L.A. County Hopes to Improve Home Visiting Options for Homeless Moms

home visiting
L.A. County is hoping to expand home visiting services to include mothers who are are on the brink of homelessness or living in unstable situations. Photo courtesy of First 5 L.A.

With homelessness among women and children rising in Los Angeles, county leaders are looking to offer more home visiting services to new mothers and their babies living in shelters, jails and mental health facilities.

Home visiting programs are designed to offer pregnant and newly parenting women and families — often those considered at-risk of child maltreatment — voluntary services with the goal of helping prepare them to raise healthy children. Providers, who may be trained nurses or social workers, work to help new mothers create a nurturing environment for the child’s first three years of life, which are most critical in terms of early-childhood developmental milestones.

This year L.A. County has devoted an estimated $140 million to various types of home visiting services split across several different agencies, but in recent months county officials have noticed a gap in home visiting services: mothers who are homeless or at the brink of an unstable living situation when expecting.

In 2018, the county’s Department of Public Health helped 112 women who had experienced homelessness at some point during their pregnancy. Los Angeles leaders say that figure is likely an undercount because the county’s program lacks the means to reach the most vulnerable women.

As a result, Los Angeles County supervisor Hilda Solis introduced a motion recently to have the departments of public health, mental health and children and family services, along with nonprofit public agency First 5 LA, to find ways to expand services to women who are sheltered or unsheltered and are experiencing homelessness. A list of strategies will be due for review early next year, but the motion said that may include looking beyond programs that serve high-risk mothers like the Nurse Family Partnership, Healthy Families America and Parents as Teachers.

“We must support mothers and their infants by investing in services that help them in those critical first three years of a child’s early development,” Solis said in a statement. “These efforts are necessary to lift families out of hardship and set them on a course to self-reliance.”

In recent years, L.A. County’s investment in home visiting has skyrocketed, thanks to new state, local and federal funding streams. There are currently nine home visiting programs employed across the county, varying according to the intensity level of services and the child’s age — moving from prenatal services all the way up to 5 years old for some programs. First 5 LA, the nonprofit public agency funded largely by state tobacco tax revenues, funds some home visiting programs. The Department of Public Health uses newly available state funds to finance its programs. County and federal monies are also used to fund these programs.

The number of women described as homeless increased by 13 percent this year compared to last year, according to data by the Los Angeles Homeless Services Authority (LAHSA). Each year, the agency conducts a point in time count across Los Angeles County. This year, there were 18,331 homeless women counted, both in shelters and on the street. That’s about a third of all homeless people living on the street.

And among the nearly 60,000 homeless people countywide, 9 percent are children living with family in shelters or on the street, a 5 percent increase from 2018, according to LAHSA.

Women are more likely to be homeless because of domestic or sexual violence, experts say.

That’s why expanding the in-home family visits to shelters would be a much needed service, according to Pat Bell, executive director of House of Ruth. The organization runs a Los Angeles County domestic violence shelter. Women who come in, who are pregnant, most likely haven’t received the prenatal care they need until it’s too late, Bell said. She recalls one client who was pregnant with twins. One twin was stillborn.

“That story is an example of many of the issues that pregnant women face, particularly when they are coming to domestic violence shelters,” Bell said. “In-home services won’t work for a domestic violence victim, not with the abuser there. ”

Expanding the in-home visits would help to shrink the wide gap between what’s available and what is still needed, especially among African American women, said Linda Aragon, director for the county’s public health division of maternal, child and adolescent health.

“While we have seen an overall decline in rates of infant mortality and preterm births over the past decade, we have not seen a decline in the significant gap in birth outcomes between African Americans and other racial/ethnic groups,” Aragon said.

There are 18,650 high risk families who do not have access to intensive home visiting services, Aragon said, adding that among high-risk women and their families, at least 4,057 women were homeless during their last pregnancy.

“Comparing our current home visiting capacity to community need, reveals substantial gaps, especially for our most vulnerable women and their families,” Aragon said. “Given the difficulty in counting this population, we believe that this is an under-representation of the number of homeless pregnant women in Los Angeles County.”

Experts agree that home visiting programs help parents provide a safe and supportive home for their children.

“They are an effective preventative support for at-risk families, this includes pregnant and parenting teens,” said Amara Suarez, a spokeswoman for the Los Angeles Department of Children and Family Services. “These programs reduce entry into the child welfare system, strengthen bonding between parent and child, improve parenting skills and increase independence/self-reliance.”

Other organizations that offer in-home visits directly say they commend county leaders for seeking ways to expand the programs.

Spiritt Family Services provides various family oriented and in home services across Los Angeles County, usually through referrals from hospitals. Of the 7,000 individuals assisted in one kind of program they provide, 12 percent are homeless and another 31 percent are at risk of homelessness, meaning they likely live with relatives.

“In addition to in-home services, there also needs to be focus on affordable housing,” said Elvia Torres, executive director for Spiritt Family Services. “I think these (in-house visitation) programs are wonderful but we also struggle with finding stable housing.”


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Susan Abram
About Susan Abram 11 Articles
Susan Abram is a freelance writer who previously covered public health and L.A. County government for the Los Angeles Daily News. You can find her on Twitter at @SAbramLA.