'Pre to Three' helps families

"I had to quit my job, it was just too much," Ruiz said.

"I thought I needed to be getting more than three hours of sleep at night."

She currently lives in a two-bedroom apartment in Redwood City with her mother, high school-aged brother, and her sister who has a two-year-old daughter. The landlord has raised the rent twice in the past year.

But there is one thing that Ruiz doesn't have to worry about -- health care for herself and her expected baby girl. She has already decided to name the baby Ariana.

Ruiz is a client of the Prenatal to Three Initiative of the San Mateo County Health Services Agency, or "Pre-to-Three," a program available to low-income families with pregnancies or newborn children covered by Medi-Cal throughout the county.

"They've got my mind okay," Ruiz said. "They help me relax. They have helped me with everything. Everything I've asked for they've helped me with."

The program's key components include home visitation, parenting support groups and education classes, central registration and referral of children, education and advice on parenting, and providing referrals for other community help groups.

Pre-to-Three nurses and community workers also visit pregnant women in the Redwood City jail and answer questions the women have.

"We talk about their pregnancy and decreasing their stress, because stress causes a lot of pre-term labors," said public health nurse, Nancy Rose. She added that almost all of the women they visit in the jails are there on drug-related charges.

Pre-to-Three has been in existence since 1996 and last year serviced 23,000 clients with home visits. Many people eligible for the program don't even know about it, Rose said.

The services for the program are primarily billed to Medi-Cal, but the program also receives funding from various charities and foundations.

"We mostly assess our clients for health, psychological and social problems -- and depending on their needs we make a plan and refer them to various services," Rose said.

After the initial visit, nurses follow up with their clients on a monthly basis, and they can continue to make home visits until the baby is three years old. Nurses do not provide medical care, but they link the client to services.

A typical client of Pre-to-Three, Rose said, is someone who is a recent immigrant, Spanish-speaking, married -- often with children, living in poverty and socially isolated. She added that because of the housing crunch in the county, many people are much worse off here than in other parts of California or the country.

Rose, who was previously a public health nurse in Denver, said the clientele in San Mateo County have several unique needs -- and most of them stem from their limited English skills. Three quarters of all Medi-Cal births are to Latino families. Rose said there are also a lot of Tongan women and children in the program.

"There are a lot of women with low literacy rates. There are also low breast feeding rates and high poverty levels," Rose said.

"People are spending $1200 to $1300 a month to live in a tiny apartment when they only make $1500 a month," Rose said. "And there is usually a family per bedroom."

Often the homes she visits are in terrible condition and have up to 27 people living in them.

"The kitchens are never clean, there are mice and cockroaches and a lot of tuberculosis cases," Rose said. "It's so crowded, if one person gets sick, everyone's sick and often there's no heat."

Rose has noted that in the past eight months she has worked for the program, close to one-half of all the clients she has been referred to are leaving the county.

"They used to go to Stockton and Sacramento, but now a lot of them are actually leaving the state," Rose said. "They have to go somewhere where it's more livable."

Another woman in the program, Charlotte Ropp, lives in a small second-floor Redwood City apartment with her two sons.

The space is cramped and the living room is crowded with car seats, a baby walker, and a crib full of toys and blankets. The heavy shades on the windows keep out most of the light as voices from the TV soap operas murmur in the background.

One of the two small couches -- both covered with '70s-patterned sheets -- is the bed for her 17-year-old son. Ropp shares a room with Randy, her 11-month-old son.

"It's hard [for many of the clients] because their credit is usually not good and the list for Section Eight housing [subsidized housing for low-income people] is closed and it has a one year wait list," Rose said.

Once people wait for and receive their vouchers they have 120 days to find a place where a landlord will accept the voucher. "And no one will accept [the voucher]," Rose added. "It's a huge problem."

So for now, Ropp's apartment will have to do -- roaches and all.

Rose has been visiting with Ropp and her son Randy ever since he was born and visits them about once or twice a month.

Yesterday, Rose and Manuel Villacorta, a public health nutritionist for Pre-to-3, visited with Ropp and Randy.

Randy was having difficulty digesting baby formula so Villacorta started feeding him a pre-digested formula. Now that he's older, Villacorta slowly wants to take Randy off the pre-digested formula.

Villacorta gave Ropp a day-by-day guide of how to feed Randy and asked her to chart everything he eats for a few days.

Rose said Randy is the happiest baby she visits. "Whatever Charlotte does -- it's good, because he is a happy baby," she said. "You can really tell the difference with the stay-at-home moms."

Ropp said the program has helped her immensely. "They have helped be with being a mother again," Ropp said. "They've helped with encouraging me and supporting me. I love when they come out here, I wish they came every day."

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