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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. Housing and CPS Policies. (Child)

Approach. Engage families through social service support programs to reduce both homelessness and CPS involvement.

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Overview. It is crucial for child welfare systems, policymakers, and communities to address the root causes of homelessness and provide support services to families to prevent children from experiencing the harmful effects of homelessness and Child Protective Services. (CPS) involvement. Early intervention, stable housing, access to mental health services, and support for families can help mitigate the impact of these challenges on children's well-being and development. Homelessness and involvement with CPS can have significant negative effects on children's well-being and development.[1]

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):

  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
  • 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.

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. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-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 social service support programs and providers trained to address the intersecting needs of families facing housing instability and child welfare involvement. (Assesses workforce capacity building for integrated support)
  • Number of collaborative partnerships led by Title V established between housing providers, child welfare agencies, and community-based organizations to coordinate support for families. (Shows cross-system collaboration and service integration)

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

PROCESS MEASURES:

  • Percent of social service support programs that utilize evidence-based practices to engage and serve families at risk of homelessness and CPS involvement. (Measures quality and responsiveness of service delivery)
  • Percent of social service support providers and partners trained by Title V who demonstrate commitment to dismantling the disproportionate impact of housing instability and CPS involvement. (Shows impact of workforce)

OUTCOME MEASURES:

  • Percent of families receiving social service support who report increased housing stability, economic security, and overall family wellbeing. (Measures family-reported outcomes and resilience)
  • Percent of families receiving social service support who demonstrate improved protective factors and reduced risk factors associated with child maltreatment and neglect. (Assesses impact on family strengthening and prevention)

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

PROCESS MEASURES:

  • Number of families receiving social service support who report increased housing stability, economic security, and overall family wellbeing. (Measures family-reported outcomes and resilience)
  • Number of families receiving social service support who demonstrate improved protective factors and reduced risk factors associated with child maltreatment and neglect. (Assesses impact on family strengthening and prevention)

OUTCOME MEASURES:

  • Number of families supported by Title V receiving social service support who experience improved child health, developmental, and educational outcomes as a result of increased housing stability and reduced CPS involvement. (Measures long-term, two-generation impact on child and family wellbeing)
  • Number of communities partnered with Title V that demonstrate significant reductions in rates of family homelessness and foster care placement through implementation of integrated housing and child welfare prevention strategies. (Assesses population-level impact on key outcomes)

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

PROCESS MEASURES:

  • Percent of resources and funding allocated to community-rooted organizations and initiatives working to address the impact of housing instability and child welfare involvement. (Assesses resource allocation and program prioritization)
  • Percent of housing, child welfare, and social service system leaders partnered with Title V who demonstrate increased understanding and commitment to dismantling the root causes that drive the intersection of family homelessness and CPS involvement. (Shows transformative narrative and institutional change impact)

OUTCOME MEASURES:

  • Percent of families supported by Title V receiving social service support who experience improved child health, developmental, and educational outcomes as a result of increased housing stability and reduced CPS involvement. (Measures long-term, two-generation impact on child and family wellbeing)
  • Percent of communities partnered with Title V that demonstrate significant reductions in rates of family homelessness and foster care placement through implementation of integrated housing and child welfare prevention strategies. (Assesses population-level impact on key outcomes)

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] Palmer, A. R., Piescher, K., Berry, D., Dupuis, D., Heinz-Amborn, B., & Masten, A. S. (2023). Reprint of: Homelessness and child protection involvement: temporal links and risks to student attendance and school mobility. Child abuse & neglect, 139, 106156.

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.