Universal Access to Counsel, Housing Court, and Child Mental Health: Evidence from New York City

• In Event: Civil Legal Assistance as a Health Intervention: Evidence, Access, and Measurement

Abstract

Introduction. The United States faces dual crises in housing insecurity and children’s mental health. Evictions are among the most common pathways into housing insecurity and homelessness. Children who experience homelessness and housing insecurity have worse mental health.

Research Question. We study the effect of housing insecurity on homelessness and children’s health. Specifically, we examine families who had a case filed against them in New York City (NYC) housing court from 2016 to 2019. We ask how receiving a possessory judgment, which is the first step towards eviction, affects future housing stability and the physical and mental health of children in affected families. Because families who receive possessory judgments may be more disadvantaged than families who do not, we use the staggered rollout of the NYC Universal Access to Counsel program (UA) to study causal effects. UA provides free legal services to housing court defendants with incomes less than 200% of poverty.

Data. We merge Medicaid claims for New York City children aged 4-17 to housing court records from the NYS Office of Court Administration’s “Customized Statewide Landlord and Tenant (LT) Data Extract” using apartment-level addresses. We identify homeless shelters using addresses from the U.S. Department of Housing and Urban Development’s (HUD) Housing Inventory Count for the NYC Continuum of Care. Our analytical sample encompasses 15,022 children and 128,000 half-year observations in 13,780 unique families.

Methods. We use a difference-in-differences instrumental variable framework to identify causal effects. First, we present event studies comparing reduced-form outcomes among children exposed and not exposed to UA. Then, we produce static DID estimates of the effects of possessory judgment on housing and health outcomes, using UA exposure as the instrument.

Results. We find that UA availability reduces the probability of possessory judgment by 8%. Children in families with possessory judgments are 68% more likely to be evicted, 1.6 times more likely to change addresses, and 8 times more likely to reside in a homeless shelter in the post-filing period. They are also 53% more likely to have any mental health claim, 53% more likely to have therapy claims, and 83% more likely to have claims for a psychiatric medications. The effects are strongest among children without prior mental health claims. The increase in claims for mental health cannot be explained by children being more likely to see providers generally.

Conclusions. Our results show that housing court filings and possessory judgments lead to housing insecurity and homelessness even when they do not lead to formal eviction. Adverse housing court outcomes, in turn, lead to increased mental health diagnoses and treatment among school-aged children. This suggests eviction-prevention programs like UA have benefits beyond outcomes in housing court.

Author

• Michael Thomas Cassidy, Icahn School of Medicine at Mount Sinai
  Presenting Author