Mothers’ Helpers

AN FRANCISCO —  Bucking a national trend to get tough with welfare mothers, a nurse and a onetime labor organizer are teaming to lavish care and patience on women they say society is too quick to write off.

“We never give up,” said Martha Ryan, a nurse who once planned to spend her life running community health projects in the Third World.

Instead, she founded and directs San Francisco’s Homeless Prenatal Care program; a year and a half after its 1989 launch, she was joined by social worker Vivian Harris, who once worked organizing farm workers.

Unique in California, the privately financed program seeks out and helps homeless mothers get off the street and into rehabilitation. Eventually, some moms are trained to go back into the community as health workers and counselors.

Ryan’s operating principle is simple: A woman is most willing to change her life when she is pregnant. What makes the program unusual is its offer of a one-stop aid station.

“I have never met a mom who wanted to hurt her baby,” Ryan said. Given enough support, even the most seemingly hopeless, drug-addicted homeless women can become good mothers, she insists.

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Meet Tammy, who grew up in foster homes and found herself homeless and pregnant when she was 11. Today, off drugs and mothering an 18-month-old daughter, Tammy credits Ryan and her staff with helping her change her life.

“They are my family,” said Tammy, who declined to give her last name.

Seated in the program’s Market Street drop-in center, Tammy spoke as her daughter, Anika, played at her feet. The little girl, her hair divided into tiny braids decorated with brightly colored ponytail rings, is the first of Tammy’s nine children not to be given up to the state’s social welfare system.

“This is the only baby I ever had that was born clean and lived with me,” Tammy said, scooping her daughter into her arms. “They fought for me. Martha stuck her neck out for me.”

Last year, Prenatal Care, with a staff of 14 and a budget of $450,000, served more than 500 women and their children. Many are longtime welfare recipients. Ninety percent are single. Most have substance abuse problems.

The program seeks out women in trouble, helping many into shelters, or guiding them to subsidized housing or residential treatment programs, as appropriate. They help people while they wait to enter treatment programs. The program handles referrals for women who need mental health care.

And it helps women navigate the social welfare bureaucracy by making the phone calls, writing the letters, filling out the forms.

Ryan does routine prenatal checkups and nutritional counseling, while other staff members may accompany women when they meet with social workers or appear in family court.

In Tammy’s case, Ryan, Harris and other staffers helped her end her crack addiction and stay clean through pregnancy. They helped her find an apartment and taught her mothering skills. They went to court with her and helped her convince a judge that she was a fit mother.

“This staff here is mostly recovering addicts,” Tammy said. “They have been through what you’ve been through. They help you if you want to be helped. They just don’t leave you alone.”

Because of who they once were, the women on her staff are “the perfect role models” for those they counsel, Ryan said.

“My name is Leila and I had a good week and a good weekend,” said one outreach worker, opening a recent support group session for mothers at the program’s drop-in center.

Leila (not her real name) is 36, the mother of four and a recovering crack addict. She credits Prenatal Care with helping her end her addiction, get off the welfare rolls, and move her children out of public housing and into an apartment in a safe neighborhood.

Now, she said, she is helping women battle the same demons she fought.

“I’ve been waiting all week to get back here so that I can get a little support,” said Gwen, a rail-thin woman. She’s living in a homeless shelter for recovering addicts and is trying to kick drugs. “I come here and it makes me hold on for the rest of the week.”

Ryan predicts that reforms in welfare laws aimed at ending long-term dependency on public aid will drive more women to the center in search of help.

“People are already frantic. We are already getting more people in here, afraid of what will happen to them when they get cut off,” she said.

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As families begin seeing support from the state dry up, the need for more privately financed programs such as Ryan’s is sure to increase, said Eloise Anderson, director of California’s Social Services Department.

“The larger citizenry is very angry about women who are having children who they cannot take care of,” said Anderson, whose outspoken criticism of welfare programs has drawn blistering attacks from program supporters. “The general populace is not sympathetic. . . .

“But the one thing we know is that the woman who finds herself homeless and drug-addicted, whose child is taken from her, that woman will replace that child because of a psychological need. And if you take the next one, she will replace that child.

“In the long term, if we are going to protect the child, we have got to deal with the parent issues,” Anderson said. “It is good that somebody is doing that.”

Ryan, Harris and their staff actively search the city’s shelters, visit its welfare offices and comb its streets looking for pregnant women.

“We go to food lines, we go to street corners, we go to the AFDC offices on the first and the 15th of the month, when they are handing out checks,” said social worker Nancy Frappier, who coordinates Prenatal Care’s follow-up program for mothers of newborns. “We have a whole schedule of routes, places to look for women.”

Some days, Frappier acknowledged, “it is intense.” There are women who time and again drop out of treatment programs, go back to the streets, lose yet another child to the welfare system.

“But you look around at the staff, at where some of these women have come from, and you know you aren’t just beating your head against the wall.”

After training community health workers in Somalia and Sudan in the 1980s, it seemed natural to do the same in her home town, Ryan said. The idea of targeting homeless pregnant women grew out of volunteer nursing work Ryan did at a San Francisco shelter for homeless families in 1989.

To her surprise, Ryan said, she found no health care program specifically aimed at homeless, pregnant mothers. She wrote a proposal to a foundation for a grant and in the fall of 1989, got it. Ever since, the program has existed on grants from 14 foundations and individuals, as well as fund-raising events.

“Moms were having their kids taken away from them, just because they were homeless,” Ryan said. “I thought something needed to be done.”

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For Harris, work at the Prenatal Center is a political statement--social work with an attitude.

“I never wanted to be a social worker,” Harris said. “I thought that was not a politically correct thing to do. But this program is about empowering women, about helping them fight back.”

She and many of her co-workers argue that the system is biased against poor women, especially poor women of color.

“What usually happens is, we end up in an adversarial relationship with Child Protective Services,” said Harris, who organized farm workers in the 1960s.

It is that aspect of relentless advocacy that sometimes gives pause to health and social welfare officials who otherwise have nothing but praise for Prenatal Care.

“They’re on the front line. They’re out there, dealing with women who are terrified of the system, and I think they do a terrific job,” said Lynda Frattaroli, a senior social worker at San Francisco General Hospital.

But occasionally, Frattaroli said, she has clashed with Prenatal Care staff members over the wisdom of discharging a newborn with its mother. Sometimes, she said, the staff members are overly optimistic about a mother’s ability to care for a child, and sometimes overly critical of the social welfare system’s decision to take a baby.

“We have to make calls on the side of the safety of the child,” said William Bettencourt, an administrator with San Francisco’s Human Services Department dealing with family and children services.

“It’s a horrible thing when you have to take a child, because people love their kids, but sometimes it has to be done.”

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The drop-in center is crowded five days a week with mothers, babies, toddlers and, sometimes, fathers, requesting everything from bus fare to help finding a job. Some come with specific needs. Others just like to hang out and chat.

From a warren of offices in need of fresh paint and new carpets, staffers dole out disposable diapers, boxes of food, clothes and cosmetics. Walls are plastered with public health posters and snapshots of clients and their children, and floors are littered with donated toys.

Boxes of donated disposable diapers, a tray of donated lipsticks, stuffed animals and stacks of paperwork leave just enough space for Ryan to squeeze behind her desk. Women continuously walk in, rummage, show her their babies and detail their latest setbacks.

Ryan listens, even as she dials one social welfare agency or another, badgering bureaucrats to come up with housing, make space in a rehabilitation program, or, in one woman’s case, ensure that she can have a state-funded tubal ligation after the delivery of her seventh child.

“I had a mom just come in and crash on my couch one day,” Harris said. “So I just saw my clients in the stairwell. They didn’t mind. And when Martha walked by and saw what was going on, she said: ‘I like this.’ ”

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A One-Stop Approach

Organizers say that what distinguishes the program is its approach in reaching out to pregnant women in trouble and following through on a variety of fronts. Among the services:

* A drop-in center on Market Street.

* Information about drug- and alcohol-abuse programs.

* Shelter referrals and placement.

* Residential treatment program referrals.

* Welfare program information.

* Prenatal physical examinations and referrals.

* Job information.

* Specific needs, such as diapers, toys, clothing.

* Help dealing with government agencies.