Preliminary Outcomes for Boston's Healthy Start in Housing Program

Homelessness is correlated with poor maternal physical and mental health and increased risk for preterm birth and subsequent adverse child health outcomes. In 2011, the Boston Public Health Commission (BPHC) and Boston Housing Authority (BHA) developed the Healthy Start in Housing Program (HSiH) to improve life course outcomes among women with a high risk pregnancy and address longstanding inequalities in birth outcomes. HSiH provides intensive case management and priority access to BHA housing to homeless women experiencing high risk pregnancies. As lead evaluators, Boston University School of Public Health, conducted in person structured interviews with women enrolled in the program to assess the longitudinal impacts of program participation. Interviews were conducted at baseline, when a woman completed her housing application, and at 5 months, 9 months, and 12 months after baseline. Assessments included measures of maternal mental and physical health. Preliminary data from 24/40 HSiH participants who, to date, have completed 8 months of follow-up demonstrate moderate to large improvements in depressive symptoms (effect size 0.64); physical health (effect size 0.67); and mental health (0.64), calculated as Cohen’s d, the standardized mean difference. Updated data will be presented for all participants who have completed 8 months of follow up. HSiH demonstrates promise to improve the life course of vulnerable women. Given the potential for this program to serve as a model for other public health initiatives, results of this evaluation are of interest to other public health authorities and MCH agencies.