Critical Time Intervention in Preventing Homelessness Among Veterans with PTSD - Research Paper Example

? Does Critical Time Intervention Prevent Future Homelessness among Veterans Suffering From Post-Traumatic Stress Disorder California University, Northridge Abstract This research study is designed to predict the situation in the veterans suffering from Post-Traumatic Stress Disorder (PTSD) in terms of their homelessness. In this study, the effectiveness of social services alone or social services coupled with Critical Time Intervention (CTI) is evaluated to assess the homelessness of the veterans suffering from Post-Traumatic Stress Disorder (PTSD). The sample of this study includes seventy participants such that half of them is the ones who are provided with only social services, and the other half was provided with both the social services as well as Critical Time Intervention (CTI). Eighteen months’ period has been considered for this study such that the behaviors of veterans during the later nine months out of eighteen months are studied. The results show that the group of veterans who were provided with only social services, spent eighty-seven nights out of their homes whereas the group of veterans who were provided with both the social services and Critical Time Intervention (CTI), spent only thirty-two nights outside their shelter. The findings of these results ensure that Critical Time Intervention is still a better therapy to rehabilitate the veterans suffering from Post-Traumatic Stress Disorder (PTSD). The implication of this study holds that the time after Post-Traumatic Stress Disorder (PTSD) is quite critical to prevent veterans suffering from Post-Traumatic Stress Disorder (PTSD) from their likely future homelessness. Introduction Homelessness has become a major area of concern not only in underdeveloped countries, but also in developing and developed countries. The definition of homeless veterans includes the status of both veterans and homeless. A veteran is a person who has served in the naval, active military or air service. Many studies related to homeless veterans describe veterans as any person who served in the military, irrespective of the discharged status or active duty. Homeless, as defined by McKinley-Vento Act, is an individual who lacks regular, fixed and adequate nighttime residence. Therefore, homeless veterans are those individuals who have served in the naval, air or military forces and due to experiencing Post-Traumatic Stress Disorder have gone homeless. This paper discusses the impact of treatment of Critical Time Intervention along with social services in veterans to avoid future homelessness. Critical Time Intervention (CTI) is a clinical trial tested approach which helps in preventing homelessness among those individuals who are mentally ill. It is a widespread belief that mentally disabled people are treated, accommodated and provided with care at community centers, but we frequently fail to do so. In the U.S, the risk of people suffering from schizophrenia to get homeless is 20% to 50%. It is an arguable point that prevention of homelessness among mentally disabled people is a crucial issue for public health. Those men and women who get homeless not only suffer from destitution and demoralization but are also exposed to other adversities including becoming a victim of assault or rape or contracting severe medical diseases such as tuberculosis, etc. It might be impractical and unrealistic, but to a certain extent, the associated risks can be reduced. Critical Time Intervention (CTI) was designed to prevent people who are suffering from mental disabilities from becoming homeless. For these people, the change from institutional and public living is highly vulnerable. At this point of time, the mental health programs being offered currently are less for homeless people, whether they are street, shelters or justice systems. Those that exist usually fail to provide community care services after the patients move into housing. The lack of support usually results in homelessness of mentally disabled people. The purpose of CTI is to reduce this problem by providing a specialized transition for this critical period which bridges the gap between community services and homelessness. Researchers have always been curious to determine the effectiveness of implementing programs related to Critical Time Intervention (CTI). In this regard, extensive research has been conducted in order to determine if Critical Time Intervention (CTI) along with social and community services can be beneficial for mentally disabled veterans or clients. A brief literature corpus which highlights some important studies conducted in the relevant area has been mentioned in the subsequent sections of this paper. In order to prevent homelessness in mentally disabled men, Susser et al. (1997) conducted research. In this study, authors attempted to build a bridge between community and institutional care. The scholars found out that the difference between two groups, one having CIT along with community services, and the other having only community services, did not diminish. Susser et al. (1997) stated that strategies which focus on CIT may contribute to prevent homelessness among mentally disabled people (Susser et al., 1997). Drake, Wallach and Hoffman (1989) conducted a study and took a sample of 187 patients with chronic mental illness. According to the clinicians, 10% were homeless occasionally while 17% patients were homeless predominantly. Drake, Wallach and Hoffman (1989) found that younger and male patients were more likely to be homeless due to several reasons such as street drugs, abuse of alcohol, variety of psychological problems, treatment noncompliance, etc. (Drake, Wallach, & Hoffman, 1989). Cohen and Thompson (1992) stated that people who are mentally ill and homeless are different from other homeless people because it is believed that their homelessness is caused by poor implementation of institutionalization and mental disorders. In addition to that, Cohen and Thompson (1992) stated that the recent political and socioeconomic shift has contributed immensely to homelessness among all groups irrespective of their mental illness. The authors further stated that mental distress is high and common among almost all homeless persons (Cohen & Thompson, 1992). Caton, Wyatt, Grunberg and Felix (1990) provided results related to pre- and post-evaluation of the mental health-day treatment program for those men who are homeless. The findings supported the need to perform controlled experiments for the psychological treatments of the mentally disabled homeless people (Caton et al., 1990). In the research of Morse et al. (1992), a continuous treatment program was experimented, which included a high staff-to-client ratio, assertive outreach and intensive care management. After the study of twelve months, it was found that clients spent less time being homeless, had increased income, self-esteem and interpersonal adjustments and showed fewer psychiatric symptoms. The clients who underwent a continuous treatment program spent fewer days homeless, were more satisfied with treatment programs and used more resources and community services than other groups of clients (Morse et al., 1992). Leda and Rosenheck (1992) conducted a study on homeless veterans who participated in treatment programs. The study was conducted in medical centers of California, Ohio and Florida. Multiple dimensions, such as alcohol abuse, social contacts, drug abuse, employment, income and housing were examined. It was found that improvement in psychiatric symptoms was related to community adjustment and superior housing outcomes (Leda & Rosenheck, 1992). After reviewing the relevant studies, it can be stated that most studies are inclined towards supporting CTI treatment along with social and community services. In order to prevent homelessness among mentally disabled people, this paper moves to the next level where qualitative study supports the prior mentioned studies. Methodology This research on the importance of Critical Time Intervention can be viewed in terms of its effects. In order to evaluate the effectiveness of Critical Time Intervention among the veterans, two control groups have been formed such that one of the control groups is provided with the social services only. Conversely, the other control group is provided with both the social services and Critical Time Intervention (CTI) services. As far as the independent variables are concerned, two variables, i.e. social services and CTI, are used as independent variables. The dependent variable used in this study is the number of nights which these veterans stay outside the shelters. The research study involves the sample of seventy veterans such that half of them belong to that control group to which only social services are provided. The other half consists of those veterans who have received not only social services but also CTI services. The ages of the veteran are between twenty-two and forty years. These veterans which are included in the samples belong to the Los Angeles shelter for homeless veterans. These are the veterans, who have spent eighteen months as Post-Traumatic Stress Disorder (PTSD). The control group which has been provided with social services only is provided with only nine months whereas the one which was provided with both the social services and CTI were provided with first nine months as CTI, and then they were left to live their normal lives for the next nine months, i.e. effectively eighteen months in total. The later nine months of CTI group and the whole nine months of the social services group are observed to figure out the average number of nights spent outside the shelter by each group. Research Hypotheses H0: Veteran suffering from Post-Traumatic Stress Disorder (PTSD) cannot prevent future homelessness if they are provided with social services along with Critical Time Intervention. HA: Veteran suffering from Post-Traumatic Stress Disorder (PTSD) can prevent future homelessness if they are provided with social services along with Critical Time Intervention. Hypothesized Results The results of this study can be inferred by figuring out the number of nights spent outside the shelters or homes by those veterans who are suffering from Post-Traumatic Stress Disorder (PTSD). The average of the participant under this study was around 28.3 years. During the nine months of observation, on average around eighty-seven nights are spent outside the shelter by the control group who were provided with only social services. On the other hand, the other control group which was provided with both the social services and Critical Time Intervention (CTI) spent on average around thirty-two nights out of nine months’ observation period. This result shows that the null hypothesis for this research study has been rejected which stated that Veteran suffering Post-Traumatic Stress Disorder (PTSD) could not prevent future homelessness if they are provided with social services along with Critical Time Intervention. In this way, the alternative hypothesis which stated that Veteran suffering Post-Traumatic Stress Disorder (PTSD) could prevent future homelessness if they are provided with social services along with Critical Time Intervention can be accepted. This shows that there is a much greater gap present between the social services alone and social services coupled with Critical Time Intervention (CTI) therapy for the veterans suffering from Post-Traumatic Stress Disorder (PTSD). Discussion and Implications According to the findings of the present research, Critical Time Interventions (CTI) has turned out to be an emerging therapy especially for prevention of homelessness. The study has highlighted two main outcomes regarding the exercise of CTI. The first outcome is in fact the main result of this study which holds that Critical Time Intervention has remained mostly successful in preventing homelessness of Post-Traumatic Stress Disorder (PTSD) veterans as compared to those veterans who were only provided with social services. On average, it can be noted that the ratio of homelessness among social services group is twice more than that of Critical Time Intervention group (eighty-seven homeless nights versus thirty-two homeless nights). Therefore, CTI has stronger ability to prevent homelessness, but it cannot prevent it entirely. Another important aspect of this study is that with the passage of time, the difference between the number of nights spent outside the shelter between both groups is on an increasing trend rather than decreasing or being constant. This is mainly due to the fact that in the case of the group of veterans provided with social services only, the number of nights they spent outside the shelter is increasing at a greater pace than that of the group which was provided with additional CTI therapy. In the above graph, the distance between the two lines is widening up as the number of months of observation are increasing. In a nutshell, CTI therapy is found out to be one of the best strategies which can not only prevent homelessness at an early stage, but it can be planned out once the rehabilitation process of a Post-Traumatic Stress Disorder (PTSD) veteran has started off. References Caton, C. L., Wyatt, R. J., Grunberg, J. and Felix, A. (1990). An evaluation of a mental health program for homeless men. Am J Psychiatry, 147(3), 286-9. Cohen, C.I. and Thompson, K. S. (1992). Homeless mentally ill or mentally ill homeless? Am J Psychiatry, 149(6), 816-23. Drake, R. E., Wallach, M. A. and Hoffman, J.S. (1989). Housing instability and homelessness among aftercare patients of an urban state hospital. Hosp. Community Psychiatry, 40(1), 46-51. Leda, C., and Rosenheck, R. (1992). Mental health status and community adjustment after treatment in a residential treatment program for homeless veterans. Am J Psychiatry, 149(9), 1219-24. Morse, G. A., Calsyn, R. J., Allen, G., Tempelhoff, B. and Smith, R. (1992). Experimental comparison of the effects of three treatment programs for homeless mentally ill people. Hosp Community Psychiatry, 43(10), 1005-10. Susser E, Moore R, Link B. (1993). Risk factors for homelessness. Epidemiol Rev., 15(2), 546-56. Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W. Y. and Wyatt, R. J. (1997). Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter. Am J Public Health, 87(2), 256–262. Read More