Use Case 3. Testing a cross‐sector process to inform housing policy in one US city

Children living in unstable, unaffordable, unsafe, and low‐quality housing are at significant disadvantage. Such housing insecurity creates a hostile environment. The complexity of challenges range from substandard conditions to impending housing loss to eviction to homelessness plague families in cities across the US. These problems arise in part from dysfunctional housing systems in which those working within these systems are often siloed from one another, rules are disconnected from lived experience, power gradients are reinforced, and response times are considered nonurgent to nonexistent by those poised to intervene. In Cincinnati, OH, the Housing Action Team (HAT), including the Wellbeing with Community Improvement team of ACT and housing stakeholders, sought to identify solutions to persistent housing challenges by implementing strategies that disrupt these system factors while maintaining a focus on child health and wellbeing. To form HAT, the Wellbeing with Community team convened a cross‐sector team, placing child experience at the center of our process. HAT included individuals actively engaged in solving housing insecurity with families, including healthcare, social service agencies, and nonprofit organizations. In weekly huddles with structured sharing of active housing insecurity cases, HAT members collaborated to identify root causes, real‐time solutions, gaps, and immediate action steps. We generated cross‐sector, child‐centered, evidence‐based policy recommendations and created a process that may be applied to other content and settings. The HAT conducted a case‐based, action‐oriented learning process using quality improvement and qualitative methods. Prompted by discussions with stakeholders, our team generated learnings about how the housing system functions for children. We huddled weekly, with one member presenting one to two active cases of families experiencing housing insecurity, using a standard situation‐background‐assessment‐recommendation format adapted from healthcare communication. We analyzed discussion content to identify themes from which we developed housing problem categories. For each category, we completed a failure‐mode‐and‐effects analysis to outline existing processes, ways in which processes fail, and opportunities for improvement. Our team assessed each case for whether existing policy and/or policy under consideration could contribute to preventing or solving identified problems. We determined the number of families that would have been helped by each policy under consideration and the number that would still be affected by policy gaps. Over 13 weeks, HAT discussed 17 cases, averaging nine participants per huddle. We identified common housing problems for children, provided a forum for rapid cross‐sector action and learning, and developed a process by which child experience could inform policy. We identified four categories (housing displacement, legal eviction, substandard housing conditions, and lack of affordable housing) and documented real‐time solutions for seven cases (41%). We identified a policy under consideration that would have helped three to four times more families than any other candidate policy. We identified 14 gaps for future policy to address to improve housing security for children. The top three gaps were unequal accountability between landlord and tenant, lack of funding for civil cases concerning housing, and lack of robust tenant education. We presented findings to stakeholders and policymakers to inform decisions on housing policy. We are now adapting this approach to address multiple unmet social needs for children and families in Cincinnati.