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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 Prescriptions (Child)

Approach. Integrate case management with a focus on social determinants of health to improve stable housing for families experiencing housing insecurity and other health-related social needs

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Overview. The 'Housing Prescriptions as Health Care' intervention is designed to address housing instability and homelessness among medically complex families by providing priority placement in affordable housing and a range of support services. The 'Housing Prescriptions as Health Care' intervention shows promise in improving both housing stability and health outcomes for medically complex families experiencing homelessness or housing instability by integrating housing and support services. This intervention is designed to mitigate the risk of homelessness and enhance the overall well-being of families facing multiple health and socioeconomic challenges.[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.
  • Mental Health. This strategy promotes emotional, psychological, and social well-being of individuals and communities.

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 healthcare providers trained to assess and address housing needs as a key social determinant of health for families with children. (Measures workforce capacity building for social needs integration)
  • Number of partnerships established between healthcare organizations, housing providers, and community-based organizations to facilitate housing prescriptions and care coordination. (Shows cross-sector collaboration for integrated support)

OUTCOME MEASURES:

  • Number of families with children who secure and maintain stable, affordable housing as a result of receiving housing prescriptions and support services. (Measures direct impact on housing stability outcomes)
  • Number of children in families receiving housing prescriptions who have improved health outcomes, including reduced emergency department visits and hospitalizations. (Assesses impact on healthcare utilization and health status)

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

PROCESS MEASURES:

  • Percent of healthcare providers who consistently and accurately screen families for housing needs and provide appropriate housing prescriptions and referrals. (Measures quality and reliability of social needs screening and response)
  • Percent of housing prescription providers and partners who are trained in cultural humility, trauma-informed care, and health equity principles. (Shows workforce competency for equity and responsiveness)

OUTCOME MEASURES:

  • Percent of families receiving housing prescriptions who report improved housing stability, reduced housing-related stress, and increased sense of agency in meeting their housing needs. (Measures family-reported outcomes and support)
  • Percent of children in families receiving housing prescriptions who meet age-appropriate developmental milestones and demonstrate resilience in the face of adversity. (Assesses impact on child health and development)

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

PROCESS MEASURES:

  • Number of healthcare payment models and incentives established to support the sustainable integration of housing prescriptions into routine care delivery. (Measures systems change for financing and sustainability)
  • Number of health systems that adopt housing prescriptions as a standard of care and incorporate them into quality improvement and population health initiatives. (Assesses institutionalization and spread of social needs integration)

OUTCOME MEASURES:

  • Number of communities that demonstrate reductions in health disparities and improvements in health equity through the widespread adoption of housing prescriptions and other social needs interventions. (Assesses community-level impact on advancing health and housing justice)
  • Number of healthcare and housing organizations that form accountable partnerships to jointly address the housing and health needs of families with children in a coordinated, equitable manner. (Shows transformative impact on fostering cross-sector alignment and shared accountability)

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

PROCESS MEASURES:

  • Percent of housing prescription initiatives that are designed and implemented with meaningful input and leadership from families with lived experience of housing instability and health inequities. (Measures depth of community engagement and co-creation in program development)
  • Percent of housing prescription investments and resources allocated to community-driven, culturally-specific housing solutions that build on the assets and resilience of families. (Assesses equity and community power-building orientation of resource distribution)

OUTCOME MEASURES:

  • Percent reduction in racial, ethnic, and socioeconomic disparities in access to healthy, affordable housing and positive health outcomes among families with children receiving housing prescriptions. (Measures impact on dismantling housing and health inequities)
  • Percent of communities that demonstrate sustained shifts in the structural and social determinants of housing inequities, such as residential segregation, concentrated poverty, and discrimination, as a result of the transformative potential of housing prescriptions. (Shows long-term, root cause impact on disrupting systems of oppression and reclaiming community power)

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] Bovell-Ammon, A., Mansilla, C., Poblacion, A., Rateau, L., Heeren, T., Cook, J. T., ... & Sandel, M. T. (2020). Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized Trial: Findings an intervention which seeks to improve child health and parental mental health for medically complex families that experienced homelessness and housing instability. Health Affairs, 39(4), 613-621.

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.