"She Went Above and Beyond": A Mixed-Methods Examination of Implementing Cti with Housing-Unstable Families Whose Children Are in Foster Care

Background and Purpose: Housing instability and involvement in child welfare are common experiences for low-income families. According to nationally representative estimates, one in six housing unstable families involved in the child welfare system has children placed in foster care, and reunification rates for these families are slower and less likely than for housed families. In order to support these families who face multiple challenges, the Cuyahoga Partnering for Family Success (PFS) conducted a randomized controlled trial in which treatment group families were provided quick access to public housing and Critical Time Intervention (CTI) services. CTI, an intensive case management model, has shown effectiveness in helping homeless single adults to stabilize. To our knowledge, few studies have explored the implementation of the model with families, and fewer have examined how child welfare-involved, housing-unstable families and their providers experience CTI. This study describes how CTI was implemented, lifts the voices of families and their providers, and examines outcomes related to use of homeless services, public assistance, and subsequent child maltreatment via administrative data.

Methods: A mixed-methods approach was used to describe experiences with CTI and outcomes associated with its delivery. Quantitative data on clients’ demographics, use of homeless, public assistance and child welfare services came from the Homeless Management Information System (HMIS), county child welfare, and county public assistance data. Individual qualitative interviews from clients, program workers, and child welfare workers and focus groups (N=52) were conducted over a five-year period to explore clients and workers’ experiences with the program, clients’ challenges and strengths, and recommendations. Qualitative data trustworthiness safeguards included peer debriefing, member checks, and triangulation.

Findings: HMIS data indicated that treatment group families were more likely to remain stably housed and less likely to return to homelessness, however, there was no significant difference in new child maltreatment reports between treatment and control groups. Interviews with staff and clients revealed that the rapidity with which clients were housed was one of the most successful and important aspects of the intervention. Obtaining housing quickly was identified as important in providing families with necessary stability, meeting their basic needs, and providing a foundation to work on other challenges (e.g., mental health, substance abuse, parenting). Qualitative interviews found that coaching and empowerment, cornerstones of CTI, were key themes, with both clients and their service providers describing these. A strong, trusting relationship with service providers, combined with service navigation advice, helped increase clients’ confidence and motivation to complete their child welfare case plans and progress toward reunification, however, most clients felt the services ended too soon.

Implications: The findings indicate that having quick access to public housing is a critical first step to improving the well-being of housing-unstable, child welfare-involved families. These families face a variety of challenges, and they need extensive and long-term support to address underlying issues that are related to both housing instability and child welfare involvement to achieve stability. Thus, the current time frame for CTI may need to be adjusted for this population.