The Implementation of Maternity Group Home Programs: Serving Pregnant and Parenting Teens in a Residential Setting. Costs Depend on Service Intensity and Comprehensiveness

04/22/2005

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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