At large position one and chair of this city council quality of life committee, and we're pleased to be meeting this afternoon to hear a presentation.

I want to note those council members present with us are Councilmember Sally Elkorn and Councilmember Amy Peck as well.

We have staff from Councilmember Mario Castillo's office, Councilmember Twilight Carter's office, Mayor Pro Tem Martha Castex Tatum's office, Councilmember Tiffany Thomas's office, and Councilmember Joe Panzarella's office as well.

This meeting is being broadcast, and we will have a chance for public comment.

I'm not sure how many folks have signed up, but whoever is present will give you the option to make some public comment if you so choose.

This afternoon, we will be hearing a presentation on access to health care and assessment and report.

So without further ado, we'll go ahead and recognize you, Dr.

Shelton, for this uh presentation.

And we will we'll watch it on the screen.

We didn't print it out, so we'll save save a few trees today, and uh be pleased to follow after.

Thank you.

Good afternoon.

Thank you so much for um inviting us here and allow us to speak to you.

Again, my name is Dr.

Melissa Shalton, and I work for the City of Houston Health Department, and my counterpart is um Brandon Maddox.

I'm gonna have him tell a little bit about himself before we get started, and how we really came.

This is more of a story, how we came together to do a collaborative project, which is I believe it's the first project that is very in-depth between the City of Houston Health Department and Harris County.

And Brandon, before you do that, I just want to recognize that uh Councilmember Willie Davis has joined us as well.

So go ahead, Brandon.

Good afternoon.

Um, and thank you for the opportunity to be here.

My name is Brandon Maddox.

I'm the director of planning and innovation for Harris County Public Health.

Um I work under uh Leah Barton for the public health department.

And um, you know, like like Dr.

Shelton said, uh, this has been a truly collaborative experience between um Harris County and the City of Houston.

It's one of the first major reports, and it's a report that uh both the city health department and the county health department are required to do as part of our public health accreditation.

And um, yeah, it's been it's been an incredible journey.

We've been working on this since June or July of uh 2025, and I'm really excited to see what comes out of it.

Because I think a lot of times we we develop reports and uh we publish it out, and the extent that somebody reads it, you know, that's that's great.

But the action and uh the recommendations and the commitments that come out of it, those are really um where we see uh this report having a lot of value.

So just thank you.

You bet and just a quick question before you get started.

Are it is the city and the county required to do this report jointly or separately, or how does that work?

So we're not required to do it jointly, but it's beneficial and streamlined, and we actually serve the same um population, especially when we're talking about patients and clients and so forth.

And it was um because our clients cross over whether from City of Houston to go to access Harris County resources or whether Harris County clients and patients access that.

So it was very beneficial, and it is required.

Thank you.

You may proceed.

Okay.

So again, um, as I mentioned, I'm from the City of Houston Health Department, and I also want to um mention that I'm under the leadership of Dr.

Tran, Teresa Tran, our uh new director, and so forth.

And again, it's a pleasure for us to be working together on this project.

Next slide.

So, as we are gonna talk a little bit about this um project, access to care assessment and report.

There's some key components we really want to have a storytelling to inform everyone about, as we all know, there are challenges when it comes to individuals accessing health care, whether they're receiving it, being able to pay for it, whether they have insurance or not.

So, what we're gonna have our conversation and discussion with you all is a little bit about um the report, what type of methodology, the summary of findings, and the three main topics that we came across in regards to whether it's affording care, finding care, receiving care.

We kind of call it like the three C's, and then of course, what our next steps are going to be.

Next slide.

So with again, the support report is and our actions are aligned with our accreditation because both health departments are um accredited.

Next slide.

And with this, as I mentioned earlier, we have four different types of um categories for that identify specific gaps and barriers.

One, we did we conducted a landscape analysis and community health data, collecting population demographics, but most importantly, that you're going to be finding that we're going to discuss momentarily is about the recommendations and opportunities for action that we've really received with through the conversations of our um community partners, such as our providers, leadership from Harris County Health Department, the our City of Houston Health Department, Harris Health System, and also Harris Center, and that will help drive where we're trying to move forward to.

Next slide.

So with this, as we mentioned, in these three C's as affording, finding, and receiving care, we do have to look at whether it's primary, behavior, dental care, and safety net facilities and so forth.

And these are what helps with the breakdown.

Next slide.

So we look to the far right, or maybe to your left, the health department's strategic priority to ensure access to care and resources.

This aligns with what our City of Houston mayor initiatives are.

And then, of course, we have the key initiatives that support the mayor's priorities.

Next slide.

So we're gonna talk a little bit about affording care.

And then I'm also gonna have Brandon give like a couple of examples too, so we can kind of make this uh flow a little bit differently.

So some of the matters, next slide.

The why affording care matters really is to help people determine whether they're seeking care at all.

One of the most important factors, as we all know, is the cost barrier, also people delaying or preventive um delaying preventive care due to the fact they don't have the resources.

So one of our key findings definitely through our analysis, conversations with providers, is the health care costs regardless of the insurance status, the coverage gap, regardless of who's eligible or who are not eligible for government services and affordability.

That's not um definitely evenly uh distributed.

Next slide.

So, Brandon.

Sure and thank you, Dr.

Shelton.

So from a uh community health survey that we um deployed back in 2024 as part of our community health assessment.

Um, when we asked, you know, what was the the reason that uh you delayed care if you did in fact delay care within the first 12 within the last 12 months, um, cost was the most common reason.

Um in addition, you know, we we know that about one in five people lack health insurance, and uh one in six people experience poverty within uh Harris County and the city of Houston, and these are really the biggest barriers to whether or not people can afford care at all.

So, with that, our community partners and providers, next slide.

They actually we came up with seven um recommendations.

Those recommendations are throughout, whether it's receiving, affording um care.

So the first one, um, as it aligns with the coverage gap, it remains a critical structure barrier.

So there is a thin line between coming in and seeing your health care provider versus someone deciding to put food on the table.

So next slide.

So the first uh recommendation was to continue to develop a coordinated affordable care policy, and this policy is breadth across various various entities, whether it's a community health workers, health care navigators, also food for medicine models.

And an opportunity for this, which is one of our the recommendations for the community partners is to strengthen multi-sector areas as it pertains to policy.

So hopefully, as we all know, that policy can make an impact when it comes to individuals receiving or having the ability to receive health care services and resources.

One of the most important things is really to look at not only engaging our community partners, whether it's Harris County, whether it's the City of Houston, FQ, HC, the fairly qualified health centers, community-based organizations.

We all have a commonality where it can help drive us being able to have a specific policy.

And lastly, using data.

Data helps with community stories to help drive to make compelling briefs and so forth.

Next slide.

Is we really would want to continue to expand public health benefits enrollment efforts, and that's whether you're going through Medicare, the CHIP community, the children health insurance plan, Texas women, and so forth, in regard to that.

One of the opportunities for action will be to one is to create some type of a referral pathway.

And again, I don't know if everyone's familiar with the community health workers.

This has been a really driving force utilizing those particular individuals who are actually from those communities and they can relate to our clients and so forth.

Also, another is to standardize some type of warm handoff practices between agencies so that residents are directly connected to a specific enrollment partner.

Brandon, did you have some?

Yeah, on the benefits enrollment piece, we know that this has a huge return on investment, and I think because of that, whether it's the city of Houston or Harris County or any FQHCs, we all do some sort of resource navigation.

We all do some sort of benefits enrollment.

And so one of the recommendations or the actions that was really exciting out of this one was just getting people who are doing similar work in the same room to talk about are they serving similar populations or is there better coordination of resources that can be happening across our jurisdiction.

So excited to see that one come forward.

Next slide.

So we're gonna move into finding care.

Next slide.

This deals with care that's affordable, depends on whether services are available and so forth.

So some of the key findings, again, as we were speaking with our community partners and so forth, with safety net provider shortages, is a very um is concerning and an increased demand limited to access to care.

Next slide.

Also, as you see a stat here, one in four people in Texas, which is a very general stat statistic for the state of Texas, they don't have a primary care provider.

So when this happens, that means that when a patient can't find a provider, they often later encounter disease versus getting some preventive health care if they did have a provider that was um monitoring um their care okay next slide.

So another barrier um i mentioned earlier is transportation is very significant um in regards to that.

Next slide.

One other thing that's coming in is the uh telehealth.

So with telehealth, meaning that an individual may be able to access uh care services via um the internet but there is a statistic that about nine percent of the households like internet access um and it's affordability so if you are a low income or don't have the funds to cover that that can make an impact in reference um to that so this definitely does not help um as fully with covering or closing the gap when it comes to accessing particular health care services next slide so recommendation number three we've actually talked breadth across whether it's our health system the city of houston health department in Harris County about expanding efforts to embed community health workers or resource navigators within partner organizations to really help support those um non-medical drivers so one of the things that recommendations or opportunities for action is to basically uh convene and share best practices from various organizations and so forth leveraging those resources um from various providers or community partners and then definitely expanding partnerships which um they do in great excuse me um integrating the um the CH the community health workers into community hubs I would just add that um whenever we think about our health care infrastructure in uh the city of Houston and in Harris County it's not that there is not enough infrastructure there's plenty of clinics whether they are federally qualified health centers safety net clinics community health clinics to go around and what we heard from our community partner feedback sessions when we introduced these recommendations and got feedback from them was there just needs to be more awareness of what all of those resources are and how to direct people to the facilities the locations the clinics that are near them it's really optimization of the resources we have we're a huge jurisdiction with lots of great resources here in Harris County and the city of Houston but it's a matter of getting people to the place that they need and is closest to them in a way that's accessible.

Next slide so Brandon actually kind of touched point on enhancing an infrastructure that's already there to help support and close loops and so forth.

A couple of areas that opportunities for action again create and one of the projects that we are working on and deploy a simple tool for residents providers and frontline public health workers this tools actually can be utilized whether it's um the community members and so forth to help them locate and find accessible care and so forth.

Also another is the opportunity for action is to develop a standardized SOP to deploy across various agencies and train on the gold standard of care navigations and so forth so this will help not only utilizing a tool to help people to individuals and agencies and providers to locate and identify resources but to put that in place where everyone has the standard of procedure next slide recommendation five it's about basically the workforce improving the community health workers workforce development and sustainability so without professional development without recruitment it can potentially limit the number of community health workers but by us working collectively together helps to promote community health workers and um care navigators within specific careers and we would strongly would like to um to advocate to employees on best practices when they do recruit, they hire or retain those individuals to help in regards to access to care.

Next slide.

Receiving care.

This is one of the last ones.

So when you receive care, one of the concerns is language barriers and health literacy, cultural differences.

These are some of the impacts that a provider can fill among themselves as well as the person that's receiving the care.

So as we know that language and culture barriers sometimes limit the individuals' ability to really to help navigate and use care, and also it can impact mistrust or deepen that mistrust.

A lot of times individuals may have some lack of sufficient systemic support, and again, a public policy directly or indirectly can affect that ability to receive care for that individual.

Next slide.

Next slide.

Did you want to talk a little bit about this?

Okay.

So public policy again, both directly and indirectly affects community members, ability to receive care.

So you see, this is a very broad stat.

Nearly three in 10 immigrant adults reported skipping or postponing health care in the past 12 months, which ended up being an increase based on other data that was that's available.

And sometimes and sometimes is really the fear of accessing care, which is a real concern, and so forth.

So as you see here, about one in five Harris County community members are non-citizens.

Next slide.

It's basically implementing a cultural responsive engagement strategies and institutional policies that directly address historical trauma, the cultural mistrust, and so forth, in order for that to really happen, again, that is where collaboratively where the local health departments, the FQHCs, the community-based organizations, and other entities that can come together.

What's a good opportunity for action is using trusted messages, using individuals such as our community health workers to help support those community outreach and education activities.

Another is to promote best practices to ensure safe and secure health care access for immigrants and for non-citizens.

Next slide.

So for example, we know that individuals, depending on where they work, it may not be feasible for an individual to go to, maybe let's say to a clinic, is um in the morning, eight o'clock or nine, they may need to be at work.

So test flexible clinic hours, service delivery models for working residents, definitely supporting the expansion of school-based clinics, telehealth services in schools, because then they have those resources because as we mentioned earlier, there is a significant number of households who have limited access to internet.

Then also allows services to be offered at all different types of schools without jeopardizing their fundings, and then lastly, identifying other um think outside the box, identifying other locations, and these are ideas that came up again through our community partners, maybe through the public libraries, faith-based organizations, and community centers.

Next slide.

So after hearing this, what is our next steps?

Well, between the City of Houston Health Department and Harris County Public Health Department, as we complete this report, again, we've been working on this project.

Actually, this month is a year, because we started June 2025.

So it's been a full year.

And once we complete the report, we also are, again, we mentioned earlier about a tool.

So we are developing and launching a web-based interactive safety net facility tool that will help the providers accessible to community members and to health departments and or any entity that needs it to find accessible and relevant care.

Then starting this fall, and that's this summer, between July and August, that will be launched and the report will be completed.

So we also, for part of our accreditation, we do have to have a community health assessment that has to be conducted, it has to be within five years of when an entity such as our departments have to go up for reaccreditation.

So since we've worked on this particular project, we've decided to work and made sense to work on collaborative for the community health assessment, which will start this fall of 2026.

And then with that, with the results of the community health assessment, we also invited, and they are eager to with um the Harris Health system.

So that way we can have an enriched report for the assessment to see where we need to focus our resources and so forth.

What are our priorities and to really reduce duplication and so forth and to help guide what our next actions are going to be and so forth?

Did you have any questions?

Sure.

The only thing that I wanted to to piggyback on is um, you know, as part of a phase two for this, we really want to develop and launch a web-based interactive safety net facility tool.

This comes from that finding of hey, it's really hard for people to find and receive the care that they need.

Um while this may not help people to um afford care past what they're able to today, if you put yourself in the shoes of like a community member or perhaps a community health worker who's helping a community member to find some type of follow-up care that their provider or that a clinic that they've been to has um told them, hey, you need to find some sort of follow-up care for neurology.

Um this is really intended to allow somebody to put in their address, find the type of care that they need, and then to be uh directed over to to that facility, and that's really difficult today.

There's not really a one-stop source of information for that in um Houston or Harris County.

And then, you know, when we when we pitched this, uh I want to also tell a story from um Dr.

Tran.

She had mentioned that prior to being the City of Houston Health Director, she was an emergency room physician.

And um, when she was there, if somebody did need follow-up care but wasn't able to be served by that uh hospital system, the direct connection was to Harris Health, regardless of whether Harris Health was the right um uh location for that individual, or if there was a nearby federally qualified health center that uh could support that person.

So we think this is gonna be really really uh really neat, really helpful for the public.

Um, and uh yeah, just excited to do that with y'all.

Next slide.

And in closing, we do want to share with you all the team that did a lot of work um on this project and so forth, and these are members of both teams from the City of Houston Health Department and from Harris County Public Health and so forth.

So we're really looking forward for our next project, but what we're asking is are there any feedback or um any insight that you would like to share with us because as we're presenting to add to the report because there could be some things that are going on that maybe the city of Houston Health Department and Harris County may not necessarily be aware of.

Thank you.

Alright, thank you for asking that, and thank you for the presentation.

We'll now have uh question and an answer uh part of this, but before I do that, I do want to recognize that we've had staff from Council Member Jackson's office and council member Selena's office from the start of the meeting.

We have um Council Member Alcorn in the queue.

Thank you, Chair, and thank you for the presentation.

I love that y'all are working together on this and working together on a lot of fronts from my understanding.

So really appreciate that.

I even before you kind of closed with uh talking about the tool, I highlighted that as in your presentation.

You know, just even Googling around while y'all were talking, you know, trying to find affordable it is, you know, they've kind of list some safety net clinics, they live some, list some FQHCs, but there's no common uh navigation, I guess.

You guys, that the county has a uh kind of navigating an application to figure out what kind of assistance you can get.

I did see that, like you go through and get you can I mean somebody can figure out like what they can get, like whether they qualify for Medicaid or CHIP or or whatever, you guys help with that, correct?

Correct.

Do we do that as a city or not really?

We do.

Okay.

Everybody does it then.

So what I'm saying is like I guess that's easier to figure out what assistance you can get than where to apply that assistance.

Correct.

And where are you in the development of the tool?

So uh we we believe that the first iteration, which is going to include, you know, City of Houston, Harris County Public Health, Harris Health Center, and uh Harris Center Clinics to be deployed in July, August.

So that'll just be our clinics.

It won't be like all the FQHCs and all that.

Not yet, but we do have plans to incorporate this.

Yeah, I mean, I think that's so important to just get the whole how many FQHCs are there in Houston?

I think sixty-three.

Okay.

Including FQHC look-alikes, and that doesn't include all of the community health centers that are not considered an FQHC.

And when is a safety net clinic the same thing as an FQHC or when I think about a safety net clinic?

I think about anywhere that somebody can access care that is not, you know, a for-profit um, I used to be on the advisory board of San Jose Clinic, like that's a safety net clinic.

Like for um, you know, uninsured, completely uninsured, and and um, okay, thank you so much.

I I think that's great that you're doing that and and I look forward to seeing it expand.

Thank you for that.

Councilmember Alcorn.

Um I've got a few questions for you.

Your presentation referenced CHW's community health workers, or I may have that uh wrong.

Can you can you uh talk a little bit about uh where we find these community health workers and who employs them?

So, and then I'll let I'll piggyb um Veroff to Brandon.

So for community health workers, there it depends on the um program or the entity that they are hiring those community health workers.

So let's just say, for example, you have a program that may require community health workers to work within that particular community or that particular um program, you advertise it, it is a certification that individuals go through and they do keep a certain number of hours, and the the luxury of it's been around I think since 1920s, and started in the federal level, the Indian Bureau of Health, if I'm not mistaken, of the community health workers in regards to that.

So this they've been around for quite a bit, so it just depends on what the needs that um like so for our health department, we definitely need them.

Um we do have staff that went through the training.

So if we have to conduct outreach, maybe let's say um our staff member speaks the language, the culture, can help guide, depending on what the project is and so forth.

So a lot of areas do have community health workers, it just depends on what they utilize them for, and usually um it's for navigation and also uh making sure or helping them access resources.

All right, I'm curious to know who provides that training and certification and whether you all think we have enough uh community health workers at this time.

So that I know of, I know the state of Texas, is that correct?

The state of Texas provides training for community health workers, and I believe there's also um contractors that provide that certification training.

All right, um, you've worked together a lot to collaborate on this assessment and and report.

Have you seen uh areas where uh the city and county can collaborate?

Yes, and and even um even today uh we know that both the city and the county provide uh preventative health services of varying types.

Um one way that we do that is through the use of mobile units that go out to communities and out into neighborhoods and community centers, and um I also know that the the groups that are responsible for uh you know the strategic and organizational decisions of where those uh those units go are meeting to discuss.

Are we are we perhaps going to the same places?

Are we making the most of our geographic coverage?

Um, are there opportunities for ours to refer to yours when there's a service that you know maybe they provide that we do not?

Um so there are uh opportunities for that.

Have you all looked at possibly can combining certain systems?

I know you've described a process where you sort of work in coordination.

Have you all looked at uh possibly combining uh services?

I don't want to speak out of turn, but I I would say um not yet.

Uh I think that these are discussions that um Leah and Dr.

Tran are likely having at this time to, you know, any time when a um uh insight or an opportunity comes up, uh there's likely a discussion between you know our leadership that says uh who should be doing this, you know, who's on first in this given given instance, and um should we be doing it together or should there be some some um combination of the two?

Okay, thank you for that.

The uh council member Alcorn asked about safety net centers, um, but we also have community health centers, and I've become aware uh learn more about a few of them.

Any idea how many safe uh community health centers we have now?

I don't have that we can find that out for you.

Okay, and and um do you think do you think we have enough of them?

That is hard to answer.

Um there are so many needs across our our geography, um, but in terms of whether we have enough, what what we heard uh time and time again from our community partner feedback sessions was um let's optimize the use of the resources that we do have.

I I can't say definitively whether we have enough or too many or not enough.

Um but in a uh environment where we're seeing fewer and fewer federal funds.

I would think that uh using the resources that we have and and um coordinating across them such that we're using them in an optimal way is is the way to go.

Okay, and and last thing I'll ask is uh on next steps.

You mentioned aligning uh this community health assessment and uh community health improvement plan.

Have you all and by you all uh the county and the city health departments become begun working on the improvement plan?

So currently um, because our city of Houston Health Department is going through reaccreditation, but we are um working with um Harris County, one of our um access to care, that is one of their the priorities just as it is with ours.

So the answer is yes, but for what's listed there is the next steps for the next community health assessment and the next um community health improvement plan.

So we are working together on that, but that's one of the areas we do collaborate on is access to care.

Yes, okay, thank you for that.

That's all the questions I have.

I don't see anyone else in the queue, so we will say thank you for the presentation and for your work, and look forward to more progress in the future as we try to care for those folks who who need that assistance.

So thank you both.

Thank you for your time.

Thank you, everyone.

All right.

We haven't had anyone sign up from public to offer comment.

However, if anyone is here and would like to comment, we'll certainly hear from you.

Is there anyone in the audience who would like to offer comment?

Okay.

Hearing none, we'll go ahead and uh adjourn this meeting and say thank you to all who participated, and we'll look forward to seeing you all again next month.

Thank you.