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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. Affordable Housing Initiatives (Child)

Approach. Increase the number of affordable homes to families who are struggling to meet their basic needs

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Overview. Affordable housing refers to housing that is deemed affordable to those with a median household income or below, typically defined as costing no more than 30% of a household's income. Affordable housing is designed to provide safe, decent, and stable living arrangements for individuals and families who may otherwise struggle to meet their housing needs due to financial constraints. Lack of affordable housing can lead to housing insecurity, where individuals and families face challenges in accessing and maintaining suitable housing, which in turn can impact various aspects of their well-being, including child maltreatment risk. Evidence has found that housing affordability may protect against child mental and physical maltreatment.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

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 families with children who are identified and engaged in accessing affordable housing initiatives and support services. (Assesses outreach and engagement of focus population)
  • Number of landlords, developers, and community partners engaged in expanding affordable housing options and creating welcoming, inclusive communities for families with children. (Shows multi-sector collaboration for affordable housing production)

OUTCOME MEASURES:

  • Number of families with children who are able to access and maintain stable, affordable housing as a result of tailored initiatives and investments. (Measures direct impact on increasing affordable housing access and stability)
  • Number of children in families living in stable, affordable housing who experience improved health, developmental, and educational outcomes. (Assesses impact of affordable housing on promoting child wellbeing and opportunity)

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

PROCESS MEASURES:

  • Percent of affordable housing initiatives and policies that are designed with robust community engagement and leadership from families with children most impacted by housing instability and cost burden. (Measures centering of lived experience and expertise in affordable housing solutions)
  • Percent of affordable housing navigation and support services that are provided in families' preferred languages and tailored to their unique cultural and linguistic needs. (Shows language access and cultural humility in service delivery)

OUTCOME MEASURES:

  • Percent of families with children living in affordable housing who report high levels of housing stability, quality, safety, and satisfaction. (Measures family-reported housing and wellbeing outcomes)
  • Percent of affordable housing communities that demonstrate strong social cohesion, civic engagement, and collective efficacy among residents. (Shows social and community benefits of affordable housing beyond individual family outcomes)

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

PROCESS MEASURES:

  • Number of local and state policies and plans adopted that prioritize the production and preservation of affordable housing for families with children. (Measures systems change and policy implementation for affordable housing supply)
  • Number of public awareness campaigns launched to build community understanding for addressing families' affordable housing needs as a key driver of health equity and economic mobility. (Shows field-building and narrative change efforts)

OUTCOME MEASURES:

  • Number of communities that experience significant reductions in the number of families with children facing housing cost burden, instability, and homelessness as a result of comprehensive affordable housing initiatives. (Measures population-level impact on housing security and wellbeing)
  • Number of affordable housing initiatives and policies that catalyze broader community development efforts and investments, such as in transportation access, workforce development, or education equity. (Assesses ripple effect and synergistic impact of affordable housing on other social determinants of health)

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

PROCESS MEASURES:

  • Percent of affordable housing policies and investment decisions that are made through inclusive, participatory process that center the voices and leadership of families. (Measures authentic community power-building in affordable housing governance)
  • Percent of narratives and public conversations around affordable housing that frame it as a fundamental human right and public good, essential for family and community wellbeing, rather than as an individual burden or deficit. (Shows transformative narrative change impact)

OUTCOME MEASURES:

  • Percent reduction in racial, ethnic, and economic segregation in access to affordable, high-quality housing and neighborhood opportunities among families with children. (Measures impact on dismantling structural inequities in housing and communities)
  • Percent of communities that demonstrate sustained shifts in the political, economic, and social conditions that perpetuate housing inequities for families with children, such as through more equitable distribution of power, land, and resources. (Shows long-term, transformative impact on rectifying root causes of housing injustice)

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] Marcal, K. E. (2022). Domains of housing insecurity: Associations with child maltreatment risk. Child Abuse & Neglect, 131, 105696.

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.