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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...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Family-reported service utilization
  • Qualitative feedback from families and staff
  • Patent-reported self-efficacy and coping skills Family/child outcomes

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. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of service providers and community-based organizations partnering with Title V 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)

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

  • 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 family-centered practices. (Shows workforce capacity for responsiveness)

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

  • Number 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)
  • Number 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)
  • Number of children and families supported by Title V 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 partnered with Title V 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?”)

  • 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)
  • Percent of children and families supported by Title V 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)
  • Percent of communities partnered with Title V 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)

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 challenges 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.