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Strengthen the Evidence for Maternal and Child Health Programs

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.

Overview: Read a summary of the issue related to Title V

Housing instability can occur due to high housing costs, difficulty making housing payments, poor housing quality, unstable neighborhoods, overcrowding, frequent moves, eviction, homelessness, or reliance on temporary housing programs.1 Homelessness is the most extreme form of housing instability. A woman’s housing status while pregnant directly impacts birth outcomes and the health of the growing child.2 Stable housing promotes positive maternal and child health outcomes.2

Definitions. Housing stability, affordability, safety, and quality are intersecting constructs that all affect health outcomes, as do the physical and social characteristics of neighborhoods.3 The relationship between housing and health is complex, therefore, it is important to understand these housing pathways:

  • Stable (or secure) housing means that people are not living in uncertainty about their housing situation and generally have a choice over when to move.
  • Affordable housing is when a household spends no more than 30% of their gross income for housing costs like rent, mortgage, and utilities. It can be subsidized (funded in part by public or private non-profit dollars) or unsubsidized (naturally occurring affordable housing).
  • Safe housing is described as housing that does not jeopardize the health, safety, or welfare of its occupants and that permits access to electricity, heat, and running water for the benefit of those living in the house.
  • Quality housing refers to the physical condition of a person’s home as well as the quality of the social and physical environment in which the home is located, such as air quality, home safety, space per individual, and the presence of mold, asbestos, or lead.

The health impacts of neighborhoods include both the environmental and social characteristics of where people live, including the availability of resources such as public transportation, grocery stores, and places to exercise, as well as measures of segregation, crime, and social capital.3

Pregnancy. During pregnancy, housing instability is associated with inadequate prenatal care, pregnancy complications, and adverse birth outcomes, including preterm birth and low birthweight.1,4 Evidence shows impacts such as severe maternal morbidity, higher rates of mortality in the one-year postpartum period, and negative impacts on mental health.5,6 Eviction and homelessness are two of the most disastrous events in terms of housing instability and are directly linked to negative health outcomes for mothers.7 Mothers who were evicted experienced higher rates of material hardship, depression, high parental stress, and worse health for themselves and their children.7 Maternal mental concerns escalate the risk of homelessness; robust associations also exist between postpartum depression and risk for homelessness.7

Children. Among children, housing instability is associated with poor health, lower weight, developmental risk, and social and emotional behavior issues.8,9,10,11,12 Experiencing unstable housing as a child is comparable to an adverse childhood experience (ACE).10,13 Young children who experience housing deprivation are exposed to a form of toxic stress at a critical time in their development, which contributes to long-term health consequences.7,13 Although young children who experienced prenatal or postnatal homelessness alone had increased negative health outcomes, those who experienced both prenatal and postnatal homelessness had even more serious health consequences.11 Housing instability is associated with problem behavior in early childhood, can alter emotional regulation, can inhibit verbal abilities, stifle academic achievement and educational attainment, and increase the risk of chronic disease.12,14,15,16,17

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

Data Sources: Learn more about the issue and access the data directly

Pregnancy. This component is measured through data collected from the Pregnancy Risk Assessment Monitoring System (PRAMS). Studies have reported that between 4% to 9% of pregnant women experience homelessness and even more have unstable housing arrangements.1

Children. This component is measured through data collected from the National Survey of Children’s Health (NSCH). In 2022, 15.4% of parents or caregivers of young children aged 0-5 reported experiencing housing instability in the past year; and 17.8% of parents or caregivers of children aged 6-11 reported experiencing housing instability in the past year.18

With regard to the individual items:

  • In 2022, 13.4% of parents or caregivers of young children aged 0-5 reported that during the past 12 months, there was a time when they were not able to pay the mortgage or rent on time; and 14.0% of parents or caregivers of children aged 6-11 reported that during the past 12 months, there was a time when they were not able to pay the mortgage or rent on time.19
  • When asked how many places this child had lived during the past 12 months, 2.1% of parents or caregivers of young children aged 0-5 selected 3 of more places; and 3.6% of parents or caregivers of children aged 6-11 selected 3 or more places.20
  • When asked since this child was born, have they ever been homeless or lived in a shelter, 1.1% of parents or caregivers of young children aged 0-5 selected yes; and 2.7% of parents or caregivers of children aged 6-11 selected yes.21

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

Key Findings and Emerging Issues: Read more from the literature

The following are key findings emerging from the literature:

  1. Innovative models to address housing instability include Housing First, an evidence-based service model providing rapid access to permanent housing and supportive case management to end homelessness,46 and Housing Prescriptions as Health Care, a model that integrates health, housing, legal, and social services to improve health outcomes at the household level.47
  2. Strategies with promise for pregnant and postpartum women include publicly supported affordable housing,48 rapid rehousing recognizing pregnancy as a criterion to meet requirements;49 early intervention wraparound support that is continuous and coordinated during pregnancy;49 housing and supportive services, including substance use/mental health counseling;50 and housing and supplemental income.50
  3. For children, housing programs such as housing vouchers and subsidies,52,53 flexible funding,54 supportive housing,55,56 rapid rehousing,57 and homelessness prevention58 demonstrate some effectiveness in increasing housing stability, improving access to social services, and strengthening aspects of family well-being, such as psychological health and food security.
  4. Policy changes, like shelter eligibility policies for homeless families, can have unintended consequences, such as increased use of pediatric emergency department visits for homelessness, that require reconsideration.59
  5. There is an array of services and supports focused on helping families with complex social needs experiencing housing instability, such as early intervention and family support,60-63 wraparound services,64,65 and case management and social support66 that have led to improved child development and behavior as well as improved parental well-being.
  6. A cross-cutting theme is the focus on addressing the mental health and social vulnerabilities of women, children, and families in need of safe, secure, and stable housing.50,60,62,63,67
  7. There is growing literature focused on teen homelessness.68 Even though the age range for this measure does not focus on youth, they are another population in need of housing stability. 

Research. Multiple strategies are emerging as potential approaches to advance this NPM, but haven’t been studied with enough rigor to be included in the evidence-based continuum. Additional research is needed to verify outcomes, but initial studies have shown promise of these strategies in MCH settings:

  • Integrating housing stability components into home visiting to provide support and resources to pregnant women and new mothers.69
  • Enhancing education and employment opportunities for women to increase financial stability and housing security.70

Research Gaps: Learn where more study is needed

Topical Area Knowledge Gaps. Lack of studies on:

  • Examining lesser-known reasons for homelessness in pregnant women and mothers with children, beyond common factors like domestic violence and evictions.
  • Investigating the relationship between gestational age (particularly 32-36 weeks) and increased vulnerability to housing instability.

Specific Intervention Research Gaps. Lack of studies on:

  • Evaluating the effectiveness of existing support programs for children and pregnant women experiencing homelessness through long-term studies.
  • Developing interventions for critical periods during pregnancy and the early postpartum period to prevent housing instability.
  • Assessing the impact of integrating housing stability services with prenatal and pediatric care.

Methodological Gaps. Lack of studies on:

  • Creating a comprehensive risk assessment tool for early identification of housing instability among pregnant women and children.
  • Designing population-based studies to understand the association between housing dynamics and infant health across diverse communities.

Strategy Video: Watch a summary of evidence-based/informed strategies

Watch a short video discussing state-of-the-art, evidence-based/informed strategies that can be used or adapted as ESMs. Experts in the field discuss approaches, the science, and specific ways that Title V agencies can implement and measure these approaches.

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.

A. 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

B. Align with the Needs of the Population

Consider the following findings related to this performance measure.

The Role of Title V: Get ideas on how to implement strategies

Title V agencies can foster partnerships to improve housing stability for women and children by:

  • Collaborating with the housing and community development sectors to develop and implement cross-sector solutions to meet the housing needs of children and their families.7
  • Supporting the integration of trauma-informed community development practice to better meet the complex needs of households.7
  • Addressing the acute social needs of women, children, and families through clinic-based screening, education, counseling, and referral to support services for those experiencing unstable housing.39,40,41
  • Working with MIECHV programs to ensure women continue to receive home visiting services for one year postpartum and are able to speak to a trusted provider about housing needs.42
  • Educating pediatricians on the “Housing First” model and how to coordinate services with local social service organizations.43
  • Working with family resource centers providing comprehensive services and supports to help families with young children in need of housing resources.44
  • Supporting the work of Head Start and other high-quality early care and education programs to help mediate the impacts of housing instability among children and families with lower incomes.45

SDOH and Health Equity Considerations: Identify ways to advance health for all

Social Determinants of Health (SDOH)

The role of housing as a strong SDOH is well-established, recognizing the ways in which a lack of stable housing can negatively affect health and well-being.1,7,8,22,23 The association between housing status and health may be even stronger during pregnancy because of the need for health behavior changes and the increased engagement with healthcare.1

Structural and sustainable solutions are needed to address the longstanding impacts of discrimination and to improve housing and reproductive health.24 For children, health care providers are increasingly recognizing the need to partner with families to meet basic needs, such as housing, and alleviate stressors to better enable children to be healthy and thrive.25,26  

Promising SDOH approaches to promote housing stability include:

  • Expanding direct housing assistance efforts, which are often coordinated with other wraparound health care and social services, to prioritize resources toward expectant families who are at higher risk of adverse outcomes or families with young children.7
  • Implementing community planning and neighborhood improvement strategies, such as the “Healthy Beginnings at Home” initiative providing rental assistance with housing stabilization services to pregnant women living in unstable housing who are at greater risk of infant mortality.7,27
  • Integrating housing stability programs and school systems to connect families to housing resources sooner by allowing families to apply for assistance at schools, authorizing education agencies to distribute assistance, and funding navigator positions in schools.28

Health Equity

Policies of red-lining, proof of income, and discrimination against single women with children disproportionally affects women of color seeking stable housing in affordable neighborhoods.27 Women of color are at higher risk of domestic violence once they become pregnant; domestic violence is a leading cause of homelessness.29 Discriminatory housing policies disproportionately harm Black survivors perpetuating cycles of economic and housing instability.30

Pregnant women who report housing instability are more likely to self-identify as Black, be younger, have a lower educational attainment, and have a lower income than those with stable housing; these sociodemographic factors have been associated with adverse pregnancy outcomes.1,31 With Black women being disproportionately evicted, solutions are needed to rectify harms and disadvantages faced by Black women.32

Strategies to achieve equitable and inclusive access to stable housing include:

  • Expanding access to housing in low-poverty neighborhoods through housing mobility programs, such as “Moving to Opportunity,” which provides rental assistance and housing counseling.7,8
  • Using supportive housing models that combine affordable housing and intensive coordinated services to prioritize households facing multiple barriers to housing stability and those most impacted by structural and institutional racism.33
  • Increasing access to housing choice vouchers to enable more families to stay housed and avoid wrongful denial of rental housing.32              
  • Enacting policies that account for demographic disparities, investing in preventive eviction diversion programs, and enacting source-of-income nondiscrimination laws.32, 34

Special Considerations: Tease out ways to zoom in on populations of focus

Children with Special Health Care Needs (CSHCN) and Children with Disabilities

Families with CSHCN and/or children with disabilities face larger financial hardships that can affect their housing status.35 Research demonstrates that compared to children without SHCN, CSHCN are more likely to live in families who were behind on rent in the past year; moved two or more times in the past year; and were homeless during the child’s lifetime.36

For those children who qualified medically or financially for Supplemental Security Income (SSI), SSI may help to mitigate housing instability and insulate families from the disruptions that occur with frequent moves or homelessness.36 To improve the health and well-being of CSHCN, housing must need their medical and accessibility needs and families of CSHCN experiencing hardship need referrals, support, and access to affordable housing.36, 37

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 movable within the realities of Title V programs and lead to health equity 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

Toolkit References: From the Evidence Accelerator

1 DiTosto, J.D., Holder, K., Soyemi, E., Yee, L.M. (2021). Housing instability and adverse perinatal outcomes: A systematic review. American journal of obstetrics & gynecology MFM 3(6): 100477.

2 The Network of Public Health Law. (2021). The Public Health Implications of Housing Instability, Eviction, and Homelessness.

3 Taylor, L. (2018). Housing and health: an overview of the literature. Health Affairs Health Policy Brief, 10(10.1377).

4 Robinson, K., Sherman, A. D., Ogunwole, S., Meggett, J., & Sharps, P. (2022). Social determinant of housing instability and adverse pregnancy outcomes: a scoping review. The Journal of Perinatal & Neonatal Nursing, 36(2), 118-130.

5 Association of Maternal & Child Health Programs. (2020). Housing as a Platform for Treatment and Recovery: Opportunities for Title V at the Intersection of Stable Housing, Mental Health, and Substance Use.

6 Clark, R., Weinreb, L., Flahive, J., Seifert, R. (2019). Homelessness Contributes to Pregnancy Complications. Health Affairs 38(1).

7 Reece, J. (2021). More than shelter: Housing for urban maternal and infant health. International Journal of Environmental Research and Public Health, 18(7), 3331.

8 Office of Disease Prevention and Health Promotion. (n.d.). Health People 2030: Housing Instability.

9 Acosta, S. (2022, February 15). Stable Housing Is Foundational to Children’s Well-Being. Center on Budget and Policy Priorities: Off the Charts Policy Insight Beyond the Numbers.

10 DeCandia, C. J., Volk, K. T., & Unick, G. J. (2022). Evolving our understanding: housing instability as an ACE for young children. Adversity and resilience science, 3(4), 365-380.

11 Gaitan, Veronica. (2019, January 02). How Housing Affects Children’s Outcomes. Urban Institute.

12 Gaylord, A. L., Cowell, W. J., Hoepner, L. A., Perera, F. P., Rauh, V. A., & Herbstman, J. B. (2018). Impact of housing instability on child behavior at age 7. International journal of child health and human development: IJCHD, 10(3), 287.

13 Disease Control and Prevention. (2024). About Adverse Childhood Experiences | Adverse Childhood Experiences (ACEs) | CDC

14 Wood, D., Halfon, N., Scarlata, D., Newacheck, P., & Nessim, S. (1993). Impact of family relocation on children's growth, development, school function, and behavior. Jama, 270(11), 1334-1338.

15 Ziol‐Guest, K. M., & McKenna, C. C. (2014). Early childhood housing instability and school readiness. Child development, 85(1), 103-113.

16 Fowler, P. J., McGrath, L. M., Henry, D. B., Schoeny, M., Chavira, D., Taylor, J. J., & Day, O. (2015). Housing mobility and cognitive development: Change in verbal and nonverbal abilities. Child Abuse & Neglect, 48, 104-118.

17 Shonkoff, J. P., & Fisher, P. A. (2013). Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Development and psychopathology, 25(4pt2), 1635-1653.

18 Child and Adolescent Health Measurement Initiative. 2022 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [05/01/2024] from [www.childhealthdata.org]. NSCH 2022: Children who experienced housing instability in the past year, Nationwide, Age in 3 groups (childhealthdata.org)

19 Child and Adolescent Health Measurement Initiative. 2022 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [05/01/2024] from [www.childhealthdata.org]. NSCH 2022: Not able to pay mortgage or rent on time, Nationwide, Age in 3 groups (childhealthdata.org)

20 Child and Adolescent Health Measurement Initiative. 2022 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [05/01/2024] from [www.childhealthdata.org]. NSCH 2022: Number of places child has lived in the past 12 months, Nationwide, Age in 3 groups (childhealthdata.org)

21 Child and Adolescent Health Measurement Initiative. 2022 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [05/01/2024] from [www.childhealthdata.org]. NSCH 2022: Child ever experienced homelessness or lived in a shelter, Nationwide, Age in 3 groups (childhealthdata.org)

22 Rolfe, S., Garnham, L., Godwin, J., Anderson, I., Seaman, P., & Donaldson, C. (2020). Housing as a social determinant of health and wellbeing: Developing an empirically-informed realist theoretical framework. BMC Public Health, 20(1), 1138.

23 Cutts, DB, et al. (2011). US housing insecurity and the health of very young children. Am J of public health, 101(8), 1508-1514.

24 Bhatnagar, P., Abdus-Salaam, R., Canzater, S., Efetevbia, V., Freeborn, R., Girard, V., Nedhari, A., F Perry, D.F., Snowden, E., & Watson, K. (2024). Housing Justice Is Reproductive Justice: A Review of Housing Justice as a Structural Determinant of Black Women and Birthing People’s Reproductive Health in Washington, DC: Mamatoto Village.

25 Jeung, J. (2021). Special Health Needs: Non-Medical Necessities Matter, Too - HealthyChildren.org

26 Sokol, R., Austin, A., et al. (2019). Screening Children for Social Determinants of Health: A Systematic Review. Pediatrics, 144(4).

27 Coalition on Homelessness and Housing in Ohio. Healthy Beginnings at Home. (n.d.). https://cohhio.org/healthy-beginnings-at-home/

28 Boshart, A. (2023). How school administrators can be key partners in housing stability. Housing Matters: An Urban Institute Initiative. https://housingmatters.urban.org/articles/how-school-administrators-can-be-key-partners-housing-stability

29 ACOG. Committee Opinion Number 518: Intimate Partner Violence. Reaffirmed 2022.

30 Williams, A. Gwam, P. Domestic Violence Survivors Urgently Need Housing Stability & Solutions during the Pandemic. (2021). Urban Institute.

31 Clark, R. E., Weinreb, L., Flahive, J. M., & Seifert, R. W. (2019). Homelessness contributes to pregnancy complications. Health Affairs, 38(1), 139-146.

32 Bluthenthal, C. The Disproportionate Burden of Eviction on Black Women. (2023). The Center for American Progress.

33 The Corporation for Supportive Housing. Standards for quality supportive housing guide. (2022). https://www.csh.org/wp-content/uploads/2022/11/Standards-for-Quality-Supportive-Housing-Guidebook-2022.pdf

34 Eviction Innovation. (2024). Eviction Diversion Programs. https://evictioninnovation.org/innovations/eviction-diversion-programs/

35 Rose-Jacobs, et al. (2019). Housing instability among families with young children with special health care needs. Pediatrics, 144(2).

36 Children’s Healthwatch. (2018). CSHCN and Disabilities: Solutions for Stable Homes. Boston Medical Center.

37 Berman Institute of Bioethics. (2023). Raising Children with Medical Complexity: Issues in Housing and Household Expenses. Assessing the housing challenges for children with medical complexity in the State of Maryland. Johns Hopkins University.

38 United States Interagency Council on Homelessness. (2019). Evidence-Behind-Approaches-That-End-Homelessness-Brief-2019.pdf (usich.gov)

39 Ng, R., Gunatillaka, N., Skouteris, H., Blane, D., Blewitt, C., Nielsen, S., & Sturgiss, E. (2023). Screening for Unstable Housing in a Healthcare Setting. Public Health Reviews, 44, 1606438.

40 Reyes, A. M., Akanyirige, P. W., Wishart, D., Dahdouh, R., Young, M. R., Estrada, A., ... & Simon, M. A. (2021). Interventions addressing social needs in perinatal care: a systematic review. Health equity, 5(1), 100-118.

41 First, L. (2018). Housing Instability: A New Screen for Adverse Health Issues for Caregivers and Children | AAP Journal Blogs | American Academy of Pediatrics.

42 National Home Visiting Resource Center. (2022). Equity Initiatives in Home Visiting (nhvrc.org)

43 Gabbay, J. M., Stewart, A. M., & Wu, A. C. (2022). Housing Instability and Homelessness—An Undertreated Pediatric Chronic Condition. JAMA pediatrics, 176(11), 1063-1064.

44 Family Resource Centers - First Things First

45 Georgia Family Connection Partnership. Linking Stable Hosing to Child Well-Being.

46 Tiderington, E., Bosk, E., & Mendez, A. (2021). Negotiating child protection mandates in Housing First for families. Child abuse & neglect, 115, 105014.

47 Bovell-Ammon, A., Mansilla, C., et al. (2020). Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized Trial: Findings an intervention which seeks to improve child health and parental mental health for medically complex families that experienced homelessness and housing instability. Health Affairs, 39(4), 613-621.

48 Muchomba, F. M., Teitler, J., & Reichman, N. E. (2022). Association between housing affordability and severe maternal morbidity. JAMA network open, 5(11), e2243225-e2243225.

49 Theobald, J., Watson, J., Haylett, F., & Murray, S. (2023). Supporting pregnant women experiencing homelessness. Australian Social Work, 76(1), 34-46.

50 Slesnick, N., Zhang, J., Feng, X., Mallory, A., Martin, J., Famelia, R., ... & Kelleher, K. (2023). Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial. Journal of Substance Abuse Treatment, 144, 108917.

51 Pantell, M. S., Baer, R. J., Torres, J. M., Felder, J. N., Gomez, A. M., Chambers, B. D., ... & Jelliffe-Pawlowski, L. L. (2019). Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. American journal of obstetrics & gynecology MFM, 1(4), 100053.

52 Gubits, D., Shinn, M., Wood, M., Brown, S. R., Dastrup, S. R., & Bell, S. H. (2018). What interventions work best for families who experience homelessness? Impact estimates from the family options study. Journal of Policy Analysis and Management, 37(4), 835-866.

53 Brown, S. R., Thurber, A., & Shinn, M. (2023). Mothers’ perceptions of how homelessness and housing interventions affect their children’s behavioral and educational functioning. American Journal of Orthopsychiatry.

54 Bomsta, H., & Sullivan, C. M. (2018). IPV survivors’ perceptions of how a flexible funding housing intervention impacted their children. Journal of family violence, 33(6), 371-380.

55 Fernández, C. R., Licursi, M., Wolf, R., Lee, M. T., & Green, N. S. (2022). Food insecurity, housing instability, and dietary quality among children with sickle cell disease: assessment from a single urban center. Pediatric Blood & Cancer, 69(5), e29463.

56 Brott, H., Kornbluh, M., Banfield, J., Boullion, A. M., & Incaudo, G. (2022). Leveraging research to inform prevention and intervention efforts: Identifying risk and protective factors for rural and urban homeless families within transitional housing programs. Journal of Community Psychology, 50(4), 1854-1874.

57 García, I., & Kim, K. (2020). “I Felt Safe”: The role of the rapid rehousing program in supporting the security of families experiencing homelessness in Salt Lake County, Utah. International journal of environmental research and public health, 17(13), 4840.

58 Kube, A. R., Das, S., & Fowler, P. J. (2023). Community-and data-driven homelessness prevention and service delivery: optimizing for equity. Journal of the American Medical Informatics Association, 30(6), 1032-1041.

59 Stewart, A. M., Kanak, M. M., Gerald, A. M., Kimia, A. A., Landschaft, A., Sandel, M. T., & Lee, L. K. (2018). Pediatric emergency department visits for homelessness after shelter eligibility policy change. Pediatrics, 142(5).

60 Spiegel, J. A., Graziano, P. A., Arcia, E., Cox, S. K., Ayala, M., Carnero, N. A., ... & Sundari Foundation. (2022). Addressing mental health and trauma-related needs of sheltered children and families with trauma-focused cognitive-behavioral therapy (tf-cbt). Administration and Policy in Mental Health and Mental Health Services Research, 49(5), 881-898.

61 Graziano, P. A., Spiegel, J. A., Hayes, T., & Arcia, E. (2023). Early intervention for families experiencing homelessness: A pilot randomized trial comparing two parenting programs. Journal of Consulting and Clinical Psychology, 91(4), 192.

62 Ginn, C., Mughal, M. K., et al. (2020). Engaging From Both Sides: Facilitating a Canadian Two-Generation Prenatal-to-Three Program for Families Experiencing Vulnerability. Canadian Journal of Nursing Research, 52(2), 117-128.

63 Bradley, C., Day, C., et al. (2020). ‘Every day is hard, being outside, but you have to do it for your child’: Mixed-methods formative evaluation of a peer-led parenting intervention for homeless families. Clinical child psychology and psychiatry, 25(4), 860-876.

64 Holtrop, K., & Holcomb, J. E. (2018). Adapting and pilot testing a parenting intervention for homeless families in transitional housing. Family process, 57(4), 884-900.

65 Croft, L. A., Marossy, A., Wilson, T., & Atabong, A. (2021). A building concern? The health needs of families in temporary accommodation. Journal of Public Health, 43(3), 581-586.

66 Collins, C. C., Bai, R., Fischer, R., Crampton, D., Lalich, N., Liu, C., & Chan, T. (2020). Housing instability and child welfare: Examining the delivery of innovative services in the context of a randomized controlled trial. Children and Youth Services Review, 108, 104578.

67 Palmer, A. R., Foster, R. A., Distefano, R., & Masten, A. S. (2022). Emotional reactivity and parenting in families experiencing homelessness. Journal of Family Psychology, 36(4), 636.

68 Morton, M. H., Kugley, S., Epstein, R., & Farrell, A. (2020). Interventions for youth homelessness: A systematic review of effectiveness studies. Children and Youth Services Review, 116, 105096.

69 Ramakrishnan, R., Holland, V., Agu, N., Brady, C., & Marshall, J. (2022). Characteristics Associated with Participant Attrition and Retention in a Perinatal Home Visiting Program. Prevention science: the official journal of the Society for Prevention Research, 23(6), 1007–1017. https://doi.org/10.1007/s11121-022-01338-8

70 Marçal, K. E., Choi, M. S., & Showalter, K. (2023). Housing insecurity and employment stability: An investigation of working mothers. Journal of Community Psychology, 51(7), 2790-2801.

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.