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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 Trust Funds (Pregnancy)

Approach. Support the use of Housing Trust Funds to increase housing stability for families

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Overview. Housing trust funds (HTFs) are a suggested strategy to increase affordable, quality housing options[1, 2] and minimize the displacement of residents experiencing economic challenges that can follow such neighborhood improvements.[3] Housing improvements have been shown to positively affect health outcomes, especially when improvements address warmth and energy efficiency.[4] HTFs may help meet the housing needs of families experiencing economic challenges, including the needs of those with the lowest incomes;[5] program funds are typically designated for these families.[6]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

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 affordable housing units created or preserved through HTF investments. (Shows the direct output and productivity of HTF resources)
  • Number of families with limited financial resources who apply for and receive housing assistance through HTF-supported programs. (Indicates the reach and tailoring of HTF benefits to the intended population)

OUTCOME MEASURES:

  • Number of families with limited financial resources who achieve housing stability through HTF-supported affordable housing. (Shows the approach's impact on its primary goal of promoting housing security)
  • Number of children in families with limited financial resources who benefit from increased residential stability and access to opportunities as a result of HTF-supported housing. (Indicates the approach's spillover impact on child well-being and life chances)

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

PROCESS MEASURES:

  • Percent of HTF-supported affordable housing units that meet or exceed quality standards for design, construction, and management. (Shows the commitment to providing high-quality and sustainable housing solutions)
  • Percent of HTF-supported affordable housing units that are located in neighborhoods with access to employment, education, healthcare, and other essential services. (Indicates the approach's focus on creating housing opportunities in thriving and inclusive communities)

OUTCOME MEASURES:

  • Percent of families with limited financial resources living in HTF-supported affordable housing who experience reduced housing cost burden and increased financial stability. (Shows the approach's effect on improving the economic conditions and resilience of families)
  • Percent of neighborhoods with HTF-supported affordable housing that demonstrate increased socioeconomic diversity and integration. (Indicates the approach's contribution to fostering inclusive and equitable communities)

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

PROCESS MEASURES:

  • Number of cross-sector partnerships (e.g., with housing developers, service providers, community organizations) established to leverage HTF investments and expand affordable housing opportunities. (Shows the level of collaboration and coordination to maximize the impact of HTFs)
  • Number of policy and systems changes pursued to create a more enabling environment for HTF capitalization, utilization, and sustainability. (Indicates the broader institutional and regulatory reforms needed to optimize HTF impact)

OUTCOME MEASURES:

  • Number of dollars saved in public spending on healthcare, emergency services, and social programs as a result of improved housing stability among families experiencing economic challenges in HTF-supported housing. (Shows the approach's fiscal impact and return on investment across multiple sectors)
  • Number of affordable housing policies, programs, and financing models that are scaled or replicated based on the demonstrated success and learnings of HTF-supported initiatives. (Indicates the approach's catalytic effect on driving systemic solutions to the affordable housing crisis)

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

PROCESS MEASURES:

  • Percent of HTF governance structures and decision-making process that include meaningful representation and participation from families with limited financial resources and communities most impacted by housing instability. (Shows the approach's commitment to inclusive and equitable governance)
  • Percent of HTF allocation and investment strategies that prioritize racial and social equity goals, such as reducing disparities in access to affordable housing and advancing fair housing principles. (Indicates the approach's intentionality in using HTFs as a tool for equity and justice)

OUTCOME MEASURES:

  • Percent reduction in housing instability and homelessness rates among families with limited financial resources in communities with sustained HTF investments in affordable housing. (Shows the approach's population-level impact on reducing equity gaps and ensuring housing security for all)
  • Percent of public and private sector leaders who champion HTFs as a critical and mainstream strategy for advancing housing affordability, equity, and community well-being. (Indicates the approach's influence on shifting narratives and building broad-based support for transformative housing solutions)

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] Urban-Newman 2005 - Newman SJ. Low-end rental housing: The forgotten story in Baltimore’s housing boom. Washington, D.C.: Urban Institute; 2005.

2 APA-Meck 2003 - Meck S, Retzlaff R, Schwab J. Regional approaches to affordable housing. Washington, DC: American Planning Association (APA); 2003: Report No. 513/514.

3 Damewood 201[1] - Damewood R, Young-Laing B. Strategies to prevent displacement of residents and businesses in Pittsburgh's Hill District. September 2011.

4 Thomson 2015 - Thomson H, Thomas S. Developing empirically supported theories of change for housing investment and health. Social Science & Medicine. 2015;124:205-214.

5 AIC-HTF - All-In Cities, an Initiative of PolicyLink. All-In Cities Policy Toolkit: Housing trust funds (HTF).

6 Scally 2012 - Scally CP. The past and future of housing policy innovation: The case of US state housing trust funds. Housing Studies. 2012;27(1):127-150.

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.