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Use of a Critical Time Intervention to Promote Continuity of Care After Psychiatric Inpatient Hospitalization

Dr. Dixon is affiliated with the Department of Psychiatry, University of Maryland School of Medicine, 737 West Baltimore St., 5th Floor, Baltimore, MD 21201 (e-mail: ldixon{at}psych.umaryland.edu). Dr. Goldberg, Dr. Lucksted, Dr. Brown, Dr. Kreyenbuhl, Ms. Fang, and Ms. Potts are with the Department of Veterans Affairs Capitol Healthcare Network, Mental Illness Research Educational and Clinical Center, Baltimore, Maryland. Dr. Iannone is with the Department of Psychology, Villa Julie College, Baltimore.

OBJECTIVES: This study assessed the effectiveness of a brief three-month critical time intervention (B-CTI) model in improving continuity of psychiatric outpatient care for individuals with serious mental illness who are discharged from inpatient psychiatric treatment facilities. METHODS: A total of 135 consenting veterans who were diagnosed as having serious mental illness and were discharged from an acute inpatient unit were randomly assigned to receive either B-CTI or usual care. The three-month B-CTI intervention begins before discharge. A B-CTI clinician meets with the patient, assesses needs, and maintains a high level of patient contact after discharge. Participants completed interviews at baseline and three months later. Chart reviews provided data on service utilization in the six months postdischarge. RESULTS: Compared with the control group, the B-CTI group had significantly fewer days between their hospital discharge and their first outpatient service. B-CTI participants were more likely to have had an outpatient visit and to have had more total mental health and substance abuse visits within 30 and 180 days of discharge. They had greater continuity of care as evidenced by a greater number of two-month blocks with two or more outpatient visits over 180 days. Participants in the B-CTI group reported receiving more help in making and keeping medical and mental health appointments, making family contact and community connections, and receiving information on prescribed medications. CONCLUSIONS: This study provides evidence that a B-CTI targeted at the point of inpatient discharge can be helpful in promoting postdischarge continuity of care for persons with serious mental illness. The limited association of improved continuity of care with patient outcomes in this brief intervention demands further study.

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