At the end of the month, Julia Noto is losing her Child Protective Services job as a nurse going into homes with babies, most with mothers who used drugs during pregnancy.
Noto said she doesn't understand why the Sacramento County Board of Supervisors last week cut 49 CPS jobs – many of them front-line workers – to close a $10 million general fund deficit.
Supervisors have called the cuts agonizing but necessary, given the fiscal realities and their commitment to public safety. They saved the deepest cuts for public health and social services.
Noto wants people to understand the dimensions of those cuts: At-risk babies such as those born with drugs in their systems or to abusive parents now will have less chance of healthy, normal futures.
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"We are saving babies' lives," Noto said. "Law enforcement goes onto the streets and saves lives. We go into people's homes and save lives."
Many of the babies Noto and her colleagues work with are born into low-income households where drugs and other problems persist. It doesn't take a demographer to know these infants will be lucky to break the cycle of poverty and substance abuse that is their family legacy.
Noto's job is to visit these babies in their first three months of life. She weighs them, teaches mothers how to care for them, and helps families work the bureaucracy to get social services.
Visiting the babies' homes
Angel and Joseph, 3-month-old twins born a month premature and with methamphetamine in their systems, are typical of the babies Noto visits.
CPS took the kids from their mother and put them in the care of Maria Zavala, 24, who lives in a cockroach-infested double-wide trailer. Zavala is not related by blood but is essentially a cousin-in-law. There are 11 people living in the trailer, including Zavala's parents, her brother, her own child and other relatives.
They live on the $326 a month Zavala gets in welfare, $200 a month in food stamps plus the couple of hundred dollars her father brings in working odd jobs, Zavala said.
Noto made her monthly visit to the Zavala household last week. She weighed the babies, checked their motor skills, advised Zavala what to do if the one baby's eye mucus got worse and noted their development.
"If it wasn't for her input and knowledge, I wouldn't know what to do," Zavala said.
But Noto is more than just a nurse. She's a family friend young women can talk to about raising their kids. She's also an advocate, going beyond her nursing duties to help families deal with bureaucratic mazes many are ill-equipped to face.
Because of a paperwork error, one of the twins was successfully enrolled in Medi-Cal while the other was not. This meant Zavala was able to get enough baby formula for only one child, Noto said.
"They had to share food. We're down to one can," Zavala said last Friday, sitting in her darkened trailer, an enormous flat-screen television illuminating the room.
Noto said she spent hours calling Medi-Cal, social workers, doctors and others, trying to get the problem solved. She was finally able to get Angel a prescription for baby formula that Zavala can fill at another county social service program.
In a recent visit to another client's home, mold covered the bedroom walls – black and gray blankets of mold spreading across entire sheets of drywall. Noto called environmental health officials, city code enforcement officers and CPS supervisors, trying to get the house fixed and the family moved.
Noto burst into tears talking about leaving her job.
"Who's going to help my clients? Who is going to be there when they have these questions?" she said. "That's why I do my job: to serve the community and for those who need it most – to advocate for those who can't do it for themselves."
Blows to CPS, public health
The CPS cuts mark the latest blow to the agency. Several recent Bee investigations following an increase in child deaths revealed numerous problems within CPS.
The Sacramento County grand jury issued a scathing report about CPS in April 2009. County officials pledged to fix the system.
Regardless, the supervisors have continued to gut CPS as the county grapples with budget deficits. Their latest cuts drop the division's staff from nearly 1,000 employees on July 1, 2007, to fewer than 700 today.
The county also plans to save just under $1 million by referring fewer kids to foster care. Not only will more children be staying in homes with potentially troubled parents, but there will be fewer CPS workers to monitor their living conditions.
"I am concerned about our ability to continue and maintain the significant improvements CPS has made," said Ann Edwards-Buckley, Department of Health and Human Services director. She said officials are working to reorganize the division and hope to have a plan in place soon.
The loss of Noto's job affects both social services and public health. The county had 114 nurses in the Department of Health and Human Services in January 2007 but was down to 86 at the start of this year. These are nurses who work with the elderly, homeless people and disadvantaged children, including some under CPS supervision.
The county was able to save 15 nurses in the Nurse Family Partnership program through June, thanks to First 5 funding, which is state money for early childhood programs. The partnership program pairs low-income first-time mothers with nurses. The nurses work with the family from pregnancy until the children are 2, and the program is proven to help with development, said Glennah Trochet, the county's public health officer.
"These kids are more likely to graduate high school," Trochet said, adding that the program faces closure after July 1 if First 5 funding doesn't continue.
The supervisors have called public safety their top priority. Officials said some social service programs have strict mandates limiting the county's ability to spread cuts evenly, and that there are few places to go to cut discretionary revenue.
So, fewer public nurses like Noto will visit babies born addicted to heroin, newborns with congenital syphilis, or homes burdened with histories of domestic violence and drug abuse.
Even though Noto is losing her job working with babies under CPS supervision, she can continue working as a county public health nurse.
Sacramento County still has a pot of federal funds that can be used only for H1N1, Trochet said. The county needs to spend that money by the end of June.
At the end of the month, Noto begins her new job: helping immunize residents against the flu.