Implications and Recommendations

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 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),

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.