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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. Early Intervention and Family Support (Child)

Approach. Provide children and their families experiencing housing instability or those in shelters with support services to secure housing and address mental health and other needs

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Overview. Early interventions and family support can have a significant positive impact on families experiencing homelessness by addressing their unique needs and challenges. By providing tailored support, addressing parenting challenges, promoting mental health, and facilitating access to services, these interventions can make a significant difference in the lives of homeless families and contribute to their overall well-being and stability.[1,2,3]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.

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. Case Management (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 service providers and community-based organizations partnering to deliver comprehensive, coordinated support to children and families in need. (Assesses collaborative capacity and service integration)
  • Number of child and family-focused support services provided, including housing navigation, mental health counseling, parenting education, and child development screenings. (Shows volume and range of support services)

OUTCOME MEASURES:

  • Number of children experiencing housing instability who receive timely and appropriate developmental screenings, assessments, and interventions. (Assesses impact on early detection and intervention for developmental delays)
  • Number of families with children who demonstrate improved mental health, reduced parental stress, and enhanced parent-child relationships through support services. (Shows impact on family wellbeing and functioning)

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

PROCESS MEASURES:

  • Percent of early intervention and family support services that are grounded in evidence-based, trauma-informed, and developmentally appropriate practices. (Measures quality and effectiveness of services)
  • Percent of early intervention service providers and staff who are trained in cultural competence, anti-racism, and family-centered practices. (Shows workforce capacity for equity and responsiveness)

OUTCOME MEASURES:

  • Percent of children experiencing housing instability who demonstrate improved social-emotional, cognitive, and physical development after receiving early intervention and support services. (Measures impact on child development outcomes)
  • Percent of families receiving support services who report satisfaction with services supporting their children's health, learning, and development. (Assesses impact on family capacity and support)

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

PROCESS MEASURES:

  • Number of early childhood education, healthcare, and social service systems that adopt standardized screening and referral protocols to identify and support children and families experiencing housing instability. (Measures systems change and coordination)
  • Number of cross-sector initiatives and coalitions formed to support policies and investments that address the comprehensive needs of children and families experiencing homelessness. (Assesses collective impact and field-building efforts)

OUTCOME MEASURES:

  • Number of children and families experiencing housing instability who show long-term improvements in health, educational attainment, economic stability, and overall quality of life as a result of early support. (Measures life course impact and social mobility outcomes)
  • Number of communities that implement comprehensive, coordinated support systems for children and families experiencing homelessness, resulting in population-level reductions in child and family adversity. (Assesses community transformation and resilience)

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

PROCESS MEASURES:

  • Percent of early intervention and family support programs that are designed and led by individuals with lived experience of homelessness and housing instability, especially from medically underserved communities. (Measures community power-building and leadership)
  • Percent of system leaders, policymakers, and funders who demonstrate increased understanding and commitment to addressing family homelessness as a critical issue of racial, economic, and health justice. (Shows narrative and systems change impact)

OUTCOME MEASURES:

  • Percent of children and families from medically underserved communities who report that early intervention and support services valued their cultural identities, upheld their dignity, and advanced their self-determination. (Assesses effectiveness in embodying anti-bias and liberatory practices)
  • Percent of communities that demonstrate sustained shifts in public narratives, power structures, and resource allocation toward preventing family homelessness and ensuring that all children and families thrive. (Shows transformational impact on social justice and liberation)

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.
[2] Fareed, N., Singh, P., Jonnalagadda, P., Swoboda, C., Odden, C., & Doogan, N. (2022). Construction of the Ohio Children's Opportunity Index. Frontiers in Public Health, 10, 734105.
[3] 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.
[4] 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.
[5] Ginn, C., Mughal, M. K., Pruett, M. K., Pruett, K., Perry, R. L., & Benzies, K. (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.
[6] Ramakrishnan, J. L., & Masten, A. S. (2020). Mastery motivation and school readiness among young children experiencing homelessness. American Journal of Orthopsychiatry, 90(2), 223.
[7] Bradley, C., Day, C., Penney, C., & Michelson, D. (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.
[8] Ijadi-Maghsoodi, R., Feller, S., Ryan, G. W., Altman, L., Washington, D. L., Kataoka, S., & Gelberg, L. (2021). A sector wheel approach to understanding the needs and barriers to services among homeless-experienced veteran families. The Journal of the American Board of Family Medicine, 34(2), 309-319.

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.