The Implementation of Maternity Group Home Programs: Serving Pregnant and Parenting Teens in a Residential Setting. The Teen Living Program (Massachusetts)


Basic Program Structure. The Massachusetts Teen Living Program (TLP) includes 20 regular TLP group homes and 3 transitional Supportive Teen Parent Education and Employment Program (STEP) facilities for pregnant and parenting teens throughout the state. The TLP homes and STEP facilities can house 177 teens and their children, making the program the largest maternity group home network in the country. The network 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 state's Temporary Assistance for Needy Families (TANF) program. The program began in 1995 as part of state welfare reform legislation that, among other changes to the state welfare program, required teen mothers to live in an adult-supervised setting as a condition of receiving cash assistance. The state funded TLPs as an option for those who did not have an appropriate relative or guardian with whom they could live. The first homes opened in 1996. The network is fairly centralized, with DSS guidelines governing the services the homes must offer and the population they must serve. However, the homes have flexibility in making decisions about their specific structure and rules. In addition to regular meetings, the network director has frequent — sometimes daily — informal contacts with home directors.

Funding Sources and Levels. The program operates on an annual budget of about $8.2 million, of which $2.4 million is from DSS and the remainder from DTA. In addition, the program is in the last year of a three-year grant from ASPE to provide outreach services to the fathers of TLP residents' children. The amount of funding the network provides to each home varies by program size and location. The average monthly cost per TLP resident ranges from around $3,500 to $4,800, depending on the cost of living in the area. STEP program costs are considerably lower, about $2,300 per bed each month, because of the lower level of supervision and services. The homes rely almost exclusively on the network funding to operate; however, some receive small donations and in-kind contributions from local organizations in their communities. Homes also require residents to contribute 30 percent of their monthly income — typically TANF benefits — to the program.

Eligibility Rules and Referral Sources. All homes require that residents be: (1) between the ages of 13 and 20; (2) Massachusetts residents; and (3) pregnant or parenting. In addition, residents must have no other appropriate adult-supervised place to live and must be willing to abide by the rules of living in a TLP home. Each bed within the network is designated 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. There is considerable overlap between these two groups, however, as most residents in DSS beds also receive TANF, and some residents in DTA beds also have DSS cases. The source of referrals also depends on the type of slot. All placements to the 102 DTA beds are made by the network coordinator, who is a state-level DSS staff member. Referrals to the 64 DSS beds are made by regional DSS staff. Placements in the network's 11 emergency beds are made by DTA staff directly. These beds are available for immediate use for teens in crisis situations or while they wait for an opening in a regular TLP bed.

Setting and Structure of the Homes. The TLP network covers the entire state of Massachusetts, although homes are more prevalent in population centers. Each TLP home follows one of two structural models: (1) congregate programs for most teens, or (2) apartment-model programs for older teens who are better able to take care of themselves and their children. Congregate-model programs have 24-hour-awake staff. Staff members have frequent contact with residents and provide them guidance on parenting and life skills through role modeling and informal instruction. Teens have their own bedrooms, which they share with their children; however, bathrooms, kitchens, living rooms, and eating areas are shared by all group home residents. Residents of congregate homes typically pool their food stamps and rotate cooking duties. In apartment-model programs, two or three teens and their children share an apartment, with each teen responsible for preparing her family's meals. Staff in these homes may provide somewhat less supervision than those in congregate homes, although apartment-model homes all have staff on site 24 hours a day. Most of the homes in the network are congregate-model programs; only five use the apartment model. In addition to these two types of TLPs, the network includes three STEP programs — apartment-model facilities for TLP “graduates” who are transitioning to independent living. Residents of STEP homes still receive some supervision and case management and attend group sessions and classes, but less frequently than other TLP residents.

Staffing Patterns. All TLP group homes have staff on site 24 hours a day. However, congregate homes must have awake staff at all times, while some apartment-model homes have live-in house parents instead. Staff-to-teen ratios are established for each home individually by the state's Office of Child Care Services (OCCS), which licenses all TLP group homes. TLP network staff reported that OCCS typically requires ratios of one staff person per five teens, with more staff during peak times and fewer staff at other times. At the TLP group homes we visited, the number of staff ranged from about 4 to 11 full-time-equivalent staff, with larger homes typically having more staff. Each home uses a mix of full-time and part-time staff. STEP programs have much lower staff-to-teen ratios than the congregate and apartment-model TLPs, since they serve more mature teens who are transitioning to independent living. STEP programs are staffed by a case manager 20 hours per week, and they often share staff with nearby TLPs.

Core Program Services. All homes provide a number of regularly scheduled group and individual sessions to their residents. Homes typically have three or four group sessions a week, including life skills/parenting groups and weekly house meetings. All homes use the Preparing Adolescents for Young Adulthood (PAYA) curriculum, which was developed by DSS for adolescents and includes some sections specifically for teen parents. Residents also meet weekly with their case manager, who develops and updates a service plan for each teen. Some homes have masters-level social workers on staff to provide counseling; others will connect residents with therapy providers covered by Medicaid. 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, TLPs offer follow-up assistance to former residents. The programs also provide outreach and case management services to the fathers of current residents' children.

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