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
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
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.
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;
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.