Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Housing Instability: Child.

MCHbest Logo

Strategy. Affordable Housing Initiatives. (Child)

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

Return to main MCHbest page >>

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 aims 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 supported by Title V 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 collaborating with Title V engaged in expanding affordable housing options and creating welcoming communities for families with children. (Shows multi-sector collaboration for affordable housing production)

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

PROCESS MEASURES:

  • Percent of affordable housing initiatives and policies promoted by Title V that are designed with robust community engagement and leadership from families with children most impacted by housing instability and cost burden. (Measures centering of practical experience and expertise in affordable housing solutions)
  • Percent of landlords, developers, and community partners collaborating with Title V engaged in expanding affordable housing options and creating welcoming communities for families with children. (Shows multi-sector collaboration for affordable housing production)

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

PROCESS MEASURES:

  • Number of affordable housing navigation and support services that are provided in a way that results in reported satisfaction with services. (Shows access in service delivery)
  • Number of public awareness campaigns launched to build community understanding for addressing families' affordable housing needs that results in an increase in knowledge and/or skill. (Shows field-building and narrative change efforts)

OUTCOME MEASURES:

  • Number of communities partnered with Title V 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 promoted by Title V that catalyze broader community development efforts and investments, such as in transportation access and workforce development. (Assesses ripple effect and synergistic impact of affordable housing on other causes of health outcomes)

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 a participatory process that centers the voices and leadership of families. (Measures authentic community power-building in affordable housing governance)
  • Percent of narratives and public conversations promoted by Title V 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 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)
  • Percent of affordable housing initiatives and policies that catalyze broader community development efforts and investments, such as in transportation access and workforce development. (Assesses ripple effect and synergistic impact of affordable housing on other non-medical influences on health)

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.