The Real Cost of Prisons Weblog

Her euphoria may be difficult to comprehend. The woman is homeless, subsisting on $342 a month in government checks and battling what she calls a “garbage can” of drug addictions that include methamphetamine, marijuana and crack cocaine.

But she has made a soft landing at one of San Francisco’s best-kept secrets: the Homeless Prenatal Program, a nonprofit center created 19 years ago that could help turn her and her baby’s lives around.

The Homeless Prenatal Program has evolved from its original mission of helping destitute women give birth to and then keep healthy babies to become a resource dedicated to stabilizing entire families. It offers what this particular woman excitedly described here as “a plethora of services” for mental health, housing and substance abuse problems. It combines those with an array of alternative health approaches not usually available to the poor, like yoga, massage and chiropractic treatments.

“People call me a reckless optimist, and you have to be to do this kind of work,” said Martha Ryan, founder and executive director of the Homeless Prenatal Program. “But I see enough success. I see people really able to turn their lives around, and I see their children be able to move forward and have a different life.”

The program sees 3,000 people a year, 91 percent of them women. Twenty people arrive each day for an intake session, referred by other agencies or through word on the street. Sixty percent of the clients are homeless, and the most pressing problem, Ms. Ryan said, is finding safe, affordable housing, especially for women who are at risk of losing their children to Child Protective Services.

But Ms. Ryan said the real common denominator was poverty and abuse as a child. More shocking than the sheer numbers, she added, was that the cycle keeps going. Children of women she treated 18 years ago are now clients, pregnant or with children and living in poverty like their mothers.

Half of the 53 staff members have been homeless, abused or drug addicted themselves. As part of turning their lives around, they trained as community health workers in a 12-month program that teaches office and outreach skills. Some find permanent work at the center. Others move on to nonprofit groups.

Here, working out of offices decorated with family pictures and their children’s drawings, the women speak a shared language with those whose lives have hit bottom.

“There’s a sense that people who don’t have lots of money or don’t have certain requirements can’t take care of their children — but that’s just not the case,” said Laure McElroy, a community health worker whose son was born two months after she finished a methadone program. “I have hope for everyone who comes through the door, because I know as a parent you have to make things work. You just have to.”

One morning, Ms. McElroy started a file for a 41-year-old drug-addicted homeless woman who is pregnant with her second child. Five years ago, her newborn son had been put into foster care and later adopted, and she was terrified the authorities would take this baby, too. Ms. McElroy gently guided her through the forms and arranged for a follow-up visit with a case manager to sort out housing, health and welfare issues.

But the woman didn’t return for the appointment. When someone from the program called, looking for her at the mental health clinic where she receives two medicines for depression, her case manager said she had not come back recently for the medication.

“That’s the trick, how do you engage someone who is out there?” Ms. Ryan said. “It’s all about creating trust with somebody, having them come in here and begin to take care of themselves. It doesn’t always work. But if you save one, you’ve paid for the program.”

Ms. Ryan, a family nurse practitioner specializing in maternal and child care, got the idea for a program working in a family shelter while finishing her master’s degree in public health at the University of California, Berkeley, in 1988. She had spent years nursing at refugee camps in Somalia, Uganda and Sudan and thought she would return to that work. But in San Francisco she found that pregnant homeless women received no care and had nowhere to go until they turned up at the county hospital to give birth.

“And everybody said, ‘Wow, that’s terrible,’ and nobody did anything,” Ms. Ryan said. She took a grant-writing class and a year later received her first award, for $62,000.

“I knew I wouldn’t be going back to Africa,” she said. “I’d found the third world in America.”

According to the National Center on Family Homelessness, an estimated 3.5 million people will experience homelessness every year nationwide. Forty percent will be in families. Eight percent of poor families will become homeless at least once a year.

The center reports that among homeless women under age 50, 8 percent reported being pregnant at the time that they were homeless. Ninety-two percent of homeless women say they had been physically or sexually abused severely either in childhood or adulthood.

The Homeless Prenatal Program’s statistics are impressive. Of the 115 births to clients each year, 92 percent of the babies are of normal weight, and 95 percent are drug free. Last year, 360 families moved into permanent housing. Ms. Ryan said she recognized early on that pregnancy was the perfect time to catch a homeless client, but that the major work began after the baby was born. So, to keep women from feeling they must be pregnant to receive services, her team devised a program to address the family.

Computer and language classes and tax preparation and Narcotics Anonymous sessions are provided. Housing, mental health and immigration problems are addressed, and child care and art classes are available. The San Francisco Food Bank delivers more than 1,000 pounds of produce every Monday morning.

Yoga and prenatal classes provide consistency to the women who enroll in eight-week sessions, which culminate in a baby shower. The women appear preoccupied, exhausted and tense. But laughter comes as the yoga teacher tries to describe Kegel exercises in Spanglish. And when she dims the lights to sing a chant, her voice provides a moment of relaxation for the women, some of whom don’t know where they will sleep.

The program’s annual budget is $4 million. About half comes from the City of San Francisco. Ms. Ryan says she has applied for state and federal money but never received any, which mystifies her. (She has hired two grant writers to work on that.) Foundations provide 40 percent of the money. But there is a 10 percent gap, so Ms. Ryan must find more private donors. She is considering holding lunches at the offices, which are in the Potrero District. The building vibrates with life and hope, and Ms. Ryan will hold the deed when she pays off the mortgage in a year.

“I really believe that some of us are born with a lot of opportunities, and others with absolutely none,” Ms. Ryan said, adding: “If a hundred people come in here, they might not move out of poverty, but they might move into a little better life for themselves and for their children. If they are kinder to their children and believe more in themselves, then that’s worth it.”

http://www.nytimes.com/2007/11/12/giving/12PRENATAL.html?pagewanted=print

Copyright 2007 The New York Times Company