Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial.

To help create an evidence base in Europe for effective interventions that improve the well-being of homeless people, we tested whether critical time intervention (CTI), a time-limited intervention developed to support vulnerable people during times of transition, is effective outside the United States. For this multicenter, parallel-group randomized controlled trial, 183 adults who were moving from shelters in the Netherlands to supported or independent housing were allocated to CTI or care-as-usual. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9-month follow-up. Outcomes were analyzed with three-level mixed-effects models. The primary outcome did not differ between groups. CTI had a significant effect on family support and, for people experiencing less social support, psychological distress. Groups did not differ significantly on social support, fulfillment of care needs, quality of life, self-esteem, excessive alcohol use, or cannabis use. Because few participants were homeless at 9 months, more research is needed to establish whether CTI can prevent long-term recurrent homelessness. Given recent emphasis on informal support in public services and positive effects of CTI on family support and psychological distress, CTI is a fitting intervention for Dutch shelter services.

The effectiveness of interventions during and after residence in women's shelters: a meta-analysis.

BACKGROUND: Due to intimate partner violence (IPV), a proportion of some women seek safety from their abuser in shelters. Little is known yet about whether the received shelter interventions, offered during and after women's stay, are effective. Therefore, a meta-analysis of studies was performed, testing the effectiveness of interventions administered to female IPV victims during and/or after their residence in shelters, in terms of mental health, re-abuse and social outcomes. METHODS: From January 1985 through July 2011, five databases were searched for English-language articles. Original research articles evaluating the effects of interventions provided to IPV victims during and after shelter residence were identified. Hedges' g effect sizes and 95% confidence intervals (CIs) were calculated and pooled if three or more studies including one outcome type were available. RESULTS: Ten original studies, including a total number of 726 female IPV victims, were analysed. We found that shelter interventions were effective in improving mental health outcomes (g = -0.39; 95% CI: 0.24-0.54), in decreasing abuse (g = 0.32; 95% CI: 0.08-0.55) and in improving social outcomes (g = 0.71; 95% CI: 0.54-0.88) in shelter-based abused women. CONCLUSION: This analysis suggests that interventions provided during and after stay in a shelter are effective in improving mental health, abuse and social outcomes, but further research has to confirm this. Moreover, future studies should compare different type of interventions and should evaluate cost-effectiveness.

Factors Related To Depression and Post-Traumatic Stress Disorder in Shelter-Based Abused Women.

In this study, linear mixed-effects regression analyses were used to examine whether sociodemographic variables, abuse-related variables, and well-being variables were associated with symptoms of depression and post-traumatic stress disorder (PTSD) in abused women residing in shelters. Results pointed out that symptoms of depression severity were positively associated with migration background and the experience of physical abuse and negatively associated with self-esteem and social support. PTSD symptoms were positively associated with the experience of sexual abuse and negatively associated with self-esteem. Within women's shelters, staff could be sensitive to improving the social integration of women, especially those with a non-Dutch background, and strengthening the women's social networks and their self-esteem.

The effectiveness of critical time intervention for abused women leaving women's shelters: a randomized controlled trial.

OBJECTIVES: To examine the effectiveness of critical time intervention (CTI)-an evidence-based intervention-for abused women transitioning from women's shelters to community living. METHODS: A randomized controlled trial was conducted in nine women's shelters across the Netherlands. 136 women were assigned to CTI (n = 70) or care-as-usual (n = 66). Data were analyzed using intention-to-treat three-level mixed-effects models. RESULTS: Women in the CTI group had significant fewer symptoms of post-traumatic stress (secondary outcome) (adjusted mean difference - 7.27, 95% CI - 14.31 to - 0.22) and a significant fourfold reduction in unmet care needs (intermediate outcome) (95% CI 0.06-0.94) compared to women in the care-as-usual group. No differences were found for quality of life (primary outcome), re-abuse, symptoms of depression, psychological distress, self-esteem (secondary outcomes), family support, and social support (intermediate outcomes). CONCLUSIONS: This study shows that CTI is effective in a population of abused women in terms of a reduction of post-traumatic stress symptoms and unmet care needs. Because follow-up ended after the prescribed intervention period, further research is needed to determine the full long-term effects of CTI in this population.

Appropriate care for shelter-based abused women: concept mapping with Dutch clients and professionals.

We conducted a concept mapping exercise to gain insight into the perspectives held by abused women and professionals with regard to appropriate care in Dutch women's shelters. Three brainstorming sessions generated 92 statements that were then rated by 56 clients and 51 professionals. A total of 11 clusters were identified. The three most important clusters were "help with finding a safe house if necessary," "safety and suitable care for the children," and "a personalized, respectful approach." The most important statement was "take women seriously and treat them with respect." The mapping exercise identified key practice-based elements of intervention that should better accommodate the needs of shelter-based abused women. We have used these elements in developing a new intervention for shelter-based abused women in the Netherlands.