Adaptation of Critical Time Intervention for Young Adults with Mental Health Challenges in the Transition from Homelessness to Housing

经历无家可归的年轻人（YAEH）有很高的精神障碍患病率，然而， 他们在获得心理健康服务方面面临着独特的障碍， 症状，导致心理健康服务利用率低。过渡点从 无家可归的住房提供了一个机会，以确定心理健康症状和连接 让YAEH参与心理健康服务，以减少症状并促进住房稳定。的 2019冠状病毒病大流行加剧了心理健康症状，并增加了对服务的需求， YAEH，但它也导致恢复基金，以增加许多社区的住房支持。 迫切需要制定干预措施，以支持YAEH的心理健康挑战， 随着更多的支助性住房出现，他们从无家可归过渡到有房可住。 关键时间干预（CTI）是一种结构化、有时限的病例管理干预， 在多项随机对照试验中， 尚未在YAEH中进行测试。本研究的目标是使CTI适应从 在快速安置方案内，将无家可归者安置到支助性住房， 内容来自年轻成人治疗模型，C4，以开发CTI-YAMH（年轻成人心理健康），以及 然后在可行性试点中测试新的干预措施。具体而言，我们的目标是：目标1：完善气候技术倡议草案- YAMH干预（治疗，培训和评估协议），以确保目标机制 充分解决稳定住房和心理健康，利用迭代利益相关者反馈 完成试点测试手册的过程，然后目标2：对经过调整的CTI进行公开试验， YAMH干预，以评估随机化程序的可行性，完善结局指标， 评估可接受性，并检查干预措施影响的初步信号。这一创新 这项研究针对的是一个关键的干预点，即从无家可归到住房的过渡， 利用一个创新的适应框架-ADAPT-ITT， 通过与具有生活经验的青年和社区提供者合作，调整CTI。CTI-YAMH 干预措施旨在通过一种模式， 这可以与快速安置相结合，这是一种广泛用于社区的支持性住房模式， 美国这项R34研究的结果为CTI-YAMH的全面RCT奠定了基础 未来R01研究中的干预。

Young adults experiencing homelessness (YAEH) have high prevalence of mental disorders, however, they face unique access barriers to mental health services combined with low recognition of mental health symptoms, leading to low rates of mental health service utilization. The point of transition from homelessness to housing presents a period of opportunity to identify mental health symptoms and connect and engage YAEH into mental health services to reduce symptoms and promote housing stability. The COVID-19 pandemic has heightened mental health symptoms and increased the need for services among YAEH, but it has also resulted in recovery funds to increase housing supports in many communities. There is a critical need to develop interventions that can support YAEH with mental health challenges as they make the transition from homelessness to housing as more supported housing becomes available. Critical Time Intervention (CTI), a structured, time limited case management intervention has demonstrated success with adults with serious mental illness in multiple randomized controlled trials but it has not been tested in YAEH. The goal of this study is to adapt CTI for the context of transition from homelessness to supported housing within the rapid rehousing program, integrating mental health specific content from a young adult treatment model, C4, to develop CTI-YAMH (young adult mental health), and then test the new intervention in a feasibility pilot. Specifically, we aim to: Aim 1: Refine the draft CTI- YAMH intervention (treatment, training and assessment protocols) to ensure the target mechanisms are adequately addressed for stabilizing housing and mental health, utilizing an iterative stakeholder feedback process to finalize the manuals for pilot testing, then Aim 2: Conduct an open trial of the adapted CTI- YAMH intervention to assess the feasibility of randomization procedures, refine outcome measures, assess acceptability, and examine the preliminary signal of impact of the intervention. This innovative study targets a critical point of intervention, the transition from homelessness to housing, for an extremely marginalized group (YAEH), utilizing an innovative adaptation framework, ADAPT-ITT, to systematically adapt CTI in partnership with youth with lived expertise and community providers. The CTI-YAMH intervention aims to support a population with high unmet need for mental health services through a model that can be paired with rapid rehousing, a supportive housing model widely used in communities across the U.S. Results from this R34 study lay the foundation for a fully powered RCT of the CTI-YAMH intervention in a future R01 study.