As the sun bakes their blue Nissan Sentra, Peg and Pepper cruise the streets of Perrine on a weekday afternoon in search of Janet, an angry crack addict who suspects she is HIV-positive. With Peg behind the wheel and Pepper riding shotgun, they drive up and down streets dotted with single-lot homes, each with its own small front yard. Finally they spot Janet standing outside a house, smoking a cigarette and cradling a beautiful little girl: her daughter, still a toddler. Peg pulls the car over to the curb to talk to Janet, who's dressed in a black T-shirt and black jeans.
"I plan to give it to every nigger I can," Janet tells the pair with a snarl, referring to her HIV.
Pepper, who is HIV-positive herself, tries to reassure Janet that she probably has only the virus, and not full-blown AIDS. Essentially homeless, Janet, twenty years old, stays with friends or with her grandmother in Perrine. Remembering when Peg hung around her neighborhood begging for money and drugs, Janet tells her, "You needed help."
"I did," Peg casually admits. "So when are you gonna get treatment?"
"Monday I'll get treatment," Janet says. Her eyes start to water as she tells Peg and Pepper that she thinks she's pregnant, going on somewhat melodramatically about how, three weeks earlier, she'd tried to kill herself with an overdose of pills because of problems with her boyfriend. "Then, I thought, 'Shit, that's a man,'" Janet snuffles, beads of sweat forming on her forehead, her gold-capped tooth gleaming in the sunlight.
As Janet turns and walks away, Peg starts the car and the pair sets off in search of another client. "Every week we see her she says she's pregnant," Peg notes. "Then the next week she'll say she had a miscarriage."
Four years ago no one would have believed that Peg -- or, for that matter, Pepper -- would be out on the streets of South Dade counseling crack-addicted mothers as part of an outreach team for the Partnership to Empower Parents (PEP), a federally funded program that employs former addicts to help rehabilitate its clients. That's because four years ago Peg was a crack mother who lived on those very streets. For almost a decade, she was a homeless addict who turned tricks and bummed money to support her habit; additionally she was arrested many times on drug charges. Back then she lived day to day, wandering around in ragged clothes, barefoot, her eyes glassy. "She was a jungle animal in the city," remembers Madison James Carter, program director at the Better Way residential treatment center in Northwest Miami and PEP's former drug-treatment coordinator. "This lady should've been dead a thousand times over."
Now 35 years old and very much alive, Peg (unless surnames are provided, all of the names in this story have been changed) stands five feet nine inches tall, with scars on her face, her left leg, and left arm. Wearing a sporty beige-striped blouse-and-shorts combination and loads of jewelry -- bracelets, earrings, a gold watch -- she usually has a somewhat intimidating demeanor. And yet she exhibits a child's enthusiasm for relating the stories behind her scars, nonchalantly attributing all of them to injuries she sustained while fighting. She says she got the two-and-a-half inch one on her left cheek while sitting in a car minding her own business. Out of nowhere, she says, a woman slashed her with a razor. Peg began fighting with her, too high to notice the gushing blood. The woman also tried to cut Peg underneath her skirt, she says, but the pair of denim shorts she was wearing beneath the skirt protected her.
The scars on her left forearm and thigh are the result of bullet wounds inflicted, she claims, during a fight with her older sister (who eventually died from complications related to AIDS). Both high at the time, they began arguing when the sister found out that Peg, who was pregnant, had spent money meant for drugs on baby clothes. Peg says she shoved her sister "out of her shoes" and into a wall. Her sister responded by whipping a handgun from her purse. As the two continued to struggle, the gun went off accidentally, with a bullet entering Peg's forearm, then exiting and lodging in her thigh. Later, Peg recounts with no emotion, as if she has related the story a thousand times before, when a bullet fragment rose to the surface of her arm, she plucked it out herself. None of the scars, she insists, is the result of injecting drugs. "Crack was my first choice," she recalls, lighting up a cigarette, "and I stuck with that."
Peg's rescue from a life of self-destruction began four years ago when Gloria Thomas, a 57-year-old social worker with the Metro-Dade Department of Youth and Family Development (the agency that ran the PEP program at the time), was first assigned Peg's case. Thomas went to Peg's house in Goulds, where Peg lived with her mother, her brother, and several of her children, as well as some of her two sisters' children. Thomas learned from Peg's mother that Peg had left just minutes before. Peg's mother gave Thomas a description of her daughter's attire -- shorts, halter top, beret -- and the social worker set off to find her, cruising South Dade's decrepit neighborhoods in her white Ford Crown Victoria.
Near an abandoned building on a street of tumbledown crack houses in Goulds, Thomas spotted Peg, apparently injecting drugs. (Peg claims she was not shooting up, but rather trying to hide a crack pipe beneath a towel.) Thomas called to her, but Peg ducked and hid. Eventually Thomas persuaded Peg to talk with her.
"I hope that wasn't heroin," Thomas told her.
Peg, indignant, shot back, "I don't use heroin!"
Thomas then explained that she had been assigned Peg's case, emphasizing that she wouldn't be discouraged easily. "You may walk away from me," Thomas said, "but I won't walk away from you." She gave Peg her business card and encouraged her to call, day or night. By the time Peg finally phoned for help at least two months later, Thomas had given her more than twenty of the cards.
These days Peg works part-time as one of ten former addicts (eight women -- including Pepper -- and two men) who make up the Partnership to Empower Parents program's Drug Addiction Recovery Team (DART). On-call around the clock, they work individually or in teams of two to counsel substance-abusing mothers, most of whom are poor, black, and live in South Dade. Because of their first-hand knowledge of addiction, DART members are able to track down PEP clients -- and, once located, deal with them -- more easily than, say, a social worker.
"Our women have the same m.o. as the women they're looking for. They know where to find them," says Elizabeth Abruzzino, PEP's director. "We live in a very small town when it comes to who knows whom in that [drug] subculture." The DART members actively encourage their clients to get clean and to seek treatment, offering to drive them to a drug treatment center if necessary. Once clients get clean, DART members provide them with information about various social services, such as Medicaid, welfare (Aid to Families with Dependent Children), and food stamps. Often these women, like Pepper before she joined PEP, have lost their children to the state's Health and Rehabilitative Services (HRS), and DART personnel advocate on their behalf to get back the kids.
DART's efforts are supplemented by PEP, which helps the women find work, housing, and the means to deal with other living expenses, such as food and diapers. "We do not close cases unless people are gone or lost," explains Abruzzino. "We will carry her [the addicted mother] as long as she needs to be supported in her recovery effort. When they leave us they cannot say, 'I don't know how to get a job.'" If a client refuses to seek treatment, the DART members continue checking up on her and her children. For their efforts, Peg and her DART cohorts are each paid $7.50 an hour, working an average of 20 to 25 hours per week.
For the past three years, PEP has been managed by the Children's Home Society (CHS), a statewide private nonprofit organization based in Jacksonville that provides services to abused and neglected children. PEP is funded through a federal grant administered by Florida International University (FIU), and operates on an annual budget of $260,000. FIU subcontracts CHS to run the program, and uses the remainder of its annual $450,000 federal grant to conduct family preservation and reunification research at the school's Institute for Children and Families at Risk. PEP employs fourteen people: the ten DART workers, a case manager, a case management assistant, an FIU liaison, and director Abruzzino.
According to Dr. Scott Briar, an FIU professor of social work and director of the Institute for Children and Families at Risk, the recovery rate for PEP's clients over the past two years is 65 percent. ("Recovery rate" refers to the number of PEP clients who have stayed clean at least six months and have not given birth to substance-exposed babies.) Dr. Norma Harris, director of the Colorado Human Services Training Consortium at Colorado State University, is conducting an independent evaluation of PEP for FIU and points out that, on average, programs similar to PEP experience a dismal recovery rate of between five and ten percent. "A high percentage who come into the [PEP] program remain in recovery," notes Harris. "The relapse rate is very low. From my knowledge of addicts, the program is effective, one of the most effective in the country." Currently 81 of PEP's 147 clients are clean. However, like all former addicts, these clients -- as well as the DART members -- are not considered "cured." They remain forever in a state of recovery, always guarding against relapse.
When PEP was conceived in the summer of 1990, its principal goal was not to help crack-addicted mothers recover; instead it sought to decrease the number of babies being born to these women. Pediatricians, social workers, and mental health professionals feared the nation's foster-care system and child-welfare facilities would be flooded with infants suffering from irreparable, long-term health problems stemming from fetal exposure to crack: problems such as mental retardation, arrested development, and learning disabilities. I n August 1990 Dr. Kathy Briar, now a social work professor at Miami University in Ohio, was helping to establish the Institute for Children and Families at Risk at FIU (with her then-husband Scott Briar). She discovered that money existed in the budget of the federal Department of Health and Human Services for a program to help decrease the birth rate of crack babies.
Concerned about the increasing number of infants being born to crack moms and intent on making FIU a research leader in the fight against this problem, Briar enlisted the help of Judy Rosenbaum, then a senior management analyst at HRS (she now serves as a Medicaid administrator locally). Together they submitted a grant proposal to Health and Human Services on behalf of HRS; it described a collaborative, interagency effort to prevent infant abandonment by crack mothers. By October HRS received an initial two-year grant of $900,000 from Health and Human Services, which administers funds legislated under the federal Abandoned Infants Assistance Act. HRS, in charge of overseeing the budget for the grant money, immediately subcontracted the Metro-Dade Department of Youth and Family Development's Intensive Family Services unit to run the new program, which would provide social services to both the mothers and their babies. The unit's staff, a mix of personnel from HRS and Metro-Dade, included a health educator, an employment specialist, a drug treatment specialist, and several social workers -- among them Gloria Thomas. In March 1991, Thomas named the program Partnership to Empower Parents.
At first PEP helped both crack babies and their addicted mothers, determining that if these infants were to receive the nurturing they needed, their mothers needed to be drug-free. But by early 1992 it became clear that the program was not working. Anne Simon, now the associate executive director for CHS's western division A but at the time CHS's executive director in Miami on loan to PEP to help coordinate community services and get private-sector support for the program A remembers interagency squabbling and infighting among PEP's seven-member staff, which included Madison James Carter, a former addict then working as the program's drug-treatment counselor. After a year and a half, PEP had found only about 40 drug-addicted mothers on a list of 200 supplied by HRS, which obtained the women's names from hospitals treating mothers of substance-exposed babies.
In April 1992, Carter sent copies of a memo he'd written to Jim Mooney (director of Metro-Dade's Department of Youth and Family Development), and to Briar, Rosenbaum, and Simon, outlining a radical solution to PEP's problems: Replace the professionals with recovering drug-addicted mothers. With Simon's solid support, Carter's proposal won approval, and he began attending Narcotics Anonymous centers, circulating word that a program had immediate openings for former addicts clean at least one year. Within a week, ten ex-addicts were hired. Carter trained them for six weeks, and after two months they had found all 200 addicts on the list. FIU professor Judy Kopp taught them how to interpret PEP's rather formal client questionnaire using their own words (it covered sensitive topics such as birth control and frequency of drug use) and encouraged the former addicts to provide answers in the clients' language. In October 1992 the ex-addicts' outreach effort was dubbed the Drug Addiction Recovery Team.
"They were having fun," recalls Simon. "It was an electric group of women that understood the drug subculture. The difference between theory and reality is understood by recovering people. They know the life of crack addicts -- they barely eat, their places are filthy, in every way they're barely alive."
At the same time, Metro-Dade's Department of Youth and Family Development, fearing future funds for the program might not be secured, and wanting to pursue further work in family preservation instead of fighting substance-addiction, decided to bail out of the three-way partnership (Metro-Dade, HRS, FIU) then managing PEP. At Simon's urging, CHS stepped in to run the program, with HRS functioning as a referral service, passing on the names of potential PEP clients, and FIU taking over from HRS the task of administering the federal funds.
"We took over operations because it was a program worth saving," explains Simon. "It was a program with a significant impact on one of our community's most troubling problems: substance-exposed infants."
One August night in 1991 at 1:00 a.m., Peg phoned Gloria Thomas for help. Peg had spent the previous two weeks on a nonstop bender A drinking alcohol, turning tricks, smoking crack, not bathing, barely eating. Her body was shutting down. Thomas took Peg to the Dade County Central Intake and Detoxification unit in Northwest Miami, where Thomas pleaded for Peg to be admitted: "She's injecting drugs. She needs to be here." Peg rolled her eyes but said nothing. Although staffers insisted they didn't have a bed for Peg, Thomas assured them they did -- she'd checked beforehand -- and Peg was admitted to the treatment center.
After about ten days at Central Intake, Peg enrolled in a 28-day program for drug-addicted pregnant women at the Highland Park Pavilion, a fifteen-bed facility at Jackson Memorial Hospital. At Highland Park she learned the twelve steps of Narcotics Anonymous, while also undergoing group and individual therapies. During this time Thomas remembers Peg being extremely frightened; she wasn't convinced Peg could handle treatment. "She wanted to fix all the time," Thomas recalls now. "She was almost childlike. If somebody raised their voice to her, it threw her into a panic."
Nonetheless Peg completed the Highland Park program, whereupon she moved on to Concept House, a long-term, live-in nonprofit drug treatment center located in Northeast Miami. Peg lasted only two days in the six-month program, walking out because she disliked what she considered its many restrictive rules. Once on the outside, Peg quickly resumed using crack. Thomas caught up with her two weeks later behind an abandoned building in Goulds. Peg had to return to Central Intake Detox for a week, after which she spent two months at Merrimac, a short-term treatment center no longer in operation. Thomas then persuaded officials at Carianne, a now-defunct long-term drug-treatment center in Hialeah, to accept Peg. However, Peg almost immediately began having problems with a male staffer at Carianne she now characterizes as always picking on her. According to Peg, he once asked her if she thought she could beat him up, and she answered, "I don't know, but I'm not scared to try." Thomas had to cajole and beg Carianne to keep Peg in its program, which it did.
Peg stayed there for two years, during which time Thomas often brought her cigarettes, candy bars, sodas, clothes from Peg's mom's house, and new clothes bought by Thomas herself. Peg's family began to visit her, and she grew close to her teenage daughter. In November 1991, Peg gave birth to a nine-and-a-half-pound baby boy. Thomas provided Peg with baby clothes and shoes, a stroller, and a car seat. Peg admits now, "If Gloria would not have come around, I would not have kept him. I would have been found dead on the railroad tracks now." For the first time in her life she began to parent.
Presently Peg lives with two of her own children, ages three and fifteen, in a house in Naranja. Her seven other children were put up for adoption during her drug years. "Peg doesn't know the birthdates of her own children she put up for adoption," notes Anne Simon. "She will break down every time you mention that."
"My kids call me mamma now," Peg confides, "instead of hiding in the corner when I come home."
She joined PEP in 1993 so she could use her experiences from the street to make a difference in the lives of women in whom she sees her former self. "Peg is a model for this program," asserts Abruzzino. "They [the DART members] have all been through hell. They have almost destroyed human life but have completely turned around and moved forward."
Pepper has short hair and a squashed nose, and looks older than her 33 years. Petite and casually dressed in a blue T-shirt and shorts, Pepper, like Peg, lived a life filled with violence, drugs, and prostitution. Because she practiced unprotected sex, she contracted HIV: "I knew the condom was out there, but I wasn't using it." For seven years, she shacked up with an older widower, during which time she used money from his disability and Social Security checks to buy crack. When that money ran out, she turned tricks to earn drug money.
In 1994 PEP helped her to kick crack and to get her five kids back from HRS and relatives. For a while, she worked at Taco Bell and Checkers; she joined DART a year ago. Though she was hesitant to come aboard, she credits PEP's training program with educating her about AIDS and teaching her job skills. "Being where I've been," Pepper says, "I can explain to them [addicted mothers], 'You don't have to live like that. You can do better with your life.'" Peg and Pepper deal almost exclusively with homeless, hard-core drug users.
With Peg still at the wheel, the pair continues driving through Perrine, eventually stopping to visit Wilma, who is staying with friends in a boxy green house. Peg has been seeing Wilma for two years now; she has been clean for six months. Wilma walks up to the car and Peg and Pepper get out to talk to her. In a booming voice, Wilma says that when Peg and her former partner began coming around to see her, "I got tired of them. I hated to see them coming. But I'm glad to see them now -- I ain't got nothing to hide."
Pregnant and dressed in a gray blouse, Wilma says she was addicted to crack, marijuana, and alcohol. She has five kids, all of whom live with relatives. Now she's in search of work: "I'm looking for a telemarketing job where I can sit a little." Peg and Pepper give her advice on how she can get back her welfare, Medicaid, and food stamps benefits. "They've helped me a lot," declares Wilma. "We have that communication. We talk to where we can understand each other."
Two men, both addicts, walk by and wave hello, and after they've passed, Wilma admits that handling her druggie friends isn't easy. "They say they're happy for me," she notes, "but the first chance they get to offer me something, they test me to see if I'm strong or weak." Wilma used drugs for four years, right up to the seventh month of her most recent pregnancy. She jokes that she is "27 going on 55" as she climbs into the car's backseat so Peg and Pepper can take her to the Perrine clinic. On the way, she complains that her face is breaking out with pimples, and Peg theorizes that it's probably from her pregnancy or from quitting drugs.
After dropping off Wilma at the clinic, Peg and Pepper spot Sarah in Goulds and pull over to the curb; she's still a PEP client, but no longer Peg's. Dressed in an orange halter top and knee-length yellow pants, Sarah has stretch marks on her pot belly. She tells the DART women that she's en route to the store. Peg asks Sarah why she left a drug-treatment program after only one month. "'Cause I'm very impatient," Sarah says uncomfortably. "I guess I really wasn't ready for treatment."
Before driving on, Peg warns her, "When they beat your ass you're gonna call me." As they start to drive off, Peg stares at Sarah, noting her slow walk: "She looks like she's been up all night." To which Pepper adds, "I used to drag myself like that all day long."
On another block, a smiling motorist wearing a red bandanna cruises up next to Peg's driver's-side window. "Gimme twenty dollars," he jokes.
"I'm not gonna give you no twenty dollars," Peg answers, playing along.
"Then give me your cellular phone," he shoots back with a grin.
After some more banter, Peg and Pepper move on. "I used to be married to him when I was using," Peg explains between giggles. During their eleven-year marriage, she adds, he often would lock her in the house in a vain attempt to keep her away from drugs. But she always found a window to climb out of.
Before heading back to PEP's offices on Biscayne Boulevard at 30th Street, the pair passes by the street of abandoned buildings that Peg once called home. A man in a blue pullover with a white towel draped over his shoulder approaches the car on foot. He brandishes a wad of bills and boasts that he's no longer using drugs, claiming he's "straight as one dollar." As they drive away from him, Peg remembers, "I used to fuck up his shit all the time." She says he just drinks a lot of beer now. Peg, clean four years now, can't even have a glass of wine at dinner because she fears it will reignite her addiction. Eyes fixed on the road ahead of her, she calmly says, "I like my life how it is.
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