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Critical Time Intervention in the Transition From Hospital to Community in People With Severe Mental Illness

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ClinicalTrials.gov Identifier: NCT00621465
Recruitment Status : Completed
First Posted : February 22, 2008
Last Update Posted : December 30, 2011
Information provided by (Responsible Party):

Study Description
Brief Summary:
This study will evaluate the effectiveness of a psychosocial treatment, Critical Time Intervention, in easing the transition from hospital to community in people with severe mental disorders.

Condition or disease Intervention/treatment
Psychotic Disorders Behavioral: Critical Time Intervention (CTI) Behavioral: Usual care

Detailed Description:

Severe mental illness (SMI) encompasses a wide range of mental disorders and disabilities, but commonly includes disorders that involve symptoms of psychosis. Psychotic symptoms may involve hallucinations, a lost sense of reality, or other distressing symptoms. About 6% of people experiencing psychotic symptoms seek inpatient treatment at a psychiatric hospital. Hospital treatment for a person with SMI often focuses on rapid improvement of negative symptoms and promotion of the necessary skills to successfully return to the community after leaving the hospital. Despite preparation for community integration, the transition from hospital to community remains a difficult time for many people with SMIs, with those affected having an increased chance for suicide, homelessness, and relapse. Critical Time Intervention (CTI), a psychosocial treatment program that aims to restore skills for community living and to assist in seeking service and support in the community, may be more effective than usual care in preventing these adverse outcomes after hospital discharge. This study will compare the effectiveness of CTI versus usual services in preventing homelessness and other adverse outcomes after leaving a psychiatric hospital among people with SMI and psychosis.

Participation in this study will last 18 months. Potential participants will undergo an initial 15- to 30-minute interview that will include questions about current mental, physical, and living conditions; history of psychiatric services; and alcohol and drug use. Eligible participants will then undergo the first full interview, which will include a full review of medical records and will last between 2 and 3 hours. After this interview, participants will be assigned randomly to receive CTI or usual services. For participants assigned to CTI, a CTI specialist will visit participants in the hospital and in their homes and will stay in contact with participants for 9 months after hospital discharge. During visits with the CTI specialist, participants will receive training in community living skills and help finding service and support in the community. Participants assigned to usual services will receive the usual care and community services offered to people recently leaving a psychiatric hospital.

After leaving the hospital, participants in both groups will be asked to participate in 15 follow-up interviews, which will include repeat questions from the 2 initial interviews. Interviews will be conducted once every 6 weeks until 18 months after hospital discharge and will last between 60 and 90 minutes.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: CTI in the Transition From Hospital to Community
Study Start Date : April 2002
Primary Completion Date : October 2007
Study Completion Date : October 2007

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Active Comparator: 1
Participants will receive standard aftercare and community care services.
Behavioral: Usual care
Usual care will include the standard aftercare and community care services.
Experimental: 2
Participants will receive usual care and the Critical Time Intervention.
Behavioral: Critical Time Intervention (CTI)
CTI is designed specifically to enhance the continuity and focus of care during the transition from psychiatric hospital to community care. CTI does not replace community treatment and support, but instead is meant to complement available services. CTI will provide training in community living skills and in team-managed transfer of caregiving from hospitals to services and supports in the community. Participants will receive CTI for 9 months after hospital discharge.
Behavioral: Usual care
Usual care will include the standard aftercare and community care services.

Outcome Measures

Primary Outcome Measures :
  1. Number of adverse outcomes after hospital discharge, particularly homelessness [ Time Frame: Measured over 18 months ]

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 59 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Diagnosis of psychosis
  • Homelessness during the 18 months before study entry
  • English speaking
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00621465

United States, New York
Rockland Psychiatric Center
Orangeburg, New York, United States, 10962
Sponsors and Collaborators
New York State Psychiatric Institute
National Institute of Mental Health (NIMH)
Principal Investigator: Daniel Herman, DSW NYS Psychiatric Institute
More Information

Responsible Party: New York State Psychiatric Institute
ClinicalTrials.gov Identifier: NCT00621465     History of Changes
Other Study ID Numbers: R01 MH059716,#4640R
R01MH059716 ( U.S. NIH Grant/Contract )
First Posted: February 22, 2008    Key Record Dates
Last Update Posted: December 30, 2011
Last Verified: December 2011

Keywords provided by New York State Psychiatric Institute:
Case Management
Severe Mental Illness

Additional relevant MeSH terms:
Psychotic Disorders
Mental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders