Maternity Group Homes for Young Mothers in Florida: A Mixed Methods Examination

RESEARCH REPORT

Maternity Group Homes for Young Mothers in Florida: A Mixed Methods Examination MAY 31, 2022

CONTENTS Introduction........................................................................................................................................... 2

Principal Investigator: Melissa Radey, Ph.D., MSSW, MA

Research Team................................................................................................................................. 2 Background........................................................................................................................................... 2

Co-Principal Investigator:

Prevalence and Consequences of Early Pregnancy and Parenting................................................ 2

Shamra Boel-Studt, Ph.D., MSW

The Intersection of Early Childbearing and the CPS System .......................................................... 2 The Importance of Learning About Early Pregnancy and Parenting in Florida................................ 3 Current Study.................................................................................................................................... 3 Methodology.......................................................................................................................................... 3 Aim 1................................................................................................................................................. 4 Sampling........................................................................................................................................ 4 Data Collection.............................................................................................................................. 4

Funded by the Florida Institute for Child Welfare Contract Number: 142001 530 100601 Learn more about the Institute on our website: FICW.FSU.edu

Data Analysis................................................................................................................................. 4 Aim 2................................................................................................................................................. 4 Aim Overview................................................................................................................................ 4 Sampling........................................................................................................................................ 4 Data Collection.............................................................................................................................. 4 Data Analysis................................................................................................................................. 4 Aim 3 ................................................................................................................................................ 5 Overview........................................................................................................................................ 5 Sampling........................................................................................................................................ 5 Data Collection.............................................................................................................................. 5 Data Analysis................................................................................................................................. 5 Findings................................................................................................................................................. 5 Aim 1. Description of Maternity Homes............................................................................................ 5 Aim 2. Description of Services Received from Maternity Homes and Current Wellbeing ............... 6 Aim 3. Understanding Young Mothers Experiences of Maternity Group Homes............................. 8 Theme 1: Adversity, Crisis, and Rejection..................................................................................... 8 Theme 2: Tension Between Useful Programs and Structured Delivery..................................... 10 Theme 3: Unfulfilled Aspirations for Connection......................................................................... 12 Theme 4: Slow Progress Towards Independence...................................................................... 13 Discussion........................................................................................................................................... 14 Overview of Major Findings............................................................................................................. 14 Limitations....................................................................................................................................... 14 Implications and Recommendations............................................................................................... 15 References.......................................................................................................................................... 17 Appendix............................................................................................................................................. 19

TABLES AND FIGURES Figure 1. Summary of Project Methodology and Integration of Study Aims....................................................................................................... 4 Table 1. Characteristics of Young Mothers with Maternity Home Experience..................................................................................................... 7 Table 1. Continued............................................................................................................................................................................................... 8 Table 2. Services Provided at Maternity Group Homes...................................................................................................................................... 8 Table 3. Current Receipt of Public Assistance and Extended Foster Care Among Mothers with Maternity Group Home Experience ������������ 8 Table 5. Hardships Experienced in the Past Year............................................................................................................................................... 9 Table 6. Themes Related to Maternity Group Home Residents and Experiences............................................................................................. 9 Table 4. Support Networks of Mothers with Maternity Group Home Experience................................................................................................ 9

Introduction Early pregnancy and parenting are related to educational, financial, and social disruptions for young adults and increased risk of poor developmental outcomes for their children. In addition, pregnancy and parenting disproportionately affects vulnerable subgroups of the adolescent population, including low-income, Black, and female teens. The Family First Prevention Services Act (FFPSA) provides funds for states to mitigate poor maternal and child outcomes among early parents. One mitigation approach, maternity homes, receive FFPSA funds. However, we know little about the operation and impact of maternity homes in Florida. This project’s goal was to gain knowledge about maternity homes for pregnant and parenting young mothers in Florida and their impact on maternal and child well-being.

RESEARCH TEAM Melissa Radey, MA, MSSW, Ph.D., principal investigator, is the Agnes Stoops Professor of Child Welfare at the Florida State University (FSU), College of Social Work (CSW). Shamra BoelStudt MSW, Ph.D., co-principal investigator, is an Associate Professor at the FSU, CSW. Together, they conceptualized the project, designed the methodology, led advisory board meetings, conducted small group interviews with maternity group home providers, and conducted the qualitative analysis. Radey led the Institutional Review Board (IRB) application, quarterly reports, and the analysis of survey data, and Boel-Studt led the description of program models. This report is their collaborative effort.

In terms of research and data management tasks (e.g., contacting potential participants, assigning interviewers), Chris Collins, a Ph.D. candidate at the FSU, CSW and research assistant, served as the project manager. Three FSU CSW MSW graduates, Keishann Corley, Kristine Posada, and Bushra Rashid, all research assistants, assisted Radey and conducted most interviews with young mothers.

Background

PREVALENCE AND CONSEQUENCES PREGNANCY AND PARENTING

OF

EARLY

Although teen births in Florida and the U.S. are at record lows, 16.2 and 17.4 births per 100,000 respectively,1 the U.S. has the highest teen birth rate among industrialized countries. Early pregnancy and parenting are related to educational, financial, and social disruptions for young adults2 and increased risk of poor developmental outcomes for their children.3 In addition, pregnancy and parenting disproportionately affects vulnerable subgroups FLORIDA INSTITUTE FOR CHILD WELFARE

of the adolescent population. Young mothers face the disparate burden of parenthood and poor outcomes, including higher rates of school dropout, unemployment, and poverty, compared to their children’s fathers.4,5 Approximately 80 percent of teen pregnancies are unplanned and 90 percent of teen mothers are not married.6 Moreover, motherhood is the most common reason teen girls drop out of school. Approximately 50 percent of teenage mothers receive their high school diploma by age 22 compared to 90 percent of women without early births.7 Socioeconomic status, race, and ethnicity are associated with teen pregnancy. Low-income adolescent girls face higher rates of teen pregnancy and parenting relative to their higher-income counterparts.8,9 The birth rate among Black and Hispanic teens is twice the rate of non-Hispanic White teens and 5 times the rate of Asian teens.10 Low education levels, few opportunities for positive development, and family instability also increase teenage girls’ risk of early pregnancy.9 In addition, teen mothers often cannot break the cycle of intergenerational disadvantage. Their children have higher odds of dropping out of high school, having mental health problems, being incarcerated during adolescence, giving birth as a teenager, and facing unemployment as a young adult.11 Coupled with the strain of early parenthood, teen mothers face higher levels of risk in virtually all measured areas of wellbeing for themselves and their children. As such, early motherhood perpetuates intergenerational gender, race, and social class inequalities.12 Therefore, examining services among teen mothers is a valuable mechanism to address disproportionality and disparities and promote anti-sexism, antiracism, anti-classism, and inclusivity.

In 2020, appointed by the National Academies of Sciences, Engineering and Medicine (NASEM), renowned experts in adolescent health produced a report concluding that pregnant and parenting youth need resources to promote success and access comparable opportunities to their non-parenting counterparts.13 This project provides a first response to this call by determining and examining resources and services available to pregnant and parenting teens through maternity homes in Florida, focusing on those involved in the Child Protective Services (CPS) system, to promote maternal and child well-being.

THE INTERSECTION OF EARLY CHILDBEARING AND THE CPS SYSTEM Youth involved in the CPS system are a large, policy-relevant subpopulation of those at risk of early pregnancy and parenting. A full 37 percent of all U.S. children, including more than 50 percent of Black children, encounter the CPS system prior to age 18.14 In terms of high engagement with the system, 6 percent of U.S. children and 2

12 percent of Black children experience at least one foster care placement as a child.15 Moreover, children with CPS involvement history experience greater risk of early pregnancy and childbearing16 with female youth aging out of foster care experiencing the highest risk.17,18 Although Florida data are not available, Dworsky and Courtney (2010) analyzed data from the Midwest Study and the National Longitudinal Study of Adolescent to Adult Health, a nationally-representative sample of adolescents, and found that 50 percent of female youth still in care or recently aged out became pregnant by age 19 compared to approximately 20 percent of sameaged females in the general population.17 Particularly troubling, while the overall teen birth rate declined dramatically in the last decade, incidence of teen births among those involved in foster care remained stagnant, suggesting an increase in the proportion of teen births that foster care-involved youth represent.19 In addition, parents currently or formerly involved in the child welfare system often cannot break the cycle of maltreatment. Two-fifths of children of foster youth were subject of substantiated reports of maltreatment, and one in ten mothers faced their children being placed in care by the age of five.20 THE IMPORTANCE OF LEARNING ABOUT PREGNANCY AND PARENTING IN FLORIDA

EARLY

Pregnant and parenting teens deserve research attention. High parenting rates coupled with poor outcomes indicate the importance of meeting the needs of pregnant and parenting adolescent girls, including those disproportionately represented in the CPS system.

Importantly, although pregnant and parenting teens face steep obstacles, a recent study suggests that the relation between foster care system involvement, early parenting, and poor outcomes is not causal. In other words, teens in and aging out of the system face high levels of adversity and these levels of adversity account for their poorer outcomes rather than the system itself.21 Child welfare system involvement did not exacerbate pregnancy risk, and, in some cases, involvement lowered the risk. Connecting with and providing services to pregnant and parenting teens, regardless of CPS involvement, can improve maternal and child well-being for youth facing steep obstacles as they negotiate early pregnancy and parenting.

The role of the child welfare system in lowering risky behaviors including unplanned pregnancies highlights the potential for services and interventions to build upon the strengths of teen mothers to facilitate their healthy launch into adulthood while also nurturing their children’s early development. Rather than approaching their parenting role as a barrier, this project took a strength-based approach to build upon teen mothers’ commitment and dedication to be good mothers and providers.22 The ability to provide needed services for expectant and parenting mothers and their children presents “twice the opportunity” to make an impact on young lives—mother and child—and disrupt the cycle of disadvantage and vulnerability.

We are not the first to recognize the importance of intervention with expectant and parenting teen mothers. The FFPSA provides funds for states to mitigate poor maternal and child outcomes among early parents. Maternity homes, one mitigation approach, will continue to receive federal funding. However, despite the interest in meeting the needs of these young families and FFPSA-dedicated funding for maternity homes to serve them, we lack empirical knowledge on service delivery and the outcomes of teens served in maternity homes. This project capitalizes on the opportunity to reach young mothers at a time in which they value intervention, service, and connection to survive as young adults and as parents.22 Although not empirically-supported, preliminary, largely anecdotal, evidence suggests the power of maternity homes for teen mothers and their children.23

FLORIDA INSTITUTE FOR CHILD WELFARE

CURRENT STUDY The overarching goal of this project was to gain knowledge about maternity homes for pregnant and parenting young mothers in Florida and their impact in preparing mothers and their children to survive, thrive, and reach their potential as contributing members of society. The project had three specific aims: 1) To describe the program models, services, and target population served in maternity homes in Florida, 2) To document the services that maternity home residents receive and how these services contribute to maternal and child wellbeing after program exit, and 3) To gain insight into mothers’ and providers’ experiences with maternity homes and perceptions of service impact within the context of young mothers’ lives.

This project is significant because only when we understand how maternity homes operate; the population served, including mothers’ history of CPS involvement; the services provided; and service impact can decision-makers develop appropriate, responsive services to meet the needs of young mothers. From our strengthbased perspective, the birth of a child presents new parents an opportunity for change—and typically forces change. We view births from young mothers as an opportunity to reach and serve mothers (and their children) in ways that they may not have welcomed before their child’s birth.22 Prominent stakeholders invested in promoting family and child wellbeing identify the need to examine services for pregnant and parenting teens,13 including the disproportionate sub-population of young mothers aging out of care.24 The proposed project responded to these calls that had been left unanswered.

For maternity homes to best meet the needs of young mothers, we need to understand their reach and functionality in the lives of those who stand to benefit from services. Through our inclusive, statewide approach which relied up their unique insight and perspectives, this project gave a voice to pregnant and parenting teens, recognizing that although they shared a common challenge and opportunity to parent their children, their diverse backgrounds and experiences contributed to their needs and successes. In addition, identifying services associated with positive development is cost effective.25 Policymakers need research-based guidance on what types of supports—and aspects of maternity homes—are most important and cost effective to promote maternal and child well-being among young mothers.

Methodology To gain knowledge about pregnant and parenting teens, maternity homes in Florida, and how services impact maternal and child well-being, we used a multitiered, mixed methods approach.

The approach included convening a stakeholder advisory panel; conducting program reviews; surveying mothers with maternity home experience; and interviewing maternity home providers and mothers with maternity home experience. Figure 1 depicts how project aims built upon one another through complementary strategies and methods to gain knowledge about maternity homes.

The stakeholder advisory panel included the executive directors of each participating maternity home, at least one additional staff member from each home, and two young mothers currently living in an independent living program who had experience living in a maternity home.

3

Figure 1. Summary of Project Methodology and Integration of Study Aims

AIM 2 To document the services that maternity home residents receive and how these services contribute to maternal and child wellbeing after program exit.

Aim Overview The purpose of this aim was to provide preliminary evidence of the role of maternity home structure and services on maternal and child outcomes. This is the first study to our knowledge that considered services received from maternity homes in Florida and indicators of maternal and child well-being.

AIM 1 To describe the program models, services, and target population served in maternity homes in Florida.

Sampling We collected program data from all maternity homes in Florida participating in the study (4 of the 9 maternity group homes licensed by the Department of Children and Families (DCF) in June, 2021).

We had conversations with two additional home directors who decided not to participate due to recent or upcoming turnover in executive leadership. In addition to the two who opted not to participate, two executive directors left their positions and homes during the first four months of the project, demonstrating high levels of turnover during this time period. To encourage project participation, we provided a $500 honorarium to program directors to recognize the value and importance of their time and project commitment. Our program partners represented diverse programs.

They were located throughout the state (i.e., Broward, Duval, Lee and Marion Counties). The four programs also included newly- and well-established homes with various eligibility requirements, levels of staff stability, levels of supervision, and program services.

Data Collection The PIs, assisted by the project manager, obtained documents available publicly (e.g., website) and through maternity home directors (e.g., program manual, handbook). One team member reviewed each program’s documents using a project-developed data extraction tool that guided uniform data collection across homes. The extraction tool covered domains including the origins and mission of the program; application process and referral sources; characteristics of the mothers and children served; services offered; and discharge protocol. We verified information obtained through the document reviews and gained information not available through qualitative interviews (see Aim 3 below). To increase data reliability, two researchers completed data extraction tools for two of the homes. During a team meeting, we discussed discrepancies, reached consensus, and revised the extraction tool as needed. We also collected program information from Florida Safe Families Network (FSFN) and the Quality Standards Assessment, an assessment DCF requires for all licensed residential group homes and shelters to complete as part of annual re-licensure.

Data Analysis We systematically reviewed all documents on each identified domain on the extraction tool. This objective, comprehensive review offers a description of maternity home programs in Florida that participated in the study.

FLORIDA INSTITUTE FOR CHILD WELFARE

Sampling We surveyed maternity home graduates and those no longer receiving services through Qualtrics (N = 36). We recruited mothers in a variety of ways. Upon survey launch, we reached out to our advisory panel members and all maternity home providers throughout the state with study and Qualtrics link information. We also individually emailed each independent living coordinator (ILC) in the state with the same information. After two ILCs asked us for endorsement from the Youth and Young Adult Transition Services Specialist, we reached out to the specialist. Approximately two weeks from initial survey launch, the specialist contacted all ILCs on our behalf asking them to share the survey information with potentially eligible youth. We also emailed the survey details and link to the statewide director of Florida Youth SHINE, a youth run, peer driven organization that empowers current and former youth in foster care to change the culture of the child welfare system.

We also incorporated snowball sampling, a common technique for hard-to-reach populations including mothers with maternity home experience, by asking survey respondents to share the survey link with others that may be eligible.

Data Collection Respondents accessed the survey through a provided Qualtrics link. Due to advisory panel feedback about many Spanish-speaking mothers with maternity group home experience, we created a Spanish version of the survey. The survey, regardless of language, presented the study overview; the consent form; and demographic, service receipt, and well-being items (see Appendix 1 for English version). Sixty-one potential respondents entered the survey, and 36 respondents successfully completed the survey. Mothers received $15 cash transfers within 24 hours of survey completion.

Data Analysis Survey data were analyzed using descriptive statistics and correlations to examine the relations between received services and maternal well-being. Important to note, many mothers (n = 12) continued to receive independent living services often as an extension of their maternity homes. Mothers also stayed at homes for various lengths of time and, among those who exited, varied in their lengths of time between home departure and the time of the survey. Mothers also lived at a variety of homes, sometimes multiple homes; whereas some homes were licensed by DCF, and others were not. Homes included Alpha House (n = 4), Children’s Harbor (n = 5), Hands of Mercy Everywhere (n = 3), Children’s Home Society (n = 2), His House (n = 2), Our Mother’s Home (n = 1), Mater Filius (n = 1), Hebron Refuge (n = 1), Birdie’s Nest (n = 1), Sumpter by Grace (n = 1), and Solve (n = 1). With the small number of mothers at each home, the analyses are exploratory and descriptive.

4

AIM 3 To gain insight into mothers’ and providers’ experiences with maternity homes and perceptions of service impact within the context of young mothers’ lives.

Overview The purpose of this aim is to gain insight about how and why mothers’ experiences with maternity homes shape their and their children’s development and wellbeing. We conducted interviews with staff members at each participating home and with mothers who completed surveys. This aim sets the foundation for more rigorous evaluations by identifying key characteristics of maternity homes and indicators of well-being important to measure when evaluating maternity home effectiveness.

Sampling Provider interviews. All participating group homes were eligible for an interview. Mother interviews. We invited all mothers who successfully completed the survey to participate in an interview.

Data Collection Provider interviews. Interview teams consisting of the PIs or one PI and the project manager conducted small group interviews via Zoom with staff members at the four participating maternity homes. Two team members participated in each interview. Two to six group home staff members participated in each interview (N = 16). Provider experience with young mothers in group homes ranged from less than one year to 18 years of experience working with mothers aging out. Executive directors as well as direct care staff members participated in each interview. All of the providers were female, and most were non-Hispanic White with a couple of Hispanic providers. Interviews ranged in length from 64 to 78 with an average length of 71 minutes.

Mother interviews. The small survey sample allowed us to invite all interested respondents for an interview. At the end of the survey, each mother indicated if she was interested in participating in a qualitative interview; all except two respondents expressed interest in a qualitative interview. If the mother indicated interest, the survey provided the qualitative study purpose, indicated the anticipated interview length (45-60 minutes), and provided a consent form. Then, respondents indicated three convenient times for the interview. The project manager reviewed the suggested interview times, contacted the interviewers, and sent text confirmation of interview time to the participant within 24 hours. If the interview was more than 48 hours from survey completion, interviewers sent interview reminders 1224 hours prior to the interview. If the participant was not available at the scheduled interview time, we reached out to her at least three additional times to re-schedule the interview. Of the 34 interested participants, we successfully completed 29 interviews. Interviews lasted 58 minutes, on average, with the shortest interview being 33 minutes and the longest being 93 minutes. Participants received $30 for their time. Following the interview, interviewers completed notes to provide any relevant context. During verbatim transcription, any identifying information (e.g., names of people, places) was removed.

Data Analysis Interviews were digitally recorded. Recordings were downloaded to a password-protected computer and uploaded to Nvivo 12 software for analysis.26 Qualitative analysis of both provider and mother interviews followed thematic analysis. Thematic analysis is a recursive, detailed approach appropriate for identifying and FLORIDA INSTITUTE FOR CHILD WELFARE

analyzing patterns,27 and therefore is well-suited to explore the understudied areas of maternity homes and young mothers. To start, each investigator became familiar with the data by reading through transcripts. Following, the PIs generated initial codes separately for all of the provider interviews (n = 4) and eight selected transcripts from mothers. We developed a list of primary codes, along with the associated data excerpts, using NVivo 12 software.

Next, each transcript was coded by two of the interviewers. Through discussion, use of coding outlines, and discussions with the interviewers, we identified overarching themes pertaining to young mothers, maternity home supports, and challenges (Braun & Clarke, 2006).27 PIs then reviewed the themes to assess if each theme was distinct, a fair representation of the data, and relevant to the research questions. We then defined and named the themes (Braun & Clarke, 2006).27 Advisory board members served as sources of member checking to ensure the credibility of the themes and provided insight into potential oversights or biases manifested in the coding process.

During analysis of the qualitative transcripts, we discovered that mothers with foster care experience (n = 31) typically lived in different homes and had access to different services than those who did not (n = 5). Therefore, we restricted the sample to mothers with a foster care history to learn about DCF-funded maternity homes. We lacked sufficient sample size to examine mothers receiving services in non-DCF-funded homes. In addition, most mothers completed a qualitative interview (n = 29), and these interviews provided critical context to understanding services. Rather than the objective receipt of a service, the mothers’ insight about the service influenced both a) her perception of service receipt and b) the perception of the service’s usefulness. Therefore, we limited the sample to mothers with foster care experience who completed a qualitative interview (n = 25). We included all provider, small-group interviews (n = 4, 16 participants).

Findings

AIM 1. DESCRIPTION OF MATERNITY HOMES This section provides a detailed description of four out of the nine (44%) DCF-licensed maternity homes in Florida as of June 2021.

Program directors and staff members participated in interviews and served on the advisory panel. Programs were located in the Central, Northeast, Southeast, and Suncoast regions. Maternity homes resembled family-style homes with kitchens, bathrooms, and private rooms for mothers and their children. Two were located on campuses with other programs and two were independent homes located in neighborhoods. Three out of four programs were accredited (Council on Accreditation = 2, Commission of Rehabilitation Facilities = 1). Two programs had a six-bed capacity and the remaining two had a 10-bed capacity. One provider reported they were at capacity (6 of 6 beds filled), two others were near halfcapacity (6 of 10 beds filled, 3 of 6 beds filled, 1 missing information).

All four providers aimed to provide long-term placement. In practice, they reported wide variation ranging from short-term placements up to four years. Providers reported an average length of stay for residents from 8 to 12 months.

All four programs served pregnant and parenting teen mothers in the foster care system with DCF. The community-based care lead agencies served as the primary referring agencies. Homes served pregnant and parenting mothers ranging in age from 11 to 21 years.

Most providers identified that they did not serve mothers with a history of violence or a severe psychiatric disorder. One program required medical documentation indicating the mother was not currently pregnant with another child. Providers further reported using discretion when making decisions to accept a placement based on fit with the other residents and the program.

Program goals or mission consistently prioritized: a) helping teen 5

mothers establish safety, b) developing positive parenting skills, and c) preparing for independent living. Programs used both shift care (n =2) and house parent (n =2) staffing models. Two identified as faith-based programs. Most consistently, providers described their approaches as relationship-based with an emphasis on skill development, competency, and healthy parenting. Across interviews, providers mentioned a goal of preventing an intergenerational cycle of abuse and family separation. Rules and regulations varied in nature and extent across programs. Programs commonly required school attendance. Rules focused on behavioral expectations (e.g., cell phone off each evening, “modest dress,” respect others, no smoking). Two programs required participation in programs and services (e.g., individual counseling, independent living skills groups, parenting classes, medical appointments, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Supplemental Nutrition Assistance Program (SNAP)).

Three programs mentioned using a reward or point system where mothers could earn allowance or additional allowance for meeting expectations for service participation.

Core services included basic needs assistance for mothers and their children, access to health care, case management (e.g., individual service plan and goals), parenting classes, life skills training, counseling or therapy, nutrition classes, vocational training, childcare, and transportation. Programs varied in the extent to which they provided services directly or coordinated service delivery with external providers (e.g., independent clinicians). Program directors often noted working with community partners and universities to offer additional education or vocational opportunities (e.g., yoga classes, I-empathize workshop on sexual exploitation). Three of the four programs reported working with Healthy Start, a home visiting program to provide education and supports for mothers. Multiple programs also helped mothers apply to Keys to Independence to take their driver’s license exam. In addition, providers commonly connected mothers with assistance programs and resources such as WIC, SNAP, and childcare. Programs also offered a variety of educational options including public school programs, Graduate Equivalency Degree (GED) programs, specialized schools for girls or teen mothers (e.g., Pace, Lee Adolescent Mothers Program), vocational training programs, or community college programs. All programs reported providing discharge planning and aftercare services to some degree. Two programs had transitional living apartments or designated rooms for mothers preparing to age out of foster care. The more independent arrangements provided an opportunity for mothers to take greater responsibility for themselves and their child with continued supports. Programs assisted mothers by connecting them with extended foster care, helping them to identify housing, providing household supplies (e.g., furniture, dishes), facilitating the process to obtain necessary documentation (e.g., educational transcripts, medical, ID, social security card), and connecting them with community resources.

In addition to the four maternity homes described above, surveyed mothers mentioned experiences with seven additional maternity homes. Three of these homes were also licensed by the DCF and, therefore, served pregnant and parenting teens in the foster care system. Four other settings were identified that provided placements for young mothers who are enrolled in extended foster care or Postsecondary Education Services and Support (PESS) programs that provide stipends for rental housing and other supports. Because these seven programs did not participate in the current study and we could not confirm the limited information publicly available, we did not include descriptions of these programs.

AIM 2. DESCRIPTION OF SERVICES RECEIVED FROM MATERNITY HOMES AND CURRENT WELLBEING Table 1 provides a sample description of mothers with maternity group home experience in Florida (N = 25; see Table 1 for sample FLORIDA INSTITUTE FOR CHILD WELFARE

description). All mothers became parents and entered maternity homes in their teens with nearly 75 percent doing so before their 18th birthdays. The surveys typically occurred shortly after (or during) their maternity home experience; mothers were typically in their late teens or early twenties with the oldest mothers being 25 years old. Most mothers identified as non-Hispanic Black (64%) with the remaining mothers either Hispanic (20%) or non-Hispanic White (16%). Most mothers were not new to the foster care system: they averaged about five years in care with 40 percent experiencing 10 or more placements. Although almost all mothers had multiple foster care placements, most had experience at only one maternity home (72%). Almost one-half (48%) of mothers had experienced homelessness during their lifetimes and four (16%) had exchanged sex for food, money, drugs, or shelter, further illustrating a portrait of high disadvantage for mothers with maternity home experience.

In terms of their current circumstances, mothers were generally socioeconomically disadvantaged. One mother had education past high school (i.e., a trade school) while most had less than a high school education (40%) or high school/GED education only (56%).

Yet, mothers were interested in education: nearly one-fourth were currently enrolled in an educational program and another onefourth were interested in enrolling. Only one-third of mothers were employed, and their jobs reflected their precarious positions. Only two mothers held their jobs for more than six months and no one earned more than $18 per hour. No mother held a professional position; mothers were most commonly employed in the service industry. Only one-half of mothers reported to be in very good or excellent physical (56%) or mental (48%) health. In terms of their relationships and families, 48 percent of mothers were single and the remaining were partnered with the father of their child(ren) (20%), or another person (32%). Approximately one-half of mothers Table 1. Characteristics of Young Mothers with Maternity Home Experience Variables

N

Percent

18-19

10

40.0

20-22

13

52.0

23+

2

8.0

13-15

6

24.0

16-17

12

48.0

18+

7

28.0

Non-Hispanic, Black

16

64.0

Hispanic

5

20.0

Non-Hispanic, White

4

16.0

1-3

5

20.0

4-6

14

56.0

6-12

6

24.0

1-4

6

24.0

5-9

9

36.0

10+

10

40.0

1

18

72.0

2

6

24.0

Age

Age when entered first maternity home

Race and ethnicity

Number of years in foster care

Number of foster care placements

Number of maternity homes

3 Ever homeless (yes)

1

4.0

12

48.0

6

Table 1. Continued Variables

N

Percent

Ever exchanged sex for necessities (yes)

4

16.0

Less than high school diploma

10

40.0

High school diploma only

12

48.0

GED only

2

8.0

More than high school/GED

1

4.0

Enrolled

6

24.0

Not enrolled, but interested in school enrollment

7

28.0

Not interested

12

48.0

Not employed

16

64.0

1-34 hours per week

4

16.0

35+ hours

5

20.0

Not employed

16

64.0

0-3

5

20.0

4-6

2

8.0

>6

2

8.0

Not employed

16

64.0

$10 or less

1

4.0

$11-14

6

24.0

$15-18

2

8.0

Excellent/very good physical health (yes)

14

56.0

Excellent/very good mental health (yes)

12

48.0

Highest level of education

Engagement in additional education

Hours employed

Months employed

Wage

Relationship status

were currently living in independent living programs. Of those who left, most lived in apartments with (16%) or without (16%) partners.

The remainder lived with relatives (8%), another group placement (8%) or at a shelter (16%). Most mothers had one child (64%) and very young children. Two-thirds of mothers were caring for a child under 2 years old. In addition, a full 36 percent of children had been involved in a child welfare investigation and in three of these cases the child had been removed from the mother’s care at least once.

In addition to housing, mothers received a range of services at maternity group homes (see Table 2). Between 64 percent to 76 percent of mothers received each of the following: independent living skills, parenting skills, educational assistance, counseling or therapy, and medical care coordination. Slightly fewer—but still the majority—received childcare assistance (52%) and friendships with others in the home (52%). Mothers who received each service rated the helpfulness of each service on a scale of 0 (did not help me at all) to 4 (helped me a whole lot). Childcare received the highest mean rating on its helpfulness with small variation (mean = 3.8, sd = .60) while independent living skills received the lowest mean rating with larger variation (mean = 2.78, sd =1.30). Mothers most commonly identified housing (24%) or independent living skills as the most helpful service (28%). The final column in Table 2 shows that among mothers who exited at least one maternity home (n = 20), the need for basic assistance, including childcare (40%), housing (35%), and educational services (25%), was high. Of the comprehensive list of potential needs, mothers most commonly noted needs to improve their financial well-being, including employment (55%) and financial help (60%); only one mother indicated that she was all set when she left the maternity home (results not included in table).

Table 2. Services Provided at Maternity Group Homes Maternity Home Services Housing/Living with other moms

Received N

%

25

100

Perceived Quality

Rated as Most Helpful (%)

Rated as Most Difficult* (%)

Needed Upon Exit (%)

NA

24.0

32.0

35.0

NA

4.0

28.0

5.0

%

M

Single

12

48.0

Structure in home

With father of child

5

20.0

With someone other than child(ren)’s father

8

32.0

Independent living skills

18

72.0

2.78

1.30

28.0

0

10.0

Parenting skills

16

64.0

3.12

1.09

8.0

8.0

25.0

Educational assistance

17

68.0

3.35

.86

4.0

4.0

25.0

Child care assistance

13

52.0

3.77

.60

4.0

0

40.0

Counseling or therapy

19

76.0

2.84

1.34

12.0

0

10.0

Medical care coordination

17

68.0

3.18

1.29

0

0

20.0

13

52.0

3.17

1.34

4.0

8.0

15.0

Living arrangement Independent Living Program

13

52.0

Alone in apartment/home

4

16.0

With partner

4

16.0

With relatives or friends

1

4.0

Group placement

1

4.0

2

8.0

0*

1

4.0

1

16

64.0

2

4

16.0

3

4

16.0

Under 1 year

7

28.0

1 year

10

40.0

2-4 years

7

28.0

5 years

1

4.0

Child ever involved with DCF investigation

9

36.0

Child ever removed with mother’s care

3

12.0

Shelter/homeless Number of children

Age of youngest child

*One participant was pregnant with her first child.

FLORIDA INSTITUTE FOR CHILD WELFARE

Relationships with other mothers

NA

* Two mothers specified that rude staff members were the most difficult part of the home (8%) and three others stated another reason, but did not specify.

Tables 3 and 4 illustrate mothers’ moderate levels of public assistance or extended foster care benefit receipt coupled with weak social network support. Only about one-fourth of mothers had enough people to rely on for emotional and practical support, and only two mothers (8%) had enough people to rely on for a $100 loan. A significant minority had no one to turn to for emotional and 7

practical support (12-24%), and the majority had no one to turn to for a $100 loan. In addition, most mothers felt that too few or too many people relied on them for social support; only about one-third of mothers perceived that the right amount of people called on them for various aspects of support.

Table 3. Current Receipt of Public Assistance and Extended Foster Care Among Mothers with Maternity Group Home Experience N

Percent

Temporary Assistance for Needy Families (TANF)

2

8.0

Supplemental Security Income (SSI)

1

4.0

Supplemental Nutrition Assistance Program (SNAP)

22

88.0

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

17

68.0

Medicaid

13

52.0

Rental Assistance/Section 8 Housing

2

8.0

Independent Living Program (ILP) assistance

13

52.0

Extended foster care assistance

13

52.0

*NA: Not Asked Table 5 displays hardships mothers experienced within the last year.

Despite high levels of SNAP and WIC participation, 60 percent of mothers reported that they or their children received free food or went hungry due to a lack of resources. Slightly fewer mothers (n = 11, 44%) could not pay rent, nine of whom reported experiencing homelessness within the last year. In addition, most mothers (n = 13, 52%) had difficulty paying utility or phone bills.

High levels of hardship likely contributed to their maternity home stays: 13 mothers remained living in an independent living program at the time of the survey.

Survey results provide a descriptive portrait of disadvantage among maternity group home residents that extends beyond their maternity home stays. Despite receiving concrete, parenting, and therapeutic resources at maternity homes, most mothers continue to struggle to meet their needs after they leave. In addition, many self-report low ratings of physical and mental health.

AIM 3. UNDERSTANDING YOUNG MOTHERS EXPERIENCES OF MATERNITY GROUP HOMES The overarching goal of this project was to gain knowledge about maternity homes for pregnant and parenting young mothers in Florida. We aimed to understand the population of maternity home residents, their daily experiences living in the home, their strengths, and their needs from mothers’ and providers’ perspectives. We organized findings according to the overarching, integrated themes identified from the provider and parent interviews. Table 6 outlines the four central themes reflected in the findings: 1) adversity, crisis, and rejection, 2) tension between useful programs and structured delivery, 3) unfulfilled aspirations for connections, and 4) slow progress towards independence. Themes were distinct, yet interdependent. For example, mothers’ challenging backgrounds influenced their abilities to develop connections with others. For mothers, we follow quotes with a unique letter identifier, the mother’s age, and self-reported, current living arrangement. We identify each maternity home with a letter followed by a number for each provider participant within the home. The discussion builds upon the identified themes to inform maternity home operation, child welfare policy, and future research.

Theme 1: Adversity, Crisis, and Rejection Mothers with maternity home universally experienced adversity in their lives. Family turmoil, placement disruptions, and violence were commonplace. Most mothers expressed moving among multiple relatives, foster homes, and group homes. Ten mothers (40%) reported that they had experienced 10 or more foster care placements, several had lost count, and 12 (48%) had experienced homelessness. Many mothers described a combination of past physical abuse, sexual abuse, and intimate partner violence. One mother’s description of her childhood with sexual abuse, physical abuse, and abusive partners typifies the high level of disadvantage: "I spent my years as a kid in foster care in and out of the system, in and out of the court system, always dealing with problems, being hurt and stuff” (Mother A, 20-year-old living with family). Providers’ descriptions of the mothers they served reflected an understanding that “they all have trauma for the most part…whether it is physical, sexual, neglect, or whatever else they didn’t tell us that’s not documented” (Home A, Participant 1). Providers recognized emotional and behavioral impacts of this trauma and adversity. The comments that “They’re always going to be affected by their trauma” (Home C, Participant 1) and “there's not going to be this perfect little

Table 4. Support Networks of Mothers with Maternity Group Home Experience People mothers can rely on to:

Informal Safety Net

People who rely on mothers to:

Enough (%)

Some (%)

No One (%)

Right Amount (%)

Too Few (%)

Too Many (%)

Listen to problems

28.0

60.0

12.0

36.0

44.0

20.0

Have your back/trusted friend

28.0

48.0

24.0

NA

NA

NA

Do small favors

24.0

64.0

12.0

36.0

48.0

16.0

Take care of your child/children

25.0

54.2

20.8

40.0

44.0

16.0

Loan you $100

8.0

40.0

52.0

29.2

41.7

29.2

Table 5. Hardships Experienced in the Past Year N

Percent

Food

15

60.0

Housing

11

44.0

Utility

13

52.0

FLORIDA INSTITUTE FOR CHILD WELFARE

8

Table 6. Themes Related to Maternity Group Home Residents and Experiences Theme

Description

1. Adversity, crisis, and rejection

• Histories of trauma and deprivation: abuse, neglect, and foster care system involvement created instability and difficulties in meeting basic physical and emotional needs • Histories of rejection: mothers felt alone without dependable relationships. Pregnancy disrupted precarious conditions and relationships.

• Intergenerational patterns of dependency and maltreatment: Poverty, instability, and child welfare system involvement served as multi-generational obstacles.

2. Tension between useful programs and structured delivery

• Access to programs and basic essentials: maternity home providers offered a wide assortment of services (e.g., independent living, life skills, individual therapy, group counseling) and basic necessities (e.g., diapers, clothing, food, shelter, transportation). Providers focused on providing innovative programs while mothers desired programs directly related to developing financial independence.

• Services as a source of structure. Providers viewed services as providing important weekly structure. Mothers desired this structure, yet desired flexibility given their situations rather than micromanagement.

• Lack of explicit service coordination: disconnected, often repetitive, program content from separate providers limited some mothers’ receptivity to content. Providers focused on delivering critical content rather than tailoring services to each resident.

3. Unfulfilled aspirations for connections

• Lack of trust: Mothers’ pasts increase skepticism of provider, family member, and peer intentions. Providers’ prioritization of safety creates high levels of surveillance of mothers.

• House drama: Mothers disagree among themselves and with staff members leading many mothers to prioritize leaving the home or avoiding contact with others.

• High turnover: Mothers and providers leave maternity homes frequently. Mothers’ volatile circumstances and relationships often create short stays. Child welfare providers, particular frontline workers, often experience short job tenures.

4. Slow progress toward independence

• Aligned, yet difficult goals: Although providers and mothers held common goals (e.g., education, employment, housing), mothers prioritized “freedom” from government systems while providers recognized mothers’ many needs.

• Unpredictable obstacles: Networks (e.g., needy biological family members) and situations (e.g., abusive partners, child health needs) interfered with progress.

• Continued instability: Instability was one of few constants in mothers’ lives. Providers wanted to prepare for it while mothers remained surprised in their continually difficult situations.

angel that shows up ever” (Home A, Participant 1) reflect a common provider sentiment.

Mothers also described rejection from their biological families— either before or after their first pregnancies. Several mothers (n = 5) entered maternity homes because they were kicked out of their homes or placements. For example, one mother described her mother’s reaction to her pregnancy and the lasting consequences of the rejection: I was pregnant at the age of 14. My mom basically [said] “[H] ere's [daughter’s name]. I don't want her. Like–and she's pregnant. Here you go.” And on top of that, she went against me, and she was the one that told the judge, “Like I don't think

FLORIDA INSTITUTE FOR CHILD WELFARE

my daughter's ready to have a kid.” And that's when all the– the system happened" (Mother B, 20-year-old living in a group home) The mother then described how she believed she lost custody of her first child due to her young age and her mother’s baseless claims of immaturity.

Rejection shaped mothers’ early experiences often extending beyond biological families to foster families, group homes, and romantic partners. One mother, for example, explained that when she entered foster care her adoptive parents were not “kind,” and she ran away to live with her boyfriend’s family. She expressed that when no one filed a missing person’s report for her she realized how little she meant to others. Once she became pregnant, her boyfriend’s mother kicked her out of the house to a homeless shelter. Once the shelter staff learned she was a minor, she was transferred to a maternity home (Mother C, 18-year-old living with her partner).

Although each mother revealed a unique story of trauma and instability, mothers commonly described unstable, unloving childhoods and pregnancies that exacerbated their tenuous situations (e.g., disrupted housing, introduced post-partum depression). Providers recognized the often desperate circumstances leading to mothers’ maternity home placements and the fact that the placements were often their last resort if they wanted to live with their children. One provider described mothers’ childhoods as marked by instability: I mean obviously they are in foster care, so they didn't have really healthy, positive upbringings and their own parents were not successfully able to parent them. But more than that, too. I just think that most of our girls have not come from places where they had consistency in anything. (Home D, Participant 1) Mothers struggled to break the intergenerational cycles of dependency and maltreatment. High levels of instability, coupled with few resources, defined mothers’ circumstances. Mothers prioritized parenting differently than their own mothers. For example, the mother quoted earlier whose own mother turned her over to DCF upon learning of her pregnancy expressed a common goal to break the cycle of maltreatment: “my aspirations in life is to make sure that [my daughter] never has to go through [the foster care system]” (Mother A, 20-year-old living with family). Providers noted mothers’ struggle to be “good parents.” For example, one provider explained: A lot of their trauma stops them from being good parents or what they've learned hasn't been a great example. So they take some of the things that they've learned, those things that they don't want to do that their parents have done, but they don't know how to do it the correct way. For example, how to communicate with their baby, not yelling at their baby, when to feed their babies, when to give their baby a bath. (Home C, Participant 1) Several mothers had already lived apart from their children— usually through formal or informal relative placements—within the first few years of their children’s births. A couple pregnant mothers lived in maternity homes without their older children. And, because maternity home placements were often the only options to live with their children, when maternity home placements were disrupted, mothers often were separated from their children. Several mothers explained when they were kicked out of maternity homes (n = 7), they were separated—at least temporarily—from their children due to their limited housing options (e.g., homelessness, group home that did not allow children). Past trauma coupled with continued disadvantage and volatility illustrate the difficulty of providing mothers the tools to parent differently.

9

Theme Summary

Mothers faced high levels of adversity, stress, and rejection.

Unplanned pregnancies often exacerbated mothers’ delicate balance of resources and support. Providers recognized mothers’ difficult past and current situations. They viewed maternity homes as key opportunities to support mothers at critical times in their lives; they also recognized the difficulties in serving mothers with such complex, difficult histories.

Theme 2: Tension Between Useful Programs and Structured Delivery Provided Programs

Together, mothers had experiences in 11 maternity homes. Across programs, providers focused on teaching a variety of life skills mothers needed to care for themselves and their child(ren). Despite living in various homes, most mothers reported receiving a range of core services including independent living skills, parenting skills, educational assistance, counseling or therapy, and medical care coordination. In addition, the vast majority of mothers expressed that they had access to transportation for medical appointments and weekly shopping trips as well as the necessities for their babies (e.g., diaper, wipes, clothing). Mothers valued programs and services that focused on meeting their basic needs in the present (e.g., diapers) and the future (e.g., financial literacy), and they benefited from the security of having their needs met. For example, one mother reflected on her maternity home experience as a “fake world” because “you're not stressing about the bills, you're not stressing about how can I feed the kids.” (Mother D, 25-yearold living as sole provider in an apartment). Mothers typically found programs, such as parenting, independent living, or nutrition classes “useful, but demanding,” and they often expressed that their appreciation increased over time. One mother’s explanation of how she first questioned the need for services and later found them useful exemplifies a common sentiment among mothers: [W]hen I was in the maternity home they implemented different classes as far as parenting skills go, parent and child nutrition, life skills, stuff like that. In the beginning I thought, "Hey, why am I doing this? This is something dumb. I shouldn't have to learn this. I know this." But in reality, once I had [my child] I was like, "Whoa, okay, these things that I was learning are actually useful." (Mother A, 20-year-old living with family) Reflections such as these are consistent with providers’ aims to give mothers tools to prepare them for the future. One provider explained: “…they're teenagers. They are, a lot of them, are parenting as well. And so, whatever we teach them, or we help them understand the goal is that they can implement something similar with their own kids down the line. And, we very rarely get to see the benefits of all that, but we know that we're planting that seed.” (Home D, Participant 1) Another provider highlighted the discrepancies between her aspirations for mothers in achieving their full potential and mothers’ receptivity to services: …I know that they can achieve so much more [than they currently are]. So it's like I'm constantly providing services and it's like, “Are you really taking advantage of the service? Are you really listening? What more can I do? How can I help you?” But it's like they have to grow. They might not be ready to accept [growing up] yet, but at some point in their life they will accept it.

(Home C, Participant 2) Mothers’ lack of engagement in services may reflect their presentorientated mindset. Although mothers almost exclusively mentioned the benefits of programs to promote living independently (e.g.,

FLORIDA INSTITUTE FOR CHILD WELFARE

driver’s licenses, financial literacy), several providers mentioned using innovative programs (e.g., baby yoga) to connect and engage mothers.

Although most mothers expressed similar experiences of useful services, several mothers did not. Some programs required participation in services while other programs’ services were “voluntary” but “strongly encouraged.” Mothers generally voiced that attendance requirements were problematic rather than the course content. For example, one mother disagreed that she should continually attend parenting classes even though she “graduated” from the class multiple times since arriving at the home. In another instance, a mother explained that although she found most programs helpful, as a non-Spanish speaker, she did not agree with the requirement to attend a weekly program delivered only in Spanish. The only consistent content complaint related to religious content. Several maternity group homes had religious affiliations or offered routine prayer groups and church attendance. Although all providers stated that religious participation was optional, several mothers discussed mandatory religious services. Multiple mothers stated that although they knew that the services may be optional, they felt pressure to attend because they wanted to please the providers.

In addition to finding services unhelpful, a couple of mothers expressed that their homes did not offer services to young mothers.

These few mothers described the homes as “somewhere to stay” and “renting out a room and no more” (Mother E, 21-year-old living in a group home). These exceptional cases were mothers who were living in independent living wings of maternity homes or adult group homes with less regulations and oversight than maternity homes for youth under the age of 18.

Structure of Service Delivery

Promoting structure and autonomy Reflected in complaints about program attendance requirements, mothers’ general appreciation for programs did not translate into an appreciation of highly-structured service delivery. Instead, mothers desired structure with flexibility given their individual circumstances and time of adjustment during pregnancy and early motherhood.

Mothers wanted to be part of a home rather than part of a system.

They commonly expressed that the structure of services and house rules were “demanding” creating “a repeating record” for each day: get up, go to school, pick up child, eat dinner, take care of child/attend program, go to bed. Regardless of home variation on structure by location and age of child (e.g., pregnant residents typically had less structured time), mothers desired decisionmaking power. For example, one mother who highly valued the home’s provided skill-building programs (e.g., education, budgeting, cleaning, and cooking) explained how the structure of service delivery bothered her: I felt like I had no control over my life, and I had no control over even my own daughter's life because I got told when to wake up. I got told when breakfast was, when lunch was, when dinner was. I got told when I'm to take a shower, y'know? I got told when I could go outside... It's dehumanizing to anybody, but especially when you're a young parent and you're trying to figure it all out on your own, feeling like you have no control over your own life, much less your own kid's life, really hurts. (Mother F, 25-year-old living as sole provider in apartment) Many mothers mentioned the desire for control in their lives, especially as they adjusted to early motherhood. Another mother expressed that not being able to walk outside without permission made her “feel like you’re in a jail.” (Mother G, 22-year-old living in a shelter).

Providers recognized that many residents resisted rules and structure. They grappled with tension between wanting to provide

10

structure and wanting to support mothers’ autonomy, independence, and sense of personal responsibility. Finding balance for each mother while maintaining consistency in the program expectations was difficult. To this point, one provider stated, “Every girl is their own person. They have their own personality, their own goals, and dreams,” (Home A, Participant 1) yet mothers often had not “come from places where they had consistency” (Home D, Participant 1) or established expectations. Therefore, residents often experienced “consistency in rules, consistency in consequences” for the first time in the maternity home. First-time structure and consistency often introduced conflict. One provider explained that residents’ frustration with structure is not unique to living in a maternity home: “Just like any other kid in the entire world, [residents] don't enjoy getting consequences. Nobody does” (Home D, Participant 1).

Another provider mentioned the challenge mothers encountered with managing program expectations and the importance of instilling accountability: So, it's a lot of load to bear for them to have to be parents as well as teenagers, but we try to remind ourselves that they're just kids too, and, like, sometimes they want to just do normal teenage girl stuff and walk around the mall or whatever. But at the end of the day, we do have to hold them a little bit more accountable because they are either parents or about to be parents. So, that's the goal: we want them to be successful parents. (Home D, Participant 1) Mothers also wanted to become successful parents, but they did not always feel set up to succeed. One mother who was living in an independent living apartment identified the paradox of homes’ high level of structure coupled with the expectation of adult responsibility: “They want us to make adult decisions, but we're treated like childs. And if we don't comply with the littlest things, termination papers are dangled right in front of our faces. And I can't stand that" (Mother H, 21-year-old living in a group home). This mother further explained that in one incident a staff member blamed her for a roach infestation which could be considered neglect, and the directors “always believe the [staff] over us.” Yet, in this instance, the home was shut down soon after for unsanitary conditions, including rats, which the resident stated went well beyond her personal level of cleanliness.

Enforcing consequences Similar to the mother above, several mothers perceived maternity home staff members as enforcers trying to catch mothers’ mistakes.

They described circumstances in which staff members or other residents reported their parenting to DCF in circumstances they deemed unnecessary, such as feeding a 4-month-old infant table food, incessant crying (e.g., “your baby is crying too much. It's neglect,” Mother I, 19-year-old living in a group home), or a child darting in the street momentarily. Real and perceived threats of DCF involvement as well as revoked privileges for not following home rules frustrated mothers. Yet, providers identified DCF reports as one of few motivating factors for mothers. One provider explained: “So that's one of their biggest fears and I think their biggest motivation to say like, ‘Oh, let me get it together because DCF can get called.’” The provider further explained mothers’ perceptions despite providers’ best efforts to support mothers: “[They feel that they’re living] through a lens of everybody's watching them. And, they just have that fear that somebody's going to get them…We're here to support you. We're here to guide you. That's the whole point of a maternity home, but that fear is instilled in them.” (Home C, Participant 1) Indeed, several mothers expressed that they felt set up to disrupt their placement. Although many mothers described homes’ negative consequences, several mothers also discussed being rewarded for following house rules. Several homes set up “markets” weekly or monthly in a home’s living room or garage. Mothers enjoyed earning

FLORIDA INSTITUTE FOR CHILD WELFARE

“baby bucks” and spending the bucks for extra clothing and toys.

Providers also rewarded meeting expectations by offering mothers with more free time. For example, one provider explained: “As long as you do your expectations, I will let you be free. But most of the time, half of the day, you're doing expectations.” (Home C, Participant 1) Promoting a safe, healthy home Mothers commonly voiced that structure or rules in the maternity home, regardless of their behavior, interfered with the placement “feeling like a home.” In particular, mothers—but largely not providers—discussed rules around childcare and food.

Approximately one half of mothers had access to ad-hoc childcare through other residents or staff members while the other half did not.

One resident explained how staff members “love taking care of our children…it felt like oh you have a lot of grandmas at home” (Mother J, 21-year-old living as sole provider in an apartment). This resident, similar to others with available ad-hoc childcare, valued both the trusting relationships with others and the break from their child.

Those without access to informal care felt the onus of motherhood.

For example, they described showering with the child in a bouncer in the bathroom and juggling fussy children while trying to make a meal. One mother who experienced postpartum depression explained how her lack of childcare overwhelmed her: “I had to do this [parenting] 24/7 constantly without any breaks. That’s what really drained me. That was what really, really drained me and was super hard for me.” (Mother K, 18-year-old living with her partner).

In terms of structure regarding food, providers differed in how they handled meal shopping and preparation. Most homes helped mothers register for SNAP benefits while mothers living at one home stated that their provider would not allow receipt due to the home’s religious affiliation, and, instead, gave mothers a weekly food allowance. Many providers took mothers to the grocery store weekly to purchase food. In other homes, staff members shopped for mothers after taking their shopping requests—an arrangement that commonly frustrated mothers. In terms of preparation, some mothers were on their own, others cooked for each other on a schedule, and others had chef-prepared meals. Regardless of the arrangement, several mothers mentioned that they wanted more freedom around food, particularly around what and when to eat. Yet, providers at one home explained why structure around food and healthy eating is important: Most of the girls’ nutrition, I mean when they first come in, is just horrific to begin with. Some of them didn't know where their next meal was coming from and so you know they either want to hoard the food or they're just so used to being able to get junk. And so, they don't know what's healthy for them, especially when they're pregnant…that's real, you know, trying to get them to understand that you are also supporting your baby's nutritional needs not just your own. (Home B, Participant 3) A few mothers who received an allowance to shop for themselves expressed that they did not have enough money to feed themselves and their babies. One mother explained, “We'd only get $50 at [local grocery store] every Wednesday which I don't think was enough because I had a baby to feed, too” (Mother K, 18-year-old living with her partner). In one extreme case, a mother mentioned that she decided to leave the home because she was pregnant, hungry, and denied access to food during off-meal hours (Mother L, 20-year-old living in a group home).

Theme Summary

Together the narratives of maternity home services and operation reveal the vital and intricate role that maternity homes serve for residents. Generally, mothers desired services and structure. At the same time, they wanted structure that was individual- and circumstance-specific. They also simultaneously wanted freedom

11

and guidance to navigate early motherhood. Providers identified the difficulty of introducing structure given mothers’ histories of adversity, stress, and rejection. Providers identified mothers’ struggle between structure and independence and viewed structure as central to successful parenthood.

Theme 3: Unfulfilled Aspirations for Connection Connections within Maternity Homes

Mothers and providers prioritized connections and opportunities for “motherly love.” Yet, mothers’ past experiences interfered with the ability to form healthy relationships; mothers lacked trust in others including providers and other residents. When asked about her connections with others, one mother expressed a common sentiment: It's one of those things where it's like everybody that you think you can count on ends up letting you down. So it's easier to just not count on anybody, and you don't have to worry about it.

(Mother F, 25-year-old living as sole provider in apartment) Similarly, another mother explained her value on self-reliance for both herself and her children: [Single parenting] is a challenge, but I still get through it. Like it's very depressing. I get stressed out. I feel very alone. But I still do it because I can't let my daughter like feel like, “Oh, my mom needs help to raise us…that means I need somebody when I get older.” No, you don't need nobody. You can do it yourself.

(Mother B, 21-year-old living in a group home) As this mother did, many mothers voiced that they distanced themselves from providers. Others who cautiously established trust with providers discussed how staff members betrayed their trust during their stay. One mother, for example, described how she felt the director betrayed her when a staff member accused the mother of having an overnight guest which was strictly forbidden. The mother denied having the guest, but the director kicked her out of the home due to the staff member’s accusations. The mother explained how the staff members “give the appearance that they welcome, but everybody turns out grimy at the end of the day” (Mother H, 21-year-old living in a group home). The incident reinforced the mother’s hesitancy to develop trusting relationships. Other mothers echoed this mother’s feeling that staff members may appear helpful at first, but “anything they help you with, they will throw in your face” (Mother M, 18-year-old living in a group home). Multiple mothers stated that providers are clear in their roles by stating, "[w]e're here temporarily. We're not here forever" (Mother N, 22-year-old living with her partner).

The temporary nature of maternity homes was in the forefront of mothers’ and providers’ minds. Mothers often viewed the home as a response to the crisis of an unintended pregnancy. They commonly aimed to leave as soon as possible. For example, one mother who stayed for a total of seven months and prided herself on having moved in with her boyfriend explained, “I was the longest one [at the maternity home]…and I’ve been the only girl at their house, at this maternity home, that’s ever stayed that long” (Mother C, 18-year-old living with her partner). Providers voiced a desire for longer stays to provide mothers greater consistency; yet, they mentioned that the high level of turnover perpetuated short stays among both staff members and mothers.

Despite staff and resident turnover and difficulties in developing and maintaining trust, some mothers bonded with their providers and viewed the providers’ commitment to them as turning points in their lives. One mother, for example, described how the maternity home director was the godmother of her baby and one of few people she could turn to in an emergency (Mother L, 20-year-old living in a group home).

Providers also expressed connections with mothers, describing FLORIDA INSTITUTE FOR CHILD WELFARE

their ability to establish trusting relationships as key to mothers’ successes. For example, a provider described the importance of relationships: “[T]he biggest thing is they love us…they know they are loved, and they have a family and that continued support is there. They know that we are just one call away” (Home C, Participant 1).

Elaborating on their relationship-focused approach, another provider stated: I think if nothing else, if the girls didn't get anything out of counseling or anything out of parenting or anything of any of the services we throw at them, just knowing that for however long we had them, if someone cared, truly cared, and listened, and wanted to see them succeed, then that's a benefit in itself. And if that's the only thing I think we can provide, then I'm ok with that too. It's not just a group home; it's not just a place to lay your head; it's a place where hopefully you felt loved and protected and secure and cared for. (Home D, Participant 1) When asked about the difficulties of living in maternity homes, the vast majority of mothers complained about “mama drama” (Mother O, 20-year-old living in a group home). Mothers described their arguments as similar to other adolescents except that they were living with each other without time apart. They argued about boys, including children’s fathers, and house rules, such as curfews, drugs, and visitors. As part of the drama, mothers commonly discussed how shouting and fighting were typical in homes leading mothers to feel unsafe or expedite their departures to other housing arrangements. When explaining her reason for leaving the home after seven months, for example, one mother explained that the noise in the house interfered with her and her infant’s sleep (Mother C, 18-year-old living with her partner).

With almost universal “drama” complaints, mothers also recognized that they contributed to the problem. Mothers referred to their younger (or current) selves as having an “anger management problem” or having a “hothead.” Mothers most commonly described situations in which they would be arguing with another resident, other residents would take sides, and then staff members would intervene into the drama siding with some residents and punishing others. One mother justified her outbursts ultimately directed at staff members: I know I'm not perfect and definitely didn’t always come off right, and sometimes I would get mad and start yelling at the staff and stuff like that, but I feel like I had to get to that point whenever I just felt like I wasn’t being heard, so I started yelling. (Mother K, 18-year-old living with a partner) Similar to this mother, when asked what could have helped her the most, another mother stated, “The staff actually, like, listening or care about what I’m saying” (Mother G, 22-year-old living in a shelter). Indeed, mother-staff interactions were fundamental to maternity home experiences. Outbursts at staff—even if inadvertent or misdirected—resulted in home expulsion for several mothers (n = 7).

Providers acknowledged challenging interactions between mothers in the home. Yet, they aspired for mothers to form supportive relationships with staff members and one another. Multiple homes created outings for mothers to bond. The following statement reflects provider emphasis on peer relationships: …we really look for ways for our girls to actually bond together, because if they all get along together then everyone's lives are better. So, all those events that they get to do on the weekends or together as a group, hopefully help to make some relationships.

(Home D, Participant 1) Connections Outside of Maternity Homes

Outside of the maternity home, most mothers perceived weak networks for both emotional and practical supports, often due to 12

their unplanned pregnancy or perpetual dysfunction from their biological families. Similar to other mothers, one mother explained how “after I got pregnant and stuff, I just, like, distanced myself a lot from a lot of people" (Mother C, 18-year-old living with a partner).

Although most mothers identified someone to listen to their problems (n = 22), support members were often dealing with their own crises including shelter living, mental health problems, or addiction. For example, one mother viewed her father’s calls from prison as her source of emotional support. Practical support was even more limited. Most mothers stated that they could rely only on themselves. This self-reliance, however, sometimes resulted from few network resources rather than a network member’s lack of desire to help. One mother explained her experience upon returning from a day visit with her aunt: [L]ast time I went up there, when she dropped me off, my auntie started crying when she saw the condition of the house I was in, and she wanted me to come back up there with her. But I couldn't impose on the fact 'cause my auntie and my uncle – they got six kids…they're retired military and everything, but still, like, the house is not big enough. (Mother H, 21-year-old living in a group home) Similarly, another mother explained how she reached out to family for groceries when she was eight months pregnant and on bedrest: “I hate asking people for things, and I've always been like that growing up, so having to do that, it was really hard for me." (Mother A, 20-year-old living with family) Weak networks were particularly problematic for mothers in maternity homes because of their volatile circumstances. One mother explained how her son’s recent health problems illuminated her limited support: [H]e had a little bit of oxygen in him, and I was taking a shower, and I didn't realize it. And my son was like basically dead, and I was scared…I couldn't take my daughter to the hospital with me. The hospital gave me a hard time. I couldn't contact nobody.

(Mother B, 21-year-old living in a group home) In addition to mothers facing uncontrollable situations, several mothers described how rash decisions that ended their maternity home placement (e.g., fighting, running away when angry, moving in with a boyfriend) showed the limits of their network support. For example, one mother who decided to move in with a boyfriend who quickly left her homeless declared leaving foster care “the worst decision of my life” (Mother P, 21-year-old living in a group home).

The very conditions that dictate maternity home placement— the need for safe housing and care during pregnancy and early motherhood—often translate to few network supports.

However, several mothers felt supported by family or friends, typically from new romantic partners or extended family. Supported mothers also recognized that support may disappear further increasing self-reliance. When asked about her support when she left a maternity home, one mother explained: “It was good. It lasted for a good minute. It was all right” (Mother Q, 18-year-old mother living in a group home). Another resident who was eight months pregnant perceived family support, but also expressed concerns that her family would not accept her after her son’s birth (Mother R, 19-year-old living in a group home).

Theme Summary

Mothers and providers both wanted mothers to develop connections within and outside of the maternity home. However, the circumstances that led mothers to the maternity home placement (e.g., unplanned pregnancy, rejection from family) commonly led to mothers’ hesitancy to trust others. Moreover, their lack of trust, coupled with unhealthy ways of handling conflict (e.g., fights), contributed to high “drama” in the homes and early departures for mothers and staff members alike.

FLORIDA INSTITUTE FOR CHILD WELFARE

Theme 4: Slow Progress Towards Independence Similar to the common desire for connection, mothers and providers voiced similar goals for mothers: to live with their children in stable housing, to further their educations, and to obtain good jobs. With these shared goals, mothers often lacked immediate, goal-oriented plans and celebrated much smaller successes. For example, one mother claimed success by “waking up with [my] kids every morning.” (Mother S, 20-year-old living in a shelter). Likewise, another mother explained that although she still lacked a high school diploma, childcare, and employment, she reached success simply by living: [A] few years ago I didn’t think I was going to make it out alive past 18. I'm just doing a lot better emotionally, physically. I just changed a lot, and I'm glad that I changed…the way that I am now, nobody would recognize me back then. (Mother K, 18-yearold living with her partner) Providers at all four maternity homes reported offering mothers a variety of services from concrete resources, connection to services, and periodic check-ins after home exit. Despite these, providers explained that mothers often “struggle” or experience “hiccups” once they leave the home because there is no one to enforce structure (e.g., school, employment) or address other daily needs.

As one provider stated, “it’s really, really hard for them to be selfmotivated” (Home D, Participant 1). Similar to mothers, providers recognized the importance of small successes. Yet, compared to mothers who celebrated survival, providers defined small successes as incremental, measurable progress in which they made “piece by piece” improvements to become healthy, independent, and stable providers for their children (Home C, Participant 1).

Mothers gave themselves grace in reaching their goals because of high levels of adversity and their unstable environments. They were engaged in “a chess game” waiting for an interruption to their delicate balance of resources. One mother explained her day-today coping strategy: "When it comes to [my son], I'm not really a long-term thinker. I kind of think momentarily because any given situation can change" (Mother I, 19-year-old living in a group home). Likewise, when asked what supports could help them, many mothers stated that they did not need supports despite their limited resources. For example, one mother explained how she was “taking it day-by-day to…work and progress;” she just requested “patience” (Mother T, 22-year-old living with a partner). Mothers valued their autonomy and commonly voiced that they did not need outside resources.

Yet, mothers’ difficult adjustment to independent living was common.

And, while valuing independence, mothers wanted concrete skills to succeed. One mother explained how she needed more than a bed when she exited the maternity home: They'll just be like, "Oh, well, you've got to get out of here so we're going to get you an apartment.” Okay, then how is she going to pay her bills? How is she going to get back and forth to work? How is she going to go to work and who is going to watch her baby? Nobody thinks about any of that. They just expect you to just figure that out on your own, and I don't like that because I'm obviously here for a reason. I'm in a situation; I need help in my situation. I don't need you to just help me find somewhere to lay my head. I need help figuring this out. Like, how am I going to do this? (Mother N, 22-year-old living with her partner) For this mother, to “do this” meant to successfully juggle the demands of living independently. And, as with this mother, most mothers desired additional classes on financial literacy. Congruent with providers’ concerns about low levels of service engagement, some mothers admitted that while they had attended classes, they were not ready for the content at the time. In addition, mothers desired assistance with obtaining driver’s licenses and cars to prepare to live on their own. Only one mother in the sample owned a car, and most lacked driver’s licenses. As such, mothers 13

expressed that relying on buses in areas with weak, unreliable public transportation systems prevented them from securing dependable jobs and childcare. Providers, too, recognized this need. One maternity home director explained that she needed funding for designated staff members to help mothers to prepare for their driver’s licenses; similar to other providers, she did not have the human resources to invest in mothers’ long-term transportation needs.

learned of the survey from their maternity home director or case manager. A full 52% (n = 13) of mothers were receiving extended foster care services compared to the national average of 25 percent of youth with foster care experience.29 Mothers in extended foster care fare better on all measured outcomes (e.g., higher school enrollment, higher rates of employment, greater housing stability, decreased food insecurity, increased social support) compared to their peers who leave foster care on or around their 18th birthdays.30

The context of mothers’ lives reflects their progress towards independence. Mothers in our sample were young adults with an average age of 20. All mothers described unmet aspirations for raising their families successfully through additional education, better jobs, or both. However, several mothers expressed that they were no longer living in the crisis mode of their early motherhood.

These mothers tended to be living with an employed partner or relative that offered both income and emotional stability. Two mothers, for example, had partners in the military and both of these mothers had military aspirations themselves. The “chess game” maternity home residents faced was difficult to manage with sole responsibility for a household. A dependable champion of support provided a couple of mothers relief from hardship and instability.

The high number of services provided to mothers in maternity homes to address their high level of needs is remarkable. Most mothers reported receiving independent living skills, educational assistance, counseling or therapy, medical coordination, childcare assistance, and friendship within the home. Recipients’ rating of helpfulness for each utilized service (0 = not at all helpful, 4 = helped a whole lot) indicated that they rated the services highly (2.78 (independent living skills) -3.77 (childcare)). The helpful services, however, did not eliminate mothers’ high levels of need. Upon exit, only one mother indicated that she was all set. Most mothers indicated their difficult financial situations, desiring employment or financial assistance.

Their need for money is also reflected in their public assistance receipt and social support networks. Despite high levels of SNAP receipt (88%), only three mothers (12%) received cash assistance from TANF or SSI; only two mothers (12%) could turn to family or friends for $100 in an emergency. Perhaps not surprising given their vulnerable conditions, 80 percent of mothers reported experiencing at least one food, housing, or utility hardship in the past year.

Theme Summary

Mothers and providers voiced similar goals for mothers, namely to live independently through acquiring necessary education and skills. Both also recognized inevitable “hiccups” in meeting goals.

Yet, mothers had lower standards of success (e.g., staying alive and maintaining custody of child) while providers defined success through continued, measurable progress towards goals. Both groups also recognized the need for additional services (e.g., driver’s license preparation) to promote independent-living success.

Discussion

OVERVIEW OF MAJOR FINDINGS Maternity programs throughout the state (i.e., four or six regions) participated in the study serving as consultants on an advisory panel and participants in small group interviews. All four programs were licensed by the DCF and served pregnant and parenting teens in foster care. Program services primarily focused on promoting safety for young mothers and their children, and providing education and skills aimed at preparing mothers for independently supporting themselves and caring for the child(ren). Although service models and approaches varied, they commonly included a relationship-based approach and an emphasis on education and skill development. All programs provided some form of parenting training; independent or life skills training; access to childcare; counseling; case management services, connecting mothers with public assistance and community resources. Programs are designed to also assist with discharge planning services to transition mothers to independent living or other living arrangements. Survey respondents identified an additional seven programs as current or former placements. However, little information was available about these programs including eligibility criteria or provided services.

Survey results indicate that maternity homes serve a population with high socioeconomic disadvantage, typically with many years of foster care experience and multiple foster care placements. In part due to their young age, mothers tend to have a high school diploma or less and lack employment. Yet, despite their young age, only about one-half of mothers reported being in very good or excellent physical and mental health compared to about two-thirds of the general adult population.28 The high level of disadvantage among our sample—mothers who largely remained connected to the foster care system—is important and likely understates the level of disadvantage among the general population of mothers with maternity home experience. Twenty-two of the 25 respondents FLORIDA INSTITUTE FOR CHILD WELFARE

Qualitative interviews with mothers and their providers offer context to understand mothers’ survey responses and experiences.

Thematic analysis revealed four interrelated themes. First, adversity, crisis, and rejection overwhelmed mothers’ lives. They experienced histories of trauma, deprivation, and rejection. Moreover, pregnancies disrupted their precarious conditions and relationships.

Poverty, instability, and child welfare system involvement served as multi-generational obstacles. Second, mothers’ high access to and use of services was tempered by their frustrations in following rules and a perceived lack of tailored services to meet their individual needs. Mothers were often not receptive to providers’ goals to offer structure to promote success for mothers. After leaving homes, most mothers wanted financial literacy skills and driver’s licenses; some mothers recognized that their homes had offered these services, but they did not take full advantage. And, providers recognized the formidable barrier of not only providing services but fully engaging mothers in these services. Third, lack of trust, house “drama,” and high turnover among both mothers and providers led to unfulfilled aspirations for connections. Although mothers and providers wanted to develop trusting relationships, mothers’ backgrounds, coupled with common “anger problems” leading to fights in the homes, perpetuated mothers’ cycle of self-reliance. Fourth, and finally, although mothers and providers had high aspirations for mothers to reach independence, few did so. Mothers often wanted separation from the system, perhaps too soon from providers’ perspectives.

The unstable and unpredictable lives of mothers interfered with stable employment, childcare, housing, and self-sufficiency.

LIMITATIONS First, the lack of a sampling frame of mothers with experience living in maternity homes and the subsequent use of convenience sampling means that findings may not apply to the general population of maternity home providers or mothers with maternity experience, particularly outside of Florida. The sample likely overrepresents maternity home providers with more experience and with more established programs. In addition, 22 of the 25 sampled mothers learned of the survey through foster care system providers. Youth with connections to the foster care system after their 18th birthdays are the minority (25%) and tend to be more advantaged than their peers who are disconnected.29 14

Second, our small sample (providers: n = 16; mothers: n = 25) coupled with the diversity of the sample (e.g., length of stay, timing of stay, number of maternity group home experiences) make inferential statistics (e.g., identifying relationships between variables) inappropriate. Therefore, the quantitative analysis was descriptive in nature, and we did not have necessary power to analyze the data with mixed methods. In addition, only one surveyed mother did not want to participate in an interview. However, due to logistics in connecting with mothers, six mothers did not complete qualitative interviews. Mothers who completed interviews did not statistically differ from interviewed mothers on descriptive data (e.g., background characteristics, services received, quality ratings of services received, public assistance use, social support, hardship) with a couple of exceptions. Mothers without interviews were more likely to have a child who had been involved in a child welfare investigation, more likely to receive SSI (suggesting experience with a disability), and less likely to receive SNAP or WIC. These indications provide additional evidence that our analytic sample was more advantaged than the broader population of mothers with maternity home experience.

IMPLICATIONS AND RECOMMENDATIONS The data from maternity home descriptions, mothers, and providers can inform maternity home operation. Most importantly, the Florida DCF could benefit from enhanced data collection efforts. First, we used multiple recruitment strategies to include providers and mothers with maternity home experiences. Although the majority of providers of DCF-licensed homes expressed interest when we contacted them, two directors ultimately decided not to participate because their homes were in the midst of major transitions (e.g., executive leadership turnover, empty house due to anticipated service delivery changes). As a result, we successfully recruited four of nine providers, two of whom changed executive directors over the course of the one-year project. Despite instability among several providers, interest in study collaboration was strong.

Our recruitment efforts with mothers also showed promise. All eligible mothers who started an online survey completed it, and all mothers except one who completed surveys expressed interest in completing an interview. With this success, sampled providers and mothers likely differed from non-participants (see Limitations). The foster care system could benefit from DCF administrators collecting data from all maternity home providers and a more generalizable sample of residents. Providers, for example, could submit an annual count of mothers served, months in operation, average length of stay, and quantity of services provided. This count could include young mothers served in DCF-licensed homes as well as other programs not licensed by DCF to determine which mothers are receiving which services and which current programs may be missing. In addition, strategic efforts (e.g., survey distributed to all mothers who gave birth while receiving DCF foster care services in Florida) to survey mothers who have aged out of foster care with maternity home experience could inform practice and policy.

Although connecting with mothers who have aged out of foster care is notoriously difficult,22 tracking mothers who leave care is an important first step to improve data collection, increase service provision, and evaluate services.

Due to the limited sample size and limited generalizability, the following implications are suggestive only and subject to additional study. That said, findings provide initial support for recommendations in the following areas: maternity home networks, maternity home programming, staff training, care coordination, and extended foster care eligibility requirements.

First, several maternity home providers were eager to participate in the advisory panel in part as an opportunity to connect with other providers throughout the state. Policymakers interested in meeting the needs of young mothers in maternity homes may FLORIDA INSTITUTE FOR CHILD WELFARE

want to consider establishing a statewide network to oversee maternity homes and allow providers to connect with one another.

Networks can offer homes funds and staff to provide technical assistance, support, and advocacy. In addition, networks could develop requirements for standardization including case records and documentation that referring agencies provide for young mothers to facilitate proper referral and service planning. Networks also could facilitate cooperation among homes (e.g., referrals) and the opportunity to learn from one another. For example, several mothers with experience in one home explained that their maternity home provider did not allow residents to sign up for public benefits, such as SNAP, due to the home’s religious affiliation. Network connections could minimize misinformation. In addition, home coordination may allow a continuum of care among homes in which mothers enter more structured homes with 24-hour supervision and advance to independent living apartments as they develop life skills.23 Although some providers mentioned that they had one or multiple independent living beds within their homes and one had an independent living wing, congregating mothers with similar levels of need, if possible, may help to deliver appropriately tailored services.

Second, mothers and providers prioritized programming that prepared mothers to live independently with their children. With this common prioritization, current situations often forced mothers to live in the present rather than prepare for the future. To increase mothers’ receptivity to programs, providers can emphasize the application of program content to their lives to help mothers recognize that program engagement will contribute to smoother transitions after they leave the homes. For example, mothers desired additional skills for independent living, including financial literacy. Providers can connect how home responsibilities (e.g., grocery shopping, making doctor’s appointments, applying for public benefits) will help mothers develop independent living skills.

In addition, maternity home providers often invite various groups to offer programs to mothers. Connecting content from various programs (e.g., how nutrition relates to food budgets) can help mothers integrate acquired knowledge to develop skills.

Third, mothers and frontline providers often stayed at maternity homes for short periods. High levels of structure commonly frustrated mothers while the demands of frontline child welfare positions often lead to high staff turnover. The balance between providing some program structure for safety and security and some level of freedom is challenging. Due to their backgrounds of adversity, trauma, and rejection, many mothers experience structure for the first time at the home during their life transition to motherhood. To help mothers adjust to structure, mothers and providers can develop case plans upon maternity home arrival when engagement and motivation tend to be strong. Case plans can clearly outline rewards for completing small accomplishments (e.g., school enrollment, program attendance, program completion, chore completion) and provide levels of independency allowing mothers more choice, freedoms, and responsibilities as they demonstrate life skills to further prepare them for life after home exit. In terms of staff retention, additional training may afford frontline providers with additional skills to work with mothers successfully thereby increasing job satisfaction and decreasing turnover. Although trainings may be house specific, our interviews suggest specific training in dealing with populations with high levels of adversity, trauma, deprivation, and rejection. In addition, conflict resolution skill training may allow workers to avoid physical and verbal confrontations that often contributed to mothers’ early dismissals from the homes.

Fourth, mothers and providers identified that mothers not positioned to succeed after they exited the homes. Most commonly, mothers waited for driver’s licenses, car ownership, childcare, and stable housing in order to reach their goals for self-sufficiency, specifically employment. Because most mothers left the home unexpectedly due to dismissal or a desire to join others (e.g., relatives, boyfriends), 15

providers should anticipate and prepare for untimely departures.

Several mothers discussed the spontaneity of their decisions (e.g., getting into a fight, running away) and their regret (e.g., “worst decision of my life”). Perhaps, providers could discuss the realities that mothers will face outside of the home while working with mothers to put the necessary supports in place. Yet, we recognize the steep challenges that providers face because of mothers’ present-focused mindsets. Celebrating and rewarding progress (however small) and helping mothers develop future-oriented thinking may lengthen stays and contribute to more successful transitions after exit.

Fifth, the extended foster care program contributes to better access to services and better adult outcomes. Youth in extended foster care have higher odds of educational enrollment and employment while having lower odds of homelessness and disconnection from school or work compared to their peers who exited care before their 19th birthdays.30 However, only 25% of foster youth participate in extended foster care,29 and, although estimates are not available, enrollment is likely lower among mothers aging out of care due to their extraordinary adversities. Our finding that mothers struggle to overcome their adverse backgrounds and transition to independence after exiting maternity homes suggests the importance of extended foster care particularly for this vulnerable, two-generation population.

Encouraging participation can facilitate healthier mother and child outcomes. To do so, custodial parenting can be added to the list of qualifying criteria. The current requirements of stable employment or educational enrollment does not consider the additional barriers, namely childcare, that mothers face to stay productively engaged.

Default extended foster care enrollment upon maternity home exit and limited eligibility reverification (e.g., annual) could keep mothers engaged in the foster system to meet their basic needs while also recognizing the inevitable instability as mothers navigate the simultaneous demands of independent living and early motherhood.

FLORIDA INSTITUTE FOR CHILD WELFARE

16

References 1

1

Center for Disease Control (CDC; 2021). Teen birth rate by state. National Center for Health Statistics. https://wonder.cdc.gov

2

2

Kane, J. B., Morgan, S. P., Harris, K. M., & Guilkey, D. K. (2013). The educational consequences of teen childbearing. Demography, 50, 2129–2150.

3

3

Pogarsky, G., Thornberry, T. P., & Lizotte, A. J. (2006). Developmental outcomes for children of young mothers. Journal of Marriage and Family, 68, 332–344.

4

4

Abele, A. E., & Spurk, D. (2011). The dual impact of gender and the influence of timing of parenthood on men’s and women’s career development: Longitudinal findings. International Journal of Behavioral Development, 35, 225–232.

5

5

Combs, K. M., Begun, S., Rinehart, D. J., & Taussig, H. (2018). Pregnancy and childbearing among young adults who experienced foster care. Child Maltreatment, 23, 166–174.

6

6

National Center for Health Statistics (NCHS; 2020). Annual births: Final data reports for the years 1999-2018 and Nonmarital childbearing in the United States, 1940-1999. Available from http://www.cdc.gov/nchs/births.htm

7

7

Perper, K., Peterson, K., Manlove, J. (2010). Diploma attainment among teen mothers: Child trends, Fact sheet publication #2010-01. Washington, DC: Child Trends.

8

8

Berzin, S. C., & De Marco, A. C. (2010). Understanding the impact of poverty on critical events in emerging adulthood. Youth & Society, 42, 278–300.

9

9

Penman-Aguilar, A., Carter, M., Snead, M. C., & Kourtis, A. P. (2013). Socioeconomic disadvantage as a social determinant of teen childbearing in the US. Public Health Reports, 128(Suppl 1), 5-22.

10

10 Livingston, G., & Thomas, D. (2019). Why is the teen birth rate falling? Washington DC: Pew Research Center.

11

11 Hoffman, S.D. (2008). Kids having kids: Economic costs and social consequences of teen pregnancy. Washington, DC: The Urban Institute Press.

12

12 Paranjothy, S., Broughton, H. K., Adappa, R., & Fone, D. (2009). Teenage pregnancy: Who suffers? Archives of Disease in Childhood, 94, 239–245.

13

14

15

16

17

18

19

20 21

22

23

24

25

26

13 National Academies of Sciences, Engineering and Medicine (NASEM; 2020). Promoting positive adolescent health behaviors and outcomes: Thriving in the 21st century. Washington, DC: The National Academies Press.

14 Kim, H., Wildeman, C., Jonson-Reid, M., & Drake, B. (2017). Lifetime prevalence of investigating child maltreatment among US children. American Journal of Public Health, 107, 274–280.

15 Wildeman, C., & Emanuel, N. (2014). Cumulative risks of foster care placement by age 18 for U.S. children, 2000–2011. PLoS One, 9(3), e92785. https://doi.org/10.1371/ journal. pone.0092 16 Putnam-Hornstein, E., & King, B. (2014). Cumulative teen birth rates among girls in foster care at age 17: An analysis of linked birth and child protection records from California. Child Abuse & Neglect, 38, 698–705.

17 Dworsky, A., & Courtney, M.E. (2010). The risk of teenage pregnancy among transitioning foster youth: Implications for extending care beyond age 18.

Children and Youth Services Review, 32, 1351-1356.

18 Shpiegel, S., Cascardi, M., & Dineen, M. (2017). A social ecology analysis of childbirth among females emancipating from foster care. Journal of Adolescent Health, 60, 563–569.

19 King, B., Putnam-Hornstein, E., Cederbaum, J. A., & Needell, B. (2014). A cross-sectional examination of birth rates among adolescent girls in foster care. Children and Youth Services Review, 36, 179–186.

20 Dworsky, A. (2015). Child welfare services involvement among the children of young parents in foster care. Child Abuse & Neglect, 45, 68-79.

21 Font, S. A., Cancian, M., & Berger, L. M. (2019). Prevalence and risk factors for early motherhood among low-income, maltreated, and foster youth.

Demography, 56, 261-284.

22 Radey, M., Schelbe, L., McWey, L. M., Holtrop, K., & Canto, A. I. (2016). “It's really overwhelming”: Parent and service provider perspectives of parents aging out of foster care. Children and Youth Services Review, 67, 1-10.

23 Hulsey, L. K., Wood, R. G., & Rangarajan, A. (2005). Implementation of maternity group home programs: Serving pregnant and parenting teens in a residential setting. US Department of Health & Human Services. https://aspe.hhs.gov/report/implementation-maternity-group-home-programsserving-pregnant-and-parenting-teens-residential-setting 24 Florida Department of Children and Families (DCF; 2013). Response to the Independent Living Services Advisory Council 2013 Annual Report.

Retrieved March 17, 2021 from https://www.myflfamilies.com/service-programs/child-welfare/lmr/docs/2013LMRs/2013%20ILSAC%20Report%20 final.pdf 25 Peters, C. M., Dworsky, A., Courtney, M. E., & Pollack, H. (2009). Extending foster care to age 21: Weighing the costs to government against the benefits to youth. Chicago: Chapin Hall at the University of Chicago. Available: http://www.maac4kids.org/empowerMEnt/Chapin%20Hall%20 Issue%20Brief-Extending%20Foster%20Care.pdf 26 NVivo. (2018). NVivo 12 [Software]. Available from http://www.qsrinternational.com

FLORIDA INSTITUTE FOR CHILD WELFARE

17

27

28

29

30

27 Braun, V., & Clarke, V. (2006). Using https://doi.org/10.1191/1478088706qp063oa

thematic

analysis

in

psychology.

Qualitative

Research

in

Psychology,

3(2),

77–101.

28 US Department of Health & Human Services (2016). Early Release of Selected Estimates Based on Data. From the National Health Interview Survey, 2015. Centers for Disease Control. Available at: https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605_11.pdf 29 Annie E. Casey Foundation (2018). Fostering youth transitions: Using data to drive policy and practice decisions. Retrieved from: https://www.aecf.org/ resources/fostering-youth-transitions/ 30 Rosenberg, R., & Abbott, S. (2019.) Supporting older youth beyond age 18: Examining data and trends in extended foster care. Child Trends.

FLORIDA INSTITUTE FOR CHILD WELFARE

18

Appendix Survey Target Population: Mothers with Experience Living in a Maternity Home in Florida Introduction: This is a survey to better understand your current situation and experiences. You will be answering questions about yourself and your child(ren). Try to be as honest as you can. Some questions may be sensitive and hard to answer. Your responses will be kept completely confidential—no one will know your answers. You do not have to answer anything you don’t want to answer.

a. Are you 18 years or older? YES NO (YES stays) b. Have you ever lived at a maternity home in Florida while you were pregnant or parenting? (YES stays) If does not qualify: Thank you for your interest in the study. You do not meet study criteria at the current time.

1a. Please list all of the maternity homes that you have stayed. (text box) 1b. What is your age in years? ___________ (age range 18-40) 2. Describe your ethnicity/race. (Mark all that apply) African American/Black

American Indian

White/Caucasian Asian Hispanic/Latino Multiracial Other (please specify)___________________________________ 3a. Have you ever been in foster care?

YES

NO

(IF NO: Skip to Q6) 3b. IF YES: Are you currently in foster care?

YES

NO

(If YES: Skip to Q4) 3c. If NO: How old were you when you left care? __________years 4. How many total years have you spent in foster care? [if less than one year, write 1] 5. How many foster care placements have you had?

1

2

3

4

FLORIDA INSTITUTE FOR CHILD WELFARE

5

6

7

8

9

10 or more

19

6. Where are you living right now? (Mark all that apply) Alone in apartment/home/dorm

With the parent of my child(ren)

Independent living Maternity home With biological parents

With a partner (not parent of your child(ren))

With foster parents

Group home

With relatives Shelter Other (please explain) __________________________ 7. Have you ever had to live with friends because you didn’t have a place to stay?

YES

NO [If no, got to Q8]

7a. [IF YES] Did this happen at least once after you became a mother?

YES

NO

7b. How old were you the last time that this happened? AGE IN YEARS (acceptable range: 1-40) 7c. Were you familiar with the option of extended foster care at that point in time?

YES

NO

I was never in foster care.

8. Have you ever had to live in a car, in another place not meant for sleep, or on the streets because you didn’t have a place to stay?

YES

NO [If no, got to Q9]

8a. If YES: Did this happen at least once after you became a mother?

YES

NO

8b. How old were you the last time that this happened? AGE IN YEARS 8c. Were you familiar with the option of extended foster care at that point in time?

YES

NO

I was never in foster care.

9. Have you ever exchanged sex for food, money, shelter, or drugs?

YES

NO

The next couple of questions ask about your stay at maternity homes.

10a. How old were you when you first lived at a maternity home? AGE IN YEARS (Range 12-23) 10b. How many different maternity homes did you live in? (Range: 1-20) 10b. How old were you when you left your last maternity home? AGE IN YEARS (check box: still living at maternity home)

FLORIDA INSTITUTE FOR CHILD WELFARE

20

11. What were the circumstances that led to your stay? MARK ALL THAT APPLY It was my foster care placement.

My parent(s) kicked me out of the house.

I wanted help with my pregnancy/baby.

I wanted to be able to stay in school.

I didn’t have anywhere else to go.

My parent(s) decided that the home would be best for me and my baby.

My foster parent(s) decided that the home would be best for me and my baby.

I learned about the opportunity from another agency.

Other: Specify ____________________ 11a. Do you feel like you had a voice in the decision to live at the maternity home?

YES

NO

12. Which of the following services did you receive while living at the home?

Independent living skills Parenting skills Education Child care Counseling/Therapy Medical care Friendship from someone at the home Friendship from someone outside of the home Other (Specify: _______________________) 13. Looking back, how valuable was each of the services from 1 (did not help me at all) to 5 (helped me a whole lot).

(Likert scale will appear for each utilized service in Q12) Did not help at all

(1)

Helped a whole lot

(2)

(3)

(4)

(5)

14. The most helpful part of living in the home was: List utilized services, AND housing, structure/rules, living with other mothers, educational services other specify 15. The most difficult or disappointing part of living in the home was: List all services, housing, structure/rules, living with other mothers, educational services other specify 16. When you left the home, did you feel ready to leave?

YES

NO

16a. At the time, would you have liked to stay in extended foster care?

YES

NO

I was never in foster care.

FLORIDA INSTITUTE FOR CHILD WELFARE

21

17. What did you continue to need after you left the home? (CHECK ALL THAT APPLY) I am still in extended foster care.

Nothing. I was all set.

Housing Structure/rules Independent living skills Parenting skills Friendship from other mothers Education Employment Financial help Access to social services Child care Counseling/Therapy Medication management/Access to medications Medical care Life skills coach Friendship from someone at the home Other: Specify ______________________ 18. What was your living arrangement when you left the maternity home?

Alone in apartment/home/dorm

With the parent of my child(ren)

Independent living

With a partner (not parent of your child(ren))

With biological parents

Group home

With foster parents Shelter With relatives

Still living at maternity home. (PUT AS FIRST OPTION)

Other (please explain) __________________________ The next section asks about your current situation.

19. Are you currently in school?

YES

NO

(IF YES: SKIP to Q19b)

19a. IF NO, are you interested in attending additional schooling at this time? SKIP TO Q20 19b. [If yes] Indicate your current level of study.

High School GED Program Community College Trade/Vocational 4 year university Other (please specify) ______________________

FLORIDA INSTITUTE FOR CHILD WELFARE

22

20. What is the highest level of education you have completed?

High school - Grade __________ High School Completed GED Community College Trade/Vocational 4 year university Other ________________ 21. Are you employed right now? (Circle One) YES

NO

(IF NO: Skip to 21e)

21a. If YES How many hours do you typically work per week? ______ hours 21b. What is your hourly wage? ______ dollars (Range $1-$50) 21c. How many months have you been with your current employer? _______ months 21d. What category best fits your job?

Office job Restaurant Retail/Sales Child care Other (Please specify):________________ 21e. What arrangement do you have for your child[ren] while you work and complete school?

With child[ren]’s father

With another relative

Childcare center

School/After school program

In-home childcare provider

I do not have childcare

I do not need childcare 21. How would you rate your health? (Poor to Excellent left to right) Excellent

Very Good

Good

Fair

Poor

(4)

(3)

(2)

(1)

Very Good

Good

Fair

Poor

(4)

(3)

(2)

(1)

(5) 21a. Are you currently pregnant?

YES

NO

22. How would you rate your mental health?

Excellent

(5)

23. Are you currently in a romantic relationship?

YES

NO

(IF NO: go to Q25)

24. [If yes] Is the romantic relationship with the parent of your child (or one of your children)?

YES

NO

FLORIDA INSTITUTE FOR CHILD WELFARE

23

25. Please fill out the following with information about your child(ren): Youngest Child, then Child 2 (starting with child 2: Option: I do not have any more children. Skip to 25g. up to Child 10 a.

Age (in years)

b.

Gender (Male/Female)

c.

Do you live with your child?

YES d.

NO

Your relationship with that child’s father Excellent

Very Good

Good

Fair

Poor

(4)

(3)

(2)

(1)

Very Good

Good

Fair

Poor

(4)

(3)

(2)

(1)

Very Good

Good

Fair

Poor

(4)

(3)

(2)

(1)

(5)

e.

Child’s physical health Excellent

(5)

f.

Child’s behavior Excellent

(5) ONLY ASK ONCE g.

Has your child or any of your children ever been involved in a child protective services/DCF investigation?

YES h.

NO

Has your child or any of your children ever been removed from your care?

YES

NO

26a. We want to get a sense of your ability to depend on family and friends. Please indicate if you have no one, some, or enough people to support you in each area: No one

(0)

Some people

Enough people

(1)

(2)

Put scale to right all on one screen

A.

Someone to listen to your problems

B.

Has your back/ trusted friend

C.

Someone to do small favors

D.

Someone to take care of your child/children

E.

Someone to loan you $100

FLORIDA INSTITUTE FOR CHILD WELFARE

24

26b. Now we want to get a sense of how many demands you face from your family and friends. Please indicate if you have too few, the right amount, or too many people asking for your support in each area: Too few

Right amount

Too many

(1)

(2)

(0) A.

To listen to their problems

B.

To do small favors

C.

To take care of their child/children

D.

To loan them money

26c. Do you need help with legal assistance right now, such as with pending criminal charges or child custody?

YES

NO

27. We want to get a sense of how you’ve managed to survive financially in the last year.

27a. Please indicate which of the following sources provide you with benefits: (CHECK ALL THAT APPLY) Temporary Assistance for Needy Families (TANF) or cash welfare Supplemental Nutrition Assistance Program (SNAP) or food stamps Nutrition Program for Women, Infants, and Children (WIC) Medicaid Housing rental assistance or Section 8 Social Security Disability Other: Specify 27b. Please indicate your experience of any of the following because there wasn’t enough money in the last 12 months: (YES/NO for each) A. Receive free food or meals?

B. Did your child/children go hungry?

C. Did you go hungry?

D. Did you not pay the full amount of rent or mortgage payments?

E. Were you evicted from your home or apartment for not paying the rent or mortgage?

F. Did you not pay the full amount of a gas, oil, or electricity bill?

G. Was service turned off by the gas or electric company, or did the company not deliver oil?

H. Was service disconnected by the telephone/cell phone company because payments were not made?

I. Did you borrow money from friends or family to help pay bills?

J. Did you move in with other people even for a little while because of financial problems?

K. Did you stay at a shelter, in an abandoned building, an automobile, or any other place not meant for regular housing even for one night?

L. Was there anyone in your household who needed to see a doctor or go to the hospital but couldn’t go because of the cost?

Please write below anything else you would like to add that might be important for us to know about you or your experiences.

(Text box)

FLORIDA INSTITUTE FOR CHILD WELFARE

25

In order to pay you $10, we need your phone number and CashApp id. Please provide below: Phone number (with right format) CashApp id: We also would like to talk with you about your experiences. We will pay you $25 for an interview. Interviews last about an hour. Are you interested?

YES

NO

(If no: skip to thank you)

If Yes: Please identify three days and times that you are available for an interview.

NOTE: Please list days and times at least 48 hours from now.

Thank you for your time. We will send your compensation within 48 hours.

FLORIDA INSTITUTE FOR CHILD WELFARE

26