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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. Homelessness Prevention Programs (Child)

Approach. Collaborate with Medical providers and social service case managers to screen and assist families with children who may face homelessness

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Overview. Homelessness prevention programs have a significant impact on families and children by providing support and resources to help prevent them from experiencing homelessness. These programs are designed to to address the root causes of homelessness and provide stability to families facing housing insecurity. Homelessness prevention programs play a crucial role in supporting families and children by providing stability, improving health outcomes, enhancing family dynamics, supporting education, promoting economic stability, and building resilience.[1,2,3,4,5] Evidence has found that by addressing the root causes of homelessness and providing the necessary support, these programs have a positive impact on the lives of families and children experiencing socioeconomic challenges and housing instability[4,5].

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.
  • Health Equity. This strategy helps contribute to reducing disparities or avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.
  • 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. Screening (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 medical providers and social service case managers trained to screen families with children for housing instability and risk of homelessness. (Measures workforce capacity building for prevention)
  • Number of partnerships formed between healthcare, social service, and housing organizations to provide coordinated prevention services to families with children. (Shows cross-sector collaboration for prevention)

OUTCOME MEASURES:

  • Number of families with children who avoid homelessness and maintain stable housing as a result of prevention program participation. (Measures direct impact on homelessness prevention)
  • Number of children in families receiving prevention services who maintain consistent access to healthcare, including well-child visits and developmental screenings. (Assesses impact on healthcare utilization and preventive care)

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

PROCESS MEASURES:

  • Percent of families with children engaged in prevention programs who receive culturally responsive, trauma-informed, and strengths-based services. (Assesses family-centeredness and responsiveness of service delivery)
  • Percent of prevention service providers and partners who reflect the cultural, linguistic, and socioeconomic diversity of the communities served. (Shows cultural relevance and representation in prevention workforce)

OUTCOME MEASURES:

  • Percent of families with children receiving prevention services who report increased housing stability, financial security, and overall family wellbeing. (Measures family-reported outcomes and resilience)
  • Percent of children in families receiving prevention services who meet age-appropriate developmental milestones and demonstrate positive social-emotional functioning. (Assesses impact on child development and thriving)

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

PROCESS MEASURES:

  • Number of healthcare and social service systems that integrate housing stability screening and prevention protocols into routine practice and quality improvement efforts. (Measures systems change and institutionalization of prevention)
  • Number of community-wide initiatives implemented to build public awareness and support for investing in upstream homelessness prevention strategies for families with children. (Assesses efforts to shift narrative and build political will for prevention)

OUTCOME MEASURES:

  • Number of families with children who experience improved health, social, and economic outcomes as a result of participating in homelessness prevention programs. (Measures holistic, long-term impact on family wellbeing)
  • Number of communities that demonstrate significant reductions in rates of family and child homelessness through implementation of comprehensive prevention strategies. (Assesses population-level impact on homelessness reduction)

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

PROCESS MEASURES:

  • Percent of homelessness prevention programs for families with children that are designed and implemented with direct leadership and decision-making from families with lived experience of housing instability. (Measures authentic community partnership and power-sharing)
  • Percent of prevention resources and funding allocated to community-based, culturally-specific organizations working to address the root causes of housing instability for families with children in medically underserved communities. (Assesses equity and social justice orientation of prevention investments)

OUTCOME MEASURES:

  • Percent of families with children from historically medically underserved communities who report experiencing prevention services as culturally affirming, dignity-preserving, and supportive of their family's self-determination and aspirations. (Assesses effectiveness of prevention programs in embodying anti-bias and liberatory practices)
  • Percent of communities that demonstrate sustained shifts in the structural and systemic determinants of family homelessness, such as housing discrimination, employment barriers, and lack of affordable child care, as a result of transformative prevention efforts. (Shows long-term, root cause 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] 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.
[2] Clark, R. E., Weinreb, L., Flahive, J. M., & Seifert, R. W. (2018). Health care utilization and expenditures of homeless family members before and after emergency housing. American journal of public health, 108(6), 808-814.
[3] Clark, R. E., Weinreb, L., Flahive, J. M., & Seifert, R. W. (2019). Infants exposed to homelessness: health, health care use, and health spending from birth to age six. Health Affairs, 38(5), 721-728.
[4] Sandel, M., Sheward, R., Ettinger de Cuba, S., Coleman, S. M., Frank, D. A., Chilton, M., ... & Cutts, D. (2018). Unstable housing and caregiver and child health in renter families. Pediatrics, 141(2).
[5] Sylvestre, J., Kerman, N., Polillo, A., Lee, C. M., Aubry, T., & Czechowski, K. (2018). A qualitative study of the pathways into and impacts of family homelessness. Journal of Family Issues, 39(8), 2265-2285.

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.