Evaluating the Impact of Emergency Maternity Housing on Mother and Child Well-being, Housing, and Employment

Last registered on June 06, 2022

Pre-Trial

Trial Information

General Information

Title
Evaluating the Impact of Emergency Maternity Housing on Mother and Child Well-being, Housing, and Employment
RCT ID
AEARCTR-0009509
Initial registration date
June 01, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
June 06, 2022, 5:13 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Affiliation
University of Notre Dame

Other Primary Investigator(s)

PI Affiliation
University of Notre Dame
PI Affiliation
University of Notre Dame
PI Affiliation
University of South Carolina

Additional Trial Information

Status
In development
Start date
2022-05-30
End date
2025-12-01
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Low-income women are over five times more likely than affluent women to experience an unintended pregnancy, and this pregnancy can seriously hinder their ability to improve their economic situation, given that unplanned childbearing is associated with higher rates of poverty, less family stability, and worse outcomes for children (Reeves & Venator, 2015). Pregnancy can also increase a woman’s risk of homelessness, and pregnant women face greater health risks while unstably housed (Clark et al., 2019). While many individuals face housing insecurity, pregnancy creates an additional barrier to the climb out of poverty and toward a path of self-sufficiency. In response to this dilemma, there are over 450 maternity housing programs that exist to serve and support pregnant women (Peterson, 2020). These homes are residential-focused programs that often offer wrap-around support for residents, such as access to prenatal care, social support, mental health treatment, substance abuse treatment, life skills and employment training, support towards goal achievement, and parenting classes. There is little evidence about how effective these programs are at improving immediate or longer-term outcomes for mothers and their babies. Researchers are collaborating with five maternity homes to use a randomized controlled trial to evaluate the impact of their services on mother and child health, housing, and self-sufficiency outcomes.
External Link(s)

Registration Citation

Citation
Brown, Jessica et al. 2022. "Evaluating the Impact of Emergency Maternity Housing on Mother and Child Well-being, Housing, and Employment." AEA RCT Registry. June 06. https://doi.org/10.1257/rct.9509-1.0
Experimental Details

Interventions

Intervention(s)
The control group will be referred to other services in the home’s locality – this could include other maternity homes, other general homeless centers, agencies that could help them access Medicaid or WIC, etc. Some of the homes might also have the ability to provide diapers or women’s clothing to women in the control group.

The treatment group moms will be given the option of moving into the home and provided with a bed, prenatal care, food, etc. They typically have a caseworker or advocate with whom they will set goals, such as finding employment or childcare. The caseworker will guide her in achieving these goals. The moms also have access to group or individual counseling, parenting classes, support for advancing their education, some basic transportation services, etc. Moms may remain in the home typically up to one year post-birth of the child. Some mothers are unable to live under the house rules and are asked to leave. Others leave voluntarily before the birth of the child for a variety of reasons. We discuss how these departures impact the estimates of treatment effects below.
Intervention Start Date
2022-05-30
Intervention End Date
2025-12-01

Primary Outcomes

Primary Outcomes (end points)
Pregnancy Outcomes, Life Satisfaction, Life Stability
Primary Outcomes (explanation)
Pregnancy Outcomes:
1. Primary measure: Baby carried to term
- Follow up survey question asking baby’s gestational age at birth
- Hypothesis: The intervention may increase the client's confidence in her ability to carry the child to term and give her access to health services that may improve pregnancy health outcomes. We will test the null hypothesis that there is no effect of the intervention on carrying the baby to term.
2. Alternative measure: Mom retains custody of baby
- Follow-up survey will ask whether the mother retained custody of the baby immediately after birth and whether she currently has custody of the baby.
- Hypothesis: Many of the mothers have previous interactions with state Child protective Services (CPS) and have lost custody of previous children. It is also the case that the underlying reason for their homelessness during pregnancy (e.g., drug use) may increase the chance they will lose custody of their baby to CPS once born. We will test that there is no effect of the intervention on retaining custody of the baby.


Life Satisfaction:
Primary measure: : Overall life satisfaction
- Baseline and follow-up survey asking where the client feels that his/her life is on a scale of one to ten
- Hypothesis: The intervention is designed to increase the client’s overall life satisfaction. We will test the null hypothesis that there is no effect of the intervention on life satisfaction.
Alternative measure: Sense of self-efficacy
- Baseline and follow-up survey asking about mother's sense of self-efficacy
- Hypothesis: The intervention is designed to increase the client’s sense of self-efficacy. We will test the null hypothesis that there is no effect of the intervention on self-efficacy ratings.
Alternative measure: Isolation + Loneliness scale + Depression
- Baseline and follow-up survey questions asking whether the client feels lonely, feels like they have people who support them, has experienced depression, etc.
- Hypothesis: Applicants to maternity homes indicate a high degree of loneliness and isolation and the intervention is designed to reduce this by creating a sense of community and family. We will test the null hypothesis that there is no effect of the intervention on loneliness.

Life Stability
Primary Measure: Address History
- Constructed using follow-up survey questions asking her independent living status and whether she has a mortgage or lease in her own name. Additionally, we will explore using address history information from Infutor Data Solutions, comparing information there with the housing statuses self-reported in the follow-up survey.
- Hypothesis: The intervention is designed to improve the client’s housing stability. We will test the null hypothesis that there is no effect of the intervention on the number of address changes.
Alternative Measure: Continuum of Care Utilization
- HMIS captures a mother’s interactions with other local services agencies. LEO is in the process of establishing data sharing relationships with HMIS agencies in each locality. This will capture her movements outside of having permanent addresses.
- Hypothesis: The intervention is designed to improve the client’s housing stability. We will test the null hypothesis that there is no effect of the intervention on the number of interactions with the continuum of care services.
Alternative Measure: Employment
- Mothers will be asked to report their employment in the baseline and follow-up surveys, including whether they are currently employed, how many jobs they have, how many hours per week they work, their income and the industry of their primary job.
- Hypothesis: The intervention is designed to improve the client’s employment. We will test the null hypothesis that there is no effect of the intervention on employment.
Alternative Measure: Safety Net utilization
- Mothers will be asked to report all sources of income, including welfare, in the follow-up survey.
- Hypothesis: The intervention is designed to improve the client’s access to social safety nets while simultaneously improving their employment. It is unclear whether the treatment will increase their welfare utilization as access is increased, or decrease their welfare as self-sufficiency and employment increase. We will test the null hypothesis that there is no effect of the intervention on welfare utilization.
Alternative Measure: Education
- Mothers will be asked to report their education in the baseline and follow-up surveys, including their highest level of education, vocational training, active school status, etc.
- Hypothesis: The intervention is designed to improve the client’s education levels. We will test the null hypothesis that there is no effect of the intervention on education.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Moms will call and agencies will determine if she is eligible based on basic criteria. If she is eligible, the agency will send her an intake application link to complete, which includes a consent form. After completing the survey, if she is still eligible, she will be placed on a waitlist for services. When a bed becomes available in an individual agency, the agency will call two moms at the top of the waitlist, conduct in-person interviews to confirm eligibility and good fit. They will use a computer to randomly assign one to treatment and one to control. Agency will let moms know of their status and will allow the treatment mom to move in. Moms in treatment and control will be surveyed approximately one year after the estimated due date of the child (as reported on the baseline survey).
Experimental Design Details
Not available
Randomization Method
On computer
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
0
Sample size: planned number of observations
1048
Sample size (or number of clusters) by treatment arms
534 treatment, 534 control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Assuming a baseline housing stability rate of 50.3%, initial power calculations suggest that we will be able to measure a 16.3 pp effect on housing stability after one year of enrollment, 11.53 pp effect after two years of enrollment, and a 9.41 pp effect after three years. We anticipate that we will need to enroll for at least two years. This is assuming approximately 60% of mothers assigned to treatment actually take up the program.
IRB

Institutional Review Boards (IRBs)

IRB Name
The University of Notre Dame Institutional Review Board
IRB Approval Date
2022-04-27
IRB Approval Number
22-04-7182
Analysis Plan

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