Theme 2: Tension Between Useful Programs and Structured Delivery

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., 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

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 “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