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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. Service-Enriched Housing (Pregnancy)

Approach. Develop service-enriched housing communities to increase housing stability for families experiencing economic challenges or homelessness

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Overview. Service-enriched housing is permanent, basic rental housing in which social services are available onsite or by referral through a supportive services program or service coordinator.[1] Housing and services can be provided by nonprofit, private, or government organizations; housing options can be unsubsidized, government assisted, mixed income, or a combination. Programs often support families experiencing economic challenges, older adults, people with disabilities, or veterans.[1, 2, 3] Some service-enriched housing programs also assist families or individuals experiencing homelessness; programs that support households experiencing homelessness are often referred to as permanent supportive housing.[4]

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. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare 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. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-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 limited financial resources or experiencing homelessness who apply for service-enriched housing. (Shows demand and reach of the program)
  • Number of service coordinators or case managers hired to provide on-site support in service-enriched housing. (Indicates capacity for resident services)

OUTCOME MEASURES:

  • Number of families with limited financial resources or experiencing homelessness who are housed in service-enriched communities. (Shows overall impact on housing stability)
  • Number of families who maintain stable housing in service-enriched communities for at least 12 months. (Indicates longer-term housing retention)

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

PROCESS MEASURES:

  • Percent of service-enriched housing units that are occupied. (Shows matching of housing with populations served)
  • Percent of service-enriched housing communities that offer comprehensive, evidence-based supportive services. (Indicates use of best practices)

OUTCOME MEASURES:

  • Percent of families in service-enriched housing who maintain or increase their income. (Shows progress toward economic stability)
  • Percent of families who transition from service-enriched housing to independent housing of their choice. (Indicates progress toward self-reliance)

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

PROCESS MEASURES:

  • Number of community partnerships developed to provide comprehensive services in service-enriched housing. (Shows collaboration for holistic support)
  • Number of property management staff trained in trauma-informed, culturally responsive practices. (Indicates capacity building for inclusive, supportive housing)

OUTCOME MEASURES:

  • Number of families in service-enriched housing who access physical and mental health services. (Shows connection to essential health support)
  • Number of children in service-enriched housing who maintain consistent school attendance or demonstrate improved academic performance. (Indicates impact on child stability and success)

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

PROCESS MEASURES:

  • Percent of service-enriched housing units that are accessible and accommodating for residents with disabilities. (Shows commitment to inclusion and equity)
  • Percent of service-enriched housing staff who reflect the racial, ethnic, and linguistic diversity of the resident population. (Indicates cultural responsiveness)

OUTCOME MEASURES:

  • Percent reduction in the number of families experiencing homelessness in the community after the introduction of service-enriched housing. (Shows community-level impact)
  • Percent of families with limited financial resources or experiencing homelessness who are diverted from higher-intensity interventions through service-enriched housing. (Indicates prevention of crisis and system involvement)

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] Sturtevant 2015 - Sturtevant L, Brennan M, Viveiros J, Handelman E. Housing and services needs of our changing veteran population. Washington, DC: National Housing Conference and Center for Housing Policy; 2015.

2 Castle 2016 - Castle N, Resnick N. Service-enriched housing: The staying at home program. Journal of Applied Gerontology. 2016;35(8):857-877.

3 Brown 2013b - Brown RT, Thomas ML, Cutler DF, Hinderlie M. Meeting the housing and care needs of older homeless adults: A permanent supportive housing program targeting homeless elders. Seniors Housing & Care Journal. 2013;21(1):126-135.

4 NASEM 2018 - National Academies of Sciences, Engineering, and Medicine (NASEM). Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, D.C.: The National Academies Press; 2018.

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.