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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 non-medical influences on health to improve stable housing for at risk families

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Overview. The "Housing Prescriptions as healthcare" intervention aims 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 healthcare" 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 aims to mitigate the risk of homelessness and enhance the overall well-being of families.[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 influence on health for families with children. (Measures workforce capacity building for social needs integration)
  • Number of partnerships led by Title V established between healthcare organizations, housing providers, and community-based organizations to facilitate housing prescriptions and care coordination. (Shows cross-sector collaboration for integrated support)

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

PROCESS MEASURES:

  • Percent of healthcare providers trained to assess and address housing needs as a key non-medical influence on families with children. (Measures workforce capacity building for social needs integration)
  • Percent of partnerships led by Title V established between healthcare organizations, housing providers, and community-based organizations to facilitate housing prescriptions and care coordination. (Shows cross-sector collaboration for integrated support)

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

PROCESS MEASURES:

  • Number of healthcare payment models and incentives established and successfully implemented to support the sustainable integration of housing prescriptions into routine care delivery. (Measures systems change for financing and sustainability)
  • Number of health systems partnered with Title V 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 outcome differences and improvements through the widespread adoption of housing prescriptions and other social needs interventions. (Assesses community-level impact on advancing health and fair housing outcomes)
  • 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 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 assistance programs for pregnant and postpartum individuals that are designed, implemented, and evaluated with substantive leadership and decision-making power from directly impacted individuals and communities. (Measures depth of community ownership and governance of housing interventions)
  • Percent of housing and maternal health leaders, policymakers, and other key partners collaborating with Title V who demonstrate increased commitment to advancing fair housing and reproductive outcomes as interconnected priorities and shared responsibilities. (Shows transformation in mindsets and power structures underlying housing challenges)

OUTCOME MEASURES:

  • Percent of neighborhoods and communities that experience reduced rates of adverse birth outcomes and maternal morbidity as a result of tailored housing investments and supports for pregnant and postpartum women. (Assesses community-level impact of housing interventions)
  • Percent of cross-sector initiatives and partnerships catalyzed by housing assistance programs to address the intersecting root causes of maternal and child health, such as education, transportation, and environmental support. (Shows ripple effect and collective impact of housing interventions)

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.