We propose a controlled study of the effectiveness of providing continuous mental health service for men with schizophrenia during the critical time of transition from the Fort Washington Shelter For Men to living in housing in the community in New York City. The objective of the intervention is to reduce homelessness in this population by placing and stabilizing the men in the community in this critical stage. While departure from the shelter signals a short term resolution of homelessness, it is appropriately seen as a time to increase rather than decrease supports to the men in transition. Our model of specialized support services, which we call Critical Time Intervention (CTI), draws from the successful model of community care developed in Madison, Wisconsin (Stein and Test, 1980). In response to the specific social context of men in shelters and in order to complement existing service provision in New York, we have developed a time-limited intervention which overlaps the period before and after placement out of the municipal shelter system and originates on-site in the shelter. Mindful of structural limitations on interventions with the homeless, we have aimed to develop a relatively straightforward, feasible, and replicable model of services to reduce homelessness among schizophrenic men in the shelter system. CTI focuses on stabilizing men in the community through """"""""in vivo"""""""" development of community living skills as well as assisting in coordination of and connection to social services and housing arrangements. A key aspect of CTI is that it is provided by staff who have established relationships with the men from within the shelter. Outreach and effectiveness are greatly enhanced by staff knowledge of the population and familiarity with the social context of the shelter system. A sample of 110 men will be thoroughly evaluated at intake into the study. This will include evaluation for diagnoses of schizophrenia, substance abuse, positive and negative symptoms of schizophrenia, and social functioning. After evaluation, these men will be randomized into the control (C) and experimental treatment trial (E) groups. C will receive regular services provided by the Presbyterian, Psychiatric Shelter Program at the Fort Washington Shelter. These services include outreach services, pharmacotherapy, health maintenance, development of community living skills while in the shelter, and housing placement services. Those in the experimental group will receive these services as well as """"""""in vivo"""""""" training in community living skills after placement in housing and team managed coordination of linkage to services in the community. It is hypothesized that the experimental service intervention will diminish the likelihood of recurrent homelessness among these men, both during and after the critical time intervention.
