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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. Shelter Eligibility Policies. (Child)

Approach. Develop and adopt positive shelter eligibility policies for families needing shelter placement.

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Overview. Shelter eligibility policies play a crucial role in determining the support and resources available to homeless families. Understanding the impact of these policies on families can help policymakers and healthcare providers develop strategies to address the healthcare needs of homeless populations effectively.[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 shelters and housing organizations partnered with Title V engaged in reviewing and revising their eligibility policies to better serve families with children. (Measures engagement and participation in policy change efforts)
  • Number of shelter staff and providers trained on implementing new eligibility policies and practices in a family-centered, trauma-informed manner. (Shows workforce capacity building for policy implementation)

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

PROCESS MEASURES:

  • Percent of shelters and housing organizations partnered with Title V engaged in reviewing and revising their eligibility policies to better serve families with children. (Measures engagement and participation in policy change efforts)
  • Percent of shelter staff and providers trained on implementing new eligibility policies and practices in a family-centered, trauma-informed manner. (Shows workforce capacity building for policy implementation)

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

PROCESS MEASURES:

  • Number of shelter staff who demonstrate proficiency in applying new eligibility policies and practices in a consistent, and compassionate manner. (Assesses quality and reliability of policy implementation)
  • Number of families with children seeking shelter who receive clear, relevant information about their eligibility and rights under the new policies who report and increase in knowledge and/or skill. (Shows transparency and communication effectiveness)

OUTCOME MEASURES:

  • Number of communities partnered with Title V that experience reductions in the number of families with children who are turned away from shelter or experience long wait times for services due to restrictive eligibility criteria. (Assesses population-level impact on reducing barriers to shelter access)
  • Number of cross-sector partnerships led by Title V catalyzed by the adoption of family-centered shelter eligibility policies that work to address the upstream determinants of family homelessness, such as housing affordability and economic security. (Shows ripple effect and transformative potential of policy change)

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

PROCESS MEASURES:

  • Percent of shelter staff who demonstrate proficiency in applying new eligibility policies and practices in a consistent, and compassionate manner. (Assesses quality and reliability of policy implementation)
  • Percent of families with children seeking shelter who receive clear, usable information about their eligibility and rights under the new policies who report and increase in knowledge and/or skill. (Shows transparency and communication effectiveness)

OUTCOME MEASURES:

  • Percent of communities partnered with Title V that experience reductions in the number of families with children who are turned away from shelter or experience long wait times for services due to restrictive eligibility criteria. (Assesses population-level impact on reducing barriers to shelter access)
  • Percent of cross-sector partnerships led by Title V catalyzed by the adoption of family-centered shelter eligibility policies that work to address the upstream determinants of family homelessness, such as housing affordability and economic security. (Shows ripple effect and transformative potential of policy change)

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] Stewart, A. M., Kanak, M. M., Gerald, A. M., Kimia, A. A., Landschaft, A., Sandel, M. T., & Lee, L. K. (2018). Pediatric emergency department visits for homelessness after shelter eligibility policy change. Pediatrics, 142(5).

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.