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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

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 with low incomes 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 with low incomes, 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...

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:

  • Housing trust fund allocation and project funding records
  • Affordable housing program participant demographics and enrollment data
  • Housing case management and support service delivery records

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. 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 case managers who are trained on assisting in the application process of HTF-supported programs. (Shows the direct output and productivity of HTF resources)
  • Number of families with limited financial resources who are educated by Title V on the application process of housing assistance through HTF-supported programs. (Indicates the reach and tailoring of HTF benefits to the intended population)

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

  • Percent of case managers who are trained on assisting in the application process of HTF-supported programs. (Shows the direct output and productivity of HTF resources)
  • Percent of HTF-supported affordable housing units that are located in neighborhoods with access to employment, education, healthcare, and other essential services as indicated and identified by Title V. (Indicates the approach's focus on creating housing opportunities in thriving communities)

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

  • Number of cross-sector partnerships led by Title V (e.g., with housing developers, service providers, community organizations) established to leverage HTF investments and expand affordable housing opportunities which leads to an increase in HTF applications. (Shows the level of collaboration and coordination to maximize the impact of HTFs)
  • Number of policy and systems changes pursued by Title V to create a more enabling environment for HTF capitalization, utilization, and sustainability that results in an increase in HTF applications. (Indicates the broader institutional and regulatory reforms needed to optimize HTF impact)
  • 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 that utilized a case manager to assist in the application process. (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 by Title V 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?”)

  • Percent of HTF governance structures and decision-making process that include meaningful representation and participation from families partnered with Title V with limited financial resources and communities most impacted by housing instability. (Shows the approach's commitment to comprehensive governance)
  • Percent of HTF allocation and investment strategies organized by Title V that prioritize goals like reducing differences in access to affordable housing and advancing fair housing principles. (Indicates the approach's intentionality in using HTFs as a tool for improving health outcomes)
  • Percent reduction in housing instability and homelessness rates among families with limited financial resources in communities with sustained HTF investments promoted by Title V in affordable housing. (Shows the approach's population-level impact on reducing gaps and ensuring housing security for all)
  • Percent of public and private sector leaders partnered with Title V who champion HTFs as a critical and mainstream strategy for advancing housing affordability 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.