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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Housing Instability: Pregnancy.

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Strategy. Case Management and Social Support. (Pregnancy)

Approach. Support pregnant women to find stable housing to improve birth outcomes.

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Overview. Case management plays a crucial role in supporting pregnant homeless women by providing comprehensive and individualized assistance to address their unique needs and challenges. By offering personalized support, support, and access to essential services, case management plays a vital role in empowering pregnant homeless women to improve their circumstances, enhance their well-being, and create a stable environment for themselves and their children.[1]

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):

  • 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.
  • 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. Referral and Follow-Up (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 case managers trained in providing housing-related support and resources to pregnant women. (Assesses capacity building for housing-focused prenatal case management)
  • Number of community-based organizations and housing agencies partnering with prenatal care providers to support pregnant women's housing needs. (Shows cross-sector collaboration for housing stability)

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

PROCESS MEASURES:

  • Percent of case management encounters with pregnant women that include comprehensive assessment of housing needs, barriers, and preferences. (Measures patient-centeredness and responsiveness of case management)
  • Percent of case managers who demonstrate competency in trauma-informed practices when working with pregnant women experiencing housing instability. (Assesses quality of the case management workforce)

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

PROCESS MEASURES:

  • Number of pregnant women in case management supported by Title V who report improved mental health, reduced stress, and increased social support. (Shows impact of housing-related support on psychosocial wellbeing)
  • Number of pregnant women who report high satisfaction and trust in their case management experience and housing support received. (Shows patient experience and perception of care quality)

OUTCOME MEASURES:

  • Number of pregnant women in case management who experience improved birth outcomes and reductions in adverse perinatal health events related to housing instability, such as preterm births and low birth weights. (Measures impact of housing-focused case management on population health outcomes)
  • Number of communities and prenatal care systems that demonstrate sustained reductions in housing instability and improvements in birth outcomes among pregnant women over time. (Shows long-term, population-level impact of institutionalizing housing support within prenatal care)

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

PROCESS MEASURES:

  • Percent of pregnant women in case management supported by Title V who report improved mental health, reduced stress, and increased social support. (Shows impact of housing-related support on psychosocial wellbeing)
  • Percent of pregnant women who report high satisfaction and trust in their case management experience and housing support received. (Shows patient experience and perception of care quality)

OUTCOME MEASURES:

  • Number of pregnant women in case management who experience improved birth outcomes and reductions in adverse perinatal health events related to housing instability, such as preterm births and low birth weights. (Measures impact of housing-focused case management on population health outcomes)
  • Number of communities and prenatal care systems that demonstrate sustained reductions in housing instability and improvements in birth outcomes among pregnant women over time. (Shows long-term, population-level impact of institutionalizing housing support within prenatal care)

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] Rhee, J., Fabian, M. P., Ettinger de Cuba, S., Coleman, S., Sandel, M., Lane, K. J., ... & Zanobetti, A. (2019). Effects of maternal homelessness, supplemental nutrition programs, and prenatal PM2. 5 on birthweight. International journal of environmental research and public health, 16(21), 4154.

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.