Applying a Case Management Model in a VA Homeless Program

October 2, 2026 updated by: VA Office of Research and Development

Implementing and Sustaining Critical Time Intervention (CTI) in Case Management Programs for Homeless-experienced Veterans (PII 21-285)

The VA Grant and Per Diem (GPD) case management aftercare program provides six months of case management for homeless-experienced Veterans undergoing housing transitions. This Partnered Implementation Initiative (PII) proposes to implement and evaluate Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-in 32 GPD case management aftercare sites across the nation.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The VA Grant and Per Diem case management (GPD-CM) program provides six months of case management for homeless-experienced Veterans (HEVs) undergoing housing transitions. At present, no specific case management paradigm is required in the GPD-CM program, resulting in practice variation across sites. This Partnered Implementation Initiative (PII) implements Critical Time Intervention (CTI)-an evidence-based, structured, and time-limited case management practice-at 32 VA GPD-CM sites. The investigators will use the Replicating Effective Programs (REP) implementation bundle to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external facilitation (enhanced REP) as additional support for CTI implementation. In a type 3 hybrid trial, the investigators will use mixed methods to examine the impacts of REP versus enhanced REP. Using trial data, the investigators will develop a business case analysis and implementation playbook for the investigators' program partners to support continued CTI spread and sustainment in the GPD-CM program.

Study Type

Interventional

Enrollment (Actual)

192

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • West Los Angeles, California, United States, 90073-1003
        • VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Grant and Per Diem (GPD) case management aftercare grantees in 7 Veterans Integrated Service Networks (VISN), all of whom provide 6-months of case management to Veterans who have experienced homelessness

Exclusion Criteria:

  • None

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Replicating Effective Programs (REP)

A stakeholder-informed training and technical assistance implementation strategy
Behavioral: Critical Time Intervention (CTI)

An evidence-based, structured, and time-limited case management practice

Other Names:
  • CTI
Other: Replicating Effective Programs

A stakeholder-informed training and technical assistance implementation strategy

Other Names:
  • REP
Active Comparator: REP + External Facilitation (Enhanced REP)

REP plus site specific weekly facilitation to support critical time intervention (CTI) implementation.
Behavioral: Critical Time Intervention (CTI)

An evidence-based, structured, and time-limited case management practice

Other Names:
  • CTI
Other: Replicating Effective Programs

A stakeholder-informed training and technical assistance implementation strategy

Other Names:
  • REP
Other: External Facilitation

Site-specific support to help sites develop tailored plans to implement critical time intervention (CTI)

Other Names:
  • Coaching
No Intervention: Control Group

No critical time intervention (CTI) implementation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fidelity to critical time intervention (CTI)
Time Frame: 12 months after implementation start

% of Sites with adequate fidelity to CTI at 12 months, as measured by the CTI fidelity scale
12 months after implementation start
Sustainment of critical time intervention (CTI)
Time Frame: 18 months after implementation start

% of Sites with adequate fidelity to CTI at 18 months, as measured by the CTI fidelity scale
18 months after implementation start
Dollars spent delivering critical time intervention (CTI) at each site
Time Frame: Between 6 and 18 months after implementation start

Case manager salary and benefits
Between 6 and 18 months after implementation start

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Housing stability
Time Frame: Between 6 and 18 months after implementation start

Days between entry into the GPD case management program and indicator of housing instability
Between 6 and 18 months after implementation start
Cost of critical time intervention (CTI) as Implemented
Time Frame: Between 6 and 18 months after implementation start

Mean monthly cost of CTI case management per GPD case management Veteran served, compared to the mean monthly cost in the non-CTI GPD case management programs.
Between 6 and 18 months after implementation start
Hospitalization rates
Time Frame: Between 6 and 18 months after implementation start

Number of days between entry into the GPD case management program and hospitalization, number of hospitalizations, number of bed days
Between 6 and 18 months after implementation start
Cost of Implementation Strategies
Time Frame: Through study completion, 4 years

Dollars spent on REP versus enhanced REP
Through study completion, 4 years
Return on Investment (ROI) of critical time intervention (CTI)
Time Frame: 6-, 12-, and 18-months after GPD case management program enrollment

Dollars saved via improved housing stability and decreased hospitalizations among patients engaged in CTI versus control participants
6-, 12-, and 18-months after GPD case management program enrollment
Outpatient service use
Time Frame: Between 6 and 18 months after implementation start

Number of outpatient appointments
Between 6 and 18 months after implementation start

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

VA Office of Research and Development

Collaborators

University of California, Los Angeles
University of Southern California
Center for the Advancement of Critical Time Intervention

Investigators

  • Principal Investigator: Sonya Emi Gabrielian, MD MPH, VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 1, 2021

Primary Completion (Actual)

September 30, 2026

Study Completion (Actual)

September 30, 2026

Study Registration Dates

First Submitted

March 10, 2022

First Submitted That Met QC Criteria

April 4, 2022

First Posted (Actual)

April 5, 2022

Study Record Updates

Last Update Posted (Actual)

October 7, 2026

Last Update Submitted That Met QC Criteria

October 2, 2026

Last Verified

October 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • PIX 22-001
  • PII 21-285 (Other Grant/Funding Number: QUERI)
  • 1I50HX003501-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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