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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. Legal Support for Tenants in Eviction Proceedings (Pregnancy)

Approach. Encourage legal support for tenants in eviction proceedings to reduce homelessness among families with young children

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Overview. Legal support in eviction proceedings includes full representation for tenants experiencing economic challenges by an attorney in court or limited legal assistance from an attorney or paralegal,[1] such as instruction on the summary eviction process, help completing and filing paperwork, and other efforts to prepare tenants to represent themselves effectively in court.[2, 3] Although not widely available, such efforts can include social service referrals or be part of comprehensive programs that also offer financial and social services, as in New York City.[3] Tenants do not have a constitutional right to counsel, unlike criminal defendants;[4] however, local government policies can establish a right to legal counsel when a family or an individual experiencing economic challenges faces loss of shelter, sustenance, or other basic human needs.[5] Available data suggests up to 90% of tenants may not have representation for eviction proceedings.[6]

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. Individual/Family-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 legal support programs or initiatives established to provide representation or assistance to tenants with limited financial resources facing eviction, with a focus on families with young children. (Shows the implementation and scale of the approach)
  • Number of attorneys, paralegals, and legal aid staff trained and deployed to provide eviction defense and support to families with young children. (Indicates the capacity and availability of the legal support workforce)

OUTCOME MEASURES:

  • Number of families with young children who avoid eviction and maintain stable housing as a result of receiving legal support in eviction proceedings. (Shows the approach's impact on its primary goal of preventing homelessness)
  • Number of families with young children who receive favorable judgments, settlements, or other positive outcomes in eviction cases through the assistance of legal support services. (Indicates the approach's effect on improving legal outcomes and protections for families with limited resources)

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

PROCESS MEASURES:

  • Percent of families with young children facing eviction who are provided with timely, accessible, and culturally responsive legal support services. (Shows the reach and equity of the approach's implementation)
  • Percent of legal support providers who receive ongoing training and resources to effectively serve families with young children facing eviction. (Indicates the quality and preparedness of the legal support workforce)

OUTCOME MEASURES:

  • Percent of families with young children who maintain or improve their housing stability after receiving legal support in eviction proceedings. (Shows the approach's long-term impact on family well-being and housing security)
  • Percent of families with young children who report increased understanding of their rights and increased ability to navigate the housing system after receiving legal support. (Indicates the approach's effect on supporting and educating families)

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

PROCESS MEASURES:

  • Number of partnerships and referral networks established between legal support providers, housing supporters, social service agencies, and early childhood programs to comprehensively address the needs of families with young children facing eviction. (Shows the level of multi-sector collaboration and coordination to support the approach)
  • Number of policy and system changes supported and implemented to strengthen legal protections and due process rights for tenants facing eviction, particularly families with young children. (Indicates the efforts to create a more favorable legal and policy environment for the approach)

OUTCOME MEASURES:

  • Number of evictions prevented or delayed as a result of legal support services, allowing families with young children to access emergency rental assistance, housing subsidies, or other financial support to regain housing stability. (Shows the approach's ripple effect on connecting families to complementary resources and services)
  • Number of communities that adopt a right to counsel or universal access to legal representation for families with young children facing eviction, inspired by the demonstrated impact and value of the approach. (Indicates the approach's potential for replication, scaling, and systems change)

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

PROCESS MEASURES:

  • Percent of families with young children facing eviction who report feeling treated with dignity, respect, and empathy by their legal support providers. (Shows the approach's commitment to trauma-informed and compassionate care)
  • Percent of legal support programs for families facing eviction that are sustainably funded and resourced to provide holistic, high-quality, and accessible services. (Indicates the long-term viability and capacity of the approach)

OUTCOME MEASURES:

  • Percent reduction in racial and socioeconomic disparities in eviction rates and housing instability among families with young children in communities where legal support services are equitably provided and delivered. (Shows the approach's impact on advancing housing justice and racial equity)
  • Percent of key partners (e.g., courts, policymakers, funders, landlords) who recognize and value the role of legal support services in creating a more fair, humane, and effective eviction system that prioritizes housing stability for families with young children. (Indicates the approach's success in shifting power dynamics and transforming the eviction landscape)

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] Holl 2016 - Holl M, van den Dries L, Wolf JRLM. Interventions to prevent tenant evictions: A systematic review. Health and Social Care in the Community. 2016;24(5):532-546.

2 Pattanayak 2013 - Pattanayak CW, Greiner DJ, Hennessy J. The limits of unbundled legal assistance: A randomized study in a Massachusetts district court and prospects for the future. Harvard Law Review. 2013;126:901-989.

3 Seedco 2010 - Hoffman L, Rodriguez LM, Seigel B, et al. Housing help program: Homelessness prevention pilot final report. Structured Employment Economic Development Corporation (SEEDCO). 2010:1-53.

4 Gold 2016 - Gold AE. No home for justice: How eviction perpetuates health inequity among low-income and minority tenants. Georgetown Journal on Poverty Law and Policy. 2016;XXIV(1):59-87.

5 BBA 2012 - Boston Bar Association Task Force on the Civil Right to Counsel (BBA). The importance of representation in eviction cases and homelessness prevention. 2012:1-10.

6 Greenberg 2016 - Greenberg D, Gershenson C, Desmond M, et al. Discrimination in evictions: Empirical evidence and legal challenges. Harvard Civil Rights-Civil Liberties Law Review. 2016;51:115-158.

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.