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Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention.

ABSTRACT: Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse outcomes by providing support to individuals during challenging life course transitions. While several narrative reviews suggest the benefit of CTI, the evidence on the model's effectiveness has not been systematically reviewed. This article systematically reviews studies of CTI applied to a variety of populations and transition types. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) guidelines, we reviewed 13 eligible experimental and quasi-experimental studies. Findings were summarized by individual outcome domains, including housing, service engagement use, hospitalization or emergency services, mental health, substance use, family and social support, and quality of life. CTI had a consistent positive impact on two primary outcomes-reduced homelessness and increased service engagement use-among different populations and contexts. Despite the effectiveness of CTI, the specific mechanisms of the model's positive impacts remain unclear. Implications for practice, policy and research are addressed.

SUBMITTER: Manuel JI

PROVIDER: S-EPMC9832072 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention.

Manuel Jennifer I JI Nizza Megan M Herman Daniel B DB Conover Sarah S Esquivel Laura L Yuan Yeqing Y Susser Ezra E

Administration and policy in mental health 20221014 1

Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse outcomes by providing support to individuals during challenging life course transitions. While several narrative reviews suggest the benefit of CTI, the evidence on the model's effectiveness has not been systematically reviewed. This article systematically reviews studies of CTI applied to a variety of populations and transition types. Following the Preferred Reporting Items for Systematic Review an ...[more]

PMID: 36229749

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Project description:BackgroundLower socioeconomic status (SES) is associated with poorer dietary habits and fewer family meals. Therefore, initiatives to empower families with a lower SES to adopt healthier meal practices are employed. The objective of this study was to evaluate a nationwide intervention "Dinner is served at 1-2-3 euros", developed by a Belgian retailer in collaboration with social organizations. It targets families with a lower SES and aims to promote more balanced and freshly cooked meals by providing recipe booklets of affordable meals at a guaranteed price of 1, 2, or 3 euros per portion. The process evaluation aimed to gain insight into the implementation process (Reach, Recruitment, Dose-delivered, Context), the satisfaction with the intervention (Dose-received), and the perceived impact of intervention participation.MethodsA mixed-methods study combining qualitative (i.e., focus groups and individual interviews) and quantitative research (i.e., surveys) was conducted. An interview with the retailer (n = 1), three focus group interviews with the involved social organizations (n = 15), and interviews with participants of "Dinner is served at 1-2-3 euros" (n = 26) were carried out, as well as surveys among these social organizations and participants.ResultsSocial organizations were generally satisfied with the project and appreciated the collaboration with the retailer. The main barrier to implement the project was a lack of time to help participants subscribing. Participants appreciated the inspiration from the recipe booklets, and the recipes' ease of preparation, their healthiness, and the variety. However, the recipes were sometimes deemed too exotic for participants' children. Participants also appreciated the budget friendliness, although the price guarantee mechanism of 1, 2 or 3 euros per portion was not always clear. Positive effects were mentioned in areas such as perceived healthy cooking and eating, improved cooking skills and ideas, and reduced financial concerns.ConclusionsIn general, participants and social organizations were satisfied with the delivery and implementation of the intervention. Participants also noted some positive effects on their meal practices. Future research should provide insight into the intervention's effectiveness and impact on the healthiness of participants' dietary choices.Trial registrationThe study protocol was pre‑registered prior to data collection at Clinicaltrials.gov (NCT05595551-27/10/2022).

Project description:BackgroundExcessive gestational weight gain (GWG) is associated with adverse health outcomes in both the mother and child. Many previous lifestyle interventions in women with excess weight during pregnancy encouraging appropriate GWG have been unsuccessful, and there remains no consensus about the content, format, or theoretical framework of GWG interventions. We assessed the feasibility and acceptability of a remote health coach intervention to promote healthful lifestyle behaviors and appropriate GWG among overweight pregnant women.MethodsAt one northeastern US clinic, we enrolled 30 overweight (pre-pregnancy BMI ≥ 25 kg/m2) pregnant women at a median gestation of 12.5 weeks (IQR: 11-15) into a one-arm trial. We connected participants with a health coach to provide behavioral support to help participants adopt healthful lifestyles during pregnancy. Health coaches contacted participants by phone every 2-3 weeks to monitor goals, and sent emails and text messages between calls. Participants completed baseline (N = 30) and follow-up (N = 26) surveys at the end of the intervention (36 weeks gestation), as well as follow-up phone interviews (N = 18).ResultsAmong 30 participants, median age was 32 years (IQR: 28-33), median self-reported pre-pregnancy BMI was 27.3 kg/m2 (IQR: 25.7-31.1), and 17/30 were white, 9/30 African-American, and 3/30 Asian. Three-quarters (22/29) of participants completed at least a college degree. Although 25/30 participants reported in baseline surveys that they worried about being able to lose the weight postpartum that they expected to gain during pregnancy, just 12/26 participants reported the same at follow-up (P < 0.001). In follow-up surveys, 21/26 participants reported that health coaches were helpful in keeping them motivated, and 22/26 thought the phone conversations helped them face problems and find solutions. Based on qualitative assessment, several themes emerged in follow-up interviews about the quality of the intervention including accountability and support from health coaches. Participants also expressed desire for more visual resources and integration with standard clinical care to improve the intervention.ConclusionsWe demonstrated feasibility and high participant satisfaction with our remote health coach intervention during pregnancy. We identified areas in which we could refine the intervention for inclusion in a full-scale RCT, such as integration with clinical care and additional visual resources.Trial registrationRetrospectively registered at ClinicalTrials.gov ( NCT03080064 , 3/14/2017).

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Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention.

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Supporting Vulnerable People During Challenging Transitions: A Systematic Review of Critical Time Intervention.

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