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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Housing Instability: Child.

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Strategy. Case Management and Social Support (Child)

Approach. Support families in need of stable housing services and community programs to improve child mental and physical health outcomes

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Overview. Case management plays a crucial role in supporting families experiencing homelessness, especially those involved with child welfare. Effective case management can provide individualized services tailored to the specific needs of each family, helping them navigate complex systems and access necessary resources. Overall, effective case management for families experiencing homelessness, particularly those involved with child welfare, is essential for providing holistic support, addressing underlying issues, and promoting stability and well-being for both parents and children.[1]

Evidence. Mixed Evidence. Strategies with this rating have been tested more than once with results that sometimes trend positive and sometimes show little effect. These strategies still have potential to work; however, further research is needed to understand the components of the strategies that have the most potential in producing consistent positive results. (Clarifying Note: The WWFH database calls this "insufficient evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Referral and Follow-Up (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of case managers and support staff trained to provide family-centered, trauma-informed services to address housing and health needs. (Assesses workforce capacity and competency)
  • Number of community-based organizations and programs partnering to provide comprehensive housing and social support services to families with children. (Shows service integration and collaboration)

OUTCOME MEASURES:

  • Number of families with children who secure and maintain stable housing through case management and support services. (Measures direct impact on housing stability)
  • Number of children in stable housed families who access and utilize primary and preventive healthcare services. (Assesses impact of housing on healthcare utilization)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of case management and support services that utilize evidence-based, culturally responsive practices tailored to the unique needs of families with children. (Measures quality and relevance of services)
  • Percent of case managers and support staff who are representative of the cultural and linguistic diversity of the families and communities served. (Shows cultural competence and responsiveness of workforce)

OUTCOME MEASURES:

  • Percent of families with children receiving case management who report improved family functioning, parenting skills, and overall household stability. (Measures family-level outcomes and wellbeing)
  • Percent of children in stable housed families who maintain regular school attendance and demonstrate improved academic performance. (Assesses impact of housing on educational outcomes)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships and referral protocols established between housing providers, healthcare systems, schools, and community-based organizations to support families with children. (Measures system coordination and integration)
  • Number of community-wide initiatives implemented to build public awareness and support for addressing family homelessness and its impact on child health and development. (Shows efforts to shift narrative and build political will)

OUTCOME MEASURES:

  • Number of families with children who experience improved overall quality of life and reduced stress as a result of stable housing and support services. (Measures family wellbeing and resilience outcomes)
  • Number of communities that demonstrate significant reductions in the prevalence and duration of family homelessness over time. (Assesses population-level impact on housing stability)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of case management and support programs that are designed and implemented with direct input and leadership from families with lived experience of homelessness. (Measures authentic community engagement and co-production)
  • Percent of case managers, service providers, and system leaders who demonstrate ongoing commitment to anti-bias, culturally humble, and trauma-informed practices. (Shows individual and institutional transformation for equity)

OUTCOME MEASURES:

  • Percent reduction in racial, ethnic, and socioeconomic disparities in the prevalence and impact of family homelessness on child health and wellbeing. (Measures impact on advancing health equity and social justice)
  • Percent of families with children from medically underserved communities who report experiencing case management and support services as culturally affirming, dignifying, and aligned with their self-determined goals. (Assesses effectiveness in promoting agency and power of impacted families)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] 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.

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.