An estimated 100,000 people with mental illness are released to communities from prison each year. These individuals frequently have co-occurring substance abuse disorders. They enter an extreme life transition where there are few, if any, rehabilitative resources for ex-prisoners, much less those with mental illness or their families. What is done by, for, and with these individuals under such stress can make the difference between a new life;and a return to the conditions that contributed to the old life. We propose a randomized field trial of the Critical Time Intervention (CTI). CTI is a nine month, phased intervention of psychiatrically supervised time-limited case management to support transition from institutional settings to community life. It has an evidence base of efficacy for individuals with mental illness leaving homeless shelters, as well as cost effectiveness in those settings. It has been replicated for individuals leaving state psychiatric hospitals and in the Veterans Affairs medical system. A demonstration of effectiveness for homeless women with mental illness in shelters earned CTI a place among evidence based practices featured in the President's New Freedom Commission report. CTI has never been tested for people leaving jail or prison. CTI, tested against an enhanced reentry planning from prison, is expected to be more effective in reducing recidivism and increasing the chances for community integration for this population. Because so many have substance use disorders, we are proposing a service integration support strategy for co-occurring substance abuse disorders. At least 352 men leaving prison for Camden County, NJ will be randomized, half to receive CTI and half to receive an enhanced reentry planning intervention. The implementation and effectiveness of the intervention will be assessed by interviews at 1, 3, 6, 9, and 18 months post release, collecting clinical data as well as data on treatment engagement and community integration. We will test the mediating role of growth in resources from community connections.
