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A social service program on the brink

Home visiting helps at-risk mothers be better parents. But the program remains in jeopardy despite the Illinois stopgap budget deal.


Two-and-a-half-year-old Noah in a playlot behind the Metropolitan Family Services office. Noah and his family receive home visits from the agency. - SUNSHINE TUCKER
  • Sunshine Tucker
  • Two-and-a-half-year-old Noah in a playlot behind the Metropolitan Family Services office. Noah and his family receive home visits from the agency.

Even before Noah was born, it was clear his early years would be difficult. An ultrasound when his mother was pregnant showed two holes in his heart and other cardiac abnormalities. He stayed in the hospital after his birth, in November 2013, and had his first heart surgery two weeks later. Recovery from that operation kept him in the hospital until he was three months old. After two months at home, he had to return to the hospital for a second heart surgery.

The heart defects weren't Noah's only challenges. He was born into a low-income family that lives in Auburn-Gresham. His mother, Kristin, had had her own arduous childhood. Kristin's parents were drug addicts and she'd been neglected, according to her grandmother, Susan. When Kristin was five, Susan assumed custody of her. Kristin had therapy for developmental delays and behavioral problems, and attended schools for students with learning disabilities. She was 26 and still living with her grandmother when she got pregnant with Noah. He's her only child. It was clear from early on that Susan, who's now 73, would play a central role in his care.

Noah's father is also learning disabled; he and Kristin met in school. They work part-time as baggers at different Jewels. He visits his son occasionally.

A social worker at the hospital where Noah was born recognized that the family needed help, and connected Kristin and Susan with a home-visiting program offered by a nonprofit agency, Metropolitan Family Services.

In home-visiting programs, early child development specialists typically visit first-time mothers every two weeks during pregnancy, weekly in the child's first three years, and once or twice a month after that until the child is school-age. The mothers have low incomes; most are also unmarried, and many are in their teens. Research indicates that children of such mothers are at increased risk of being abused or neglected. The home visitors make sure their clients get good prenatal care, prepare them for labor and delivery, and coach them in child care. They ensure that immunizations are received on time, and they screen their clients' children for disabilities, so that kids in need of special therapies receive them early, when they're most likely to make a difference.

From the time Noah was five months old, his home visitor has been Lorena Sanchez. (The family had another home visitor originally, but her job position changed and Sanchez stepped in.) Kristin and Susan don't always see eye to eye on matters related to Noah's care—but both say Sanchez's help has been invaluable.

Noah was slow to crawl and walk, and his cognitive and speech development have also lagged. (Besides the visits from Sanchez, Noah is seen by developmental, speech, and physical therapists.) Susan appreciates how Sanchez has mediated conflicts between her and Kristin regarding Noah. "We get a chance to vent without an argument," she says. Sanchez is "compassionate, but also firm when she needs to be. I know she always has Noah's and Kristin's interests at heart."

Kristin says Sanchez "is caring and understanding, and she's given us a lot of good advice." She too is grateful that Sanchez lets her and her grandmother air their grievances with each other. "Then she tells us we have to come together to raise Noah."

In Illinois, about 20,000 families typically receive home-visiting services. Like other social services in Illinois, home-visiting programs have been in jeopardy this year. Governor Bruce Rauner and the legislature weren't able to agree on a budget in 2015, so the state operated without one. Many home-visiting programs are primarily federally funded, and they were less affected. But agencies such as Metropolitan Family Services, whose programs were funded by the state's Department of Human Services, were in the same boat as innumerable other social service agencies in Illinois: they were providing services without being paid for them.

Last spring the state agreed to pay Metropolitan $472,000 for what then was the coming fiscal year—July 1, 2015 through June 30, 2016—for the home-visiting program Noah's family is a part of, which is known as Healthy Families. Metropolitan also had a $580,000 contract to provide home-visiting services for the state through a separate program managed by another nonprofit, the Ounce of Prevention Fund (whose president is Diana Rauner, the governor's wife).

Contracts between the state and its service providers contain a clause permitting the state to terminate the contract if sufficient funds aren't available. When no budget deal was reached last June, the state didn't invoke the clause; it just didn't pay for the services. Agencies continued providing the services, assuming that, as in past budget stalemates, an agreement would be reached and payment would be forthcoming.

But summer turned into fall, fall became winter, winter became spring, and the stalemate in Springfield continued. Agencies that were in a position to do so borrowed to meet their expenses. Metropolitan was one of these. "We're watching our line of credit grow," Laurie Sedio told me in March. Sedio is executive director of Metropolitan's Midway Center, the office where Sanchez works, on 63rd Street near Pulaski. "In a sense, we are lending money to the state. Obviously, we can only do that for so long." Sedio noted then that even if a budget deal occurred, the state wouldn't reimburse social service providers for the interest on their loans.

The governor and the General Assembly finally reached an agreement on a stopgap budget Thursday—on the last day of the fiscal year. Their deal offers a bit of relief to the social service agencies, including Metropolitan: it means they won't get stiffed completely. Under the deal's terms, they'll get paid about 65 percent of what they're owed.

But this hardly offsets the harm done to the agencies and the people they serve. Besides borrowing to keep programs open, many of the agencies curtailed services, laid off staff, and told clients they could no longer help them.

In March, Metropolitan suspended the home-visiting program it had been operating through the Ounce of Prevention. One hundred and fourteen families lost services. Many clients of other agencies had also lost services. The 25 programs funded through the Ounce ordinarily serve 2,000 families; the number being served was down by 30 percent in March, and continued to fall as agencies were forced to lay off staff, close programs, and terminate clients.

Metropolitan kept its Healthy Families home-visiting program alive, but the program shriveled. It was designed to have six home visitors serve 120 families. Because of the lack of funding, Metropolitan had stopped filling staff vacancies. By June, Noah's family was among only 43 families still being served.

The stopgap budget takes money from an existing fund for human services and makes it available to social service providers. It assures compensation to providers for the fiscal year that began Friday—but only for the first half of that fiscal year (July through December); and the money allotted is only 65 percent of what's been allotted in recent years for a six-month period. This means that state-funded social service programs likely will be operating at only about two-thirds of their normal capacity from now through December 31—and that no money is currently earmarked to pay providers for the first six months of 2017.

Home visiting "is a safety-net program that prevents huge problems in the future," Sedio says. "If an at-risk parent can feel confident in how she's raising her child, and can raise her well, that child is much more likely to be successful in school, and contribute as an adult to the economy. We are so shortsighted."

And the program's future is uncertain, notwithstanding the stopgap budget.

—Lorena Sanchez

In the late 1970s, a New York developmental psychologist, David Olds, created a home-visiting program in Elmira, a low-income town in southern New York. Olds had previously worked in a day-care center that served poor three- to five-year-olds in West Baltimore. Some of the children already had severe emotional and behavioral problems that were a product of abuse and neglect they'd been exposed to in their homes. Olds came to believe that age three was a little late for helping children from impoverished families. He also thought that interventions needed to occur where children spend most of their time—in their homes—and had to involve the primary caregiver—usually, the mother.

In Olds's Elmira program, nurses visited first-time mothers, most of whom were poor and unmarried, in their homes once every two weeks during pregnancy, weekly for the first six weeks after the baby was born, and periodically after that until the child turned two. The nurses coached and educated mothers in much the same way as the home visitors in Metropolitan's program do today. In a study published in 1986 in Pediatrics, Olds found significantly fewer instances of verified abuse and neglect among the home-visited mothers during their children's first two years, compared with similar mothers who didn't receive the visits.

Olds allowed that quality home-visiting programs wouldn't be cheap, but suggested that much of the cost in the short run would be offset by fewer foster-care placements and emergency room visits and less need for the work of child protective services. The long-range benefits could be substantial, he wrote in his study, not only financially but in the "reduction in human suffering."

Buoyed by the results in Elmira, home-visiting programs soon blossomed throughout the country. Nationally today, 200,000 families are served by federally funded home-visiting programs, and according to estimates, another 200,000 families get state-funded home-visiting services. (Far more families who qualify for home visiting still aren't getting it; in the U.S., 5.3 million children younger than three live in low-income families.) An abundance of evidence continues to indicate that home-visiting programs reduce child abuse and neglect. Some studies also have shown myriad long-term benefits from home visiting, such as better performance and behavior throughout elementary and high school, although that research isn't conclusive.

Lorena Sanchez, who's now 31, was a teller and assistant manager in a bank for two years after college—long enough to realize that working in a bank wasn't for her. Sanchez, who grew up near Midway Airport, had a liberal arts degree from the University of Illinois at Chicago, and is bilingual. A friend told her Metropolitan was looking for bilingual candidates for its home-visiting program. She joined the agency in 2009, was trained in maternal and family health, infant care, child health and safety, and infant and child development, and began seeing clients that year. She made a little less than $30,000 initially, and makes about $33,000 now.

Sanchez was uneasy at first about the prospect of going into clients' homes; she wondered how she'd be received. She found that most clients not only welcomed her visits but seemed more relaxed and willing to talk on their own turf. Almost immediately, she found the work rewarding. She realized she was playing an important role at a key stage of her clients' lives, and in the lives of their kids. She constantly reminds her clients "that they're their child's first teacher."

Many clients tell her about verbal, physical, and sexual abuse they suffered in childhood. "Those experiences obviously make it hard for them to nurture their children. They're stuck in family cycles that they want to break but don't know how to or don't think they can. I tell them, 'You're obviously strong—now I'll work to help you surpass those experiences.'"

"Some people think you just play with babies all day," Sanchez says. "But these clients have so much baggage. Whatever my client needs at the time, whatever crisis is going on? That's what we deal with."

Lorena Sanchez, a home visitor for Metropolitan Family Services - SUNSHINE TUCKER
  • Sunshine Tucker
  • Lorena Sanchez, a home visitor for Metropolitan Family Services

On a cloudy afternoon in early May, Sanchez is driving east on 71st Street, heading to her weekly visit with Noah, Kristin, and Susan.

About half of Sanchez's 13 clients are living with their own mothers. Sanchez was 25 when she started doing home visiting, and had to work to win the confidence of skeptical grandmas. "They were like, 'Well, you don't have any kids—what do you really know?' I'd tell them, 'You don't have to be a parent to have this knowledge.'"

She helped care for many nephews and nieces as a teen and draws on that experience. Her lack of children is also becoming a nonissue: Sanchez, who has long black hair and broad features, has a growing belly, because she's expecting twins in September.

The relationship between mother and grandmother is often a crucial factor in home visits. Some grandmas know how to help their daughters without taking over, Sanchez says; others are overbearing; and some are "no support whatsoever," and may have been abusive or neglectful to their own kids.

Susan has been both instrumental in Noah's care and a healthy influence for Kristin, Sanchez says. A key objective for Sanchez has been to help Kristin become a more active mom. "Grandma's mainly the one making the doctors' appointments for Noah, talking to the doctors, things like that. I tell Kristin, 'Grandma's not going to always be around, so you need to step it up.'"

East of California Avenue, Sanchez points down a side street. She says a client got shot there in a drive-by while the client was pregnant. The client and baby survived, and the mother went on to successfully complete the program.

Sanchez lives in the suburbs, and knows that a safer neighborhood is only one of the advantages her kids will have over most of her clients' kids. Another is a father who's involved from the start. When the subject of her pregnancy arises with clients, Sanchez doesn't mention that her husband is already singing to her kids and rubbing her belly to hasten early bonding.

Fathers are peripheral figures in most of the families she visits. When they are involved, it's not always a plus. Some have been abusive to the mother. Some fathers don't like Sanchez "because I empower the mother"—they don't appreciate Sanchez encouraging her moms to consider going back to school or getting a job, or simply to stand up for themselves.

Sanchez parks in front of a tidy brick bungalow on Honore Street. Kristin and Susan greet Sanchez warmly and show her into the living room. Kristin is heavyset and tall, like her white-haired grandmother. On a wall in the living room is an array of family photos and a long banner that says "Life is not measured by the number of breaths we take, but by the moments that take our breath away."

Noah, in a red T-shirt, blue bib overalls, and Velcro sneakers, emerges from a back room. He's small for two and a half. His hair is close-cropped, and he has arching eyebrows. He stands alongside his mother, warily eying the stranger in his house (me). Noah's often hyper, but not this afternoon. He climbs into his mother's lap and lays his head against her chest. Soon he switches to his great-grandmother's lap. Sanchez lures him down by pulling out a puzzle. "Ask Mommy to help you," she says, handing him the board.

The puzzle pieces have pictures of desserts—cake, pie, ice cream, cookies. Kristin holds them up one by one and asks Noah what they are. When he doesn't identify them, Kristin quickly supplies the answer and asks Noah to repeat it. He does so with difficulty. Ice cream is "eye-key," cake is "cack." He struggles to fit the pieces in the board. Kristin wraps her hand around his and guides him, a bit impatiently.

Sanchez encourages Noah throughout the visit. It's her inclination with children, but she's also modeling for Kristin. "Good job, Noah!" she says when he finishes a puzzle. "Noah gets a sticker." She fastens it to the back of his hand. "Look, it matches your outfit!"

"Good job, Noah," Kristin chimes in.

Sanchez tells me later: "When I first talk with my clients about praise and empathy, many of them don't know what that is. I ask them, 'Did your parents ever sit down with you and help you with your homework?' 'No, they just said that I had to do it—and if I didn't do it, I got hit.'"

During the hour-and-a-half-long visit, while Noah works on other puzzles, Sanchez drops in questions for Kristin. Has she been cutting down on Noah's naps, so he sleeps better at night? Yes. Has she been working with Noah every day, or mainly just letting him use his tablet? Kristin confesses to the latter.

Sanchez isn't pleased about that. Too often, moms use tablets for "leave-me-alone time," she tells me later, setting their little ones up with YouTube videos. "Sometimes moms need a little break, but when it's for hours, that's a problem. Noah needs more one-on-one interaction, especially with his mom."

"We need Noah to do more physically, like pointing to pictures in actual books," Sanchez tells Kristin. "We don't want him doing more than 20 minutes a day on the tablet." Sanchez knows Kristin has trouble reading. She's told her before that she can show Noah a picture book and make up her own story to go with the pictures.

Kristin listens intently as Sanchez continues: "With colors and shapes, ask him about real objects: 'What color is your sippy cup? What color is your shirt?' He's doing pretty well with repeating—he still has sounds he can't get, but he's trying, and it's great to see that. But we want to get to the point where we ask him what something is and he names it—he's not just repeating us.

"For homework, I want you to do more actual physical play with him—books, puzzles, blocks, all of that. That'll help his fine motor skills. With the tablet, it's too easy just to tap, tap, tap."

Sanchez organizes monthly group meetings for her clients. She tells Kristin about an upcoming lunch at a mall in celebration of Mother's Day. A manicurist will do the moms' nails after lunch. Most of the outings are for the kids too, but this one will be moms only. Kristin tells me later that the group get-togethers have been good for both her and Noah: "He gets to interact with other kids, and I get to hear from other mothers what things are like for them."

On the drive back to her office, Sanchez observes that Kristin was more alert than on other recent visits. "She has a tendency, like some of my teenage moms, to stay up late, and then she'll be nodding off when I visit. "I'm like, 'Am I putting you to sleep? You need to go to bed at a reasonable time, get up at a reasonable time.'"

When Sanchez was a novice home visitor, "I would accommodate the mother—'Oh, you don't get up until noon? OK, I'll come at one.' Now, I try to make them more responsible: 'I'll be here at ten in the morning.' They say, 'Oh, that's early.' I tell them, 'For me, that's late already.' I tell them a normal job is nine to five, and depending on the commute, they could have to get up at six or seven in the morning. I say, 'We're not teenagers anymore, we're not supposed to stay up late.'"

"I don't baby my moms," she says. "I'm not going to make their phone calls and appointments for them—I say, 'Here are the referrals, these are the things you need to do for yourself, and for your child.' We want to prepare our clients for the real world."

Noah and his mother, Kristin - SUNSHINE TUCKER
  • Sunshine Tucker
  • Noah and his mother, Kristin

In May, Metropolitan Family Services and 81 other social service agencies sued Governor Rauner and various Illinois officials, seeking payment for the work they'd done pursuant to their contracts with the state. "Because of the defendants' course of conduct, the entire infrastructure of state-supported social services is at risk of collapse," the suit maintained. Among the plaintiffs was the Ounce of Prevention. (When I called the Ounce to ask Diana Rauner her thoughts on the suit she was out of the country.)

In a supporting brief, lawyers for the agencies noted the state's failure to invoke the clause that allows the state to terminate contracts when there are insufficient funds to pay them. Instead, the state had acted as if the contracts were in force, monitoring the performance of the social service agencies in providing the services.

Metropolitan's Sedio said the lawsuit's claim was simple: "We have a contract, we delivered the services we were expected to, and we've not been paid."

The plaintiffs also noted that the social service agencies and their clients were among the chief victims of the budget impasse. State employees were being paid, schools had gotten funding, and many other vendors had been compensated. But the social service agencies "serve the poor and needy" the plaintiffs said, "and that is not a constituency that has influence or political clout."

It's not often that the principal target of a lawsuit applauds it. But shortly after the suit was filed, Governor Rauner said he thought it was "terrific," and that he shared the frustration of the social service agencies. "Frankly, in some ways, I'm cheering for them," Rauner said. "I mean, it's ridiculous. What state in America just doesn't pay its bills?"

Circuit court judge Rodolfo Garcia gave both parties time to file briefs, and set a hearing for July 13.

Noah with his great-grandmother, Susan - SUNSHINE TUCKER
  • Sunshine Tucker
  • Noah with his great-grandmother, Susan

On a Friday in mid-June, Sanchez hosts a farewell party for her clients at her office. She recently made what she expected to be her final visits to their homes, informing them the program was closing at month's end. Many of the moms cried, and sometimes Sanchez did too. But she tried to end the visits on a positive note, reminding her moms how far they'd come and urging them to build on what they'd learned.

The farewell party begins in a play lot behind the office. It's a warm, brilliant morning. Sanchez, in a T-shirt and blue-jean shorts, blows bubbles at a toddler in a purple dress—13-month-old Luna, daughter of Stephanie Segura. Segura, 23, tells me she doubted her parenting abilities initially but feels more confident now, thanks to Sanchez. Regarding the closing of the program, she says, "I feel like the state doesn't care about the next generation."

Nearby, five-month-old Tabitha sits wide-eyed in the lap of her mother, Cynthia Ruiz. "I was struggling with depression before my pregnancy and during it," says Ruiz, who's 21. "I was not in the right place to be a good mother." Sanchez kept reminding her that she was vital to Tabitha's development. "You think a baby doesn't know anything, but it's totally the opposite. I learned from Lorena that the first three years are crucial. That's when the brain cells are beginning to grow, and babies are absorbing everything." As her importance to Tabitha sank in, her depression lifted.

Tabitha makes a face as if she's about to fuss, Ruiz rocks her subtly, and the expression disappears. "It's ridiculous that they don't have money for programs like this that make new mothers be better mothers," Ruiz says.

Noah is sitting at the top of a small green slide, weighing the possibilities. Kristin and Sanchez are coaxing him. Kristin: "I don't know how to do it—can you show me?" Sanchez: "One, two, three—" Noah skims down on his back, sits up with a giggle, and rushes to the steps for another trip.

Susan, who drove Noah and Kristin to the party (Kristin doesn't drive), is beaming. "He's such an adorable child," she says. "He's got issues, but he keeps me smiling."

"That's my pride and joy right there," Kristin says.

Sanchez leads the families inside, where they lunch on salad and pizza in a conference room, serenaded by kids' songs from a boom box. The babies and toddlers contribute an occasional burp or hiccup. Sanchez passes out pink paper bags lined with white tissue paper, containing sunscreen, bubbles, budgeting worksheets, and meal suggestions for toddlers.

Her supervisor, Vanessa Schwartz, tells the group that Sanchez "talks about how she considers all of you a part of her family.

"We've had this program for 16 years, so it's devastating for us to have to end it," Schwartz says. "Unfortunately, as you know, the state is in a crisis now."

"A man-made crisis," Susan interjects from her seat.

Susan tells me later she thinks the home-visiting program has been imperiled because "the politicians aren't concerned about the smaller people. We're not on their agenda."

After lunch, Sanchez and her clients exchange good-bye hugs. Noah rises on his tiptoes and lifts his arms to Sanchez. "I can't pick you up, Noah," she says regretfully, and bends down to hug him.

Kristin tells me she wants Noah's life to be "as normal as it can be," and that she's thankful to Sanchez for helping the family move toward that goal. Susan says, "We still have some mountains to climb," but that Kristin has become "a more capable mother" because of the program.

Metropolitan has found a temporary position for Sanchez until she begins her maternity leave in the fall: she'll be doing outreach for a Head Start program from a suburban office.

In the quiet conference room after her clients have left, Sanchez says she's seen many of them "become strong women and wonderful mothers," and she's gratified to have played a role in that.

On her final trip to Noah's home, she reminded Kristin that she's Noah's first teacher. During Sanchez's two-plus years visiting the family, she'd worked to help Kristin fully accept her role as Noah's mother. "I haven't been 100 percent successful at that, but maybe 70 percent—and that's pretty good. I tell all my moms, 'There's no such thing as the best parent in world—it's about being the best parent you can be.'"

Then she heads down a hall to clean out her office.

—Laurie Sedio, executive director of Metropolitan Family Center’s Midway Center

When the temporary budget was passed and signed 13 days after the farewell party, it was both a relief and a disappointment to Metropolitan. On the one hand, they'd be getting only 65 percent of what they were owed. On the other, 65 percent was much better than nothing.

But whether social service agencies will continue doing business with the state is an open question. Metropolitan has filled out preliminary paperwork for state home-visiting contracts for the new fiscal year. "We believe in the power of home visiting, so we don't want to close the door" to providing the services, Sedio says. However, in light of this year's experience, the agency is reluctant to sign a contract unless it feels certain it will be paid for its work. The agency is considering its options.

The social service agencies' lawsuit against the state likely will proceed. "We should be paid for services rendered, and that means 100 percent," Karina Ayala-Bermejo, Metropolitan's general counsel, told me the day the budget deal was signed. Ayala-Bermejo says Metropolitan and other social service agencies are also considering filing a class-action lawsuit in behalf of their clients for the "irreparable harm" caused them by the funding shortfall.

The past year of uncertainty has damaged home-visiting programs, Sedio says, and they won't recover overnight. Some home visitors who've been laid off perhaps can be rehired, but others have already found other jobs. Some have decided to leave social service work altogether, reasoning that it isn't a stable profession. New, inexperienced home visitors will have to be trained. The rapport between home visitors and their clients, built up over months or years, has in many cases been lost. Former clients may be reluctant to start over in the program with new home visitors.

Home-visiting advocates argue that discussions in Springfield should be about expanding the program, given its proven benefits and how few eligible children are served by it. State funding for home visiting has declined slightly since 2009, according to Ireta Gasner, policy director for the Ounce of Prevention. Instead of expansion, the focus in recent years has been on "how do we keep the tip of our nose above water so we're not drowning," Gasner says.

And there's little reason to believe another crisis isn't around the corner. Sanchez was thrilled to learn that, in light of the stopgap budget, she might get to resume seeing her clients eventually. "I would love it if they brought the program back," she told me after the budget agreement was announced. "The only thing that makes me nervous is it's just a six-month fix. What's gonna happen after that?" v

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