Effects of Healthy Start in Housing on maternal mental health among high-risk pregnant women experiencing homelessness

Homelessness is associated with poor maternal health and adverse birth and child outcomes.  Healthy Start in Housing (HSiH) was developed as a partnership between the Boston Public Health Commission and the Boston Housing Authority to provide intensive case management and access to permanent housing to women experiencing the dual stresses of homelessness and a high-risk pregnancy. We conducted a quasi-experimental study to assess the effects of program participation on maternal mental health and social functioning. We are comparing HSiH participants to a cohort of demographically similar homeless, pregnant women who are not enrolled in the program. In-person assessments are conducted at study entry and 5, 9, and 12-months after baseline. With the exception of race, baseline demographic data from 75 HSiH and 52 comparison group participants revealed no significant differences between groups. The majority of study participants were unmarried, US born, and English speaking. Approximately 40% were first time mothers, 40% had symptoms consistent with major depression, and 84% had multiple pregnancy risks. Comparison group women had greater social functioning than HSiH participants. Preliminary data from HSiH participants demonstrated moderate improvements in depressive symptoms and overall social and mental functioning over 12 months of follow-up (effect size range 0.32 to 0.67). Mental health trajectories of HSiH participants will be compared to those of comparison group women to assess program impact. Study findings will inform the potential for HSiH to serve as a model for other interagency public health initiatives to address homelessness.