[ Main page of Report | Contents of Report ]
Maternity group homes offer an innovative and intensive approach to addressing the needs of an extremely vulnerable population teenage mothers and their children who have no other suitable place to live. Interest in maternity group homes has increased in recent years, due in part to recent welfare reform rules that require minor parents to live in an adult-supervised setting as a condition of Temporary Assistance for Needy Families (TANF) receipt. Yet surprisingly little is known about maternity group homes; to date there have been few studies of the implementation of maternity group home programs and no rigorous evaluations examining the effectiveness of these programs.
Given the considerable interest in maternity group homes and the roles they can play in assisting pregnant and parenting teens transition to independence, it is important to fill some of the gaps in the existing research. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (DHHS) is interested in learning more about maternity group home programs and in assessing the feasibility of conducting a rigorous evaluation to measure the effectiveness of such programs. To this end, ASPE contracted Mathematica Policy Research, Inc. (MPR) to explore options and design an evaluation of maternity group homes. The study has two main objectives: (1) document the implementation of maternity group home programs and (2) explore the feasibility of conducting a rigorous evaluation of their effectiveness. This report addresses the first objective; a future report will address the second.
Although the rates of pregnancy among teenagers have fallen steadily throughout the past decade, teenage pregnancy and parenthood remain serious problems in the United States. More than 800,000 teenagers become pregnant each year, and about a third of all young women experience a pregnancy before age 20 (Henshaw 2004; National Campaign to Prevent Teen Pregnancy 2004). The majority of teenagers who become pregnant are from disadvantaged backgrounds, and early pregnancy and childbirth create additional challenges. These teen parents and their children struggle with difficult circumstances in the short term and throughout their lives.
The problems facing pregnant and parenting teens are well documented. Teen mothers tend to be very poor, and most are single parents; this stress is often compounded by physical or sexual abuse and other health issues (U.S. DHHS 2000). Pregnancy can interrupt teens educational pursuits and early employment experiences (Maynard 1996). The negative outcomes associated with teenage pregnancy, including lifelong poverty and lengthy spells on public assistance, can follow mothers and their children for the rest of their lives (U.S. DHHS 2000). The daughters of teen mothers often become teen mothers themselves, with all the accompanying negative outcomes, thus perpetuating the intergenerational cycle of poverty and disadvantage.
Homelessness increases their risk of negative outcomes. Teens with tenuous living situations may have to leave their homes when they become pregnant. Pregnancy may be the final straw in an already unstable living situation, or their homes may be unsuitable environments in which to raise their babies due to issues of overcrowding, unsafe living conditions, domestic violence, or other extenuating circumstances. Teens in foster care who become pregnant may find that their current home is unable to accommodate their infant, and foster care placement cannot always ensure that a teen and her child will be placed together.
However, there are few housing options for pregnant and parenting teens who cannot live with a parent or responsible adult. Homeless shelters and battered women shelters often do not accept minor teens or their young children. Few teens have the financial and personal resources to live independently, particularly while caring for a young child, and teens facing housing instability are likely to be among the most disadvantaged. Furthermore, in some cases, teen parents must live in a supervised setting as a condition of receiving TANF benefits or as a condition of retaining custody of their babies.
Maternity group homes are a potential solution to this housing issue, and possibly to other challenges facing teen parents. Maternity group homes can offer an intensive package of services to meet the short- and longer-term needs of pregnant and parenting teens. In the short term, these homes provide a secure living environment with adult supervision and material and emotional support for teen parent families. Maternity group homes can also promote more positive long-term outcomes for teen parents and their children, by providing more extensive services to better prepare residents for independence. Maternity group homes can also provide necessary logistical supports such as transportation and child care to enable teen parents to pursue avenues to better their lives and their families futures.
History. Maternity group homes have a long history. Some of the maternity group homes in operation today such as Inwood House in New York, St. Anns in Maryland, and the Florence Crittenton agencies trace their origins to the 1800s (Reich 1996; Reich and Kelly 2000; and Child Welfare League of America 2004). A number of rescue homes were opened in the United States in the late 19th century to aid unwed mothers who, at the time, faced considerable social stigma in addition to economic hardship. These homes provided a safe place for young fallen women to live during and after pregnancy, as well as services intended to rehabilitate them and teach them to care for their children. Some traditional maternity homes provided services only during pregnancy, after which the usual outcome was for the mothers to give their babies up for adoption.
The need for this type of home was reduced over time, however, due to gradual social changes that made single parenthood more socially acceptable. Particularly during the 1960s and 70s, increased access to contraception made unintended pregnancies more preventable, and the reduced stigma of single parenthood led to a growing desire of unwed mothers to keep their babies. These changes led to the closing of some traditional maternity homes and the re-focusing of other programs. Some homes closed entirely, stopped providing residential services, or diversified to serving a broader population of young women in need (Child Welfare League of America 2004). Others continued their mission as maternity group homes, but with alterations to meet the changing needs. Some relocated from large facilities to smaller, community-based homes. Some homes that had only served pregnant residents extended their programs to provide assistance to the growing number of mothers who decided to keep their babies. In addition, some programs shifted from serving unmarried mothers in general to focusing on a population with the greatest need teenagers.
Teen mothers in particular still face considerable challenges in caring for themselves and their children, as discussed above. In addition, recent welfare reform rules that require minor parents to live in approved housing as a condition of TANF receipt have contributed to a resurgence in maternity group homes specifically targeted to serve pregnant and parenting teenagers who, for one reason or another, cannot live in their parents homes. For example, welfare reform prompted the creation of a few networks of maternity group homes, such as the statewide Teen Living Program established in Massachusetts in 1995.
Prior Research. While maternity group homes have the potential to address some important consequences of teen pregnancy, there are a number of gaps in the breadth and depth of knowledge collected about their operations. There have been a number of descriptive studies of maternity group homes in recent years, which have examined the characteristics of their programs and, sometimes, of their residents. However, while the existing studies provide helpful descriptive information on maternity group homes and their residents, they suffer from limitations that reduce the usefulness of their findings. In particular, most studies either provide a very brief look at a number of different homes, or a more intensive examination of a single maternity group home or network. In addition, few studies explored the implementation of maternity group homes, resulting in limited information on the challenges faced and lessons learned as staff operate maternity group home programs.
This report aims at filling some of the gaps in the past research by systematically examining the implementation of maternity group home programs across a large number of sites. To do this, we selected interesting maternity group home programs in seven states and conducted site visits to more than 20 different homes.
Site Selection. In determining which maternity group home programs to focus on in this study, we found it useful to first clarify what exactly a maternity group home is. For the purposes of the study, we defined a maternity group home as a residential program providing substantial supervision and other services primarily to pregnant and/or parenting teenagers. This definition excludes programs that provide only limited adult supervision such as having staff on site only during standard business hours on weekdays as well as programs that provide housing and supervision but no other services to their residents.
After restricting the definition, we developed a set of other criteria to help us select sites for this study. Because one main goal of the current study is to assess the feasibility of conducting a more rigorous evaluation of the effectiveness of select maternity group homes, our emphasis was on sites that seemed to have the highest potential for inclusion in such an evaluation. To this end, we focused primarily on programs that met the following four broad criteria:
We relied on a variety of resources to explore how well various maternity group home programs meet each of these criteria. These resources included the directory of maternity group homes compiled by the Social Policy Action Network (SPAN), a review of past studies of maternity group homes, Internet searches, reviews of program websites, and preliminary telephone conversations with staff from certain programs.
It was difficult to find programs that clearly met all four criteria. In particular, identifying programs that were both large enough to generate adequate samples for an evaluation and operating in environments with clear evidence of substantial excess demand for program services proved to be particularly challenging. When necessary, we prioritized the ability to generate adequate sample sizes above the existence of unmet need for program services.
Because of these selection criteria, the homes included in this study are not necessarily typical or representative of maternity group homes nationwide. In particular, because a rigorous evaluation would require large sample sizes, our selection process focused on relatively large maternity group home programs those serving relatively large numbers of resident families. To achieve these numbers, most of the sites included in this study are actually either networks of homes operated by several different organizations or programs in which multiple homes are operated by a single organization. Thus, although the individual homes included in our study are not necessarily any larger on average than other homes, those in our study are more likely to be part of larger programs. These program ties may have implications for homes funding, structure, and operations. For example, being part of a larger program my provide the homes in our study with access to resources that independent homes may not have. In addition, homes that are part of larger programs may have to follow program guidelines concerning whom to serve or how to structure the home. Thus, the homes included in our study may be different from other maternity group homes in a variety of ways.
Data Collection. Once we had selected the sites, we contacted the director of each program to request program documents and plan a site visit to gather additional information. Two site visitors went to most programs and spent two or three days in the programs coverage area. During the visits, we met with network- or program-level staff at each of these seven sites, in addition to visiting maternity group homes themselves. The text box below shows the topics discussed during conversations with staff.
|Topics Discussed During Site Visits|
At each program, we met with the program director and other staff of the network agency or managing organization. We collected any additional program documents that were available. In some cases, we also met with staff of an agency that provided the majority of funding or referrals for the maternity group home program.
We visited every maternity group home in the three programs that included fewer than four homes each (see Table I.1). In the other programs, we visited between three and five homes each. We selected which homes to visit in consultation with the network or program director, based on representativeness, variety, and location. In some cases, we also visited other, unrelated, homes in the same area. At each home, we toured the facility and met with key staff. Where possible, we also spoke with residents and observed program activities.
|State||Program Name||Number of Homes||Capacity in All Homes|
|Georgia||GCAPP Second Chance Homes||8||4||44|
|Maine||St. Andre Group Homes||4||3||16|
|Massachusetts||Teen Living Program||20a||5||167|
|Michigan||Teen Parent Supportive Housing Services Collaborative||3||3||34|
|New Mexico||Teen Parent Program||5||4||38|
|New York||Inwood House Maternity Residence||1||1||36b|
|Washington||Friends of Youth Transitional Living Program||2||2||20|
|GCAPP = Georgia Campaign for Adolescent Pregnancy Prevention
a In addition to these 20 maternity group homes, the Massachusetts program includes three homes designed specifically for more mature teens who have completed a regular maternity group home program and are deemed ready by program staff to transition to semi-independent living. However, these three homes do not fit the definition of maternity group home used in this study due to the lower levels of supervision provided.
b Inwood House officially has the capacity to serve 36 residents. However, the home has been operating below this capacity for some time and, in response, has reduced staff and converted some space for other uses. Thus, in this report, we consider the capacity to be 24 when calculating staffing ratios and costs per resident.
We visited maternity group home programs in seven states (Table I.1). Each of these programs is described briefly below. Additional detail on each program can be found in Appendix A.
Georgia GCAPP Second Chance Homes. The Georgia Campaign for Adolescent Pregnancy Prevention (GCAPP) operates a network of eight maternity group homes, located throughout the state, serving 44 teenage mothers and their babies. The program began serving teens in 2001 and is funded primarily by the Georgia Department of Human Resources (DHR). DHR provides both funding to GCAPP which uses some of this funding to support network-level staff and passes the remaining funds along to the homes and payments to homes directly for providing shelter and services to children in state custody.
Residents must be between the ages of 13 and 20. Although both pregnant and parenting teens are eligible to live in the homes, in practice most teens have had their babies before they enter the program. The program serves primarily teens in state custody. About two thirds of program residents are referred by local child welfare agencies, and another 10 percent by juvenile justice agencies.
The eight homes all offer a similar set of services, including weekly parenting and life-skills classes, regular individual therapy sessions, and weekly case management sessions. Homes also offer tutoring services, as well as transportation to medical appointments, educational events, and group outings. All homes involve congregate living, in which the each teen family has its own bedroom but shares living, dining, and kitchen areas. 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.
Maine St. Andre Home, Inc. 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. Three of the homes opened in the mid-1970s; the fourth opened in 1998. Funding for the four homes is primarily through Medicaid and a state contract.
To reside in a St. Andre group home, young women must be Medicaid eligible and either be pregnant or parenting a child younger than age three. All homes serve young mothers ages 15 to 24. One of the four homes can serve women up to the age of 30 and can accommodate mothers with two children. Most residents were referred to the program by the Maine Department of Health and Human Services, and living in the home is often a condition either of retaining custody of their children or being reunited with their children in state custody.
All of the homes follow a congregate model and have staff on site 24 hours a day. The homes all have low resident-to-staff ratios, each employing six full-time and one part-time staff member, and the program also contracts with a number of consultants. In addition to housing and supervision, each home provides a number of individual and group services to its residents. Homes convene group sessions including parenting and life-skills classes and house meetings three or four times a week, and residents must meet individually with the homes social worker each week. Some residents also meet regularly with psychiatrists who come to the home to provide therapy. Homes also occasionally provide child care and transportation for their residents.
Massachusetts Teen Living Program. The Massachusetts Teen Living Program includes 20 maternity group homes for pregnant and parenting teens throughout the state. The homes can house 167 teens and their children, making the network the largest maternity group home program in the country. The network began in 1995 as part of state welfare reform. It 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 states TANF program. The network receives most of its funding from DTA and the remainder from DSS.
All homes require that residents be: (1) between the ages of 13 and 20 years old, (2) Massachusetts residents, and (3) pregnant or parenting. Each bed within the network is designated as 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 (although there is considerable overlap between these two groups).
Most of the homes in the network are congregate facilities, but five programs follow an apartment model, in which two or three teens and their children share an apartment. Apartment-model programs are designed for older teens who are better able to take care of themselves and their children. Both types of homes have staff on site 24 hours a day, but congregate homes must have awake staff at all times, while some apartment-model homes have live-in house parents instead.
Homes typically have three or four group sessions a week, including life-skills/parenting groups and house meetings. Residents also meet weekly with their case manager, and some provide counseling to residents. 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, the homes offer follow-up assistance to former residents. The programs also provide outreach and case management services to the fathers of current residents children.
Michigan Teen Parent Supportive Housing Services Collaborative. The Family Independence Agency (FIA) of Wayne County oversees a small county-based network of providers serving pregnant and parenting teens in the Detroit area. The network includes three maternity group homes, with total capacity to serve 34 pregnant and parenting teens and their children. In addition, the network includes a parenting program and an agency that provides mental health and outreach services to support the maternity group homes. The U.S. Department of Housing and Urban Development (HUD) Supportive Housing Program is the primary source of funding for all the homes in the network, although none relies exclusively on this source.
All homes serve both pregnant and parenting teens, and each home can accommodate at least a certain number of parents with two children. None of the homes accepts teens younger than 15 or older than 18, and some individual homes have narrower age ranges. Residents must be from Wayne County, and all homes require parental consent for minors. FIA is the primary source of referrals for all three homes, and all admissions decisions are made with the approval of FIA caseworkers.
Two of the homes are congregate living facilities, and in one of these homes teens even share bedrooms. The third facility, which targets slightly older teens than the other homes, is an old apartment building in which each teen parent has her own one-bedroom apartment. All three homes have staff on site 24 hours a day, and staff at the two congregate homes must be awake at all times. Each home has at least four full-time staff and a number of part-time staff, plus some partner staff who come in to the homes to provide specific 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, covering topics related to parenting and life skills. Group and individual counseling are also commonly provided. Some homes provide child care and transportation to enable residents to attend school or work, and some homes take residents on group outings. In addition to services provided to residents, each home also offers some continued assistance to former residents after they leave the home.
New Mexico Teen Parent Program. The New Mexico Teen Parent Program, which is managed by the states Children, Youth, and Family Department, funds five group homes and three non-residential programs for pregnant and parenting teens throughout the state. The homes can serve a total of 38 pregnant or parenting young women and their children. The program began operating in 1990 and is the oldest statewide network of maternity group homes in the country. The network provides funding toward the operating expenses at all five homes, but some of the homes have substantial funding from other sources, including HUD, the child welfare system, and Catholic Charities.
By design, program operations are very decentralized, and individual homes have considerable flexibility in determining the specific services they offer and population they serve. All of the homes serve pregnant or parenting young women under age 21, but some have additional eligibility requirements, such as meeting the HUD definition of homelessness.
The setting and physical structures of the five homes vary substantially. Two are in converted single-family homes, and one is in a converted motel in a remote location. Another home is in a set of three attached two-bedroom apartments in a small town, and another is in a set of eight clustered one- and two-bedroom apartment units in a large privately owned apartment complex in an urban area.
Most of the homes provide 24-hour supervision. 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. In addition to paid staff, most homes rely on volunteers from partner organizations to provide some services to home residents. All homes offer case management services and regular parenting and life-skills classes to residents, typically meeting once or twice a week. Some provide other direct services such as tutoring, respite child care, and transportation.
New York Inwood House Maternity Residence. Inwood House is one of three New York City maternity homes for pregnant teens in the foster care system. It was founded in 1830 and has been serving pregnant teens from the citys foster care system since the 1930s. In addition to its maternity residence, which has capacity to serve 36, Inwood House operates several other programs to serve pregnant and parenting teens, as well as programs designed to reduce teen pregnancy. The Administration for Children Services (ACS), the citys child welfare agency, contracts with Inwood House to provide maternity home services and provides most of the homes funding.
The program serves pregnant young women under the age of 21 until the birth of their child. After their babies are born, state law requires that residents and their babies be placed elsewhere, typically with a foster family or in a group home for teen parents. In addition, since ACS regulations prohibit babies from residing in the maternity home, residents must not have custody of any other children. All residents must in the foster care system, and all referrals to the program come from ACS.
Inwood House operates out of three floors in a six-story former apartment building in a quiet, residential neighborhood in New York City. Residents all have their own bedrooms and share living rooms and dining areas. 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 home offers a wide array of support services, including six mandatory weekly classes on independent living skills, child birth, infant care, health, substance abuse prevention, and other special topics and weekly meetings with their case managers. Inwood House offers an on-site school for teens who are not able to find an appropriate educational program in the community. The home also offers case management services to the fathers of the residents babies, who are also invited to attend the childbirth and other classes Inwood House offers for its residents.
Washington Friends of Youth Transitional Living Program. Friends of Youth operates a small Transitional Living Program network including two maternity group homes and three residential programs for other youth populations in the Seattle area. The two maternity homes serve 20 pregnant and parenting young women and their children. Friends of Youth has operated other residential programs for youth since 1951 and opened their first maternity home exclusively for pregnant and parenting teens in 1991. The networks management is fairly centralized one Friends of Youth staff member is the program manager for both maternity homes. The majority of funding for both maternity homes is provided by HUD.
The eligibility requirements are the same at both Friends of Youth 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 age 4 when they enter the home. The homes must verify and document that applicants are homeless according to HUDs definition.
The two homes offer a similar set of services; however, one is a congregate living facility while the other is an apartment model facility. Each of the homes has a resident manager who lives on site, so someone is available to residents day and night. Each of the homes also has its own full-time case manager, and the two homes share a program manager, assistant program manager, and a pool of relief staff. The homes offer group sessions such as house meetings, parenting classes, and cooking/nutrition classes approximately weekly, and residents at both homes are required to meet weekly with their case manager. One home also contracts with external providers for mental health services. One home provides child care for its residents, while the other has only limited funding for occasional child care. Both homes provide bus passes to their residents.
The current report discusses the implementation of maternity group home programs in 22 different homes across these seven sites. This systematic examination should both fill gaps in the existing literature and provide useful information for policymakers and for organizations considering establishing maternity group homes. The rest of the report focuses on describing the implementation of maternity group home programs in these seven sites. In particular, this report addresses three sets of research questions:
Chapters II through IV of this report discuss each of these topics in turn. Chapter V summarizes the implementation lessons presented in the earlier chapters and makes recommendations for further research in this area.
1. In addition, the enactment
of Aid to Families with Dependent Children (AFDC) in 1935 had reduced the
need for maternity group homes by providing financial support for single
mothers whether widowed or unwed and their children
2. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) included requirements concerning the living arrangements of teenage parents on welfare. Unmarried minor parents must live with a parent or guardian, with few exceptions, as a condition of receiving benefits. States are required to provide or facilitate alternative adult-supervised living situations for those unable to live with a parent.
3. A recent review of the literature discussed the methodology of 17 past studies of maternity group homes and summarized their findings on a wide variety of issues (Hulsey 2004).
4. This definition excludes programs that primarily serve a much broader population (such as teens who may not be pregnant or parenting, or pregnant and parenting women who may not be teens) of which only a minority are pregnant or parenting teens. However, this definition does not exclude homes that serve a few residents who are outside of the teen age range. Most of the programs discussed in this report serve exclusively residents between the ages of 13 and 21, but a few serve women through their middle or later twenties.
5. Chapter II discusses this issue in detail.
6. In addition to these two types of homes, Massachusetts statewide network includes three transitional Supportive Teen Parent Education and Employment Program (STEP) facilities. STEP homes are apartment-model programs for older teens who have graduated from regular TLPs and are deemed ready by program staff to transition to semi-independent living. STEP programs do not fit the definition of maternity group home used in this study, because they provide considerably less supervision than other homes. None of the STEPfacilities have 24-hour staff, and some are staffed as little as 20 hours per week. Residents of STEP homes still receive some supervision and case management and attend group sessions and classes, but less frequently than other TLP residents.
7. Inwood House officially has capacity to serve 36 residents. However, the home has been operating well below this capacity for some time and has reduced staff and converted some space for other uses. Thus, in this report, we consider the homes capacity to be 24 residents when computing staff ratios and costs per resident.
8. Until recently, one of the other residential programs was a maternity group home, but FOY staff decided to transition this facility into a home for young women (ages 18 to 22), as they felt that there were fewer facilities and greater needs for this population than the young parent population.
Top of Page | Contents
Main Page of Report | Contents of Report
Human Services Policy (HSP)
Assistant Secretary for Planning and Evaluation ASPE)
U.S. Department of Health and Human Services (HHS)