Pathways Connecting Housing Assistance to Child Well-Being in Families Experiencing Homelessness.

Recent increases in family homelessness place children at heightened risk for long-term health challenges. Research has shown that long-term rental subsidies reduce emotional-behavioral and sleep problems among children in homeless families, but the pathways driving these effects are not well understood. This study examined mediating pathways between assignment to housing assistance interventions and improvements in children's emotional-behavioral and sleep outcomes three years later. We used data from the Family Options Study (FOS), a randomized controlled trial by the US Department of Housing and Urban Development, which enrolled approximately 2,300 families that experienced an emergency shelter stay across 12 US sites. Findings from mediation models adjusting for baseline family and child characteristics to test five candidate mediators-homelessness, intimate partner violence, food insecurity, economic stress, psychological distress-as potential pathways linking housing interventions with children's emotional-behavioral and sleep problems indicated that approximately half (50.7%) of the impact of priority access to long-term rental subsidies (versus usual care) on decreased child emotional-behavior problems operated indirectly through lowered parent stressors, specifically economic and psychological distress. Conversely, the impact of priority access to long-term rental subsidies on decreased child sleep problems was predominantly direct, with minimal evidence of mediation. These findings suggest that stabilizing housing is foundational for children, and its benefits extend to family well-being. Additional research is needed to identify other modifiable pathways to improved child health.