2003 ORGANIZATIONAL HERO
Homeless Prenatal Program
San Francisco, California
The Homeless Prenatal Program (HPP), an independent nonprofit organization under the leadership of Martha Ryan, R.N.P., M.P.H. '89, provides a continuum of care and support to homeless pregnant, and/or parenting women with the goal of ensuring healthy birth outcomes and an enhanced quality of life for each woman and her family.
The program searches out homeless women who are pregnant or new mothers to provide them with prenatal education and health care, substance abuse treatment referrals, housing assistance, postpartum care, and counseling. Other services include case management, advocacy and policy shaping, and training to become community health workers.
HPP recognizes that these women need much more than prenatal care. Multiple barriers prevent clients from obtaining medical care and other services needed to achieve a healthy birth and break the cycle of homelessness. A coordinated, multidisciplinary approach is used to assist each woman in regaining physical and psychological stability.
Risk factors routinely addressed include pregnancy, low birth weight and prematurity, addiction, homelessness, poverty, and partner and street violence. The program leverages pregnancy and new motherhood to transform desperation, alienation and dependency into new lives for the mothers and children.
Founded in 1989, the program has grown from serving 72 families with a part-time staff of three to serving more than 1,600 families with a staff of 25. Initial funding for the program was a result of a grant proposal written as part of a class assignment while Ms. Ryan was a graduate student at UC Berkeley's School of Public Health.
A believer in peer-delivered health care, Ryan established a system of community outreach and education that enlists the help of former clients, who, once trained, become effective community healthcare providers as well as empowered, self-sufficient parents. Today, two-thirds of HPP's staff are former clients. They are typically the first to meet with a new client and are living symbols of hope in breaking cycles of poverty, incarceration, domestic violence, and despair.
Award Presenter
Sandra R. Hernandez, M.D., is chief executive officer of The San Francisco Foundation, one of the largest community foundations in the nation. She has served on numerous national, state, and local boards and committees, including former President Clinton's Advisory Commission on Consumer Protection Quality in the Healthcare Industry and The Pew Commission on Environmental Health. From 1994-1997 Dr. Hernandez was public health director for the City and County of San Francisco, which was honored in 2001 as the School of Public Health's organizational public health hero for its leadership in combating the AIDS epidemic.The Challenge: Homelessness and the Health of Women and Children
Up to 600,000 men, women, and children go homeless every night in the United States. Homelessness is not a new problem—it has been a constant presence in American cities, towns, and rural areas for many years, although during the recession of 1981-1982, it was identified as a national issue for the first time since the Great Depression.
The data demonstrate that homeless persons have high levels of poverty, illness, and disabilities and typically they do not have health insurance. For example, in a 2001 survey in Los Angeles, it was noted that the majority of women (60 percent) had been homeless for one year or more during their lifetime; over half had no family or friends which led to social isolation; health problems included physical disabilities, inability to fill prescriptions, incidences of substance abuse, and 41 percent were affected by mental illness.
The challenge for local communities is to find ways to provide a continuum of care and support for homeless, pregnant, and/or parenting women so that they and their children will have improved health status and quality of life and will develop the personal tools needed to break their cycle of homelessness.
The School of Public Health Responds
The School of Public Health at UC Berkeley has had a long-standing, progressive teaching program in Maternal and Child Health, which since 1955 has prepared over 1,100 specialists in maternal and child health with a strong research and professional practice orientation.
Dedicated to improving the health of women, infants, children, adolescents, and families, the program has, since its inception with Professor Emerita Jessie Bierman, understood that the physical health of women and children often depends on the social and environmental aspects of their lives. As Dr. Bierman noted, "…when you come down to it, so many of the problems, real problems, that are persistent in health of children, as well as the rest of the population, are determined by people outside the public health professions: the politicians, the farmers, the economics of a country, and also the lack of real concerted study of what it is that human beings have to have in order to meet their needs."
Today faculty and students continue to carry on research that addresses problems of pregnant women and their children, examining maternal weight gain, nutrition and pregnancy outcome, maternal postpartum health, exposure to environmental reproductive and perinatal hazards, access to health care for disadvantaged populations, family planning, and AIDS prevention strategies.
In 1989 students working in the School's five-year UC Berkeley/UCSF Joint Medical Program started the Suitcase Clinic, a nonprofit agency that offers free services to Bay Area homeless and low income communities. The organization is run on an all-volunteer basis by UC Berkeley undergraduates, medical and optometry students and volunteer professionals in a number of fields. Seventy percent of their clients are homeless. On a typical evening, the clinic cares for 20-40 clients. In addition to a general drop-in clinic providing holistic care, the Suitcase Clinic also has a special Women's Clinic, meeting the specific needs of low-income and homeless women and a Youth Clinic targeting homeless youth.
To help all parents and caregivers, the School's Center for Community Wellness has developed a Parents Guide, which is filled with essential information and resources for the early years, when research shows that the emotional, physical and intellectual environment has a major impact on how children’s brains develop. Included in the guide are resources for prenatal services, including food, which are available for free or at low cost to women with limited incomes.
