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Homeless ServicesPhase 2NCT02427022

Implementation, Fidelity, and Outcomes Following Novel and Usual Critical Time Intervention Training

A Phase 2 study testing CTI in people with Homeless Services and Human Services Training, run by Center for Social Innovation, Massachusetts at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Clinical social workers and other staff providing direct care to individuals experiencing homelessness face multiple challenges in obtaining training and implementing evidence-based practices in diverse community settings. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Homeless Services, Human Services Training
What is being tested?
CTI
Could I receive a placebo?
No, everyone receives an active treatment
How many people
179 participants
Where
1 siteUnited States
Study dates
Sep 2010to Feb 2013
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Agency Inclusion Criteria:

  1. Possessing administrative-level support for implementing CTI within the agency
  2. Capability of engaging at least one CTI team in training
  3. Willingness to engage in evaluation
  4. A willingness to collect and share administrative client data

Agency Exclusion Criteria:

  1. Not possessing administrative support
  2. Not capable of of engaging at least one CTI team in training
  3. Not willing to engage in evaluation
  4. Not willing to collect and share administrative client data

Provider Inclusion Criteria:

  1. Capacity to fill one of the three roles necessary for CTI team membership or eligibility to shift into those roles: Supervisor, Field Coordinator, or CTI Worker; and,
  2. Willingness to engage in the CTI training and the study activities.

Provider Exclusion Criteria:

  1. Individuals not working as a supervisor, field coordinator or CTI Worker within an eligible service organization.
  2. Individuals not willing to engage in CTI training and study activities.

Trial locations and contacts

1 site in 1 country.

United States1 site

  • Center for Social Innovation

    Needham, Massachusetts, 02494

Other trials in United States

About this study

Official title: Phase II Evidence-Based Practice in Community-Based Social Work: A Multi-Media Strategy

Clinical social workers and other staff providing direct care to individuals experiencing homelessness face multiple challenges in obtaining training and implementing evidence-based practices in diverse community settings. Critical Time Intervention (CTI) is an increasingly popular evidence based practice with these agencies.

With funding from a Phase II Small Business Innovation Research grant from the National Institute of Mental Health, the Center for Social Innovation developed an online multi-media training on CTI which incorporates a Community of Practice approach to encourage peer-based learning.

The primary aim of this longitudinal, randomized-control study is to compare and contrast this online training modality with a face-to-face training on implementation of and fidelity to the CTI model over time. Nearly two-hundred direct service providers from 20 homeless-service agencies were randomly assigned to complete either an online or face-to-face training in CTI. Pre-post training and knowledge-retention surveys, interviews with trainers, agency administrators, and providers were conducted to track satisfaction with the training and experiences in implementing CTI. CTI-specific chart forms are used to assess fidelity to the CTI model, and administrative data from the agencies capture client-level outcomes.

Read the detailed description

In September 2008, the Center for Social Innovation (C4) was awarded a Small Business Innovation Research (SBIR) contract from the National Institute of Mental Health to test innovative ways to disseminate evidence-based practices (EBPs) in community settings. C4 selected the practice of Critical Time Intervention (CTI), a focused, time-limited case management model designed to prevent and end homelessness among people who have experienced mental illness, addiction, and trauma. CTI is widely recognized as an evidence-based practice. During Phase 1 of the project, C4 partnered with CTI experts at the Columbia University Mailman School of Public Health to develop and test a prototype version of an instructor-led online course that brought together live (synchronous) and multimedia self-paced (asynchronous) elements to train community-based social workers on the CTI model. The pilot study showed promising results in the areas of knowledge gain, knowledge retention, and confidence to implement the model. Based on these preliminary findings, C4 applied for Phase 2 funding, which was granted in September 2010.

Phase 2 of the study was completed in February 2013. This phase of the study included full product development of the online course and a randomized controlled trial comparing the online course with face-to-face CTI training (provided by our partners at the Center for Urban Community Services or CUCS). Specifically, the study included 179 service providers from 19 agencies across the United States and Canada. We randomly assigned each agency to one of two study conditions: 1) online training + community of practice, or 2) face-to-face training + telephone coaching. After they completed the training, we examined satisfaction with the training modalities, knowledge gains and knowledge retention. We then followed agencies' CTI implementation process and assessed CTI implementation readiness, experiences in implementing CTI, fidelity to the CTI model over time, and the impact of CTI implementation on the clients served by these agencies.

Being tested
CTI
Keywords
evidence based practices, critical time intervention

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CTIOther

    CTI is an empirically supported, time-limited case management model designed to prevent homelessness and other adverse outcomes in people with mental illness following discharge from hospitals, shelters, prisons and other institutions. CTI was originally developed and tested by researchers and clinicians at Columbia University and New York State Psychiatric Institute with significant support from the National Institute of Mental Health and the New York State Office of Mental Health.

Study groups in NCT02427022
Study groupRoleWhat they receive
Online CTI TrainingExperimentalServices providers in this group received a novel online CTI training. The enhanced course combines depth of knowledge among trainers, skills-based and practical approaches to learning, new technologies, and opportunities for social networking. The course is divided the knowledge, skills, and tools associated with CTI into four two-week modules. The total instruction time for the course was 24 hours.
Receives: Other: CTI
Face-to-Face CTI TrainingActive comparatorService providers in the group received 1.5-days of face-to-face CTI training at each study site with one trainer. There were a total of 8 hours of instructor led training per site. Face-to-face training sessions were followed by three assignments with feedback from trainers, and eight 60-minute telephone consultation sessions.
Receives: Other: CTI

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in confidence in CTI principles [attitudinal]

    Providers were asked to rate their confidence using a 5-point scale (1=not at all confident; 2=not really confident; 3=somewhat confident; 4=confident; 5=extremely confident) in eight key areas: 1) describing CTI as an intervention and its core principles; 2) describing who is on a CTI team and their roles; 3) describing the clinical treatment areas involved with CTI principles; 4) describing the five core skills of CTI and their purposes; 5) describing how to start a CTI program including identifying client and community needs; 6) identifying some of the challenges that might arise in trying to establish CTI in different settings; 7) how chart work differs from CTI work; and 8) describing the key indicators that CTi is implementing. Providers in both treatments were asked to complete these questions in both pre and post surveys.

    Measured: Pre and post surveys (June and July, 2011; weeks 1 and 2)

Secondary outcomes (6)

  1. Training format preference [attitudinal]

    After agencies were randomized and before training began, key informants within agencies were asked to participate in a semi-structure baseline interview where they were all asked what their preference was for training format.

    Measured: Prior to intervention (June, 2011; week 1)

  2. Participant satisfaction [attitudinal]

    Participant satisfaction was analyzed on the post survey and data were collected using a 3-point scale (1=not satisfied; 2=satisfied; 3=very satisfied).

    Measured: Post interventions (July, 2011; week 2)

  3. Participant satisfaction [attitudinal]

    Participant satisfaction was also assessed qualitatively during follow-up interviews with a subset of providers.

    Measured: Post intervention (March 2012; week 2)

  4. Confidence in readiness to implement CTI principles [attitudinal]

    Providers were asked to rate their confidence in readiness to implement CTI principles in the post-survey and data were collected on a 5-point scale (1=not at all confident; 2=not very confident; 3=somewhat confident; 4=confident; and, 5= extremely confident) (see: Aarons, 2004).

    Measured: Post intervention (June 2011; week 2)

  5. Knowledge retention [knowledge]

    Providers who participated in both treatments were asked to complete a pre and post survey followed by a follow up survey in week 6 that looked for enduring effects attributable to participation in the study. Questions were posed in each of the key outcome areas listed above (1) describing CTI as an intervention and its core principles; 2) describing who is on a CTI team and their roles; 3) describing the clinical treatment areas involved with CTI principles; 4) describing the five core skills of CTI and their purposes; 5) describing how to start a CTI program including identifying client and community needs; 6) identifying some of the challenges that might arise in trying to establish CTI in different settings; 7) how chart work differs from CTI work; and 8) describing the key indicators that CTI is implementing).

    Measured: Pre, post and follow up surveys weeks post training and six months post training (June 2011 and December 2011; weeks 1, 2 and 24)

  6. Fidelity to CTI model

    Providers completed modified version of CTI fidelity assessment paperwork based on that developed by CTI co-developer Sally Conover (see: da Silva, Lovisi \& Conover, 2014). Using the CTI forms submitted by study sites, we assigned each provider a fidelity score. This score indicated how closely the providers' implementation of CTI aligned with the original model. Providers' fidelity scores were calculated based on:

    • Compliance Fidelity: The degree to which providers implemented the key CTI components, including: early engagement and early linking; working in the community; using a three-phased approach; focusing on only a few areas; completing the intervention within nine months.
    • Competence Fidelity: Measures how well intervention was documented, including quality and thoroughness of progress notes.

    Measured: Post implementation (March 2012, June 2012, September 2012; weeks 40, 52, and 64)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Apr 2015 (estimated)
  2. Study startSep 2010
  3. Primary completionOct 2012
  4. Study completionFeb 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
179 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02427022
Sponsor's protocol ID
HHSN-271-2010-00032-C
Other IDs
HHSN-271-2010-00032-C
Status last verified
Jul 2014
First submitted
10 Jul 2014
Last updated
27 Apr 2015
Results posted
No
Data monitoring committee
No

Publications

  • da Silva, T. F. C., Lovisi, G. M. & Conover, S. (2014) Developing an instrument for assessing fidelity to the intervention in the Critical Time Intervention - Task Shifting (CTI-TS): Preliminary report. Archives of Psychiatry and Psychotherapy, 1: 55-62.

  • Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Ment Health Serv Res. 2004 Jun;6(2):61-74. doi: 10.1023/b:mhsr.0000024351.12294.65.

    PubMed 15224451

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing CTI in people with Homeless Services and Human Services Training, run by Center for Social Innovation, Massachusetts at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Apr 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in confidence in CTI principles [attitudinal] (time frame: Pre and post surveys (June and July, 2011; weeks 1 and 2)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02427022, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Apr 2015.

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