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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 document and synthesize what is known about these homes, as well as to identify gaps in the existing research. A number of studies of maternity group homes have been conducted in recent years; however, little is known about how effective they are in achieving their goals. Most studies of maternity group homes have simply examined the characteristics of their programs and, sometimes, the characteristics of their residents. There have been very few studies on the implementation and operation of maternity group homes and no rigorous evaluations of these homes that can shed any light on their effectiveness.
Existing studies that have focused on maternity group homes can be categorized into four groups:
A summary of the studies that looked at maternity group homes is provided in Table A.1 in Appendix A. These studies provide a wealth of information on the characteristics and operations of maternity group homes, useful data on the characteristics of residents, and even some promising findings on outcomes. However, large gaps remain in the collected knowledge on the impacts of maternity group homes, for several reasons.
Although some of these studies, particularly those in the third category, may interpret their results as though they were evidence of the effectiveness of maternity group homes, none of the studies conducted on maternity group homes to date have employed methodologies rigorous enough to yield true evidence of effectiveness (as discussed further in Section D below). In particular, none had an appropriate comparison group, and most lacked comparison groups entirely.
The diversity of methodologies employed by studies of different maternity group homes makes distilling a consistent message from these studies challenging. In addition, some of these studies (especially those in the second category listed above) do not describe the research methods or data sources used, which further complicates interpretation of their findings. These issues should be kept in mind as we examine the literature on maternity group homes.
Despite the limitations and inconsistent methodologies of these studies, some tentative statements can be made regarding their findings about residents of maternity group homes. In general, maternity group home residents come from disadvantaged backgrounds but exhibit normal social supports. High proportions of maternity group home residents receive various types of assistance (from the homes and other sources) while living in the homes; however, many teens do not stay in the homes as long as they could. Some of the most promising outcomes found in studies of maternity group homes are related to child health and to father involvement with the child.
This chapter first summarizes the findings of past studies of maternity group homes, focusing primarily on those studies based on more solid methodology, on a wide variety of outcomes. The discussion centers on three questions:
We then discuss the limitations of studies conducted to date and ways a rigorous evaluation might fill some of the gaps in the research.
Examining the characteristics of maternity group home residents is critical to understanding program outcomes. A number of studies have described the populations served by various maternity group homes or networks of homes. Here we synthesize the findings of these studies in order to describe some aspects of the characteristics of program residents.
Backgrounds. Not unexpectedly, maternity group home residents tend to be a disadvantaged population. Many have histories of welfare receipt, domestic violence, child abuse, educational interruptions, and housing instability. Studies have reported family reliance on welfare among as many as 76 percent of residents of some maternity group homes, and many teen mothers are themselves children of teen mothers (Saunders 1990). Different studies found that between 13 and 50 percent of residents reported being abused by their boyfriends, and an early study of Massachusetts' Teen Living Program network found that 43 percent of residents had been Department of Social Services cases when they were children (Reich 1996; and Saunders 1990). Between 37 percent and about 67 percent of residents had dropped out of school, and many maternity group home residents had been homeless or “precariously housed” before coming to the homes (Reich 1996; Saunders 1990; Saint Elizabeth's Regional Maternity Center 2004; and Fischer 2000).
Social characteristics. Despite their disadvantaged backgrounds, residents of the homes show considerable resiliency. Some studies indicate that maternity group home residents have adequate social support and related characteristics. An early study of Massachusetts' Teen Living Program network found that most residents had adequate parenting and life management skills (Reich 1996). A study of two maternity group homes in California found the clinical and psychological characteristics of residents to be similar to those of different populations of pregnant teens in other studies, although residents had lower self-esteem than older mothers in other studies, particularly on the school-academic subscale (Koniak 1989). Residents of those homes reported support networks that included 9.5 people, on average, mostly family and friends, including other maternity group home residents. Although the majority of respondents had not intended to become pregnant, they were still able to develop positive attachments to their unborn fetus.
The extent to which maternity group homes have impacts on their residents may depend on the specific experiences of these teen mothers while residing in the home. The previous chapter discussed what maternity group homes offer their residents. In this section, we describe what happens for teens in the homes, including how long they remain in residence, their satisfaction with their maternity group home experience, and what individual residents do while living there.
Length of stay. There is considerable variation in how long teens stay in maternity group homes, a result of program rules as well as the individual preferences of residents. Studies of different maternity group homes report average lengths of stay ranging from just 67 days to 2 years (Reich 1996; Fischer 2000; and Collins, Stevens, and Lane 2000).(1) Residents leave maternity group homes for a variety of reasons, including:
Since some teens leave because their need for the maternity group home has ended, and some homes are designed to provide only temporary housing, a short length of stay is not necessarily a negative outcome. However, the average length of time that teens stay in a maternity group home could be an important factor in their potential success in achieving some longer-term goals, since programs are less likely to be able to meet their goals if families stay for considerably shorter periods of time than programs intend. The literature on maternity group homes indicates that residents often leave well before any program limits on the length of time they can stay expire. For example, a study of the FDC home in Georgia found that, although that program was designed for families to remain in residence for one year, only about 17 percent of families remained that long (Fischer 2000). FDC staff considered a six-month stay to be a reasonable benchmark of commitment, but 46 percent of families left even before that point. One study of Massachusetts' Teen Living Program network reported that the average length of stay was under eight months, despite program rules allowing teens to remain for two years in many homes and an unlimited time (until they reach the maximum age of 20 or 21) in others (Collins, Stevens, and Lane 2000). However, another study of the Teen Living Program reported that the average length of stay is increasing over time (Sawyer 2000). An implementation study of the Teen Living Program concluded that the long-term nature of the program is critical (Collins, Lane, and Stevens 2003).
Satisfaction. Participant satisfaction may be correlated with more positive outcomes, since satisfied residents may be more likely to focus on achieving goals and dissatisfied participants are more likely to leave maternity group homes before they reach their goals. In addition, residents are more likely to be satisfied if the homes are providing the services they need. The literature indicates that residents are pleased with some aspects of maternity group home programs, but that they have problems with others, particularly program rules. A study of Massachusetts' Teen Living Program network found that more than 80 percent of responding current and former maternity group home residents rated child care and educational components pretty helpful or very helpful (Collins, Lemon, and Street 2000). When residents were asked what was most helpful about the maternity group home, the most common responses related to specific classes or services (24 percent), emotional support from staff and other residents (20 percent), and fulfillment of basic needs (14 percent). The most common responses when Teen Living Program residents were asked what was not helpful about the maternity group home related to program rules (26 percent) and conflicts with staff or other residents (20 percent). Elsewhere in the literature are anecdotal reports that some maternity group home residents find the numerous house rules and obligations many homes impose on residents to be overly restrictive. For example, a study of the FDC home in Georgia found that more than half of residents had difficulty abiding by rules relating to overnight leave and curfews, attendance at group sessions, employment preparation requirements, and payment of rent (Fischer 2000).
Activities and services received. Maternity group home residents seem to take advantage of the many of the support services and activities the homes offer, including education. A study of Massachusetts' Teen Living Program network found that high proportions of former residents received services such as parenting and life skill classes, education, counseling, and child care (Collins, Stevens, and Lane 2000). A study of the FDC home in Georgia, which requires residents to select from among three required tracks, found that 59 percent chose the vocational training track, 19 percent the employment track, and 16 percent the GED track (the remaining 6 percent did not stay at the home long enough to choose) (Fischer 2000). Different activities are appropriate for different maternity group home residents. An implementation study of the Teen Living Program network concluded that program flexibility is important in serving the differing needs of each individual resident (Collins, Lane, and Stevens 2003).
Public assistance receipt. Maternity group home residence may be correlated with patterns of reliance on public assistance. Although aiding their residents in achieving financial independence in the longer term is a goal for many maternity group homes, homes often encourage or even require families to connect with the benefits for which they are eligible during their residence. This can result in rising rates of reliance on public assistance between the time the teen applies to enter a maternity group home and the time the teen leaves the home, then falling rates of welfare receipt after exit. For example, in the FDC home in Georgia, which deliberately connected residents with a variety of types of public assistance benefits during the program, receipt of TANF rose from 57 percent at intake to 84 percent at exit, then fell to 43 percent, a lower level than it had been at intake (Fischer 2000).(2) A study of Massachusetts' Teen Living Program network, for which receipt of TANF is an eligibility requirement, found that about 71 percent of former residents were still receiving TANF at the time of the follow-up interview (about one year after they left the maternity group home, on average), a decline from 100 percent at the time teens entered the maternity group home (Collins, Stevens, and Lane 2000). Some decline in receipt of public assistance is to be expected, however; studies of welfare recipients have found similar reductions in welfare receipt within a year or two after enrollment (Kisker, Rangarajan, and Boller 1998).
Health of teens and their babies. Maternity group homes often attempt to promote healthy behaviors and encourage teen residents to utilize health services. Most provide assistance to residents in finding health care providers and getting to doctor appointments, and some even have health clinics on site. Thus, we might expect maternity group home residents to have adequate health care-related outcomes, despite disadvantaged backgrounds. For example, a study of two maternity group homes in California found the pregnant teen residents to be healthy, for which the study credited their ongoing obstetric care (Koniak 1989).
Other studies report positive outcomes relating to the health of children born in or residing in maternity group homes. For example, an early study of Massachusetts' Teen Living Program network found that the children of most Teen Living Program residents were in good physical health, although somewhat higher proportions had asthma (Reich 1996).(3) The Georgia Campaign for Adolescent Pregnancy Prevention (G-CAPP) maternity group homes network in Georgia reports that 100 percent of the children in the program had been immunized (G-CAPP 2004). Other studies cite positive statistics on birth weights, which can be affected by access to health care during pregnancy. These studies found that between 90 and 100 percent of babies born to residents were of normal or above-average birth weight for teenage mothers, but they offered no basis for comparison (Sylvester and Reich 1999; and Reich 1996).
Repeat pregnancies. Most maternity group homes have rules restricting visitors, particularly male visitors and overnight guests. Many also offer classes on such topics as birth control and family planning. Thus, it is not surprising that statistics on the proportions of teens experiencing repeat pregnancies during their time of residence in a maternity group home are low. In studies reporting on this issue, the percentage of residents becoming pregnant while residing in the home range from less than 1 percent to 5 percent (Sylvester and Reich 1999; Sawyer 2000; Sylvester 1995; and Reich 1996). Some of these studies compare these rates favorably to statistics on repeat pregnancies among all teen mothers nationwide, or in the local area of the particular home. This result is not surprising, however, since many teens move into maternity group homes before or soon after the birth of their child, and the length of stay in the homes is often short.
Father involvement. Many maternity group homes provide outreach or other services to the fathers of residents' babies. One study found that the percentage of fathers actively involved in their child's lives increased from about 29 percent at intake to 47 percent at exit, although only 13 percent of children's fathers actually participated in program activities (Sawyer 2000). This study also found an increase between intake and exit in the proportion receiving financial support from their children's fathers (from four percent to seven percent). However, since these changes are measured using program intake as the baseline, it is likely that some teens were not receiving support then because they had not yet delivered their baby.
Due to the variety of supports and services they provide to teen families, maternity group homes could affect a wide range of outcomes. Studies of maternity group homes have reported findings on the outcomes of former residents in a number of areas, including education, employment, child support, housing, family planning, and use of health care.
Educational pursuits. Although many teens drop out of school before entering maternity group homes, most homes encourage drop-outs to return to school, and many former residents continue their education after leaving the homes. Studies that surveyed former maternity group home residents found that 45 percent to 65 percent had pursued educational activities after leaving the program (Fischer 2000; and Collins, Stevens, and Lane 2000). The variation in educational activities among former residents is probably due, in large part, to the different age groups served by different homes. A study of Massachusetts' Teen Living Program network found that about 38 percent of former residents had obtained their GED since leaving the maternity group home, and about 21 percent of these had attended some college (Collins, Stevens, and Lane 2000).
Employment and earnings. Along with education, the employment and earnings of former maternity group home residents are key outcomes particularly relevant for their future success. Different studies have reported mixed findings on these issues. Across studies that surveyed former maternity group home residents after they left the home, reports of employment after range from 25 percent to 65 percent of former residents (Economist 1995; and Collins, Stevens, and Lane 2000; G-CAPP 2004; Fischer 2000; Sylvester 1995). This variation likely reflects a number of factors, including the diverse populations served by different homes, the labor markets in different locations, and different study methods used. The highest percentage was reported in a home where program staff place program graduates in jobs (Sylvester 1995).
Reports of percentages that ever had a job after leaving the maternity group home do not necessarily indicate employment stability, however. Different studies found that the job tenures of employed former maternity group residents ranged from an average of just 76 days to an average of about nine months (Collins, Stevens, and Lane 2000; and Fischer 2000). A study of Massachusetts' Teen Living Program network found that, although 44 percent of former residents had been employed at some point since leaving the program, only a quarter of them were employed at the time of the follow-up interview (about one year after they left the maternity group home, on average) (Collins, Stevens, and Lane 2000). The study notes that this rate compares unfavorably with the general population, in which just over half of mothers with infants under a year old are employed. However, teen parents may be more likely to be in school than older parents, and former maternity group home residents are more disadvantaged than the general population (Collins, Stevens, and Lane 2000).
The few studies that reported on the characteristics of jobs held by former maternity group home residents found average earnings ranging from about $946 to $1,200 per month (Collins, Stevens, and Lane 2000; and Fischer 2000). A study of Massachusetts' Teen Living Program network found that although those employed since leaving the program worked a substantial number of hours per week, most of their jobs were in the retail sales and service sectors, paid low wages, and did not provide health benefits (Collins, Stevens, and Lane 2000). A study of the FDC home in Georgia found that, on average, employed former residents were working full-time and earning almost $1,200 a month (Fischer 2000). The study compared former residents' earnings favorably to the $1,076 monthly amount predicted by another study for young disadvantaged mothers in the same labor market area. This study also found that the percentages of employed former FDC residents meeting two of three Congressional Research Service (CRS) income benchmarks compares favorably to an external study's findings on a sample of former JTPA participants. CRS compared the income of former JTPA recipients to three benchmarks, based on family size: the maximum AFDC benefit, the gross income limit beyond which they would no longer be eligible for AFDC, and the federal poverty line. About 91 percent of former JTPA recipients in the CRS study exceeded the first benchmark, 39 percent exceeded the second, and 31 percent exceeded the third. In comparison, only 55 percent of former FDC maternity group home residents in the Fischer study exceeded the first benchmark ($235), but 53 percent exceeded the second ($659), and 45 percent exceeded the third ($836).
Child support. Many maternity group homes provide outreach or other services to the fathers of residents' babies. In addition to strengthening their attachment to their children (a difficult-to-measure outcome) and involvement in their lives, this outreach may encourage the fathers to contribute financially to their babies' mothers. Studies of different maternity group homes reported that between 7 and 50 percent of former residents received some economic support from their children's fathers (Sawyer 2000; Collins, Stevens, and Lane 2000; and Fischer 2000). The variation could be explained by differences in program emphasis and timing of data collection for different studies. The lowest proportion reported was at time of exit from the program, while higher rates were reported at followup. The highest proportion reported was among former residents of the FDC home in Georgia, which emphasizes the importance of securing financial support from the child's father. This study found a substantial increase in the proportion receiving regular financial assistance from the father of their child, from only 14 percent at the time they entered the maternity group home to 50 percent of former residents at followup (Fischer 2000). However, since this change was measured using program intake as the baseline, it is possible that some teens were not receiving economic support then because they had not yet delivered their baby.
Housing. Since housing instability is one factor in the decision of many teens to enter a maternity group home, one might expect former maternity group home residents to continue to have a difficult time finding stable housing after leaving the security of a maternity group home. Studies of maternity group homes have found that many former residents need some type of housing assistance. Many require the financial assistance available through subsidized or public housing programs (Fischer 2000; and Collins, Stevens, and Lane 2000). Others live with friends or relatives after leaving maternity group homes rather than immediately establishing their own independent household. For example, a study of Massachusetts' Teen Living Program network found that the majority (about 58 percent) of former Teen Living Program residents were living in a temporary, rather than permanent, housing situation, most often living with family, friends, or the father of their child. Some of these temporary housing situations were probably deliberate steps along a path to more independent living, but others may be more tenuous situations. About 16 percent of former Teen Living Program residents had been homeless at some point since leaving the program, a substantially larger percentage than was found in recent investigations of homelessness among teens, which reported rates of less than 10 percent (Collins, Stevens, and Lane 2000).
Subsequent pregnancies. Having additional children can impede the progress of teen parents toward self-sufficiency. For this reason, maternity group homes often educate residents about family planning in an effort to reduce repeat pregnancies even after teens leave the home. Most studies reporting on this issue found pregnancy rates among former maternity group home residents to be similar to rates reported in other studies of teen parents or lower than (sometimes considerably lower than) the national average. These studies found that between 10 and 28 percent of teens were pregnant again one year after leaving the maternity group home (Sylvester 1995; Fischer 2000; and Collins, Stevens, and Lane 2000). The variation between findings of different maternity group home studies may be due to differences in program focus, population served, or study methodologies. One study with a follow-up period as long as four years after exit for some respondents reported a repeat pregnancy rate of 36 percent (Fischer 2000). For comparison, a study of first-time welfare-dependent teen parents in three inner-city areas found that about two-thirds had a repeat pregnancy during followup, about 28 months after intake on average, and that about half had another child in that time (Maynard 1993). A study of the general population of teenage mothers found that about one-quarter had a second child within two years of their first (Kalmuss and Namerow 1994).
Health care. The previous section discussed the health of teen mothers and their children during their residence in the maternity group home, but homes often attempt to promote lasting healthy behaviors and encourage teen residents to utilize health services even after they leave. A study of Massachusetts' Teen Living Program network found that 96 percent of former residents had some type of health insurance, although the vast majority of them (for 91 percent of former residents) were Medicaid (Collins, Stevens, and Lane 2000). About 87 percent of former Teen Living Program residents had taken their child to a doctor since leaving the maternity group home, and 82 percent had themselves seen a doctor.
While these studies provide useful descriptive information on maternity group homes and their residents, they suffer from several limitations that reduce the usefulness of their findings. There are a number of gaps in the breadth and depth of knowledge collected in specific substantive areas. In addition, these studies have suffered from a number of methodological issues, the most serious of which is the lack of a comparable control group.
The literature on maternity group homes provides limited information on a wide range of substantive topics, but more comprehensive data have been collected on only a few topic areas. Most studies either provide a brief look at of a number of different homes (the SPAN directory, for example, which catalogs almost one hundred different homes but provides only basic data on their characteristics), or a more intensive examination of a single maternity group home or network (for instance, the evaluation of Massachusetts' Teen Living Program). Thus, knowledge of some substantive issues related to maternity group homes is based on data collected from only a small minority of homes, which may not be representative of other homes nationwide. Some specific topics areas are not addressed in most studies; for example, there is little information on domestic violence or substance abuse outcomes in the research on maternity group homes. Few studies were able to explore longer-term outcomes of former residents due to short follow-up periods, or, in many cases, no followup at all after residents left the homes. 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.
Besides substantive gaps, studies of maternity group homes have suffered from the following methodological drawbacks:
Lack of comparison or control group. In order to assess program effectiveness, a study needs to be able not only to track the outcomes of program participants, but also to determine how they would have fared in absence of the programs. To accomplish this, evaluations must include an appropriate comparison group and be able to control for differences between participants and comparison group members. The ideal approach is an experimental design with a control group; if that is not feasible, a well-constructed comparison group can serve the same purpose. However, no studies in the literature on maternity group homes focused on developing a comparison group and collecting the same data on comparison group members as participants. As a result, it is difficult to interpret findings on outcomes. Many existing studies did not provide any comparisons for outcomes of maternity group home residents at all. When comparisons were drawn, statistics on program residents were typically compared to external data on the general population of teenage mothers or to other “similar” populations, which most likely differ from program residents in meaningful ways. In addition, the external data sources to which studies compared the outcomes of maternity group home residents likely used different data collected methods, measures of key outcomes, follow-up time periods, and so on. A few studies compared characteristics of the same individuals at different points of time, but this method can capture changes in their outcomes over time that would have occurred anyway, with or without the program intervention.
Small sample sizes. Program capacity, combined with average length of stay, determines how many teens can enter a maternity group home during a given intake period. As discussed in Chapter II, most maternity group homes have capacity to serve fewer than a dozen residents at a time. This limited capacity results in small sample sizes for most studies of maternity group homes, which may be one reason for the lack of more rigorous studies. The sample sizes of the largest studies included in this review range from 80 to 199 families. These numbers were achieved by pooling data across a number of different homes within a maternity group home network and/or using an intake period of up to four years (Fischer 2000; Sawyer 2000; and Collins, Stevens, and Lane 2000). Most other sources in the maternity group home literature do not state the sample sizes on which reported outcomes are based, although extrapolating from the capacity of the programs they discuss suggests that they are likely to be considerably smaller than those reported above.
Sample attrition. Another problem with many of these studies is one of sample attrition. Accurate measures of characteristics at followup require high response rates among former participants, since the outcomes of respondents may differ from those that did not respond, resulting in nonresponse bias, in addition to a reduction in statistical power. But tracking participants after they leave a program can be difficult, particularly when the program is targeted to a population with a history of housing instability. Maternity group home residents all change residences when they exit the program, and, as discussed above, many move into temporary housing. Multiple changes of address complicate tracking, and inability to track participants can lead to lower response rates. In the few studies that tracked participants after they left maternity group homes, response rates at followup ranged from 55 percent (in a study whose followup occurred as long as four years after program exit) to 65 percent (Fischer 2000; and Collins, Stevens, and Lane 2000).(4) Maternity group homes were unable to provide researchers with contact information for some residents, including those who had unlisted numbers or had moved out of the state or gone “underground” due to domestic violence.
While there have been a number of important studies of maternity group homes, there is much left to be learned. Early studies have provided useful descriptive data on some maternity group homes and their residents, but far less is known about many other homes. In addition, limitations in the methodology used in these studies severely limit what conclusions can be drawn about effectiveness. A rigorous evaluation of maternity group homes could address many of these gaps in the research.
As MPR's design study progresses, we will refine these recommendations and develop a design for a future evaluation of maternity group homes. The next steps in the design study include calling a number of homes to collect basic information on their characteristics, conducting site visits to assess the evaluability of select homes, developing questionnaires, and drafting data-collection and evaluation plans. The design effort will culminate in a final report discussing the feasibility of a rigorous evaluation of maternity group homes. By addressing gaps in past studies, such an evaluation could contribute a great deal to what is known about the effectiveness of maternity group homes.
1. This study included only former residents who had lived in a maternity group home for at least 30 days. Including residents with very short stays in the computation would result in a lower mean.
2. Other types of public assistance followed the same pattern. At intake, 52 percent were receiving food stamps, 72 percent Medicaid, and 38 percent WIC. At exit, these percentages had risen to 89 percent, 52 percent, and 87 percent, respectively. But all had fallen by followup, when 52 percent were still receiving food stamps, 66 percent Medicaid, and 14 percent WIC.
3. About 14 percent of children in Teen Living Program homes had asthma, compared to 11 percent of children in the general population nationwide (Reich 1996; U.S. Department of Health and Human Services 2004).
4. Response rates are likely to be even lower in studies that did not report them on provide other details on methodology.
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