goals. It takes a phased, strictly time-limited approach over nine months, during which CTI workers work with people to build support networks which can provide continued support after the CTI ends.
In one of the first pilots of CTI with this group in the UK, FLNG piloted the CTI model with 35 people experiencing multiple and complex disadvantage who were transitioning, most commonly, into new forms of accommodation or leaving prison.
Who CTI worked for
The project evaluation found that CTI worked better for some people than others, with the evidence suggesting that:
· CTI was particularly appropriate for men who had attained a level of stability in their lives. The process of setting goals helped to empower people and encourage them to look positively to their future, and the time limit brought a sense of focus.
· CTI was less appropriate for people experiencing crisis. The time limit could be anxiety-provoking, and it could be more difficult to engage in setting and working towards goals whilst dealing with crisis.
· CTI tended not to work well for women experiencing MCN. Most women experiencing MCN were thought to require intensive one-to-one support for longer than nine months, and access to specialist support services for women.
· CTI was not the most appropriate approach for people who find it difficult to build and maintain healthy relationships, which makes building support networks, a core element of the model, difficult. This includes people with experience of complex trauma.
Lessons from the pilot
On the basis of this research, I would encourage any projects considering adopting a CTI approach to learn from the lessons of this pilot and:
· Ensure frontline staff are trained and skilled in coaching, advocacy, relationship-building and trauma-informed approaches, and recognise that the skills needed for CTI workers are quite different to those of support workers.
· Consider the extent to which the local system is able to take on people’s support after the CTI support ends. If there are significant gaps in the system, which would make linking people in with support after CTI ends difficult, a different approach may be more appropriate.
· Consider how, as part of the project, people can be supported to develop the relationship-building skills which are essential to the core aim of strengthening social networks.
The research concluded that CTI could not be recommended as a generic approach for people experiencing multiple and complex disadvantage. Instead, it could be usefully considered either as a targeted model for a discrete group of people who meet certain criteria around stability and the ability to form relationships; or as the second step in a two-step model of support, ensuring first that people have the stability to benefit from the approach.
* Multiple and complex disadvantage, in the context of the FLNG programme, refers to people who are likely to experience at least three of the following: homelessness, reoffending, problematic substance misuse and mental ill health.