TY - JOUR
T1 - Critical time intervention for people leaving prison at risk of homelessness in England and Wales (PHaCT trial)
T2 - a pilot feasibility randomised controlled trial
AU - Williams, Adam Dale Newman
AU - Jacob, Nina
AU - Grozeva, Detelina
AU - Lloyd, Barry
AU - Moriarty, Yvonne
AU - Deidda, Manuela
AU - Achiaw, Samuel Owusu
AU - Thomas, Ian
AU - Lewis, Kelly
AU - Cannings-John, Rebecca
AU - Madoc-Jones, Iolo
AU - Fitzpatrick, Suzanne
AU - Katikireddi, Srinivasa Vittal
AU - Mackie, Peter
AU - White, James
AU - Lewsey, Jim
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
PY - 2025/12/17
Y1 - 2025/12/17
N2 - OBJECTIVE: To determine whether a full-scale randomised control trial (RCT) assessing the efficacy and cost-effectiveness of a housing led Critical Time Intervention (CTI) is feasible and acceptable. DESIGN: Pilot parallel two-arm individual level RCT, including process evaluation and embedded exploratory health economic evaluation.SETTING: Four prisons for men across England and Wales, UK.PARTICIPANTS: Men leaving prison at risk of homelessness and intervention delivery staff. INTERVENTION: CTI has four components: (1) pre-engagement phase: assessing the needs of the client and implementing a plan pre-discharge; (2) transition to community: forming relationships and goal setting; (3) try out: encouraging problem-solving and managing practical issues and (4) transfer of care: developing long-term goals and transferring responsibilities to community providers.OUTCOME MEASURES: Progression criteria: recruitment, retention, acceptability of the processes (CTI and trial method) and fidelity of intervention delivery. We also assessed the completeness of primary, secondary and exploratory outcome measures and estimated intervention costs.RESULTS: The recruitment progression criterion was met, with 92% (34/37) of approached individuals consenting to participate (target: 50%). However, the overall recruitment target of 80 was not achieved, and retention was low, only 18% (6/34) provided follow-up data, well below the 60% threshold. Retention was hindered by systemic challenges, including changes to prison release policies and reduced probation support. While the CTI model was acceptable to staff and service users, the trial design, particularly randomisation, was not. Intervention fidelity met the progression criteria. Baseline data collection for health economics and resource use was feasible, and intervention costs were estimated. CONCLUSION: This pilot trial identified significant challenges to conducting a full-scale RCT of CTI in this context, particularly around retention, trial acceptability and systemic instability. While CTI remains a promising model, a traditional RCT design may not be viable in this setting without substantial structural and ethical adaptations.TRIAL REGISTRATION NUMBER: ISRCTN46969988.
AB - OBJECTIVE: To determine whether a full-scale randomised control trial (RCT) assessing the efficacy and cost-effectiveness of a housing led Critical Time Intervention (CTI) is feasible and acceptable. DESIGN: Pilot parallel two-arm individual level RCT, including process evaluation and embedded exploratory health economic evaluation.SETTING: Four prisons for men across England and Wales, UK.PARTICIPANTS: Men leaving prison at risk of homelessness and intervention delivery staff. INTERVENTION: CTI has four components: (1) pre-engagement phase: assessing the needs of the client and implementing a plan pre-discharge; (2) transition to community: forming relationships and goal setting; (3) try out: encouraging problem-solving and managing practical issues and (4) transfer of care: developing long-term goals and transferring responsibilities to community providers.OUTCOME MEASURES: Progression criteria: recruitment, retention, acceptability of the processes (CTI and trial method) and fidelity of intervention delivery. We also assessed the completeness of primary, secondary and exploratory outcome measures and estimated intervention costs.RESULTS: The recruitment progression criterion was met, with 92% (34/37) of approached individuals consenting to participate (target: 50%). However, the overall recruitment target of 80 was not achieved, and retention was low, only 18% (6/34) provided follow-up data, well below the 60% threshold. Retention was hindered by systemic challenges, including changes to prison release policies and reduced probation support. While the CTI model was acceptable to staff and service users, the trial design, particularly randomisation, was not. Intervention fidelity met the progression criteria. Baseline data collection for health economics and resource use was feasible, and intervention costs were estimated. CONCLUSION: This pilot trial identified significant challenges to conducting a full-scale RCT of CTI in this context, particularly around retention, trial acceptability and systemic instability. While CTI remains a promising model, a traditional RCT design may not be viable in this setting without substantial structural and ethical adaptations.TRIAL REGISTRATION NUMBER: ISRCTN46969988.
KW - Feasibility Studies
KW - Prisons
KW - Quality of Life
KW - Randomized Controlled Trial
KW - Vulnerable Populations
UR - https://www.scopus.com/pages/publications/105025170940
U2 - 10.1136/bmjopen-2024-097753
DO - 10.1136/bmjopen-2024-097753
M3 - Article
C2 - 41407408
AN - SCOPUS:105025170940
SN - 2044-6055
VL - 15
SP - e097753
JO - BMJ Open
JF - BMJ Open
IS - 12
ER -