Established Evidence Results

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

Intervention Description: The current qualitative, longitudinal study examined mothers’ perceptions of how receipt of flexible funding designed to increase their housing stability may have also impacted their children’s safety, stress, mood and behavior. Forty-two mothers in the Washington, D.C. metro area were interviewed three times over a six-month period about their own safety and housing stability, as well as their children’s. Ninety-five percent of the mothers and their children were housed at the six-month interview.

Intervention Results: Ninety-five percent of the mothers and their children were housed at the six-month interview. Mothers described improvements in children’s stability and safety, decreases in children’s stress levels, and improvements to their mood and behavior. They also discussed the symbiotic relationship between their own stress and well-being, and their children’s.

Conclusion: The provision of flexible funding to assist domestic violence survivors with their housing also collaterally impacted their children’s safety, stress, mood and behavior.

Study Design: qualitative, longitudinal study

Setting: Washington, D.C. metro area

Sample Size: Forty-two mothers

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

Intervention Description: supportive housing program called Housing Prescriptions as Health Care

Intervention Results: the Housing Prescriptions as Health Care intervention led to improvements in child health and parental mental health over a six-month period for medically complex families in Boston who had experienced homelessness and housing instability. Specifically, there were decreases in the share of children in fair or poor health and in average anxiety and depression scores among parents in the intervention group compared to the control group

Conclusion: a population-specific model integrating health, housing, legal, and social services, such as the Housing Prescriptions as Health Care intervention, can improve health-related outcomes at the household level for medically complex families experiencing homelessness and housing instability. The findings suggest that addressing housing instability through a multifaceted supportive housing intervention can positively impact the health of both children and parents in these families

Study Design: pilot randomized controlled trial.

Setting: Boston, Massachusetts

Sample Size: seventy-eight homeless or housing-unstable families defined as "medically complex"; Sixty-seven families completed a six-month follow-up assessment

Age Range: mean age of the index child in the study was 2.8 years

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): Policy/Guideline (National), Social Supports, Individual Supports, Housing Supports

Intervention Description: Family Unification Program

Intervention Results: Intent-to-treat analyses suggested families randomly assigned for FUP exhibited slower increases in rates of foster placement following housing intervention compared with families referred for housing advocacy alone. The program generates average savings of nearly $500 per family per year to the foster care system. Housing subsidies provide the foster care system small but significant benefits for keeping homeless families together. Findings inform the design of a coordinated child welfare response to housing insecurity.

Conclusion: The present study tests the impact of the Family Unification Program – a HUD-funded housing intervention for inadequately housed families involved in the child welfare system – on foster care placement and costs among intact families whose inadequate housing threatened out of home placement of one or more children. A longitudinal randomized controlled trial embedded within the child welfare system shows FUP relates with significant declines in the rate of foster care placement

Study Design: randomized controlled trial

Setting: Chicago, IL

Population of Focus: social workers, policy makers, public health practitioners

Sample Size: n = 89 families with 257 children

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

Intervention Description: Rapid Rehousing Program

Intervention Results: Participants expressed feelings of insecurity in emergency shelters due to lack of privacy, theft, unsanitary conditions, and safety concerns. Families noted improvements in children's behavior and academic performance after moving into their own homes. Participants reported feeling safer and more secure once they had their own space and autonomy. Families expressed a sense of security and belonging after being housed, leading to improved relationships with family and friends and a sense of hope for the future.

Conclusion: The study highlighted the importance of the Rapid Rehousing Program in improving the security and well-being of families experiencing homelessness. Moving from emergency shelters to their own homes provided a sense of security, autonomy, and hope for the future. Recommendations included providing clear expectations about housing subsidies, offering financial education, and enhancing case management to support long-term housing security for families

Setting: Salt Lake City, UT

Population of Focus: policymakers, social service providers, researchers

Sample Size: n=31

Age Range: average age 37.5 yrs of age

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

Intervention Description: long-term rent subsidies, short-term rent subsidies, and transitional housing in supervised programs with intensive psychosocial services

Intervention Results: priority access to long-term rent subsidies reduced homelessness and food insecurity and improved other aspects of adult and child well-being relative to usual care, at a cost 9 percent higher. The other interventions had little effect.

Conclusion: The study provides support for the view that homelessness for most families is an economic problem that long-term rent subsidies resolve and does not support the view that families must address psychosocial problems to succeed in housing. It has implications for focusing government resources on this important social problem.

Setting: United States

Sample Size: 2,282 families

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): Policy (Community), Social Supports, Housing Supports

Intervention Description: tested relationships between three domains of housing - quality, stability, and affordability – with three types of child maltreatment – psychological abuse, physical abuse, and neglect

Intervention Results: Housing affordability was associated with reduced psychological and physical abuse (β = −1.10, p < 0.05 and β = −0.66, p < 0.05 respectively), but not with neglect. Neither housing quality nor stability had any significant association with any maltreatment type. The only significant predictor of neglect was maternal depression.

Conclusion: Housing affordability in particular may protect against maltreatment, but other domains of housing insecurity appear to have little to no effect controlling for other household factors. Findings highlight the need for increased affordable housing supply, as well as mental health supports for families cost-burdened by meeting basic needs.

Study Design: longitudinal survey

Setting: 20 U.S. Cities

Population of Focus: policy makers, social workers, public health, medical staff

Sample Size: N=1804

Age Range: Mothers with children aged 5 and 9

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

Intervention Description: Through a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility.

Intervention Results: Experiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility.

Conclusion: A multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

Study Design: logistic regression

Setting: Hennepin and Ramsey County of Minnesota

Sample Size: 3278 children (ages 4 to 15) whose families used emergency or transitional housing; comparison group of 2613 children who did not use emergency or transitional housing.

Age Range: children aged 4-15 yrs old

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

Intervention Description: Design: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. Settings: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. Participants: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. Measurements: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale.

Intervention Results: mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only.

Conclusion: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.

Setting: large Midwestern city

Sample Size: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline.

Age Range: women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care.

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

Intervention Description: A grounded theory approach was used to analyze semi-structured, qualitative interviews.

Intervention Results: Frontline providers exercised street-level bureaucratic discretion when interpreting child protection reporting mandates and they found ways to adapt the HF model to this population. In doing so, they worked to juggle both their mandates to child protection and to principles of HF to create a “child safety-modified” form of HF.

Conclusion: While our study shows that providers are modifying HF to address the needs of families involved in child welfare, it also raises questions as to the degree to which HF can be done with high fidelity when used with this population.

Study Design: grounded theory

Setting: 2 U.S. States

Sample Size: 13 participants working in programs that encouraged direct collaboration with Child Protective Services (CPS) in the program model and 13 participants from three non-CPS-aligned sites in a second state.