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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
Housing Instability

Introduction

This toolkit summarizes content from the Housing Instability Evidence Accelerator and the MCHbest database. The peer-reviewed literature supporting this work can be found in the Established Evidence database. Use the resources below as you develop effective evidence-based/informed programs and measures.

From the MCH Block Grant Guidance. Safe and secure housing is a fundamental social determinant of health. Housing instability can include a variety of challenges, such as difficulty making housing payments, overcrowding, moving frequently, eviction, and homelessness.1 In pregnancy, housing instability is associated with inadequate prenatal care and adverse birth outcomes, including low birthweight and preterm birth.2 Housing instability, particularly in early childhood, is linked to poor health and development.1,3 Homelessness is the most extreme form of housing instability. The highest risk period for sheltered homelessness is the first year of life and families with children comprise a third of all sheltered homeless people.4 Housing instability disproportionately burdens those with lower income and Black and Hispanic populations.1-4

Goal. To reduce the percent of pregnant women and children experiencing housing instability.

Note. Access other related measures in this Population Domain through the Toolkits page.

Detail Sheet: Start with the MCH Block Grant Guidance

DEFINITION

Numerators:

Number of women who reported being evicted, homeless, or lacking a regular place to sleep in the 12 months prior to delivering an infant

Number of children, ages 0 through 11, whose parents reported being behind on a housing payment in the past year, that the child had lived in three or more places in the past year, or that they had ever been homeless

Denominators:

Number of women with a recent live birth (PRAMS)

Number of children ages 0 through 11 (NSCH)

Units: 100

Text: Percent

HEALTHY PEOPLE 2030 OBJECTIVE

Related to Social Determinants of Health (SDOH) Objective 4: Reduce the proportion of families that spend more than 30 percent of income on housing (Baseline: 34.6% in 2017, Target: 25.5%)

DATA SOURCES

Pregnancy Risk Assessment Monitoring System (PRAMS)

National Survey of Children’s Health (NSCH)

MCH POPULATION DOMAIN

Perinatal/Infant Health and/or Child Health

MEASURE DOMAIN

Social Determinants of Health

1. Accelerate with EvidenceStart with the Science

The first step to accelerate effective, evidence-based/informed programs is ensuring that the strategies we implement are meaningful and have high potential to affect desired change. Read more about using evidence-based/informed programs and then use this section to find strategies that you can adopt or adapt for your needs.

Evidence-based/Informed Strategies: MCHbest Database

The following strategies have emerged from studies in the scientific literature as being effective in advancing the measure. Use the links below to read more about each strategy or access the MCHbest database to find additional strategies.

Housing Instability – Pregnancy

Chart of Evidence-Linked Strategies and Tools related to Housing instability during pregnancy

Evidence-Informed

Evidence-Based

Mixed Evidence

Emerging Evidence

Expert Opinion

Moderate Evidence

Scientifically Rigorous

 

Housing Instability – Child

Chart of Evidence-Linked Strategies and Tools during childhood

Evidence-Informed

Evidence-Based

Mixed Evidence

Emerging Evidence

Expert Opinion

Moderate Evidence

Scientifically Rigorous

 

Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub

2. Think Upstream with Planning ToolsLead with the Need

The second step in developing effective, evidence-based/informed programs challenges us to plan upstream to ensure that our work addresses issues early and is measurable in “turning the curve” on big issues that face MCH populations. Read more about moving from root causes to responsive programs and then use this section to align your work with the data and needs of your populations.

Move from Need to Strategy

Use Root-Cause Analysis (RCA) and Results-Based Accountability (RBA) tools to build upon the science to determine how to address needs.

Planning Tools: Use these tools to move from data to action

3. Work Together with Implementation ToolsMove from Planning to Practice

The third step in developing effective, evidence-based/informed programs calls us to work together to ensure that programs are implementable and moveable within the realities of Title V programs and lead to improved health outcomes for all people. Read more about implementation tools designed for MCH population change and then use this section to develop responsive strategies to bring about change that is responsive to the needs of your populations.

Additional MCH Evidence Center Resources: Access supplemental materials from the literature

Implementation Resources: Use these field-generated resources to affect change

Practice. The following tools can be used to translate evidence to action to advance this NPM:

Partnership. The following organizations focus efforts on advancing housing stability:


References

Introductory References: From the MCH Block Grant Guidance

1 Healthy People 2030. Housing instability. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/housing-instability
2 DiTosto JD, Holder K, Soyemi E, Beestrum M, Yee LM. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM. 2021;3(6):100477. doi:10.1016/j.ajogmf.2021.100477. https://www.sciencedirect.com/science/article/abs/pii/S2589933321001725
3 Bess KD, Miller AL, Mehdipanah R. The effects of housing insecurity on children's health: a scoping review [published online ahead of print, 2022 Feb 4]. Health Promot Int. 2022;daac006. doi:10.1093/heapro/daac006 https://academic.oup.com/heapro/advance-article-abstract/doi/10.1093/heapro/daac006/6522744
4 U.S. Department of Housing and Urban Development. The 2017 Annual Homeless Assessment Report (AHAR) to Congress, Part 2: Estimates of Homelessness in the United States. https://www.huduser.gov/portal/datasets/ahar/2017-ahar-part-2-estimates-of-homelessness-in-the-us.html

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.