BOSTON - Results of a study show that enrollment in a program that supports housing and health needs of medically complex families was associated with improved child health and parent mental health within six months. The program, Housing Prescription as Health Care (HPHC), helps families experiencing homelessness and housing instability in Boston and uses a multi-dimensional approach to address families' specific needs. Led by Children's HealthWatch at Boston Medical Center, the intervention reduced the share of children with fair or poor health by 32 percentage points in the first six months of the study.
Published in Health Affairs, the HPHC pilot program enrolled 78 families between 2016 and 2019 to determine whether the coordination of services that address housing, financial, legal, social, and health needs may improve health outcomes, when compared with current approaches.
"Our study aimed to explore how a multi-faceted intervention designed for families experiencing housing instability and homelessness might improve the health of children and their families," said Allison Bovell-Ammon, M.Div, director of policy strategy at Children's HealthWatch and the study's corresponding author. "Secure housing allows families to direct focus toward their health, while living in an environment that allows them to thrive."
At the beginning of the randomized controlled trial, 71 percent of families in the intervention group and 64 percent of those in the control group identified as homeless, while 58 percent and 55 percent report that they were behind on rent. At the six-month mark, 67 families completed the follow-up, and an analysis showed improvement in the share of children identified as having fair or poor health, and in the average anxiety and depression among parents in the intervention group. Average scores for anxiety and depression among adult family members declined by 1.38 and 1.04 points, using the Patient Health Questionnaire-2 for depression and the Generalized Anxiety Disorder two-item scale for anxiety.
Within the intervention group, there were also significant changes in child health status, and children who were housed at six months had a lower prevalence of developmental risk than those who were not. They also showed a decrease in being behind on rent, and both groups demonstrated significant reductions in their use of health care.
"Without significant new investment from the federal government, it will be difficult for health systems to adequately respond to housing needs," said Megan Sandel, MD, MPH, a pediatrician at Boston Medical Center, and coauthor on this study. "Our goal is to set families on a positive trajectory toward stability, but we can't do this alone."
Future analysis is necessary to assess the long-term impacts of this model, and to define the cost benefits associated with the direct benefits of improving child physical health and parent mental health services. This is important for understanding the ways in which tailored housing and health interventions may be able to produce a positive return on investment within pediatric populations.
Funding for this trial was supported by Boston Foundation's Health Starts at Home Initiative, and the Social Interventions Research and Evaluation Network. This project was done in partnership with Project HOPE, the Boston Housing Authority, MLPB, and Neustra Comunidad.
About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $97 million in sponsored research funding in fiscal year 2018. It is the 15th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit