The Implementation of Maternity Group Home Programs:
Serving Pregnant and Parenting Teens in a Residential Setting

Appendix A
Summary of the Seven Study Programs

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This appendix provides a summary of the seven maternity group home programs included in this study. For each program, we describe its basic structure, funding sources and levels, eligibility rules and referral sources, setting and structure of its facilities, staffing patterns, and core program services. Table A.1 presents the general characteristics of each of the seven study programs.

GCAPP Second Chance Homes (Georgia)

Basic Program Structure. The Georgia Campaign for Adolescent Pregnancy Prevention (GCAPP) operates a statewide network of eight maternity group homes, serving 44 teenage mothers and their babies. The GCAPP program began serving teens in 2001 and is funded primarily by the Georgia Department of Human Resources (DHR). The eight GCAPP homes have flexibility in determining their daily operations and procedures. However, the homes all offer a similar set of services and serve similar populations. GCAPP provides technical assistance and support to the homes in its network, helping them troubleshoot when challenges arise, such as issues involving resident behavior or government regulations. GCAPP also convenes regular meetings with program managers to provide training and discuss issues relevant to all the homes.

Funding Sources and Levels. GCAPP receives $1.4 million annually from DHR to fund the homes and provide them with assistance and support. Grants from GCAPP to individual homes currently range from about $100,000 to $150,000 per year and make up about a third of the operating budgets of these homes. Most of the rest of their funding comes directly from DHR as payments for providing shelter and services to children in state custody. Some homes also receive funding from charitable organizations and individual donations. The average monthly cost per resident family served ranges across the eight GCAPP homes from about $4,300 to as much as $6,700. In general, smaller facilities, as well as those offering more intensive support services and serving higher risk teens, have higher costs.

Table A.1.
General Characteristics of the Seven Study Programs
  GCAPP Second Chance Homes (Georgia) St. Andre
Group Homes (Maine)
Teen Living
Program (Massachusetts)
Teen Parent Supportive Housing Services Collaborative (Michigan) Teen Parent Program
(New Mexico)
Inwood House Maternity Residence
(New York)
Friends of Youth Transitional Living Program (Washington)
Sponsoring Agency/
Management Structure
Fairly centralized program overseen by GCAPP in partnership with Georgia Dept. of Human Resources Very centralized program managed by Saint Andre Homes, Inc. Very centralized program managed by Massachusetts Dept. of Social Services Fairly decentralized program funded and overseen by Wayne County Family Independence Agency Decentralized program funded and overseen by New Mexico Children, Youth, and Family Dept. Very centralized program run by Inwood House Very centralized program run by Friends of Youth
Program Capacity
(Families) and Number of Homes
44 in 8 homes 16 in 4 homes 167 in 20 homes 34 in 3 homes 38 in 5 homes 36 in 1 home 20 in 2 homes
Key Funding Sources State TANF funds and federal child welfare funds for foster care placements Mainly from Medicaid funds; also state funds for residential services for young mothers Mainly state TANF funds; some state child welfare funds Mainly from HUD Supportive Housing Program grant; also other HUD grants, United Way, private donations Primarily from state funds allocated for teen parent services, also HUD and child welfare Funded primarily through federal child welfare funds for foster care placements; also some Medicaid funding Mainly HUD funding, with additional help from the United Way and private donations
Approximation of Average Monthly Cost per Resident Family $4,300 to $6,700 $8,600 (includes health service costs paid by Medicaid) $3,500 to $4,800 $1,200 to $4,200 $1,300 to $3,300 $6,000 $1,300 to $3,200
Main Referral Sources Primarily regional child welfare agencies Primarily regional child welfare agencies; also hospitals, shelters, schools Primarily state welfare agency; also regional child welfare agencies Primarily county welfare agency Schools, hospitals, child welfare, juvenile justice All referrals from
New York City child
welfare agency
Public health clinics, foster care, shelters, crisis hotlines, other social service organizations
Key Eligibility Requirements 13-20, pregnant or parenting, no other appropriate adult-supervised setting, no history of serious drug use or violence 15-29, pregnant or parenting, Medicaid eligible, not violent or active drug user, willing to follow program rules 13-20, pregnant or parenting, no other appropriate adult-supervised setting, on TANF or active child welfare case 15-18, pregnant and parenting, on TANF, no other appropriate place to live, parental consent if under 18 Under 22, pregnant or parenting, willing to follow rules, and Medicaid eligible. Under 21, pregnant,
and in New York City foster care system
18-21, pregnant or parenting, homeless by HUD definition, no severe mental health problem, not violent or active drug user
Core Program Services 24-hr (awake) supervision, life skills classes 3-4 hrs/wk, case management, tutoring, mental health counseling 24-hr supervision, life skills classes 3-4 hrs/wk, case management, mental health counseling 24-hr (awake at most homes ) supervision, life skills classes 3-4 hrs/wk, case management, outreach to fathers 24-hr (awake at most homes) supervision, life skills classes 3-4 hrs/wk, case management, some tutoring 24-hr supervision, life skills classes 1-2 hrs/wk, case management, some tutoring 24-hr (awake) supervision, health, child birth, and life skills classes 7 hrs/wk, case management, on-site school, outreach to fathers Staff on site at most times, life skills classes about once a week, case management
GCAPP = Georgia Campaign for Adolescent Pregnancy Prevention.

Eligibility Rules and Referral Sources. To participate in the GCAPP program, teenage mothers must be between the ages of 13 and 20, have no history of serious drug use or violent criminal behavior, and have a current living situation that is considered unsafe or inappropriate. The program serves both pregnant and parenting teens. However, state regulations seriously limit the number of pregnant teens the homes can serve. For this reason, most teens have already had their babies before they enter the program. Teens may voluntarily enter the homes with the permission of their parents or guardians. However, it is more common for teens who enter the homes to be in state custody through either the foster care or juvenile justice systems. Referrals are generally handled by individual homes; GCAPP is not involved. About two-thirds of referrals are from local child welfare agencies, while about 10 percent are from juvenile justice. Other referrals come from a mix of sources, including schools, churches, hospitals, health clinics, community organizations, and family members.

Setting and Structure of the Homes. The eight GCAPP homes are located throughout Georgia: two in the metropolitan Atlanta area, one in the mid-size city of Columbus and the rest in small towns. All homes involve congregate living, in which the teens share living, dining, and kitchen areas. In all the homes, teens have their own bedrooms that they share with their babies. Most are in converted single-family homes in quiet residential areas and can serve five or six teens and their children. One home near Atlanta is in a newly constructed facility that can serve eight teen families and includes two separate apartments for house parents. Another home in southern Georgia is part of a campus of residential and educational facilities for disadvantaged and troubled youth. The latter home is operated by a social service organization that has been providing residential services to children in this location for almost 100 years.

Staffing Patterns. Although there is some variation, the basic staffing pattern at each of the GCAPP homes is fairly similar. All provide a very high level of supervision for their residents, including staff on site 24 hours a day and low resident-to-staff ratios. These staffing patterns are required by state law for facilities that house minors in state custody, as these homes do. State regulation requires a 6-to-1 resident-to-staff ratio (counting both the teen mothers and their children) during waking hours and a 10-to-1 ratio at night. In accordance with state regulations for children in foster care, teens are generally not allowed to leave the home unless they are accompanied by a group home staff member. Homes typically have two or three full-time staff members with advanced degrees: a program director, who manages the daily operations of the home and its staff, and one or two case managers. The homes also have a number of “advocates” who provide general supervision for residents. These staff may be part-time and typically do not have advanced degrees.

Core Program Services. The eight homes all offer a similar set of services, including weekly parenting and life-skills classes taught by the group home staff. These classes use the Minnesota Early Design (MELD) curriculum, which was specially designed to teach parenting skills to at-risk adolescent parents and to reduce the risk of child abuse and neglect. Classes cover a variety of topics, including child development and health, family management, and other parenting issues. The GCAPP program places strong emphasis on mental health services, and all teen residents receive regular individual therapy sessions. Some homes have licensed therapists on staff, while others contract with an outside therapist to provide this service. Residents also meet weekly with their case manager to review progress toward meeting their personal goals concerning parenting, education, and health. Homes also offer guided study and tutoring services, as well as transportation to medical appointments, educational events, and group outings.

St. Andre Home, Inc. (Maine)

Basic Program Structure. St. Andre Home, Inc. operates four maternity group homes in Maine, which can serve a total of 16 pregnant and parenting young women and their children. The organization was founded in 1940 by a local order of nuns, the Good Shepherd Sisters, which owns the buildings out of which the four group homes operate. Three of the homes opened in the mid-1970s; the fourth opened in 1998. The four homes are quite similar to each other, providing similar services and serving similar populations. The central St. Andre office handles all financial issues and provides general oversight of the homes. However, treatment planning, as well as the day-to-day functioning of the homes, is handled by staff at each home. Central office staff and staff from the four group homes work closely together and have regular and frequent contact with each other.

Funding Sources and Levels. The St. Andre group homes are funded primarily by Medicaid funds (covering about two-thirds of operating expenses) and by a state contract to provide residential services to young mothers (covering just over one-fourth of the operating expenses). Other funding comes from a mix of sources. In some cases, the children of the young mothers who reside in these homes are in state custody. In these situations, the program receives monthly payments from the Maine Department of Human Services (DHS), which are provided to organizations that house children in the foster care system. These payments cover less than 5 percent of the operating expenses of the homes. The program also receives small amounts of funding from religious organizations, the United Way, and private donations. In addition, residents with income are required to pay program fees, representing either one-fourth or one-third of their income, depending on their circumstances. Each home has an annual budget of between $364,000 and $448,000 and the average monthly cost per family served is about $8,600. Costs vary somewhat across the four homes, with one home specifically designed to accommodate young mothers with more than one child having the highest per-family costs. Unlike most other group homes visited as part of this study, the budget for the St. Andre group homes includes Medicaid-funded mental health, drug treatment, and other medical services residents receive, all of which contribute to the high per-family cost of the program.

Eligibility Rules and Referral Sources. To reside in a St. Andre group home, young women must be Medicaid-eligible and be either pregnant or parenting a child younger than age three. All homes serve young mothers ages 15 to 24, while one home serves women up to the age of 30. Most homes can accommodate only mothers with one child; however, one can accept mothers with two children. Residents cannot be a danger to themselves or others, must not be active drug users, and must be willing to follow program rules. Applications and admissions are handled by individual homes. Most referrals to the program are from DHS. Many of these referrals are situations in which the children are in state custody and are being reunited with their mothers on a trial (and closely supervised) basis. Other DHS referrals may involve young women who must live in the homes as a condition of retaining custody of their child. Other referrals come from a variety of sources, including hospitals, counselors, churches, shelters, family, and friends.

Setting and Structure of the Homes. The four St. Andre homes are located in southern and central Maine: two in Lewiston, one in Biddeford, and one in Bangor. All the homes follow the congregate model, in which the residents share living, dining, kitchen, playroom, and other common areas. Residents have their own bedrooms that they share with their children. In one home each mother has her own suite with bedroom, small living room, and bath. This home is a large four-story former rectory, while two of the other facilities are converted single-family homes in residential neighborhoods. The fourth home is a new facility specifically built as a maternity group home. Each home can serve three to five families.

Staffing Patterns. Although there is some variation, the basic staffing pattern at each of the St. Andre homes is very similar. All homes have staff on site 24 hours a day; however, overnight staff are not required to remain awake. The homes all have low resident-to-staff ratios, with each employing six full-time and one part-time staff member. Staff typically include a supervisor, a masters-level clinical social worker, and four “group life workers” who provide general supervision for residents. In addition to the staff who work directly for the homes, the program contracts with a number of consultants, including psychiatrists, medical doctors, and public health nurses.

Core Program Services. In addition to housing and supervision, each home provides a number of individual and group services to its residents. Homes convene group sessions three or four times each week. These sessions include parenting and life-skills classes, as well as house meetings. In some cases, sessions are conducted by group home staff; in other cases, outside experts are brought in to teach the classes. In addition to the group sessions, residents must meet weekly with the home's social worker. Some residents also meet regularly with psychiatrists who come to the home to provide therapy. Finally, homes occasionally provide child care and transportation for their residents.

The Teen Living Program (Massachusetts)

Basic Program Structure. The Massachusetts Teen Living Program (TLP) includes 20 regular TLP group homes and 3 transitional Supportive Teen Parent Education and Employment Program (STEP) facilities for pregnant and parenting teens throughout the state. The TLP homes and STEP facilities can house 177 teens and their children, making the program the largest maternity group home network in the country. The network is managed by the Massachusetts Department of Social Services (DSS), which oversees child welfare issues for the state, in partnership with the Massachusetts Department of Transitional Assistance (DTA), which manages the state's Temporary Assistance for Needy Families (TANF) program. The program began in 1995 as part of state welfare reform legislation that, among other changes to the state welfare program, required teen mothers to live in an adult-supervised setting as a condition of receiving cash assistance. The state funded TLPs as an option for those who did not have an appropriate relative or guardian with whom they could live. The first homes opened in 1996. The network is fairly centralized, with DSS guidelines governing the services the homes must offer and the population they must serve. However, the homes have flexibility in making decisions about their specific structure and rules. In addition to regular meetings, the network director has frequent — sometimes daily — informal contacts with home directors.

Funding Sources and Levels. The program operates on an annual budget of about $8.2 million, of which $2.4 million is from DSS and the remainder from DTA. In addition, the program is in the last year of a three-year grant from ASPE to provide outreach services to the fathers of TLP residents' children. The amount of funding the network provides to each home varies by program size and location. The average monthly cost per TLP resident ranges from around $3,500 to $4,800, depending on the cost of living in the area. STEP program costs are considerably lower, about $2,300 per bed each month, because of the lower level of supervision and services. The homes rely almost exclusively on the network funding to operate; however, some receive small donations and in-kind contributions from local organizations in their communities. Homes also require residents to contribute 30 percent of their monthly income — typically TANF benefits — to the program.

Eligibility Rules and Referral Sources. All homes require that residents be: (1) between the ages of 13 and 20; (2) Massachusetts residents; and (3) pregnant or parenting. In addition, residents must have no other appropriate adult-supervised place to live and must be willing to abide by the rules of living in a TLP home. Each bed within the network is designated either “DTA” or “DSS,” which indicates the referral source and eligibility requirements for that bed. All DTA-bed residents must receive TANF, while all DSS-bed residents must have an open DSS case for their children or themselves. There is considerable overlap between these two groups, however, as most residents in DSS beds also receive TANF, and some residents in DTA beds also have DSS cases. The source of referrals also depends on the type of slot. All placements to the 102 DTA beds are made by the network coordinator, who is a state-level DSS staff member. Referrals to the 64 DSS beds are made by regional DSS staff. Placements in the network's 11 emergency beds are made by DTA staff directly. These beds are available for immediate use for teens in crisis situations or while they wait for an opening in a regular TLP bed.

Setting and Structure of the Homes. The TLP network covers the entire state of Massachusetts, although homes are more prevalent in population centers. Each TLP home follows one of two structural models: (1) congregate programs for most teens, or (2) apartment-model programs for older teens who are better able to take care of themselves and their children. Congregate-model programs have 24-hour-awake staff. Staff members have frequent contact with residents and provide them guidance on parenting and life skills through role modeling and informal instruction. Teens have their own bedrooms, which they share with their children; however, bathrooms, kitchens, living rooms, and eating areas are shared by all group home residents. Residents of congregate homes typically pool their food stamps and rotate cooking duties. In apartment-model programs, two or three teens and their children share an apartment, with each teen responsible for preparing her family's meals. Staff in these homes may provide somewhat less supervision than those in congregate homes, although apartment-model homes all have staff on site 24 hours a day. Most of the homes in the network are congregate-model programs; only five use the apartment model. In addition to these two types of TLPs, the network includes three STEP programs — apartment-model facilities for TLP “graduates” who are transitioning to independent living. Residents of STEP homes still receive some supervision and case management and attend group sessions and classes, but less frequently than other TLP residents.

Staffing Patterns. All TLP group homes have staff on site 24 hours a day. However, congregate homes must have awake staff at all times, while some apartment-model homes have live-in house parents instead. Staff-to-teen ratios are established for each home individually by the state's Office of Child Care Services (OCCS), which licenses all TLP group homes. TLP network staff reported that OCCS typically requires ratios of one staff person per five teens, with more staff during peak times and fewer staff at other times. At the TLP group homes we visited, the number of staff ranged from about 4 to 11 full-time-equivalent staff, with larger homes typically having more staff. Each home uses a mix of full-time and part-time staff. STEP programs have much lower staff-to-teen ratios than the congregate and apartment-model TLPs, since they serve more mature teens who are transitioning to independent living. STEP programs are staffed by a case manager 20 hours per week, and they often share staff with nearby TLPs.

Core Program Services. All homes provide a number of regularly scheduled group and individual sessions to their residents. Homes typically have three or four group sessions a week, including life skills/parenting groups and weekly house meetings. All homes use the Preparing Adolescents for Young Adulthood (PAYA) curriculum, which was developed by DSS for adolescents and includes some sections specifically for teen parents. Residents also meet weekly with their case manager, who develops and updates a service plan for each teen. Some homes have masters-level social workers on staff to provide counseling; others will connect residents with therapy providers covered by Medicaid. Residents' children are screened by Early Intervention Services and are often assigned to Early Head Start. Homes will also assist residents in finding child care and many will provide transportation in some situations. Besides services to current residents, TLPs offer follow-up assistance to former residents. The programs also provide outreach and case management services to the fathers of current residents' children.

Teen Parent Supportive Housing Services Collaborative (Michigan)

Basic Program Structure. The Family Independence Agency (FIA) of Wayne County, the agency responsible for serving TANF families, oversees a small county-based network the capacity to serve pregnant and parenting teens in the Detroit area. The network currently includes three maternity group homes, an agency that provides mental health and outreach services to support the homes, and a parenting program (operated by an organization that also runs a non-network maternity home not directly supported by FIA). The agency that currently provides mental health and outreach services operated a home until recently when funding cuts from United Way necessitated the closing of this home. The three network homes offer similar services and serve similar populations; however, the network's management is fairly decentralized. FIA leads monthly meetings of the five network members and is the fiduciary agent for the network's primary funding source; however, decisions about the daily operations of the residential facilities are left to the homes themselves.

Funding Sources and Levels. The network receives Supportive Housing Program funding from the U.S. Department of Housing and Urban Development (HUD) of about $1 million annually. Each of the homes receives a HUD grant of between $135,000 and $400,000 per year, and these grants make up a substantial fraction of the operating budget of these homes. While the federal grant is the primary source of funding for all the homes in the network, none relies exclusively on this funding source. Homes also receive funding from HUD Emergency Shelter Grants, the United Way, and private donations. Each home also requires residents to contribute a quarter of their monthly income as rent. The average monthly cost per teen family served ranges substantially across the three homes, from as low as $1,200 to as much as $4,200.(1)

Eligibility Rules and Referral Sources. The three network homes serve broadly similar populations. All homes serve both pregnant and parenting teens, and each home can accommodate a small number of parents with two children. None of the homes accept teens younger than 15 or older than 18, but some individual homes have narrower age ranges. Residents must be from Wayne County, and all homes require parental consent for minors. The homes also require residents to be on TANF, and all admissions decisions are made with the approval of FIA caseworkers. FIA is the primary source of referrals for all three homes, although homes also get referrals from a number of other sources including emergency hotlines, churches, teachers, friends, and family members. The homes are not licensed to care for teens in state custody.

Setting and Structure of the Homes. All network homes are located in Detroit. Two of the homes are congregate living facilities, in which all residents share living, dining, and kitchen areas, and bathrooms. In one of the congregate homes, residents share bedrooms, with two teen mothers and their children sharing a room. Both of the congregate facilities are converted, large single-family homes in residential areas. The third facility is an old apartment building in which each teen parent has her own one-bedroom apartment. This facility targets slightly older teens than the other network homes do and is designed for young mothers who are mature enough to care for themselves and their children in their own apartment.

Staffing Patterns. All three homes have staff on site 24 hours a day, although there is considerable variation in staffing patterns and resident-to-staff ratios across the homes. The two congregate homes have 24 hour awake staff (and, in fact, one of these homes has two awake staff members on site at all times.) The apartment model facility has fewer staff than the congregate homes, despite serving more residents, and the home does not always have awake staff. Each home has at least four full-time staff and a number of part-time staff. Homes typically have a program manager, a social worker and/or a case manager, and several “specialists” who provide general supervision for residents. In addition to staff who work directly for the homes, some staff from partner organizations come in to the homes to provide services, such as teaching parenting classes.

Core Program Services. Besides housing and supervision, all the homes provide case management and a number of scheduled classes and individual meetings. The homes typically offer classes for the residents most weekday evenings, and the topics include classes related to parenting and life-skills (including such topics as budgeting, nutrition, and anger management). The residents typically are required to attend the classes, and at least one home offers them incentives to attend. Group and individual counseling are also commonly provided. Some homes provide child care and transportation to enable residents to attend school or work, while others help residents access external providers for these supports. Some homes also take the residents on outings in the Detroit area, as well as offer annual trips to other parts of the country. In addition to services provided to residents, each home offers some continued assistance to former residents after they leave the home.

The Teen Parent Program (New Mexico)

Basic Program Structure. The New Mexico Teen Parent Program (TPP), which is managed by the state's Children, Youth, and Family Department (CYFD), funds five group homes and three non-residential programs for pregnant and parenting teens throughout the state. The five homes have the capacity to serve 38 pregnant and parenting teens and their children. The program began operating in 1990 and is the oldest statewide network of maternity group homes in the country. The state program imposes broad guidelines on the services the homes it funds should offer. However, by design, program operations are highly decentralized, and individual homes have considerable flexibility in determining the specific services they offer and population they serve. State officials consider it very important for the local organizations that run these homes to have the flexibility to design programs that are appropriate for the needs of their community. The five TPP homes operate fairly independently of each other. However, the homes' directors meet a few times a year to discuss funding, services, referrals, and other issues.

Funding Sources and Levels. TPP provides $500,000 annually toward the operating expenses at the five homes. TPP grants to the individual homes range from $55,000 to $165,000 per year. For three of the five homes, TPP funding covers most (80 percent or more) of their operating budget. For these homes, most additional funding comes from regular payments required of residents, typically $150 per month paid out of their TANF checks. The other two homes receive substantial funding from other sources to cover their operating expenses. One of these homes receives only about half its funding from its TPP grant; the rest comes from a HUD grant to house homeless teens, as well as a government grant to fund housing for teens transitioning out of the foster care system. The other TPP home (which, unlike the other homes in the network, serves primarily teens referred from child protective services) receives just over half its funding from government grants to cover services for teens in the child welfare system. This home also receives about 15 percent of its funding from Catholic charities, so that its TPP grant covers less than a third of its operating budget. Monthly operating costs vary substantially across the five homes and range from about $1,300 to $3,300 per bed per year. Homes with higher per-resident costs tend to be smaller, have more staff, and provide a somewhat more intensive set of services for residents.

Eligibility Rules and Referral Sources. The homes serve pregnant or parenting young women who must enter the program before their 20th birthday and can remain until they turn 21. Residents must be eligible for Medicaid. In addition, they must be willing to follow program rules and attend school to remain in the program. Some homes have additional eligibility requirements, such as meeting the HUD definition of homelessness, a requirement for homes that receive HUD funding. The five TPP homes all handle their own referrals and applications. Homes will refer teens to another TPP home if their home is full. However, because the homes are located far apart geographically, teens are often unwilling to consider placement in one of the other homes. Referrals for the five TPP homes come from a variety of sources, including schools, hospitals, the juvenile justice system, and child welfare agencies.

Setting and Structure of the Homes. The setting and physical structures of the five TPP homes vary substantially. One home is in Albuquerque (the state's largest city); others are in small towns several hours from Albuquerque. Two are in converted single-family homes, where the residents have separate bedrooms but share living, kitchen, and dining areas. Another program is located in a set of three attached two-bedroom apartments, each of which can house two teenage parents and their children. One program operates out of a set of eight, clustered one- and two-bedroom apartment units in a large privately owned apartment complex in an urban area. Another is in a converted motel in a remote location off of old Route 66. The level of supervision and strictness of the rules imposed on residents concerning curfews, visitors, and other issues varies across the five homes.

Staffing Patterns. Each home uses a mix of full-time and part-time staff, although specific staffing patterns vary considerably across the homes. The number of full-time staff at each home ranges from two to five; however, those with fewer full-time staff typically employ more part-time staff. Full-time staff at each home include the home director and sometimes a residential coordinator, a case manager, or a counselor. Staff generally provide 24-hour supervision, including overnight and weekend shifts. Overnight staff are not required to remain awake. In addition to paid staff, most homes rely on volunteers from partner organizations to provide some services to home residents.

Core Program Services. All homes offer regular parenting and life-skills classes to residents. These classes typically meet once or twice a week and are led by home staff, although they sometimes rely on outside speakers. In addition, homes typically offer case management services to teens, regularly reviewing their progress toward meeting their program goals and offering them referrals if needed. Other services vary across the five homes. Some offer regular tutoring sessions for residents. Others provide respite child care on a limited basis and provide transportation to school, appointments, and shopping.

Inwood House Maternity Residence (New York)

Basic Program Structure. With a capacity to serve up to 36 teens, Inwood House Maternity Residence is the largest of three New York City maternity homes for pregnant teens in the foster care system.(2) The Administration for Children Services (ACS), the city's child welfare agency, contracts with Inwood House to operate the program, which serves pregnant young women under the age of 21 until the birth of their child. After their babies are born, residents and their babies must be placed with a foster family or in a group home for teen parents. Inwood House was founded in 1830 and opened its first maternity residence in 1847. It has been serving pregnant teens from the city's foster care system since the 1930s. In addition to its maternity residence, Inwood House operates several other programs to serve pregnant and parenting teens, as well as programs designed to reduce teen pregnancy.

Funding Sources and Levels. The Inwood House maternity home has an annual budget of about $1.7 million. These funds come primarily (91 percent) from ACS, which provides Inwood House with set monthly payments to cover the costs of their housing and support services. Most other funding for the program comes from Medicaid. In addition, the state provides Inwood House some TANF funding to cover case management services for the fathers of residents' babies. These government funds are supplemented with funding from private foundations. The average monthly costs per teen served by the program is about $6,000.

Eligibility Rules and Referral Sources. To be eligible, residents must be pregnant and in the foster care system. In addition, since ACS regulations prohibit babies from residing in facilities for pregnant teens in foster care, residents must not have custody of any other children. All referrals to the program come from ACS, and Inwood House is generally required to accept the referrals it receives. ACS requires all teens living in group homes (the most common setting for these teens) to transfer to a maternity residence if they become pregnant. In addition, many foster families hosting teens request that the teen be moved if she becomes pregnant. For this reason, most pregnant teens in the city's foster care system live either at Inwood House or one of the other two city maternity homes that serve foster care teens.

Setting and Structure of the Homes. Inwood House is located in a quiet residential neighborhood on New York's Upper East Side. The organization owns the six-story building and operates several programs out of the facility. Three of the floors are devoted to the maternity home and each of these floors has 12 rooms, one large bathroom, and a lounge. Because of low enrollment in the maternity residence in recent years, one of the residential floors is now used by other Inwood House programs. Residents all have their own bedrooms and share living rooms and dining areas.

Staffing Patterns. The Inwood House program serves a large number of teens, typically about 24 at a given time in recent years. Moreover, ACS regulations require 24-hour-awake staff, as well as a low resident-to-staff ratio. For these reasons, the program has a large staff of social workers, paraprofessionals, administrators, and support staff. The maternity residence is overseen by a director of residential services, assisted by a director of youth care who oversees the large staff (7 full-time and 12 part-time) of paraprofessionals who provide basic supervision and other services to residents. The home also employs two full-time social workers who provide case management services; a full-time independent living coordinator who provides life-skills training; a full-time registered nurse who coordinates residents' medical care and teaches child birth, child health, and nutrition classes; and a part-time clinical psychologist who provides group and individual therapy, as well as psychological testing, to residents. Inwood House also employs a job developer who provides career readiness training to residents and a housing specialist who assists young women aging out of foster care find appropriate housing. In addition, the program employs a full-time cook, three maintenance workers, and several other administrative and clerical staff.

Core Program Services. The Inwood House maternity home offers a wide array of support services. Residents are required to participate in six weekly one-hour classes on independent living skills, childbirth, infant care, health, substance abuse prevention, and other special topics. Residents are offered incentives for attending these sessions, including vouchers that can be used to purchase items for their baby at the program's “baby boutique.” Residents also have weekly meetings with their case managers to review their behavior, school performance, and other personal issues. Inwood House requires all residents to attend school full time if their health permits. The program offers an on-site school for teens who are unable to find an appropriate educational program in the community. This school, which is used by about one in four residents, provides daily class instruction and is taught by a certified New York City school teacher. Inwood House also operates the “Fathers Count” program for the fathers of the residents' babies. The program offers case management services to these young men, including referrals to job and education services, parenting classes, anger management groups, and legal assistance. Fathers are also encouraged to attend the childbirth and other classes Inwood House offers for its residents.

Friends of Youth Transitional Living Program (Washington)

Basic Program Structure. Friends of Youth (FOY) operates the Transitional Living Program, which includes two maternity group homes and three residential programs for other youth populations in the Seattle area.(3) The two maternity homes serve 20 pregnant and parenting young women and their children. FOY has operated other residential programs for youth since 1951 and opened their first maternity home exclusively for pregnant and parenting young women in 1991. The program's management is fairly centralized — one FOY staff member is the program manager for both maternity homes. The two homes offer a similar set of services and serve fairly similar populations; however, one home (Harmony House) is a congregate living facility while the other (Arbor House) is an apartment-model facility.

Funding Sources and Levels. The combined annual funding for the two maternity homes is about $452,000. HUD provides over $300,000 of this funding — around $200,000 to Harmony House and over $100,000 to Arbor House. The homes receive smaller amounts of funding from the state, county, and city governments; the United Way; and private donors. In addition, residents at both homes are required to contribute about a third of their incomes to the program. The two homes receive roughly similar levels of overall funding, despite their different capacities (Arbor House serves 14, while Harmony House serves 6). Thus, the average monthly cost per resident family served differs substantially, from about $1,300 at Arbor House to $3,200 at Harmony House.

Eligibility Rules and Referral Sources. The eligibility requirements are the same at both FOY maternity homes. Residents must be pregnant or parenting young women between the ages of 18 and 21 at time of entry into the home. They can have only one child, and their children must be no older than four when they enter the home. The homes must verify and document that applicants are homeless according to HUD's definition. The homes also screen applicants for severe mental or physical health problems, current drug addiction or domestic violence, and any evidence that they might be dangerous. The homes take referrals from numerous sources, including public health workers, social service providers, shelters, foster care, FOY outreach staff, a community information hotline, and former residents.

Setting and Structure of the Homes. Both homes are located in the Seattle area: one in a residential neighborhood in a northern suburb and the other in a complex with other group living facilities on a former military base on the east side of Seattle. Arbor House is an apartment model facility, while Harmony House is a congregate home. Some of the families in Arbor House share two-bedroom units while others live in individual one-bedroom units. This facility also contains a number of common areas shared by all residents and an apartment for the live-in resident manager. All families at Harmony House share living, dining, and kitchen areas, but each family has its own bedroom.

Staffing Patterns. The basic staffing pattern at the two homes is similar, and they even share some staff. Each of the homes has a resident manager who lives on site, so someone is available to residents day and night, although neither home has 24-hour-awake staff. Each home also has its own full-time case manager. The two maternity homes share a program manager and an assistant program manager with the three other residential facilities that are part of the FOY Transitional Living Program. The homes also share a pool of relief staff who provide supervision on weekends, holidays, and when a resident manager is on vacation. Since the two homes have similar numbers of staff despite widely different capacities, Arbor House has a much higher resident-to-staff ratio than Harmony House.

Core Program Services. The two homes offer a fairly similar set of services. Arbor House provides twice-monthly house meetings led by group home staff, as well as a monthly parenting class and a monthly nutrition class, both of which are taught by outside staff from partner organizations. Harmony House has weekly group meetings. In addition to group activities, residents in both homes are required to meet weekly with their case manager to review progress toward meeting their individual goals. Harmony House also contracts with external providers for mental health services. Harmony House provides child care for its residents, while Arbor House home has only limited funding for occasional child care. Both homes provide bus passes to their residents.


1. We have had a challenging time obtaining good funding information from some of the homes in this program. Therefore, these per-resident-family costs should be viewed only as approximate.

2. Inwood House officially has a capacity to serve 36 residents. However, the home has been operating below this capacity for some time, due primarily to a large drop in the city's foster care population in recent years.

3. Until shortly before our site visit in November 2004, one of the other three residential programs was also a maternity group home. However, FOY staff had recently decided to transition this home into a home for young women (ages 18 to 22) without children, because they felt this population was more in need of residential services in their area than was the young parent population.

4. Despite similar eligibility requirements, Harmony House tends to serve younger mothers who may need more supervision, while Arbor House tends to serve older mothers who are more ready for independent living.

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