This study examines the effects of housing and service interventions on the health and development of 0 -15 year old children in homeless families. An evaluation funded by the Department of Housing and Urban Development (HUD) will randomly assign 2,400 homeless families with over 5,000 children across 12 sites to one of three interventions: ongoing subsidies with no services beyond lease up, community-based rapid re- housing (temporary subsidies with housing-related services), and program-based transitional housing with intensive social services, or to usual care (typically little more than shelter). The proposed study will add a child component to the HUD study, using data collected from caregivers, observational assessments, direct assessments of children, and interviews of older children to understand intervention effects on 1) child health and development and 2) aspects of children's immediate environment hypothesized to affect child outcomes. Child outcomes include health (all children), achievement (children 2-15), behavioral problems (children 2-15), attention or self-regulation (children 2-15), other protective processes (children 8-15), and school outcomes (school-age children, including attendance, effort, grades, and school behavior). Assessments will involve maternal and child reports, age-appropriate standardized instruments with national norms or measures used in previous studies of minority and homeless families, and interviewer observations. Aspects of the immediate environment include stability (residential and school stability, low crowding, life events), caregiver well-being (low depressive symptoms, substance use), resources (child care, learning resources in the home, nutrition, low financial stress), and parenting (parental warmth, lack of hostility, involved vigilant parenting, supportive family relationships, routines). Data sources include both maternal report and direct observation of the home environment. The study will also examine how effects of the intervention vary by 1) family characteristics assessed at study entry and 2) child age. It is hypothesized that families with higher levels of psychosocial risk will benefit most from the service-intensive transitional housing intervention and that families with highest levels of prior residential instability will benefit most from on-going housing subsidies. Prior research does not provide clear guidance about the ages of children most at risk from homelessness or most likely to benefit from interventions. Analyses will include estimates based on the intervention assigned (intent to treat) and, on the programs actually experienced (treatment on the treated). Preliminary in-depth qualitative interviews with 100 caregivers and children in 5 sites will inform the later collection of quantitative data, and will yield information on how the interventions and resulting living arrangements affect family composition and parenting and other family processes and hence child outcomes. Results will inform developmental theory about the relationship between environmental circumstances and child outcomes among extremely disadvantaged children, and will inform policy and practice about how interventions to help homeless families affect children.

Public Health Relevance

This study examines the effects of housing and service interventions on the health and development of 0 -15 year old children in homeless families. It will piggy-back on a HUD-funded study in which 2400 homeless families across 12 sites will be randomized to receive ongoing housing subsidies, community-based rapid re- housing, transitional housing, or usual care. The proposed study will add a child component to the HUD study, using data collected from caregivers, observational assessments, direct assessments of children, and interviews of older children to understand intervention effects on 1) child health and development and 2) aspects of children's immediate environment hypothesized to affect child outcomes.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD066082-03
Application #
8305107
Study Section
Social Sciences and Population Studies Study Section (SSPS)
Program Officer
King, Rosalind B
Project Start
2010-08-15
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
3
Fiscal Year
2012
Total Cost
$359,276
Indirect Cost
$30,788
Name
Vanderbilt University Medical Center
Department
Social Sciences
Type
Schools of Education
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
Fisher, Benjamin W; Mayberry, Lindsay; Shinn, Marybeth et al. (2014) Leaving Homelessness Behind: Housing Decisions among Families Exiting Shelter(1.) Hous Policy Debate 24:364-386
Mayberry, Lindsay Satterwhite; Shinn, Marybeth; Benton, Jessica Gibbons et al. (2014) Families experiencing housing instability: the effects of housing programs on family routines and rituals. Am J Orthopsychiatry 84:95-109