Co-Developed Community-Based Health Interventions with Children Under 18 and Families Experiencing Homelessness in High-Income Countries: A Systematic Review

TL;DR

This paper reviews co-developed health interventions for homeless families with children in high-income countries, finding they may improve engagement and health outcomes.

Contribution

The study systematically reviews co-developed interventions for homeless families with children, highlighting gaps in terminology and involvement transparency.

Findings

Nine studies co-developed interventions with homeless families in the U.S. and U.K.

Five studies reported improved family and staff engagement.

Three studies showed better mental health outcomes.

Abstract

Background: Despite the implementation of numerous evidence-based interventions, the 2024 Point-in-Time count in the United States (U.S.) reported that 259,473 people in families with children under 18 years old were experiencing homelessness, a record high since the count began in 2007. Recent findings suggest that co-developed interventions may increase engagement with vulnerable populations and, in turn, the effectiveness of health-based programs among them. Objective: In this review, we sought to systematically search and assess the current evidence on co-developed community-based interventions with and for children under age 18 and families experiencing homelessness (CFEH) in high-income countries and their impact on health and well-being outcomes. Methods: Seven databases (e.g., Medline, CINAHL, Embase) and four additional scholarly sources (e.g., Health CASCADE) were searched (publication dates between January 2000 and February 2025). In our analysis, methodological “quality” was assessed through two primary criteria: internal validity and the extent of CFEH involvement. Results: A total of 1617 studies were screened for eligibility, and nine studies were found to have co-developed interventions with CFEH in the U.S. (n = 6) and the United Kingdom (n = 3). These were categorized thematically by socio-structural, behavioral, and combined intervention types. Five studies reported positive engagement among families and staff, whereas three reported improved mental health outcomes. Conclusions: This review highlights the potential impact of co-developed interventions on CFEH’s mental and physical well-being as well as process-based outcomes. Limitations include different definitions of “co-” terminology and homelessness across studies, as well as a lack of transparency about the extent of CFEH’s involvement in these studies. The dearth of evidence indicates that future research should employ community-based participatory research while striking a balance of working with CFEH and other partners and ensuring the data are reliable and reproducible.

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