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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 First Programs (Pregnancy)

Approach. Collaborate with Housing First programs to reduce housing instability for women and children

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Overview. Housing First programs address chronic homelessness by providing rapid access to permanent housing, without a precondition of treatment, along with ongoing support services such as crisis intervention, needs assessment, and case management. A form of permanent supportive housing, the program usually serves individuals who are chronically homeless and have persistent mental illness or problems with substance abuse and addiction. Clients can be placed in apartments throughout a community[1] or a centralized housing location with onsite support for those requiring more intensive services; clients receive housing regardless of substance use.[2] Unlike standard rapid rehousing programs, there are no time limits for Housing First program participation.[3]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported 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 women and children experiencing homelessness who are referred to or enrolled in Housing First programs through collaborative efforts. (Shows the engagement and tailoring of the intended population)
  • Number of housing units or vouchers allocated to women and children through Housing First program collaborations. (Indicates the housing resources and capacity mobilized to support the approach)

OUTCOME MEASURES:

  • Number of women and children who maintain stable housing for at least 12 months after placement through Housing First program collaborations. (Shows the approach's effectiveness in promoting long-term housing retention and stability)
  • Number of women and children in Housing First programs who experience improved health, safety, and well-being outcomes as a result of stable housing and support services. (Indicates the approach's impact on broader quality of life dimensions)

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

PROCESS MEASURES:

  • Percent of Housing First program staff collaborating with women and children who are trained in trauma-informed, gender-responsive, and family-centered approaches. (Shows the capacity and competence of the workforce to effectively serve the population)
  • Percent of women and children referred to Housing First programs through collaborative efforts who successfully enroll and engage in services. (Indicates the approach's efficiency and success in connecting the population to housing and support)

OUTCOME MEASURES:

  • Percent of women and children in Housing First programs who demonstrate progress towards their self-identified goals related to health, education, employment, or family well-being. (Shows the approach's success in supporting holistic and personalized outcomes)
  • Percent of women and children who exit Housing First programs to positive and stable housing destinations (e.g., independent housing, reunification with family). (Indicates the approach's effectiveness in facilitating successful transitions and preventing returns to homelessness)

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

PROCESS MEASURES:

  • Number of cross-sector partnerships (e.g., with domestic violence services, child welfare agencies, schools) established to provide comprehensive support to women and children in Housing First programs. (Shows the level of collaboration and coordination to address the multi-faceted needs of the population)
  • Number of policy and system changes supported or implemented to remove barriers and increase access to Housing First programs for women and children experiencing homelessness. (Indicates the efforts to create an enabling environment for the approach's success and sustainability)

OUTCOME MEASURES:

  • Number of women and children in Housing First programs who achieve increased economic stability and mobility through improved access to income, education, and employment opportunities. (Shows the approach's long-term impact on reducing poverty and enhancing family well-being)
  • Number of best practices and lessons learned from Housing First program collaborations serving women and children that are disseminated and adopted by other communities and systems. (Indicates the approach's contribution to field-building and systems transformation)

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

PROCESS MEASURES:

  • Percent of Housing First program collaborations serving women and children that actively involve women with lived experience of homelessness in the design, implementation, and evaluation of the approach. (Shows the level of authentic participation and leadership of the population in shaping the approach)
  • Percent of Housing First program funding and resources dedicated to serving women and children that are sustained and diversified over time. (Indicates the long-term commitment and investment in supporting this population)

OUTCOME MEASURES:

  • Percent reduction in the overrepresentation of women and children of color experiencing homelessness as a result of tailored Housing First program collaborations. (Shows the approach's impact on reducing racial and gender disparities in housing instability)
  • Percent of public and private funders who prioritize and invest in Housing First approaches as a proven and cost-effective solution for addressing homelessness among women and children. (Indicates the approach's influence on shifting resources and system priorities towards evidence-based practices)

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] Stergiopoulos 2012 - Stergiopoulos V, O'Campo P, Gozdzik A, et al. Moving from rhetoric to reality: Adapting Housing First for homeless individuals with mental illness from ethno-racial groups. BMC Health Services Research. 2012;12:345.

2 Patterson 2013 - Patterson M, Moniruzzaman A, Palepu A, et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Social Psychiatry and Psychiatric Epidemiology. 2013;48(8):1245-1259.

3 Urban-Cunningham 2015 - Cunningham MK, Gillespie S, Anderson J. Rapid re-housing: What the research says. Washington, DC: Urban Institute; 2015.

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.