Permanent Housing for Child Welfare-Involved Families: Family Chaos As a Mediator between Housing Stability and Child Well-Being in a Randomized Trial

Background & Purpose: Housing is a critical social determinant of health that is jeopardized when families are unstably housed. Research demonstrates associations between housing instability and adverse family and child outcomes. Detrimental effects are partially due to the relationship between housing instability and family instability. However, it remains unknown whether family instability precedes the associated impact on child development. We address this knowledge gap utilizing a natural experiment, the Family Unification Program (FUP), which provides Housing Choice Vouchers (HCV) to families whose inadequate housing risks out-of-home placement for children. Within this context, we addressed the following research questions: 1) To what extent does receipt of FUP plus services-as-usual (Housing Advocacy Program; HAP) improve family housing stability compared to services-as-usual?, 2) To what extent is FUP receipt associated with child behavioral health outcomes compared to families who receive services-as-usual?, and 3) To what extent does family instability mediate the association between housing stability and child development?

Methods: The randomized controlled trial collected longitudinal survey and administrative data on housing insecure families under investigation for child maltreatment in Chicago, IL. The study followed 150 families over 2.5 years with minimal attrition. Multilevel latent parallel growth models examined co-occurring change in housing stability (residential event histories), family chaos (Confusion, Hubbub, and Order Scale; CHAOS), and child behavioral health problems (Brief Problem Checklist; PBC). Mediation models tested indirect effects of the housing intervention (level 2) on housing stability and family chaos (level 2), which predicted child-level outcomes (level 1). Analyses occurred in MPLUS.

Results: Models provided adequate fit to the data (χ2(228)=494.39, p<0.01; ABIC=16019.42; CFI=0.90; RMSEA=0.05). Growth parameters suggested that housing stability increased over time (slope=0.10, SE=0.02, p<0.01), while family chaos remained constant (slope=-0.01, p=0.89). After including time-varying covariates, caregiver-reported child externalizing (slope=-0.65, p=0.07) and internalizing problems (slope=-0.24, p=0.44) decreased marginally but were not significant. Correlated intercepts suggested that average levels of externalizing positively related with internalizing problems as expected (b=0.59, p<0.01). Family chaos was associated with higher levels of externalizing and internalizing problems. The slope of family chaos was positively and significantly associated with slopes of externalizing and internalizing problems. Change in family chaos was predicted by the housing intervention and change in housing stability. Families receiving FUP and those experiencing sharper declines in housing instability exhibited significant declines in family chaos. The intervention also directly influenced change in housing instability and change in internalizing problems after including time-varying processes. Increases in housing stability resulting from the housing intervention led to decreases in family chaos that, in turn, predicted lower levels of internalizing problems. In addition, the mechanism accounted, in part, for both the level and change in externalizing problems.

Conclusions & Implications: Permanent housing through child welfare reduces housing instability compared to housing services-as-usual. Housing stability decreases family chaos, which improves child behavioral health. Findings emphasize the importance of affordable housing for keeping children safe and secure. Housing is a vital resource for family stability and promoting social and racial justice for marginalized families.