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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. Supportive Housing Programs (Child)

Approach. Create and implement policies that provide safe, secure, and supportive rehousing of families facing homelessness

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Overview. Supportive housing programs have a range of positive effects on children, including increased stability, reduced risk of negative health, mental health, and safety outcomes, improved well-being, and the potential for family reunification. These programs play a crucial role in supporting children and families experiencing housing insecurity and involvement with child welfare services. [1,2,3,4,5,6,7].

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some 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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Mental Health. This strategy promotes emotional, psychological, and social well-being of individuals and communities.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

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. 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 families with children experiencing homelessness who are identified, engaged, and referred to supportive housing programs. (Assesses outreach and tailoring efforts to connect families to housing and services)
  • Number of service providers, community partners, and government agencies collaborating to design and deliver comprehensive, family-centered supportive housing interventions. (Shows multi-sector partnership and coordination for holistic support)

OUTCOME MEASURES:

  • Number of families with children experiencing homelessness who are successfully placed into supportive housing and maintain stable tenancy over time. (Measures direct impact on ending family homelessness and sustaining housing stability)
  • Number of families in supportive housing who make progress toward self-determined goals related to employment, education, health, and family functioning. (Shows individualized, holistic impact on family outcomes)

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

PROCESS MEASURES:

  • Percent of supportive housing programs for families that adhere to best practices for trauma-informed, developmentally appropriate, and culturally responsive service delivery. (Measures quality and responsiveness of supportive housing model)
  • Percent of families in supportive housing who are continuously engaged as partners in developing and monitoring personalized case plans that build on their strengths, needs, and aspirations. (Assesses family agency and support in supportive housing approach)

OUTCOME MEASURES:

  • Percent of families in supportive housing who report improved safety, stability, and wellbeing for themselves and their children since entering the program. (Measures family-reported quality of life outcomes)
  • Percent of children in supportive housing who maintain consistent participation in early childhood programs, schools, and other developmentally appropriate activities. (Assesses impact on promoting educational access and continuity for children experiencing homelessness)

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

PROCESS MEASURES:

  • Number of supportive housing initiatives that leverage braided funding streams and innovative financing models to ensure long-term sustainability and responsiveness to evolving family needs. (Measures financial sustainability and flexibility of supportive housing infrastructure)
  • Number of public awareness campaigns and community engagement efforts implemented to build understanding for scaling high-quality supportive housing for families with children. (Shows field-building and narrative change strategies to galvanize support for supportive housing)

OUTCOME MEASURES:

  • Number of communities that achieve and maintain "functional zero" rates of family homelessness through the implementation of comprehensive, coordinated supportive housing initiatives. (Measures population-level impact on ending family homelessness)
  • Number of supportive housing program innovations and best practices that are codified and spread to other communities and systems serving families experiencing homelessness. (Assesses knowledge generation and diffusion impact of supportive housing models)

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

PROCESS MEASURES:

  • Percent of supportive housing initiatives that are governed and implemented through authentic, power-sharing partnerships with families and communities with lived experience of homelessness. (Measures commitment to centering lived expertise and sharing decision-making in supportive housing design)
  • Percent of supportive housing advocacy and communications that frame access to safe, affordable, and supportive housing as a fundamental human right and public good for all children and families. (Shows rights-based, universalist narrative shift in housing discourse)

OUTCOME MEASURES:

  • Percent reduction in racial, ethnic, and socioeconomic disparities in experiences of homelessness and housing instability among families with children engaged in supportive housing interventions. (Measures impact on advancing housing and racial equity)
  • Percent of families in supportive housing who report that program participation has enhanced their sense of dignity, autonomy, and self-determination in defining and pursuing their goals. (Assesses family experiences of supportive housing as a supportive and liberating intervention)

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] Ijadi‐Maghsoodi, R., Moore, E. M., Feller, S., Cohenmehr, J., Ryan, G. W., Kataoka, S., & Gelberg, L. (2022). Beyond housing: Understanding community integration among homeless‐experienced veteran families in the United States. Health & Social Care in the Community, 30(2), e493-e503.
[2] García, I., & Kim, K. (2020). “I Felt Safe”: The role of the rapid rehousing program in supporting the security of families experiencing homelessness in Salt Lake County, Utah. International journal of environmental research and public health, 17(13), 4840.
[3] Fernández, C. R., Licursi, M., Wolf, R., Lee, M. T., & Green, N. S. (2022). Food insecurity, housing instability, and dietary quality among children with sickle cell disease: assessment from a single urban center. Pediatric Blood & Cancer, 69(5), e29463.
[4] Brott, H., Kornbluh, M., Banfield, J., Boullion, A. M., & Incaudo, G. (2022). Leveraging research to inform prevention and intervention efforts: Identifying risk and protective factors for rural and urban homeless families within transitional housing programs. Journal of Community Psychology, 50(4), 1854-1874.
[5] Bomsta, H., & Sullivan, C. M. (2018). IPV survivors’ perceptions of how a flexible funding housing intervention impacted their children. Journal of family violence, 33(6), 371-380.
[6] Glendening, Z. S., Shinn, M., Brown, S. R., Cleveland, K. C., Cunningham, M. K., & Pergamit, M. R. (2020). Supportive housing for precariously housed families in the child welfare system: Who benefits most?. Children and Youth Services Review, 116, 105206.
[7] Slesnick, N., Zhang, J., Feng, X., Mallory, A., Martin, J., Famelia, R., ... & Kelleher, K. (2023). Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial. Journal of Substance Abuse Treatment, 144, 108917.

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.