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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. Income Support Programs (Pregnancy)

Approach. Implementation of housing and income supplements to pregnant and postpartum women may prevent preterm birth and prevent increased healthcare utilization.

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Overview. Income support programs provide financial assistance and resources to help meet the basic needs of perinatal women who may be unhoused by. Income support programs can help alleviate financial strain, reduce homelessness, and improve overall well-being. By providing financial assistance for things like housing support income support programs play a vital role in supporting women who may be unhoused. Evidence has found these programs may help address immediate needs, reduce financial instability, and work toward long-term stability and self-sufficiency for pregnant unhoused persons.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Client-level financial and housing support documentation
  • Patient-reported financial stability data
  • Referral pathway and follow-up data

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.

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. Outreach (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. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of pregnant and postpartum women identified and enrolled in housing and income support programs. (Measures reach and scale of support programs)
  • Number of community-based organizations and public agencies partnering to provide comprehensive housing and income support services to pregnant and postpartum women. (Shows multi-sector collaboration and service integration)

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

  • Percent of housing and income support programs for pregnant and postpartum women that are designed using evidence-based eligibility criteria and benefit levels. (Measures tailoring and adequacy of support to meet needs)
  • Percent of housing and income support program staff who are trained in trauma-informed practices to support pregnant and postpartum women. (Shows workforce competency and sensitivity)

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

  • Number of pregnant and postpartum women receiving housing and income supplements supported by Title V who report reduced stress, improved mental health, and enhanced quality of life. (Measures self-reported impact of economic support on maternal wellbeing)
  • Number of public education and awareness campaigns conducted to build community understanding and support for investing in the health and economic stability of pregnant and postpartum women that result in an increase in knowledge and/or skill. (Shows narrative change and public will-building efforts)
  • Number of pregnant and postpartum women receiving housing and income supplements who are able to transition off public assistance and achieve long-term economic security and mobility. (Measures transformative, intergenerational impact of support programs)
  • Number of communities that experience significant reductions in adverse birth outcomes, infant mortality, and child poverty rates as a result of tailored housing and income support interventions for pregnant and postpartum women. (Assesses population health impact of support programs)

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

  • Percent of pregnant and postpartum women receiving housing and income supplements supported by Title V who report reduced stress, improved mental health, and enhanced quality of life. (Measures self-reported impact of economic support on maternal wellbeing)
  • Percent of public education and awareness campaigns conducted to build community understanding and support for investing in the health and economic stability of pregnant and postpartum women that result in an increase in knowledge and/or skill. (Shows narrative change and public will-building efforts)
  • Percent of pregnant and postpartum women receiving housing and income supplements who are able to transition off public assistance and achieve long-term economic security and mobility. (Measures transformative, intergenerational impact of support programs)
  • Percent of communities that experience significant reductions in adverse birth outcomes, infant mortality, and child poverty rates as a result of tailored housing and income support interventions for pregnant and postpartum women. (Assesses population health impact of support programs)

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] Pantell, M. S., Baer, R. J., Torres, J. M., Felder, J. N., Gomez, A. M., Chambers, B. D., ... & Jelliffe-Pawlowski, L. L. (2019). Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. American journal of obstetrics & gynecology MFM, 1(4), 100053.

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.