Critical Time Intervention

Updated: Nov 20, 2017
Evidence Rating:
Top Tier


  • Program:

    A case management program to prevent recurrent homelessness in people with severe mental illness leaving shelters, hospitals, or other institutions.

  • Evaluation Methods:

    Two well-conducted randomized controlled trials (RCTs) with a combined sample of 278 men and women with severe mental illness.

  • Key Findings:

    More than a 60% reduction in likelihood of homelessness, 18 months after random assignment.

The Critical Time Intervention (CTI) seeks to prevent recurrent homelessness in people with severe mental illness leaving shelters, hospitals, or other institutions. People with such illness are estimated to comprise one-fifth of the U.S. homeless population (U.S. Department of Housing and Urban Development, 2017). CTI’s approach is to (i) strengthen the individual’s long-term ties to services, family, and friends; and (ii) provide emotional and practical support during the critical time of transition back to the community.

The nine-month program is delivered to each participant by a single caseworker – a bachelor or master’s level person trained in CTI and supervised by a mental health professional.

Phase one (“transition to the community”) covers the period before and after the client’s discharge from the institution. In this phase, the caseworker gets to know the client (starting before discharge), assesses the client’s needs, and implements a transition plan intended to link the client to services and supports in the community. The plan typically includes home visits and other meetings with the client, the client’s caregivers, and community service providers, designed to teach crisis-resolution skills, provide support and advice, and mediate any conflicts. In phase two (“try out”), the caseworker monitors and adjusts the systems of support that were developed during phase one. This phase involves fewer meetings with the client, as the caseworker encourages the client to problem-solve with the help of community resources and family members, and intervenes only if the client is receiving inadequate support or if a crisis occurs. In phase three (“transfer of care”), the caseworker helps the client develop and implement a plan to achieve long-term goals (e.g., employment, family reunification) and finalizes the transfer of responsibilities to caregivers and community providers. Each CTI caseworker typically works with 10-15 clients at a time.

CTI costs $6,633 per participant (in 2017 dollars).

Click here for Critical Time Intervention’s website.

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Study 1 – All male sample in New York City, 1990s:

Herman, Daniel, Lewis Opler, Alan Felix, Elie Valencia, Richard Jed Wyatt, and Ezra Susser. A Critical Time Intervention with Mentally Ill Homeless Men: Impact on Psychiatric Symptoms. The Journal of Nervous and Mental Disease, March 2000, vol. 188, no. 3, pp. 135-140.

Jones, Kristine, Paul W. Colson, Mark C. Holter, Shang Lin, Elie Valencia, Ezra Susser, and Richard Jed Wyatt. Cost-Effectiveness of Critical Time Intervention to Reduce Homelessness Among Persons With Mental Illness. Psychiatric Services, June 2003, vol. 54, no. 6, pp. 884-890.

Lennon, Mary Clare, William McAllister, Li Kuang, and Daniel B. Herman. Capturing Intervention Effects Over Time: Reanalysis of a Critical Time Intervention for Homeless Mentally Ill Men. American Journal of Public Health, October 2005, vol. 95, no. 10, pp. 1760-1766.

Susser, Ezra, Elie Valencia, Sarah Conover, Alan Felix, Wei-Yann Tsai, and Richard Jed Wyatt. Preventing Recurrent Homelessness among Mentally Ill Men: A ‘Critical Time’ Intervention after Discharge from a Shelter. American Journal of Public Health, February 1997, vol. 87, no. 2, pp. 256-262.

Study 2 – New York City, 2000s:

Herman, Daniel, Sarah Conover, Prakash Gorroochurn, Kinjia Hinterland, Lorie Hoepner, and Ezra Susser. Randomized Trial of Critical Time Intervention to Prevent Homelessness After Hospital Discharge. Psychiatric Services, July 2011, vol. 62, no. 7, pp. 713-719.

Tomita, Andrew and Daniel B. Herman. The Impact of Critical Time Intervention in Reducing Psychiatric Rehospitalization After Hospital Discharge. Psychiatric Services, September 2012, vol. 63, no. 9, pp. 935-937.

Clarifying correspondence with Daniel Herman (June 2011 and March 2013)

Other references:

U.S. Department of Housing and Urban Development, Office of Community Planning and Development. HUD 2016 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations – All States, Territories, Puerto Rico, and D.C. March 2017, page 2. Retrieved from:

Dixon, Lisa, Richard Goldberg, Virginia Iannone, Alicia Lucksted, Clayton Brown, Julie Kreyenbuhl, Lijuan Fang, and Wendy Potts. ͞Use of a Critical Time Intervention to Promote Continuity of Care After Psychiatric Inpatient Hospitalization. Psychiatric Services, April 2009, vol. 60, no. 4, pp. 451-458.

Samuels, Judith, Nancy Travers, Terese Lawinski, Ilyssa Berg, Dei-In Tang, and Andrea Ault. Homeless Families Program Final Report: Homeless Families in Westchester County, N.Y. – Phase 2. Final report to SAMHSA, September, 2006.