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Maternity group homes are intensive, comprehensive support programs for pregnant and parenting young women and their children. In addition to stable housing, these homes provide a wide array of services to meet the needs of the families they serve. Supervision and rules help provide the structure teens and their children need as they develop a foundation on which to build their lives. Classes on parenting and life skills aim to provide residents with skills they will need to care for themselves and their children after they leave the home. Case management services and referrals strive to ensure that residents have access to additional services homes cannot provide directly, and logistical supports — such as child care and transportation assistance — enable them to access services outside the home and to attend school, work, and other activities. In addition to this common set of services, some maternity group homes directly provide mental health services, educational assistance, follow-up services for former residents, and services to the fathers of residents' children. Through these intensive programs of comprehensive services, maternity group homes have the potential to benefit disadvantaged young mothers and their children in both the short and long term.
The preceding chapters describe the implementation of maternity group home programs in detail. This chapter summarizes some of the key findings and implementation lessons for practitioners and policymakers who are operating programs of this type or considering creating them. This information can help in designing new maternity group home programs and improving existing ones.
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Most of the homes in this study are part of state- or county-wide networks of similar homes. In addition, many of the homes are operated by larger social service organizations, which may also operate other maternity group homes and typically have broader missions as well. Network managing agencies and parent organizations can assist maternity group homes in several different ways. Providing such assistance, however, uses financial resources and may limit homes' flexibility to tailor their programs to meet local needs. Agencies and organizations should take these tradeoffs into account when considering opening a maternity group home program or creating a network.
Networks. State policymakers who are concerned about the needs of teenage parents and their children may want to consider establishing a state network of maternity group homes. Where such networks are established, local social service providers will need to decide whether to operate homes within a network. Networked maternity group home programs can offer several advantages to participating homes. One of the most important ways in which many networks support their member homes is by providing funding. In addition, network agencies typically have network-level staff devoted (at least part-time) to providing technical assistance, support, and advocacy for the homes. These types of assistance may be particularly important for creating and fostering new programs. However, even staff of established homes in some networks cited the ongoing support of the network-level agency as central to their operations.
Besides providing top-down assistance to their individual homes, networks facilitate cooperation between the homes within the network. Being part of a network can also offer homes the opportunity to learn from each other, typically through regular meetings of home directors sponsored by the network agency. These connections between homes can also inform those operating at capacity about other locations with openings, so they can refer new applicants. Networked programs often have formal or informal mechanisms for transferring residents from one home to another within the network, to find the best match between residents' needs and homes' specific service offerings.
Creating networks also enables state and local government agencies to ensure that all homes within their purview conform to certain rules. In return for providing various types of assistance, networks typically require their homes to follow at least some, often broad, rules concerning program features. For example, homes may be constrained to accept only residents who are eligible to receive other services from the network agency, such as TANF or child welfare. In some cases, network agencies are involved in the referral process, and homes are even required to accept every resident referred by the network agency. Networks may also dictate certain services that all homes must provide, as well as particular levels or types of staffing. While agencies that manage networks may consider it important to be able to focus services in certain directions and/or standardize key program elements across all of their different homes, some individual homes (and some networks) may consider the resulting loss of flexibility a disadvantage. For instance, a network that is overly centralized might limit the ability of individual homes to respond to local needs and work with the community. Specifically to avoid this type of situation, the maternity group home network agency in New Mexico designed a decentralized network that gives local organizations considerable independence in operating their homes.
On the other hand, working with a number of different homes can make it possible for networks to create deliberate variety among the homes within its service area. Some networks include different types of homes that offer a continuum of care for different types of residents. In addition to the two types of maternity group homes discussed earlier in this report — congregate and apartment model homes — the Massachusetts network includes a few transitional facilities that provide considerably lower levels of supervision than the network's other homes. These homes provide only limited adult supervision and are targeted to older, more mature teens program staff have deemed ready to move from a maternity group home into a more independent setting. Another example of this model is Rhode Island's small statewide network (not included in this study), which also provides a continuum to help residents move toward independence. Young teen residents enter the program at the first level — living in a congregate home with 24-hour-awake supervision — and move to apartment model homes with less supervision over time.
The many benefits of network support come at the price of higher program costs, however, since adding a layer of network-level staff to perform these functions increases the cost of the program. Not surprisingly, the networks that provided the greatest amount of technical support and assistance to their member homes also dedicated the most network-level staff time to overseeing the network.
Parent Organizations. Policymakers interested in funding maternity group homes or establishing networks must consider who will be responsible for actually operating the homes, and social service organizations interested in this role must consider whether they are up to the task. Active parent organizations serve many of the same functions as network agencies: providing their homes with funding and technical assistance, facilitating interactions between different homes, and encouraging standardization or deliberate variety among their homes.
In addition to the types of assistance that network agencies provide, homes can benefit from having access to the management, administration, and other staff of established parent organizations. Parent organizations often take responsibility for all financial matters — including fundraising, budgeting, and accounting — and have direct authority over all expenditures. In some cases, parent organizations own the buildings in which maternity group homes operate. Parent organizations also are often involved in hiring at least some of the staff — such as the home's director and other key professional staff — who work at the homes. In some cases, staff from the parent organization come to the homes to provide specific direct services to residents. Such arrangements can help homes access specialized staff — such as mental health professionals — that a single home may not be able to support on its own. In addition, two or more homes with the same parent organization may share a program manager, a pool of on-call relief staff, or a set of partners.
These roles are especially important for homes that do not belong to a network, although many homes benefit from the assistance of both parent organizations and networks. Parent organizations experienced in offering services to pregnant and parenting teens or operating other residential programs for adolescents in need may be better prepared for many of the challenges of operating a maternity group home, and thus have less need of the kinds of support a network can offer. Policymakers should seek out such providers to operate maternity group homes, particularly in the absence of networks. Social service organizations with less comprehensive experience in this area may want to join a larger network of homes, if this is an option in their area.
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Providers of maternity group home programs often struggle with high turnover rates among residents. Although maternity group home programs typically allow residents to remain in the homes two years or longer, or until they reach an eligibility age limit, residents often leave much sooner. In many homes, staff reported that although many residents stay in the program for a year or more, just as many leave within a month or so of their initial entry into the home
High rates of turnover are a concern to practitioners and policymakers, for two reasons. First, maternity group home program staff expressed concern that many residents leave too soon to get the full benefit of the program. The homes are not designed as temporary shelters but as longer-term programs in which residents must spend considerable time if they are to take full advantage of the rich set of services the homes provide. Second, high rates of turnover can result in a large number of empty beds in some places. Although it may be useful for homes to have a few empty beds available for new residents, programs are able to use their space and staff most efficiently when operating at or close to capacity. Too much excess capacity can also affect program funding.
How to address high turnover depends on the reasons for it. Anecdotal evidence suggests several factors that may be related to turnover rates and excess capacity:
Policymakers and practitioners might consider these issues both when designing new programs and when making changes to existing programs.
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Providing the level of support and comprehensive array of services that maternity homes offer can be expensive, but some programs have considerably lower per-family costs than others. As discussed in Chapter IV, the monthly operating costs of the homes in this study ranged from as little as $1,200 to as much as $8,600 per resident family. Those designing new maternity group home programs should consider the reasons for this considerable variation, as well as the interaction between specific program features and program costs.
This study found a generally positive relationship between program costs and the intensity of supervision and other services provided directly by home staff. Since staffing is the single largest component of program expenses at most homes, any program feature that has strong implications for staffing will have similar implications for costs. Thus, financial considerations should be taken into account when making decisions about which services to provide directly, which specific populations to serve, and what size facilities to use. Policymakers and social service organizations should consider these factors when determining the likely costs of operating maternity group home programs.
Direct Provision of More Intensive Services. Offering more direct services — such as mental health services, more frequent life-skills and parenting classes, and more intensive supervision — will require more staff, resulting in higher program costs. Some types of services may increase costs more than others. For example, providing intensive mental health services requires more highly trained staff who will likely require higher salaries.
To reduce costs, programs may be able to rely more heavily on other social service agencies and organizations in the community to provide some services to home residents. Relying on external service providers — whether on site as partners or off site through referrals — can reduce the number of paid staff needed by a home. Thus, forging close relationships in the community can enable homes to expand the services available to their residents, while at the same time holding down the homes' operating costs. For example, among the homes in our study, those that rely on existing services in the community for mental health services have lower costs than those that provide these services directly to their residents. In New Mexico's maternity group home network — which is among the least expensive programs in our study — home staff are expected to serve largely as case managers, connecting residents with other providers in the community for most services. State officials who oversee the network cited as a strength of their program the ability of their homes to access community resources. Community organizations also provide small amounts of funding and in-kind donations to homes.
Nevertheless, the ability of programs to shift some responsibilities away from home staff and onto external service providers depends on the actual availability of services in the community. In some cases, certain services will simply not be available if the group home does not offer them directly. For example, in both Georgia and Maine — where the maternity group home programs pay for mental health services for their residents — staff noted that such services were not readily available to low-income families outside the home. Staff in another state mentioned long waiting lists for mental health and drug treatment services in the area. Staff of the network agency in New Mexico — which uses a model that relies heavily on local community involvement — cautioned that not all communities can support a home based on this model.
Choice of Target Population. Specific populations may require more intensive supervision and higher staff-to-resident ratios, resulting in more staff and thus higher program costs. For example, 24-hour-awake staff typically are required to supervise teens in state custody, and some states have licensing rules that require similarly high levels of supervision for all group homes that house minors. Besides supervision, there may be other state licensing requirements and regulations relating to these populations that add expense. Thus, serving younger teens and those in state custody may lead to higher program costs. Homes that are not subject to such requirements, such as some homes that serve older or more mature teens, may provide less intensive supervision, and thus tend to have lower costs. Those designing new maternity group home programs will need to consider the implications for program costs of the population served.
Policymakers designing networks might consider creating a continuum of different types of homes within a single program, in order to meet the needs of different types of residents at the lowest cost. The homes visited for this study represent a continuum of levels of program intensity and cost. In some sites, multiple levels of intensity exist within a given program, sometimes intentionally. The programs visited in Massachusetts, Michigan, and Washington each have some homes with higher operating costs and higher levels of supervision/service intensity and other homes with lower costs and intensity, which they target to a somewhat older or more mature population. For example, Massachusetts' STEP facilities, which provide considerably lower levels of supervision than the network's other homes, operate at about half the cost of the other homes. Staff in some sites that do not have such transitional programs mentioned a need for semi-independent facilities to bridge the gap between highly structured maternity group home programs and fully independent living.
Home Size. Policymakers may want to consider operating slightly larger homes as a strategy to reduce per-resident costs. This study found that larger homes tend to be less expensive to operate, due to economies of scale. A certain minimum number of staff is needed to provide supervision and services to a few residents, but homes with adequate physical capacity often can serve additional residents without increasing their staffing levels proportionately. In locations where the need for maternity group home programs is high enough to support larger homes, and where appropriate facilities with adequate capacity are available, operating a few large homes may be more cost efficient than operating a larger number of smaller homes.
There is a tradeoff involved in operating larger facilities, however. The resulting lower staff-to-resident ratios may likely result in less personal attention given to each resident, which may be inappropriate for some populations. In particular, the same state regulations that mandate 24-hour-awake staff in homes that serve minors or teens in state custody may also specify a low staff-to-resident ratio, making it impossible for these homes to expand capacity without a proportional increase in staff. In addition, larger facilities are likely to be more institutional and less like a family, which may not provide the same kind of supportive environment a small home can.
Thus, policymakers and organizations establishing maternity group home programs may need to decide whether to offer a high-intensity, high-cost program model or a more streamlined, lower-cost model. Those that wish to serve younger teens and/or provide constant adult supervision and a richer set of direct services must anticipate the higher costs that come with that model. Homes with lower levels of funding may have to rely more heavily on partners and referrals, and/or serve a more independent population that requires less intensive supervision.
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However, some of the programs with the strictest rules may also be those that serve populations who may not be free to leave the home without consequences. For example, some homes serve primarily residents who are required to live in the home because they are in state custody or on probation, or as a condition of receiving TANF or retaining custody of their child. Because these populations may be considered to need more supervision, the homes that specialize in serving them may be required to have stricter rules.
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