Family policy programs and their effectiveness in supporting children

Prenatal Care for the Homeless

Families and children in the context of social change

The Homeless Prenatal Program

The goal of the Homeless Prenatal Program (HPP) in San Francisco is to break the cycle of childhood poverty by providing a variety of services to homeless families (Homeless Prenatal Program, 2010). The original and still primary service offered is prenatal and parenting support, in addition to housing assistance, training in personal finance and computer skills, mental health services and referrals, financial emergency assistance, and substance abuse counseling. The historical goal has been to reach out to homeless women who have become pregnant or are the head of a family and provide the relevant services and referrals to stabilize and improve their situations and thus ensure continuity of perinatal care. The prenatal care consists of on-site care and classes in prenatal self-care. Perinatal care services include home visits to help mothers provide for the infant's needs, infant wellness evaluations, and motivational support.

An important program developed within HPP was the community health worker training program, which provides homeless women employment opportunities after completion of training. Some of these women have been hired by HPP, thereby providing HPP with the skills and knowledge necessary to go out into the streets and shelters, and find the women and families who need their services (Diehl, 2004, p. 7-8). These former clients-turned-health workers also gave HPP the necessary insight for forming trusting relationships with homeless women that would otherwise avoid government programs.

Measures of Success

Several measures are used to assess the effectiveness of prenatal care and the primary ones are birth weight and pre-term birth rates. For example, when a sample of women who had given birth while homeless were surveyed in the Los Angeles area, it was found that babies born to these women were almost three times more likely to have a low birth rate and almost twice as likely to be born pre-term, when compared to national norms (Stein, Lu, and Gelberg, 2000). Some of the main contributing factors identified in the study were substance abuse, ethnicity, income, and severity of their homelessness experience (during 1st trimester, and lifetime duration and frequency). A survey of homeless women who had given birth in Northwest Florida revealed almost 40% had used alcohol and/or drugs during gestation (Bloom, Bednarzyk, Devitt, Renault, Teaman, and Van Loock, 2004).

Since beginning to keep records of their clients in 1992, HPP has helped bring into this world over 2,700 babies. Of these, 90% had normal birth weights and 95.5% were drug-free (Homeless Prenatal Program, 2010). The low birth weight outcome is very close to the national average of 6.1% (Stein, Lu, and Gelberg, 2000), so by this measure at least, HPP appears to be very successful. The average prevalence of drug use during pregnancy is estimated to be approximately 11% in urban areas and for a rural area in Minnesota, anonymous testing of urine samples revealed a 3.9% positive rate at the time of the first prenatal visit (Matti and Caspersen, 1993, p. 512). The 95.5% drug-free birth rate achieved by HPP appears to be well within national norms for urban populations and may even be lower.