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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. Wraparound Services. (Child)

Approach. Provide families, particularly parents, facing housing loss, insecurity, or emergency shelter placement with wraparound social services to improve mental health outcomes and reduce economic impacts.

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Overview. Wrap-around services benefit homeless families by providing comprehensive and coordinated support to address their complex needs, offering a holistic approach to care. Wrap-around services play a crucial role in addressing the multifaceted challenges homeless families face by supporting them on their journey towards stability and self-sufficiency.[1,2,3]

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. Case Management (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 service providers and community partners mobilized to provide a comprehensive array of wraparound supports to families, including mental health, economic stability, and other essential services. (Assesses breadth and depth of multi-disciplinary support network)
  • Number of families with children supported by Title V in housing crises who are connected to evidence-based mental health interventions and supportive services through wraparound coordination. (Shows linkage to appropriate mental health support)

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

PROCESS MEASURES:

  • Percent of service providers and community partners mobilized to provide a comprehensive array of wraparound supports to families, including mental health, economic stability, and other essential services. (Assesses breadth and depth of multi-disciplinary support network)
  • Percent of families with children supported by Title V in housing crises who are connected to evidence-based mental health interventions and supportive services through wraparound coordination. (Shows linkage to appropriate mental health support)

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

PROCESS MEASURES:

  • Number of collaborative partnerships led by Title V and referral networks established across housing, mental health, early childhood, and other key service systems to enable seamless wraparound support for families in housing crises that report high levels of engagement. (Measures system coordination and integration)
  • Number of communities partnered with Title V that implement data-sharing and technology solutions to facilitate real-time coordination and monitoring of wraparound service delivery and outcomes for families in housing crises. (Shows data-driven, accountable approach to systems management)

OUTCOME MEASURES:

  • Number of families supported by Title V receiving wraparound services who experience reductions in utilization of costly crisis services, such as emergency departments, child welfare, or social systems, as a result of improved housing and mental health stability. (Measures cross-sector impact and cost-effectiveness of upstream prevention approach)
  • Number of organizations and communities partnered with Title V that demonstrate sustained capacity and commitment to providing wraparound supports to families in housing crises, even in the face of funding or policy challenges. (Assesses systems resilience and adaptability to meet evolving family needs)

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

PROCESS MEASURES:

  • Percent of collaborative partnerships led by Title V and referral networks established across housing, mental health, early childhood, and other key service systems to enable seamless wraparound support for families in housing crises that report high levels of engagement. (Measures system coordination and integration)
  • Percent of communities partnered with Title V that implement data-sharing and technology solutions to facilitate real-time coordination and monitoring of wraparound service delivery and outcomes for families in housing crises. (Shows data-driven, accountable approach to systems management)

OUTCOME MEASURES:

  • Percent of families supported by Title V receiving wraparound services who experience reductions in utilization of costly crisis services, such as emergency departments, child welfare, or social systems, as a result of improved housing and mental health stability. (Measures cross-sector impact and cost-effectiveness of upstream prevention approach)
  • Percent of organizations and communities partnered with Title V that demonstrate sustained capacity and commitment to providing wraparound supports to families in housing crises, even in the face of funding or policy challenges. (Assesses systems resilience and adaptability to meet evolving family needs)

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] Wu, Q., Slesnick, N., & Murnan, A. (2018). Understanding Parenting Stress And Children's Behavior Problems Among Homeless, Substance‐Abusing Mothers. Infant mental health journal, 39(4), 423-431.
[2] Holtrop, K., & Holcomb, J. E. (2018). Adapting and pilot testing a parenting intervention for homeless families in transitional housing. Family process, 57(4), 884-900.
[3] Croft, L. A., Marossy, A., Wilson, T., & Atabong, A. (2021). A building concern? The health needs of families in temporary accommodation. Journal of Public Health, 43(3), 581-586.

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.