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For maternity group home programs to provide the extensive set of services, structure, and supervision described in Chapter III, they must have adequate staffing and funding. The issues of staffing and funding are closely related, since staffing is by far the greatest expense for these programs. In general, the intensive services offered by these homes require fairly large staffs, even for a small facility. In turn, these high staffing levels lead to relatively high costs for these programs.
In this chapter we examine carefully the staffing patterns and costs of operating maternity group home programs, particularly the following research questions:
Although maternity group homes tend to offer many of the same types of services to pregnant and parenting teens, they use a variety of different staffing strategies to serve their residents. Each maternity group home program must decide how many and what types of staff to use to supervise its residents and to provide each service the home offers. This section describes the staffing patterns these homes use to deliver the array of services discussed in Chapter III.
Number of Staff Members. Operating a residential program for pregnant and parenting teens and their children can require a large staff. On average, the homes we visited had 11 staff members (including both full-time and part-time staff), and about 8 full-time equivalent (FTE) staff (Table IV.1). The number of staff members varies considerably across the homes we visited, however, ranging from 4 to 28 FTE staff (4 to 39 total staff).
|Program (State)||Number of Staff Members per Home||Number of Full-Time
|GCAPP Second Chance Homes (Georgia)||4 to 6||3 to 7||7 to 13||5.5 to 9.5|
|St. Andre Group Homes (Maine)||6||1||7||6.5|
|Teen Living Program (Massachusetts)||2 to 7||3 to 11||5 to 17||3.5 to 11.5|
|Teen Parent Supportive Housing Services Collaborative (Michigan)||4 to 8||1 to 13||6 to 21||5.0 to 14.5|
|Teen Parent Program
|2 to 5||1 to 8||4 to 10||3.5 to 6.0|
|Inwood House Maternity Residence (New York)||17||22||39||28|
|Friends of Youth Transitional Living Program (Washington)||1 to 2||5 to 7||7 to 8||4.5|
|Overall Range||1 to 17||1 to 22||4 to 39||3.5 to 28.0|
|a In computing full-time equivalent (FTE) staffing
levels, we assumed that all part-time staff are half-time.
GCAPP = Georgia Campaign for Adolescent Pregnancy Prevention.
The number of staff members needed at a home depends on the number of its residents; however, resident-to-staff ratios vary considerably across the homes we visited. Some had fewer than one FTE staff member for every three resident families, while others had more than two FTE staff members for each resident family. About half of the homes we visited had more FTE staff than residents, while the other half had more residents than staff. Several program features seem to be correlated with staffing levels:
Group Home Staff and Their Roles. Most homes employ a mix of full-time and part-time staff members, as well as a mix of degreed professionals and relatively unskilled staff. On average, the homes in our study employ about five full-time and six part-time staff members (Table IV.1).(1)
The number of staff members varies considerably across homes, however. Among the homes we visited, the number of full-time staff ranges from 1 to 17, and the number of part-time staff ranges from 1 to 22.
The staff members employed by maternity group homes tend to fall into four categories:
A SAMPLE STAFFING PATTERN FOR A MATERNITY GROUP HOME
The Families First Second Chance Home in College Park, Georgia has five full-time and four part-time staff members serving eight resident families. The homes director spends half her time administering the home and the rest of her time on other Families First programs. The full-time group home supervisor, a masters-level social worker and licensed counselor, oversees the daily functioning of the home and also provides weekly individual therapy and case management services to each resident. The other full-time staff members are an activities coordinator who teaches the parenting classes and handles referrals, assessments, and follow-up services and three full-time house parents (two of whom are a married couple) who live in private apartments within the group home facility. The home also has three part-time staff members to provide supervision during weekend hours when the house parents have time off.
External Staff Who Provide Support Services. In addition to their own staff members, maternity group homes often rely on external providers to perform certain services, such as teaching classes or providing therapy to residents. These staff members typically come to the home only on a regularly scheduled day (often weekly or monthly) to provide a specific service. The homes we visited relied on three types of external staff:
An important issue to consider when examining maternity group home programs is the typical cost of serving young mothers in this setting. To fully explore this issue, it is necessary to have information both on the cost of operating the programs and on the typical amount of time residents stay in these homes. For this reason, we asked staff members to provide information on the cost of operating their programs, as well as the amount of time their residents typically remain in the homes.
Getting complete and precise information on program costs proved difficult in some instances. Program staff were sometimes reluctant to share information on costs. In addition, some of the staff we spoke with were not knowledgeable about budget issues or did not have this information readily available. In other cases, it was difficult to separate the cost of the maternity group home program from the cost of other programs the parent organization operated. In spite of these challenges, we were able to collect fairly complete information on per-resident costs from most programs. However, given the difficulties encountered, the costs reported here should be considered only as estimates of the actual per-resident costs.
Getting detailed information on residents typical length of stay proved to be even more challenging. Homes often did not keep detailed records on length of stay or did not have this information in a form that could be readily compiled and tabulated. In addition, when information on average length of stay was available from programs, it was not always clear how the information had been calculated and how, for example, the ongoing stays of current residents were factored in to any averages reported. Finally, it appeared that when staff members did not have specific information on this topic and instead gave their general sense of the typical length of stay, they tended to overestimate how long residents remained in the homes. They generally reported much longer stays than were indicated from reports based on specific data on all program participants.(3)
To address the limitations of the cost information, we report figures in terms of average monthly costs per resident family, rather than average total costs per resident family served (which would require precise information on average length of stay).(4) We then describe the available information on typical length of stay and discuss what this suggests about the typical total cost for serving young mothers and their children in this setting. However, since the length of stay information is less complete, we do not calculate specific total cost estimates per resident family served for each of the study programs.
Typical Monthly Costs. Operating a maternity group home can be expensive. Many programs reported average costs per resident family of more than $4,000 a month (Table IV.2). By far the largest expense in operating these programs is staffing cost. Salaries and benefits can make up 70 percent or more of their overall operating expenses. As discussed in Chapter III, maternity group home programs typically offer 24-hour supervision, as well as intensive support to residents. This high level of supervision and support requires a large number of staff members per resident family. These high per-resident staffing levels lead to high per-resident costs.
The cost of providing housing is another important component of program costs. Program staff indicated that housing costs represented anywhere from 10 to 30 percent of their operating expenses. There are several reasons why the proportion of program costs devoted to housing may vary. In many cases, the parent organizations that operate maternity group home programs own the buildings where the homes are located, which help keep their ongoing housing costs down. Other programs rent space for their maternity group homes. In these cases, housing costs typically are higher and represent a larger fraction of overall operating expenses. In addition, costs vary substantially by location. In general, homes located in urban areas face much higher housing costs than those in small-town or rural settings.(5)
|Program (State)||Estimated Average
Monthly Cost per
|Programs with Average to Above Average Costs|
|St. Andre Group Homes (Maine)||$8,600||1.6||4.0|
|Inwood House Maternity Residence (New York)||$6,000||1.2||24.0|
|GCAPP Second Chance Homes (Georgia)||$4,3006,700||1.3||5.5|
|Teen Living Program (Massachusetts)||$3,5004,800||1.1||8.4|
|Programs with Below Average Costs|
|Teen Parent Supportive Housing Services Collaborative (Michigan)||$1,2004,200||0.7||11.3|
|Teen Parent Program (New Mexico)||$1,3003,300||0.6||7.6|
|Friends of Youth Transitional Living Program (Washington)||$1,3003,200||0.5||10.0|
|Note: Cost estimates are approximate. Ranges indicate
the lowest and highest average per resident family costs in the homes within
a Average among the homes we visited.Figures represent full-time-equivalent staff per resident family.
GCAPP = Georgia Campaign for Adolescent Pregnancy Prevention.
Funding levels per resident vary greatly across maternity group homes. Several homes reported average costs per resident family of less than $1,500 per month, while others reported average monthly costs of more than $8,000 per family (Table IV.2). Not surprisingly, costs are closely tied to the number of staff members the home employs. Programs with average or above average costs tend to have the highest number of staff per resident (Table IV.2). For example, the Maine program had the highest costs per resident family of the programs we visited, as well as the highest staff-to-resident ratio, with 1.6 full-time equivalent staff members per resident family. Conversely, the programs with the lowest per-resident family costs (those in Michigan, New Mexico, and Washington) had the lowest number of staff per resident. These programs all averaged fewer than one staff member per resident family.(6)
In addition, programs that operate smaller homes tend to have higher per-resident costs.(7) The Maine and Georgia programs, which have above-average costs, operate homes that average fewer than six resident families per home (Table IV.2). In contrast, the average size of homes in the Michigan and Washington programs, which have relatively low costs per resident, is 10 or more. This connection between home size and per-resident costs may be tied to staffing levels. For example, it generally takes more staff per resident to offer 24-hour supervision in a home with 5 resident families than it does in a home with 10 resident families. In addition, there may be other ways in which larger homes enjoy economies of scale and are able to offer the same level of service with fewer staff members.
THE RELATIONSHIP BETWEEN STAFFING LEVELS AND COSTS
Two examples illustrate the considerable variation in staffing levels at different maternity group homes, as well as how these staffing levels affect both program services and program costs. One of the highest staff-to-resident ratios we observed was in the St. Andre program in Maine, which operates four small congregate-model homes. These homes typically have one part-time and six full-time staff members to serve four resident families about 1.6 FTE staff members per family. This high staffing level allows the home to provide a high level of service for its residents, including 24-hour supervision, parenting and life-skills classes three or four times a week, and intensive mental health treatment. It also leads to fairly high costs, about $8,600 per month per resident family served.
In contrast, one large apartment-model home operated by Friends of Youth in Washington had one of the lowest staff-to-resident ratios we observed. This facility has one full-time and seven part-time staff members to serve 14 resident families about 0.3 FTE staff members per family. Because of the lower staffing levels, the home offers a less intensive set of services to its residents. For example, unlike the Maine home, the Washington home does not offer intensive mental health services and conducts parenting and life skills classes only about twice a month. The lower staffing level at this home keeps their costs relative low, only about $1,300 per month per resident family served.
Finally, programs with higher per-resident costs generally provide a more intensive set of services. The Maine and Georgia programs, for example, place strong emphasis on mental health treatment. In both programs, residents see a trained therapist weekly. These sessions are usually conducted by a specially trained, licensed social worker who is a member of the group home staff. In addition, many residents in the Maine and Georgia programs see a psychiatrist regularly. For both these programs, the cost of this intensive mental health treatment is included in their overall program budgets. Other programs place substantially less emphasis on mental health treatment, and most residents in these other programs do not receive regular mental health therapy. In addition, the mental health treatment that is provided for residents in these other programs usually is provided by other organizations and is not part of the budget of the homes. Similarly, the New York program, which has above average costs, also offers a particularly intensive set of services. Residents in the New York program 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. No other program we observed included as many hours of formal instruction.
Typical Length of Stay. Residents of maternity group homesare generally free to remain in these programs a relatively long time. Several programs have official limits on stays of 18 to 24 months. In other programs, residents may remain in the home as long as they are below the programs age limit (often 21). Home staff often reported that they were flexible about these limits and, in some cases, allowed residents to stay beyond them if it appeared that the family would benefit from remaining in the program.
In spite of the potential for fairly long stays in these homes, it appears that the typical stay is relatively short. As mentioned, the data available on length of stay are limited and incomplete. However, in programs and homes for which this information is available, the average length of stay is about four to six months. For example, staff in the Georgia program reported that the average stay for its residents was just over four months, while staff from the Massachusetts program reported an average of about six months. Similarly, in the one Michigan home that was able to provide this information, the average length of stay was just over six months. Staff at the New York program indicated that the average stay for its residents was about five months.(8)
In some cases, residents remain in the program only a short time. In programs that had this information available, anywhere from 10 to 25 percent of residents remained in the program for a month or less. In other programs, staff reported anecdotally that residents sometimes left the program after only a few days, once it became clear to them what life in the home would be like. In other cases, residents remained in the program for a year or more. Programs that had this information indicated that 10 to 15 percent of residents remained in the program for at least a year. Staff at many homes mentioned several of their recent residents who had remained in the home for more than a year.
Typical Total Costs. We end this chapter by considering the typical total cost of serving a family in a maternity group home. To estimate this figure, we must combine information on the typical length of stay with information on typical monthly costs. Based on the information gathered in this study, it appears that a stay of five to six months is fairly typical for a family residing in one of these homes. In addition, although costs vary substantially across homes, several programs had homes with monthly costs in the $4,000 to $5,000 per-family range, which falls in the middle of the full range of costs we observed. Combining these figures suggests that a reasonable estimate of the typical cost of serving a family in a maternity group home is $20,000 to $30,000 for a five- or six-month stay. Of course, families often remain in these homes for more or less time than that. Therefore, the actual cost of serving a family in one of these homes would often be higher or lower than this range.
1. Some individuals categorized here as part-time staff are actually full-time employees of the home's managing organization but spend only part of their time working for the maternity group home itself.
2. For example, homes in the Massachusetts program have father outreach workers who provide case management and other services to the fathers of the children of maternity group home residents. These staff typically work part-time or are shared by multiple homes.
3. In many cases, it appeared that staff members based their more informal estimates on the typical length of stay primarily on those residents who remained in the home long enough for them to be easily remembered. This phenomenon may have caused some staff members to inadvertently exclude residents with short stays when providing an estimate of the typical length of stay. In other cases, staff members may have deliberately omitted residents with very short stays, since they considered these residents to have never fully engaged and participated in the program.
4. A resident family includes the young mother and her child or children. If the young woman is pregnant and has no other children in the program, the "resident family" includes only her.
5. Of course, programs with relatively low staffing levels, and thus low staffing costs, are more likely to have smaller budgets and to devote a higher fraction of their budgets to housing.
6. This pattern could also be seen among homes within a program. Among the homes in the Michigan, New Mexico, and Washington programs, those with the highest per-resident costs also had the highest number of staff per resident.
7. There is one notable exception to this pattern. Inwood House, in New York City, was the largest single facility we visited (typically serving about 24 pregnant teens) but did not have below average costs. This is most likely due to the program's relatively high staff-to-resident ratio, which was higher than other large homes we observed. Inwood House offers an especially intensive set of services for its residents, which likely requires it to have higher staffing levels (and, therefore, higher costs) than other large maternity group homes.
8. The maximum stay in the New York program is limited by the fact that residents can remain in the program only while they are pregnant. Even so, the average length of stay in the program is similar to that of other programs in which residents are allowed to remain after their babies are born.
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Human Services Policy (HSP)
Assistant Secretary for Planning and Evaluation ASPE)
U.S. Department of Health and Human Services (HHS)