Investigating the Impact of Housing Assistance on Youth Emotional and Behavioral Health and Mental Healthcare Utilization: An evaluation of the PHLHousing+ Project

About This Grant

Expanding upon the parent PHLHousing+ Study (5R01NR021122-02), the overarching goal of this proposal is to test whether interventions addressing housing insecurity as a modifiable social determinant of health (SDOH) improve youth mental health outcomes and outpatient service utilization in households of low-income renters in Philadelphia. This objective is aligned with the strategic aim of the NIMH (Goal 3) to identify opportunities to implement interventions that target modifiable SDOH (see Strategy 3.3.A). The PHLHousing+ Study comprises three groups, all of whom earn below 50% area median income, have at least one child under the age of 16 years living at home, and are renters: 301 households who receive monthly direct cash payments in lieu of a rental voucher for 3.5 years(Cash group), 169 households who receive a rental voucher (Voucher group), and 711 households on the Philadelphia Housing Authority (PHA) waitlist unlikely to receive rental assistance during the entire study period. Our analytic plan combines Cash and Voucher groups into a single Intervention group. Of the 1,181 households in the study, 95.4% are headed by single women and 86.3% are Black. There are 1,965 children in the sample, ranging in age from 3 to 15 years at baseline (M= 8.66, SD= 4.70). Monthly cash payments range from $89 to $2079, with a median payment of $881; payments vary based on household income, family size, and fair market rent. All three groups are surveyed every six months for four years; the first wave of online surveys was deployed in August 2022. Existing surveys include measures of youth emotional and behavioral problems (EBP) reported by primary caregivers. Recent approval from Philadelphia’s Department of Behavioral Health and Intellectual Disability Services (DBHIDS) allows us to pair the repeated survey assessments with de-identified Medicaid claims data for youth participants. I hypothesize that Intervention group youth will demonstrate significant decline in EBP and rates of clinically significant EBP (indicated by increased rates of symptom remission) over time compared to Control group youth (Aim 1). I hypothesize that a subsample of Intervention group youth with clinically significant EBP will be significantly more likely to initiate and retain use of outpatient mental health services compared to Control group youth (Aim 2). Study findings will inform research and policymakers of broader social and health benefits of economic interventions targeting housing as a SDOH. My fellowship training at the University of Pennsylvania will leverage extensive mentorship, coursework, workshops, and seminars. With guidance from a strong mentorship team (Drs. Jaffee, Reina, Mandell, Candon, and the Penn BAC), my proposal and the accompanying training plan provide an ideal foundation for my planned career as an independently funded, leading clinical scientist studying mental health policy and evaluating the implementation of social programs that might affect mental health and service use.