Critical time intervention for people leaving prison at risk of homelessness in England and Wales (PHaCT trial): a pilot feasibility randomised controlled trial.

Williams, Adam Dale Newman, Jacob, Nina, Grozeva, Detelina ORCID: https://orcid.org/0000-0003-3239-8415, Lloyd, Barry ORCID: https://orcid.org/0000-0003-4763-1726, Moriarty, Yvonne ORCID: https://orcid.org/0000-0002-7608-4699, Deidda, Manuela, Achiaw, Samuel Owusu, Thomas, Ian, Lewis, Kelly, Cannings-John, Rebecca ORCID: https://orcid.org/0000-0001-5235-6517, Madoc-Jones, Iolo, Fitzpatrick, Suzanne, Katikireddi, Srinivasa Vittal, Mackie, Peter ORCID: https://orcid.org/0000-0003-1494-0864, White, James ORCID: https://orcid.org/0000-0001-8371-8453 and Lewsey, Jim 2025. Critical time intervention for people leaving prison at risk of homelessness in England and Wales (PHaCT trial): a pilot feasibility randomised controlled trial. BMJ Open 15 (12) , e097753. 10.1136/bmjopen-2024-097753

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Abstract

ObjectiveTo 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.DesignPilot parallel two-arm individual level RCT, including process evaluation and embedded exploratory health economic evaluation.SettingFour prisons for men across England and Wales, UK.ParticipantsMen leaving prison at risk of homelessness and intervention delivery staff.InterventionCTI 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 measuresProgression 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.ResultsThe 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.ConclusionThis 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 numberISRCTN46969988.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Geography and Planning (GEOPL) Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR)
Additional Information:	License information from Publisher: LICENSE 1: Title: cc by, Type: cc by
Publisher:	BMJ Publishing Group
ISSN:	2044-6055
Date of First Compliant Deposit:	8 January 2026
Date of Acceptance:	28 October 2025
Last Modified:	08 Jan 2026 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/183710

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