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UNC program to help people with mental illness expands across the state

A pilot program designed to connect individuals with mental illness and complex social needs with services and support is preparing to expand into six more counties around the state.

The Critical Time Intervention (CTI) program—a collaborative effort between the UNC School of Social Work and the UNC Center for Excellence in Community Mental Health—is expected to extend into Alamance, Caswell, Gaston, New Hanover, Onslow and Cumberland counties in July, said Clinical Assistant Professor Bebe Smith, who directs the project along with co-director and Assistant Professor Gary Cuddeback.

These expansion sites will join others in Orange and Chatham, where the pilot intervention program originally launched in 2012, with funding from the Kate B. Reynolds Charitable Trust in Winston-Salem.

The CTI model is expanding as part of the Crisis Solutions Initiative, a project of the N.C. Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. Cardinal Innovations Healthcare Solutions, Alliance Behavioral Healthcare, Partners Behavioral Health Management, and Coastal Care will share nearly $1.5 million in mental health block grant funds to oversee the additional program sites. The state is also contracting with the School of Social Work’s Behavioral Healthcare Resource Program to help manage the expansion.

Over the past year, Smith helped champion support for the additional sites, in part, by promoting the successful partnerships that the Orange County team has developed with multiple community agencies, including the Orange County 100,000 Homes Task Force, a group of health, human services, and law enforcement professionals who help find housing, healthcare and services for those most at risk of dying on the streets.

“Because we have good strong relationships here, people have realized that the CTI model is a good thing and that it’s been working to help some of the most vulnerable people in our local community,” Smith said.

CTI was designed as an intensive case management program that aims to prevent recurrent homelessness in individuals with severe mental illness who are leaving shelters, hospitals or other institutions, including prisons. The model works by providing emotional and practical support during the critical time of transition and by strengthening an individual’s long-term ties to services, family, friends and the community.

Research has shown that without adequate shelter, medical or mental health care, homeless people with mental illness often wind up in emergency rooms or in jails, neither of which is equipped to provide long-term solutions. Under the CTI model, a team of trained workers led by a licensed clinician connects these vulnerable adults, including those struggling with substance abuse and addiction, to critical services within the community more quickly. As a result, people are directed toward more sustainable and effective care and diverted away from costly hospitalizations and institutionalized care.

Although outcome data for the pilot project is still being evaluated, Smith and her colleagues are pleased with what they have learned so far. Since launching, the program has assisted nearly 115 people, a little more than half of whom were male. About 45 percent of all clients were diagnosed with a mood disorder; 18 percent were diagnosed with bipolar disorder; and another 18 percent were diagnosed with post-traumatic stress disorder.

This same report, which was compiled by Nick Lemmon, MSW ‘12, found that of the total clients served over the past two years:

  • 59 percent were housed, versus 43 percent at referral.
  • 53 percent had disability benefits, versus 41 percent at referral.
  • 65 percent were receiving mental health services, versus 44 percent at referral.
  • 52 percent were connected to primary care, versus 28 percent at referral.

Such data informs how effective CTI is, but the project has also helped identify the gap that remains between homeless and mental health services, Smith said.
“It’s been interesting, especially when agencies that offer each of these services are basically serving the same population,” she said. “So that’s been an interesting conundrum—how do you bring those two things together?”

Over the next few years, Smith hopes to see CTI programs in even more counties. In the meantime, the Orange County team is preparing to join a global CTI network. The network is being developed by Daniel Herman, a professor and associate dean for scholarship and research at New York’s Hunter College, and the creator of the CTI model.
The system will give those who support CTI a chance to build relationships and learn from one another, Smith added.

“What I’m hoping is that we can develop a really robust learning community and get all of these collaborative relationships going,” she said. “But I also hope we learn more about how to roll out a new evidence-based practice and make sure that providers who are doing it are doing it well and adhering to the model and making sure that it’s quality care.”