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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. Social Screening Within Health Care (Child)

Approach. Encourage providers to administer social screenings as part of the well-child visit to assess housing stability

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Overview. Social screenings are brief questionnaires administered in healthcare settings to identify patients' social needs beyond medical care, such as access to food, transportation, and safe housing [1]. This approach offers a holistic view of a patient's well-being and allows for earlier intervention on social determinants of health that can worsen medical conditions [2]. Social screenings typically assess domains like housing security, employment, and food insecurity, often employing standardized tools with validated questions [3]. Examples of social screening questions might ask about difficulty affording rent, concerns about eviction, or having a stable place to live. Peer-reviewed research suggests that social screenings can effectively connect patients with social services, improve health outcomes, and even reduce healthcare costs by addressing upstream factors that contribute to illness.

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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.

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. Direct Care (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 children who receive social screening for housing stability as part of routine pediatric care. (Assesses reach and scale of screening implementation)
  • Number of healthcare team members trained to administer social screening for housing stability in a sensitive, culturally responsive manner. (Shows workforce capacity building for effective screening)

OUTCOME MEASURES:

  • Number of children identified as experiencing housing instability through social screening during well-child visits. (Measures effectiveness of screening in detecting housing needs)
  • Number of children experiencing housing instability who are connected to appropriate housing and social service supports as a result of social screening and referrals. (Assesses impact of screening on increasing access to needed resources)

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

PROCESS MEASURES:

  • Number of perinatal support people (e.g., doulas, community health workers, peer supporters) recruited and trained to provide culturally congruent support to pregnant women. (Measures the capacity building and workforce development efforts for the intervention)
  • Number of pregnant women matched with and receiving support from a designated perinatal support person throughout their pregnancy and postpartum journey. (Assesses the reach and utilization of the support intervention)

OUTCOME MEASURES:

  • Number of pregnant women who report feeling more supported, informed, and confident in their pregnancy and birth experiences as a result of having a perinatal support person. (Measures the psychosocial and support impact of the intervention)
  • Number of healthcare providers and systems that integrate and sustain partnerships with perinatal support people as a standard of care for pregnant women. (Shows the institutionalization and spread of the support intervention)

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

PROCESS MEASURES:

  • Number of healthcare organizations that establish standardized workflows, data systems, and quality improvement process to support consistent, high-quality social screening for housing stability. (Measures systems integration and optimization for screening sustainability)
  • Number of cross-sector partnerships and referral networks strengthened to connect children experiencing housing instability to a comprehensive array of housing and social supports. (Assesses community capacity and coordination for screening follow-up)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that integrate social screening for housing stability into performance measurement, reimbursement, and value-based payment models. (Measures healthcare financing and accountability levers for screening sustainability)
  • Number of cross-sector initiatives catalyzed by social screening data to address upstream determinants of housing instability for children, such as through increased affordable housing supply, economic supports for families, or eviction prevention policies. (Shows synergistic, transformative impact of screening on driving systems change)

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

PROCESS MEASURES:

  • Percent of social screening initiatives for housing stability that are designed and implemented with an explicit focus on advancing racial, economic, and health equity for children and families. (Measures intentionality and centrality of equity in screening approach)
  • Percent of healthcare leaders and policymakers who demonstrate understanding and commitment to addressing housing as a critical determinant of child health and health equity. (Shows shifts in mindsets and priorities related to housing and health)

OUTCOME MEASURES:

  • Percent reduction in racial, ethnic, and socioeconomic disparities in experiences of housing instability and homelessness among children receiving social screening and related supports. (Measures impact of screening on advancing housing equity)
  • Percent of families experiencing housing instability who feel that social screening and related support services are culturally affirming, non-stigmatizing, and responsive to their self-determined priorities. (Assesses screening effectiveness in promoting dignity and justice)

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] Yan AF, Chen Z, Wang Y, Campbell JA, Xue QL, Williams MY, Weinhardt LS, Egede LE. Effectiveness of Social Needs Screening and Interventions in Clinical Settings on Utilization, Cost, and Clinical Outcomes: A Systematic Review. Health Equity. 2022 Jun 24;6(1):454-475. doi: 10.1089/heq.2022.0010. PMID: 35801145; PMCID: PMC9257553.
[2] Sherin K, Adebanjo T, Jani A. Social Determinants of Health: Family Physicians' Leadership Role. Am Fam Physician. 2019 Apr 15;99(8):476-477. PMID: 30990299.
[3] Yan AF, Chen Z, Wang Y, Campbell JA, Xue QL, Williams MY, Weinhardt LS, Egede LE. Effectiveness of Social Needs Screening and Interventions in Clinical Settings on Utilization, Cost, and Clinical Outcomes: A Systematic Review. Health Equity. 2022 Jun 24;6(1):454-475. doi: 10.1089/heq.2022.0010. PMID: 35801145; PMCID: PMC9257553.

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.