Critical Time Intervention to Facilitate Exiting Sex Work: Lessons Learned From a Fidelity Assessment

IntroductionIndividuals who engage with sex work face barriers to maintaining overall health and well-being such as criminalization, stigmatization, and violence. An emerging approach to facilitating exiting sex work for individuals is through programs applying the Critical Time Intervention (CTI) model. CTI represents a time-limited practice that supports vulnerable individuals during periods of transition. The objectives of this study were to apply an existing CTI fidelity assessment to the sex work exiting program Exit Doors Here (EDH) to (1) report on the program’s fidelity and (2) discuss the effectiveness of CTI for supporting these groups. MethodsTo determine the applicability to the EDH of an existing fidelity assessment tool, we consulted with program staff through in person meetings. Staff highlighted areas for adaptation. We adapted the tool based on this feedback and used it to assess program fidelity by analyzing data from 8 participants’ CTI notes. Fidelity ratings were computed and interpreted according to established guidelines. ResultsConsultations with program staff resulted in adaptations to seven items out of the 12 comprising the fidelity assessment tool. The majority of adaptations surrounded the time-limited nature of CTI and unique needs of the program participants. In regards to the fidelity assessment using the adapted tool, half of the items were ideally implemented, one was well implemented, one was fairly implemented and two were respectively found to be poorly implemented and not implemented at all. Conclusions Difficulties in implementing selected program components with high fidelity can be attributed to specificities of the target population and to contextual factors, which are hard to control from a staff and program standpoint. This assessment reiterates the importance of considering such factors when developing and implementing programs aimed at improving the health and well-being of marginalized women such as those who engage in sex work.

Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center: Évaluer l’effet d’une Adaptation De l’intervention En Temps Critique Sur l’utilisation des Soins De Santé Chez Des Adultes Itinérants Ayant Des Besoins De Santé Mentale Dans Un Grand Centre Urbain

Objective: This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. Methods: Provincial population-based administrative data from Ontario, Canada, were used in a pre–post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. Results: Pre–post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. Conclusions: An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.

Use of Critical Time Intervention (CTI) to Promote Continuity of Reintegration After Incarceration

Critical time intervention (CTI) is a time-limited intervention originally designed to provide the continuity of support for homeless and mentally ill people released from an institution to community living. This study offers theoretical foundations for adopting CTI in the field of criminal justice. Through the lens of CTI, this study examines the needs of prisoners returning to the community, discusses the challenges faced by reentry practitioners in offering support and assistance to ex-prisoners in the community, and provides specific suggestions. This study uses focus groups and individual interviews to assess the needs, obstacles, and opportunities ex-prisoners have or face in the community, as perceived by returning prisoners and practitioners, which leads to a more in-depth understanding of the prisoner reentry process.