August 2025 State of Our Children 360 Newsletter

Deleterious Effects of Housing Insecurity and our Call to Action 

by Keenia Tappin, MD, Valley Children's Pediatrician and Valley Children's Pediatric Residency Program Faculty Coach

Marvin J. Ashton said, "Home should be an anchor, a port in a storm, a refuge, a happy place in which to dwell, a place where we are loved and where we can love." 

Unfortunately, for thousands of California residents, homelessness is on the rise and they are often left adrift. The U.S. Department of Housing and Urban development requires a count of the homeless population every other year. California’s last count in January 2024 showed a 40% increase in our homeless population over the last five years. Primary drivers for this change include economic instability, the rising cost of living without proportional increases in wages, rising unemployment rates and a lack of affordable housing options. As always, issues experienced by adults are simultaneously experienced by the kids in their care. Over the last decade, U.S. census data shows a 37% increase in homeless youth enrolled in the K-12 education system. While both adults and children are impacted by housing insecurity, the impact on children is exponentially worse. 

As far back as the 1960s, proportional correlations have been drawn between socioeconomic status and health status. In 2010, the World Health Organization (WHO) analyzed the data and created a conceptual definition for these social determinants of health (SDoH). At its essence, SDoH are “the conditions in and under which people are born, grow, work and live, and the broader set of forces and systems that shape the conditions of daily life.” WHO further broke the SDoH into five domains: neighborhood and built environment, healthcare and quality, social and community context, education access and quality, and economic stability. While there is interplay between all of the domains, exploring the relationship between housing insecurity and pediatric health outcomes is essential to solving this complex issue. 

Research on adverse childhood experiences (ACEs) has shed significant light on the long-term effects of toxic stress on the developing mind. Children who experience toxic stress have an interruption in their brain development and pivotal epigenetic changes at the cellular which result in serious adult health conditions. Children who experience toxic stress are: 

• 2 times more likely to binge drink and have a poor diet
• 3 times more likely to be a smoker
• 4 times more likely to have low levels of mental well-being and life satisfaction
• 11 times more likely to use illicit drugs 

Increases in the above risky behaviors in childhood leads to the development of heart disease, lung disease, obesity, diabetes, autoimmune disease, cancer, depression, anxiety and other mental health disorders in adulthood. Unfortunately, at this time housing insecurity is becoming an increasingly prevalent toxic stress experienced by our youth. As care providers, it is our duty to come together and help ameliorate the effect of housing insecurity on this vulnerable population. 

Thankfully, we do not work in silos. As the proverb goes, a burden shared is a burden halved. In 2020, Fresno County underwent a community needs assessment. Needs from each of the five SDoH were identified and dissected. Needs identified under the built environment category included the development, improvement and maintenance of housing. After the assessment was completed, leaders in the community came together and isolated eight priority areas to improve the health of Fresno County communities by 2030. Affordable housing is one of those priority areas. 

Now that you understand the harmful repercussions of housing insecurity on our youth, I encourage you to connect with the organizations you work for and the community organizations you serve to see how you can join the effort to solve the housing crisis. Our kids are depending on us! 

The Foundation for Health Begins at Home

By Tyrone Roderick Williams, CEO, Fresno Housing

For thousands of Central Valley children, the most important prescription for lifelong health isn’t found in a medicine cabinet — it begins at home. Stable, affordable housing is among the most powerful — and often overlooked — social determinants of health. When children have a safe place to sleep, a quiet space to study and a stable community to grow up in, they thrive in school, in wellness and in life.

Fresno Housing serves more than 50,000 residents across Fresno County, half of whom are children. We know housing is healthcare. That truth shapes our vision: thriving, inclusive communities where every person, especially every child, has access to a safe, affordable and sustainable home. Now, with uncertainty in federal and state funding, instability looms larger for the families we serve.

We manage more than 85 properties countywide and continue to build in both urban and rural communities. As rents rise faster than wages, families are being priced out of stable homes. Our developments provide affordability and a path to long-term security, especially for working parents.

The connection between housing and child health is clear. Children in stable housing experience fewer hospitalizations, stay up to date on vaccinations and perform better in school. In contrast, housing instability increases risks for asthma, anxiety, absenteeism and developmental delays. According to the National Housing Conference and Children’s HealthWatch, households with poor housing quality had 50% higher odds of an asthma-related emergency visit in the past year.

To help break this cycle, Fresno Housing works beyond bricks and mortar. Our Resident Empowerment Team provides on-site support that meets families where they are. Through after-school programs, youth activities, parenting workshops and resource fairs, we support the whole family.

We partner with First 5 Fresno County to offer Play and Learn workshops promoting social, cognitive and emotional development for children ages 0 to 5. Open to all caregivers, the program helps families support early learning at home. Our partnership with the Fresno County Superintendent of Schools expands this work through literacy programs and school-readiness support.
We’re also proud to collaborate with Valley Children’s Healthcare to provide outreach including cribs, bike helmets, and safety resources to families living in our housing communities. Together, we advance a shared vision: every child deserves a safe, supported start in life.

Through our nonprofit affiliate, the Beyond Housing Foundation, we connect parents with career development, financial coaching and pathways to homeownership — laying a foundation for generational stability. When parents gain security, children benefit from reduced stress, better sleep, stronger attendance and improved health.

Investing in housing means more than building structures, it means building health, communities, equity and a better future for every child.

We proudly partner with leaders in health, education and community development — because healthy starts begin with a home. To learn more, visit our website at FresnoHousing.org.

Medical Legal Partnerships: The Intersection Between Housing and Children’s Health

by Michelle Kezirian and Paul Carter Mullen, Central California Legal Services, Inc.

The lack of safe and affordable housing in California’s Central Valley remains an ongoing barrier for low-income families. Sub-standard rental housing, including units with mold, rodents, insect infestation and other habitability issues negatively impacts tenants with children experiencing asthma and other health issues exacerbated by environmental factors. Poverty, unhealthy living conditions and other social determinants of health are well-recognized by medical and legal professionals. However, parents struggling daily to manage their child’s chronic medical conditions often lack knowledge of how their underlying housing legal issues are linked to their families' health and well-being.

The Central Valley Medical-Legal Partnership for Children and Families (MLP) is a team effort between Valley Children’s Hospital and Central California Legal Services (CCLS), a not-for-profit civil law firm providing free legal help. We work with low-income families, helping patients with housing legal issues that impact their health and well-being. The MLP offers legal assistance to qualifying individuals with housing issues including eviction defense, housing conditions (habitability), public housing, utility problems and fair housing

Patients and families are also screened for other legal needs. CCLS’s additional legal services include help with public benefits, consumer protection and utilities, family law and immigration, healthcare access and the provision of services to seniors and veterans. MLP services are requested by completing a voluntary housing questionnaire offered by the medical provider. Those wanting immediate in-person legal services can speak with a lawyer at the MLP or by telephone during CCLS office hours. CCLS on-site staff include a staff attorney and paralegal. Services are offered in multiple languages, including Spanish and English.

Housing rights knowledge empowers individuals, families and entire communities. MLP Staff Attorney Joana Garcia states, “One observation at the MLP is that we assist families whose homes may have mold or other habitability issues, which directly impact physical health. We’ve also had the ability to speak directly with families who don’t know they have legal rights to safe housing. Now they know to ask CCLS or one of our pro bono attorneys for help.”

The MLP’s on-site services at the Charlie Mitchell Children’s Center started in February 2025. During the first six months of direct services (February-July) the MLP engaged more than 100 patients and families who requested information about legal services and 45 of those resulted in open cases for direct services. Presently, about 44% of MLP engagements result in CCLS opening a legal case service. Reasons a case may not be opened include families wanting information only, unable to subsequently contact applicant or applicant ineligibility. Everyone engaged by the MLP has their housing questionnaire reviewed by legal staff, is screened for other CCLS services and receives additional information and/or referrals as needed.  More than 20% of those seeking help are Spanish-speaking families.

The overwhelming majority of the legal issues – about 80% – are housing related. This is expected since the MLP specifically screens for housing problems. A breakdown of the other legal issues include health (6%), family (5%), public benefits (5%), immigration (2%) and other legal issues (2%).

Serving low-income and vulnerable patients and families in CCLS’s Central Valley service area, special emphasis is placed on those from rural communities. About 69% reside in Fresno County, 27% in Madera County and the remainder live in Kings and Tulare Counties.

Additional Resources