# Implementing and sustaining Critical Time Intervention (CTI) in case management programs for homeless-experienced Veterans

> **NIH VA I50** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2022 · —

## Abstract

Background: 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. National implementation of Critical Time Intervention (CTI)—an evidence-based, structured, and time-
limited case management program for HEVs experiencing housing transitions—would standardize and
improve case management in the GPD-CM program. Implementing CTI in routine care settings requires
balancing the need for CTI fidelity with adaptations to fit the diverse programs serving this population.
Moreover, some organizational contexts may require more intense and tailored supports to implement CTI.
Objectives: We propose to implement CTI at 32 GPD-CM sites. To implement and sustain CTI across these
sites, we will use the Replicating Effective Programs (REP) implementation bundle to enable sites to achieve
fidelity to CTI’s core components, while accommodating adaptations to fit the diversity of GPD-CM settings
and contexts. We will cluster randomize half the sites to also receive 9 months of external facilitation
(“enhanced REP”), an established process of providing tailored support for providers and leaders in the ir
efforts to adopt and incorporate EBPs into their routine care processes. Our Specific Aims are to: 1) Use REP
and enhanced REP to support the implementation and sustainment of CTI in 32 GPD -CM sites; 2) Compare, in
a type 3 hybrid implementation-effectiveness trial, the impacts of REP vs. enhanced REP on CTI fidelity and
sustainment, quality metrics (focused on housing stability and hospitalization rates), and costs and return-on-
investment; and 3) Generate two key products for program partners—a business case analysis and an
implementation playbook —to support continued spread and sustainment of CTI in the GPD -CM program.
Methods: We will use a CTI training and technical assistance package developed and refined in our QUERI-
VISN Partnered Implementation Initiative (PII) Start-up to implement CTI in 32 GPD-CM sites. We will use
REP to support CTI implementation at all 32 sites. Half of these sites will also receive 9 months of external
facilitation (EF, as part of enhanced REP), building on our EF experiences and materials developed in the PII
Start-up. To compare the impacts of REP vs. enhanced REP, we will conduct a cluster randomized type 3
hybrid trial. We will use a rollout design in which randomization occurs at two levels: when impleme ntation
begins (three cohorts) and the implementation strategy (REP vs. enhanced REP). We will use permuted block
randomization to balance key site characteristics among sites receiving each of these strategies across cohorts.
We will use mixed methods to assess the impacts of REP vs. enhanced REP. As fidelity to CTI influences its
effectiveness, fidelity to CTI is our primary outco...

## Key facts

- **NIH application ID:** 10419848
- **Project number:** 1I50HX003501-01
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Kristina Marie Cordasco
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10419848

## Citation

> US National Institutes of Health, RePORTER application 10419848, Implementing and sustaining Critical Time Intervention (CTI) in case management programs for homeless-experienced Veterans (1I50HX003501-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10419848. Licensed CC0.

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