Abstract: Critical Time Intervention for People Leaving Residential Substance Use Treatment: The Feasibility and Preliminary Impact of a Pilot Randomized Trial (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

Schedule:

Sunday, January 15, 2023

Hospitality 1 - Room 443, 4th Level (Sheraton Phoenix Downtown)

* noted as presenting author

Jennifer Manuel, PhD, Associate Professor, New York University Silver School of Social Work, New York, NY

Khadija Israel, MSW, Phd Student, New York University, NY

Yeqing Yuan, PhD, LCSW, PhD Student, New York University, New York, NY

Laura Esquivel, MSW, Social Work PhD Student, New York University, New York, NY

Laura Curran, MA, LMHC, PhD Candidate, New York University, New York, NY

Daniel Herman, Professor, Hunter College Silberman School of Social Work, NY

Background: Although residential substance use treatment (RSAT) has been shown to improve substance use and other outcomes, relapse following discharge is common. Few evidence-based practices exist to adequately address the unique needs of persons transitioning from RSAT. This paper describes Critical Time Intervention-Residential (CTI-R) for persons transitioning from RSAT and reports the preliminary outcomes from a pilot randomized trial of CTI-R versus enhanced treatment as usual (TAU).

Methods: Residents who were within 3 months of discharge volunteered and consented to participate in the study, completed a baseline interview and were randomized to either CTI-R or enhanced TAU using 1:1 random assignment stratified by sex. The majority of those who were excluded before randomization were discharged prematurely for unknown reasons. Following the baseline assessment, 60 people were randomized to either CTI-R (N=30) or TAU (N=30). Follow-up assessments were conducted at 3-, 6-, 9-, and 12-months. We used the 3-month data to estimate differences between treatment and comparison groups in housing and aftercare substance use services, we conducted regression analyses, with alpha set at .05.

Results: Participants were average age of 45 years, mostly male (57%)—proportional to the residential population—and self-identify primarily as African American, Black or Latino (78%) are mandated to treatment (59%) and reported mental health (68%) and physical health (47%) needs, as well as being homeless (81%) and unemployed (66%) before admission to RSAT. The most prevalent substances used were alcohol, heroin, crack/cocaine, and marijuana. Significant group differences in mental health severity and homelessness were found at baseline and controlled for in the regression analyses. We achieved a 3-month retention rate of 85%, 6-month retention rate of 77%, and 9-month retention rate of 65%, reflecting an overall retention rate of 76% through the 9-month assessment. The 12-month follow-up rate was lower at 55% due to COVID-19. At the 3-month follow-up, the CTI-Residential group had a significantly higher probability, by 19%, of being engaged in aftercare services post-discharge compared to the Enhanced TAU group. No significant group differences were found with respect to homelessness and substance use relapse.

Conclusion and Implications: CTI-R is a potentially useful model which is based on theory and grounded in harm reduction principles and evidence-based practices to provide reentry services for persons transitioning from RSAT. The significant impact of CTI-R on aftercare services warrants further analyses on its potential mediating role with respect to other outcomes, including homelessness and substance use relapse.