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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. Housing Choice Voucher Program (Section 8) (Pregnancy)

Approach. Disseminate information on Housing Choice Voucher Programs

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Overview. The Housing Choice Voucher Program (HCV), also known as Section 8, provides eligible families experiencing significant economic challenges with vouchers to help cover the costs of rental housing. Residents pay 30-40% of their income toward rent and a local public housing agency contracts with the landlord to pay the remainder, up to a specified maximum amount. Eligible households can use vouchers to move to dwellings and neighborhoods of their choice, as in the Moving to Opportunity demonstration project, or to pay rent in their current location; households must recertify income annually and can receive vouchers as long as income eligibility is demonstrated. The U.S. Department of Housing and Urban Development (U.S. HUD) provides Section 8 funds to state or municipal housing agencies which administer local programs. There are often extensive waiting lists for vouchers, sometimes lasting multiple years.[1, 2]

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. Policy Development and Enforcement (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 outreach events held to share information on Housing Choice Voucher. (HCV) program. (Indicates efforts to increase awareness)
  • Number of Housing Choice Voucher. (HCV) program applications distributed through information sharing efforts. (Shows potential reach and interest generated)

OUTCOME MEASURES:

  • Number of households who apply for Housing Choice Voucher. (HCV) programs after receiving shared information. (Indicates effectiveness of outreach in promoting action)
  • Number of households connected to Housing Choice Voucher. (HCV) program staff or navigators for application assistance through information sharing. (Shows facilitated access to the program)

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

PROCESS MEASURES:

  • Percent of information sharing efforts that focus on communities and populations with limited financial resources or experiencing social marginalization. (Indicates strategic outreach to groups facing significant barriers)
  • Percent of staff and volunteers involved in information sharing who are trained on Housing Choice Voucher (HCV) program details and communication skills. (Shows preparedness for effective outreach)

OUTCOME MEASURES:

  • Percent of households reached through the sharing of information who report increased knowledge and understanding of Housing Choice Voucher (HCV) programs. (Indicates educational impact of outreach)
  • Percent of households who complete the Housing Choice Voucher (HCV) program application process after receiving shared information. (Shows the impact of information on program access)

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

PROCESS MEASURES:

  • Number of community partners engaged to assist with the Housing Choice Voucher. (HCV) program information sharing. (Indicates collaboration for expanded outreach)
  • Number of Housing Choice Voucher. (HCV) program success stories or experiences collected and shared through information sharing efforts. (Shows use of relatable messaging)

OUTCOME MEASURES:

  • Number of households who report that shared information addressed their concerns or barriers to applying for Housing Choice Voucher. (HCV) programs. (Indicates the impact of outreach on reducing hesitancy)
  • Number of community leaders who share Housing Choice Voucher. (HCV) program information with their networks. (Shows ripple effect of outreach through community connections)

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

PROCESS MEASURES:

  • Percent of Housing Choice Voucher. (HCV) program information sharing efforts that are informed by input from groups experiencing housing insecurity. (Indicates community-driven outreach strategies)
  • Percent of information sharing efforts that are evaluated for reach, effectiveness, and lessons learned. (Shows commitment to continuous improvement of outreach)

OUTCOME MEASURES:

  • Percent increase in Housing Choice Voucher. (HCV) program applications from communities with limited access to affordable housing after tailored information sharing. (Indicates impact on reducing disparities in program access)
  • Percent of households with limited English proficiency who gain access to Housing Choice Voucher. (HCV) programs after receiving language-appropriate shared information. (Shows linguistic equity in program access)

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] US HUD-Vouchers fact sheet - US Department of Housing and Urban Development (US HUD). Housing Choice Vouchers fact sheet.

2 Ellen 2020 - Ellen IG. What do we know about housing choice vouchers? Regional Science and Urban Economics. 2020;80.

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.