Dissemination and Implementation of Critical Time Intervention: A Randomized Trial Comparing Online and Face-to-Face Training

Purpose: A well-trained workforce equipped to implement evidence-based practices (EBPs) is a critical component of preventing and ending homelessness. While there has been an increasing emphasis on implementing EBPs in homeless service settings, a gap persists between research and practice. Social workers often work in settings where demand for services is great, resources are scarce, and access to training is limited, hence there is a pressing need to identify feasible training approaches that can enhance providers’ capacity to implement empirically-supported approaches. The purpose of this study was to explore the effectiveness of two training modalities on dissemination and implementation of an evidence-based case management model—Critical Time Intervention (CTI), a time-limited psychosocial intervention that has been shown to reduce the risk of homelessness among high-risk populations. 

Methods: This study compared online with face-to-face CTI training through a randomized trial design. We enrolled provider organizations that could designate appropriate staff members with no prior formal CTI training to participate in training and who could commit to implement the model following training. We randomly assigned each organization and its staff members to one of two study conditions: 1) online training + community of practice, or 2) face-to-face training + telephone coaching. Outcomes assessed included training satisfaction, change in short-term and longer-term CTI knowledge, as well as if organizations implemented CTI and fidelity of model implementation. Data sources included pre- and post-training surveys, reviews of case records, and interviews with staff, administrators, and clients. Training costs were tracked to determine cost-effectiveness of each training modality.

Results: We enrolled 19 agencies (9 online and 10 face-to-face) and 179 staff members (99 online and 80 face-to-face). 58% of study participants had some college experience, Associate’s degree, or Bachelor’s degree. 37.5% of participants had a Master’s degree. 32% had less than 5 years of experience working in homeless services and 15% had more than 20 years of experience. There were no significant differences between the two groups on these descriptive variables. Training satisfaction was found to be significantly higher in the face-to-face group (t=5.59, p<.001) than in the online group. The online group retained more information than the face-to-face group at the six-month follow-up (t=2.19, p<.061). All agencies in the face-to-face condition and 78% from the online condition successfully implemented CTI. The face-to-face group had higher fidelity scores than the online group at the three-month follow-up (t=2.7, p=.004) but this difference was not observed at the six or nine-month follow-ups or in the aggregate fidelity scores. Face-to-face training delivery costs totaled $8,116 per agency versus $2,700 for online training.

Implications: This study provides support for the effectiveness of online training to transmit practice knowledge and uptake of EBPs in community settings at a low cost. Findings also suggest that face-to-face training may yield greater trainee satisfaction and lead to higher rates of implementation, at least over a brief follow-up period. Future research should examine how to effectively combine elements of online and face-to-face training to ensure the best possible conditions for EBP implementation and dissemination.