Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Individual Supports Social Supports Housing Supports

Intervention Description: We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter. We modeled emergency department visits, hospital admissions, and expenditures over the 24-month period separately for children and adults.

Intervention Results: Emergency department visits, hospital admissions, and expenditures rose steadily before shelter entry and declined gradually afterward, ending, in most cases, near the starting point. Infants, pregnant women, and individuals with depression, anxiety, or substance use disorder had significantly higher rates of all outcomes. Many children’s emergency department visits were potentially preventable.

Conclusion: Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk.

Study Design: longitudinal study

Setting: Massachusetts

Population of Focus: social worker, medical professional, public health practitioner

Intervention Components (click on component to see a list of all articles that use that intervention): Access Family-Based Interventions

Intervention Description: We used a retrospective case control design tocompare infants who were exposed to homeless-ness and similar infants who were born to low-income families but did not experience a home-less episode during the study period. Beginningwith records of all families who entered emer-gency shelter in Massachusetts in the periodfrom January 1, 2008, to June 30, 2015, welinked Emergency Assistance enrollment rec-ords with Medicaid claims for each family mem-ber.

Intervention Results: The analysis showed that homeless infants had slightly higher Medicaid enrollment in the years following birth compared to the comparison group. The average monthly income for homeless families was lower than that of comparison families. The study found that homeless infants had higher rates of certain health conditions during the first year of life, such as low birth weight, upper respiratory infections, lower respiratory diseases, and developmental disorders, compared to the comparison group. Despite these differences, within-year median months of service use were similar for both groups

Conclusion: infants exposed to homelessness had higher rates of health conditions, longer neonatal intensive care unit stays, more emergency department visits, and higher annual healthcare spending compared to infants in stable housing. These differences in health conditions persisted for two to three years, with asthma diagnoses, emergency department visits, and healthcare spending remaining significantly higher through age six. The findings suggest that while screening and access to healthcare can be improved for homeless infants, long-term solutions require a broader focus on addressing housing instability and income disparities. The study highlights the significant impact of unstable housing leading to homelessness on newborns' health outcomes

Study Design: retrospective case-control design

Setting: Massachusetts

Sample Size: 5,762 infants who experienced a homeless episode and 5,553 infants in the comparison group who did not experience homelessness.

Age Range: up to 6 yrs of age

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State) Social Supports Housing Supports

Intervention Description: using counterfactual machine learning to identify the services most likely to prevent reentry into homelessness for each household.

Intervention Results: Homelessness prevention benefited households who could access it, while differential effects exist for homeless households that partially align with community interests.Households with comorbid health conditions avoid homelessness most when provided longer-term supportive housing, and families with children fare best in short-term rentals. No additional differential effects existed for intersectional subgroups. Prioritization rules reduce community-wide homelessness in simulations. Moreover, prioritization mitigated observed reentry disparities for female and unaccompanied youth without excluding Black and families with children.

Conclusion: Community-and data-driven prioritization rules more equitably target scarce homeless resources.

Setting: St. Louis, Missouri

Population of Focus: policymakers, community stakeholders, social service providers, researchers

Sample Size: 10,043 households that accessed homeless services in St. Louis from 2009 to 2014

Age Range: 18 to 24 years for unaccompanied homeless youth, with an average age of 39.5 years (SD = 12.8) for household heads entering services

Intervention Components (click on component to see a list of all articles that use that intervention): Social Supports Access

Intervention Description: Caregivers of children 0 to 48 months of age were interviewed in 5 urban medical centers from May 2009 to December 2015. Caregivers reported on the following: caregiver health, maternal depressive symptoms, child’s health, lifetime hospitalizations, developmental risk, and 3 housing circumstances, which were categorized as being behind on rent in the past 12 months, multiple moves (≥ 2 in past 12 months), and child’s lifetime history of homelessness. Associations with caregiver and child health outcomes were examined through multivariable logistic regression.

Intervention Results: 34% had at least 1 of the following adverse housing circumstances: 27% had been behind on rent, 8% had made multiple moves, and 12% had a history of being homeless. Overlap between these was limited; 86% experienced only 1 adverse housing circumstance. Each circumstance was individually associated with increased adjusted odds of adverse health and material hardship compared with stable housing. Households behind on rent had increased adjusted odds of fair and/or poor caregiver health (adjusted odds ratio [aOR]: 1.91; 95% confidence interval [CI]: 1.77–2.05), maternal depressive symptoms (aOR: 2.71; 95% CI: 2.51–2.93), child lifetime hospitalizations (aOR: 1.19; 95% CI: 1.10–1.27), fair and/or poor child health (aOR: 1.41; 95% CI: 1.28–1.56), and household material hardships. Families with multiple moves and history of homelessness had similar adverse caregiver, child, health, and hardship outcomes.

Conclusion: Three forms of housing instability were associated with adverse caregiver and child health among low-income renter households. The American Academy of Pediatrics recommends social screening within health care; providers could consider assessing for behind on rent, multiple moves, and homelessness in high-risk practices.

Setting: 5 urban medical centers from

Sample Size: 22 324 families

Age Range: Caregivers of children 0 to 48 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions Social Supports

Intervention Description: We used a semistructured interview protocol with three sections that solicited participants accounts of family housing and homelessness chronologically, beginning with the circumstances that led to their current episode of homelessness (e.g., Thinking back over the past few months, what is it that brought you to the shelter?), the experiences and impacts of their current episode of homelessness (e.g., What has your stay been like here at the shelter?; How has it been for you/your children?; Since you’ve been here, has there been any change in your relationship(s) with your child(ren)?), and their expectations and concerns for the future when they obtain housing (e.g., As you think ahead to your move back to the community, what are the things you are hopeful about or looking forward to?; Are there things you are concerned or nervous about?). Interviews were conducted by trained interviewers who were graduate students in psychology or who had prior experience interviewing vulnerable people. Initial interviews were reviewed by the first author to verify the quality of the interviews and to provide guidance as needed. Interviewers also completed interview summary forms (Miles et al., 2014) to provide additional information on each interview (e.g., main issues or themes from the interview, information gained or not gained from the interview, issues or questions that could be pursued in future interviews).

Intervention Results: Findings showed that families’ experiences prior to their homelessness were characterized by vulnerability, instability, and isolation. In the emergency shelter system, families faced new challenges in environments that were restrictive, noisy, chaotic, and afforded little privacy. Participants described a further disruption of relationships and described having to change their family practices and routines.

Conclusion: Future research is needed on ways in which shelters can be more hospitable, supportive, and helpful for parents and their families to minimize negative impacts and facilitate timely rehousing of families.

Study Design: qualitative study

Setting: Canada

Sample Size: n=18