
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 Evidence—Start 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
Evidence-Informed |
Evidence-Based |
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Mixed Evidence |
Emerging Evidence |
Expert Opinion |
Moderate Evidence |
Scientifically Rigorous |
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Housing Instability – Child
Evidence-Informed |
Evidence-Based |
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Mixed Evidence |
Emerging Evidence |
Expert Opinion |
Moderate Evidence |
Scientifically Rigorous |
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Field-Based Strategies: Find promising programs from AMCHP’s Innovation Hub
Cutting Edge:
- Faith-Based Health Promotion (IN; 2024)
Emerging:
- Environmental Health Training (RI; 2012)
- Home Visiting Program for Families with High Needs (MA; 2019)
Promising:
- Transitional Housing Program (IN; 2024)
Best:
- Health Equity Zones (RI; 2019)
- Health Education, Case Management, and Patient Navigation (NY; 2019)
2. Think Upstream with Planning Tools—Lead 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 Tools—Move 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
- Find field-based resources focused on improving housing stability for women and children relevant to Title V programs in the MCH Digital Library.
- Search the Established Evidence database for peer-reviewed research articles related to strategies for improving housing stability for women and children.
- Request Technical Assistance from the MCH Evidence Center
- MCH Evidence Center Frameworks and Toolkits:
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:
- Housing Stability Screening (Alliance of Community Assistance Ministries). This screening tool is designed to assist families with referrals for rental and mortgage assistance.
- The Accountable Health Communities Health-Related Social Needs Screening Tool (CMS). This tool can help providers find out patients’ needs in 5 core domains including housing instability.
Partnership. The following organizations focus efforts on advancing housing stability:
- U.S. Department of Housing and Urban Development (HUD). Provides housing support including resources to find housing assistance.
- Robert Wood Johnson Foundation Housing Policy and Practice Portal. Provides resources on the importance of housing in promoting good health.
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