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.
