Okay.

The time is now 10.03 a.m.

on this Tuesday, December 2nd, 2025.

We'll be now called the community health meeting to order.

Madam Clerk, please call the roll.

Councilmember Castillo.

Councilmember Alderete Gavito.

Councilmember White.

Chair Government.

Here.

Chair, we have quorum.

Perfect.

Get things started, get things rolling.

First item of the agenda is proval of the minutes.

Are there any corrections to the minutes?

If not, can I get a motion to approve the minutes?

Great.

All those in favor of approving the minutes say aye.

Any opposed?

Any abstentions?

Moving along.

Let's move on to public comment.

Madam Clerk and any citizens out to speak for public comment.

Yes, Chair, we have five people signed up to speak on item number two.

Great.

Raymond Bryant?

Perfect.

On behalf of the community health workers and community health, I think that one of the greatest things the city has chosen to do is focus on community health.

And all of the programs that we've seen and the people that we've been able to work with make a tremendous difference in the community because they come and we're able to help people understand food and understand what is food and what's not food.

And uh and and know the difference between good food and junk food.

And I think that it's important for us to continue to undergird the programs because it's making a difference, and I think that it changes, I don't think I know it changes the health outcomes for so many people, and so many people have been helped through this process, and so they're learning how to grow food, learning how to prepare food, learning how to eat healthy food, and learning how to lead healthier lives.

So I think that the community health programs are excellent for the city, and they make a tremendous difference in the community, and they're doing a great job, and so we've developed some real partnerships, and so they come, they help us in all areas of the community, and we're looking forward to continuing to do great things.

We're building gardens.

So I'm actually with San Antonio Million Garden Project, and so we built gardens all over the community, and we continue to build them.

We're growing food and we're getting help uh from the community health workers and from the health department.

And so we're just thankful for the opportunities and for what it means when the city actually participates in promoting health in the community and helping the community become healthier.

So I think that that's a tremendous asset, and we're thankful for all that they do and all that is taking place, and we hope that it continues and expands as we go forward.

Thank you.

Thank you for the comments.

Uh Linda Carmen Bryant.

You have three minutes.

When do my time start?

Good morning.

Um since it hasn't started, I'll go ahead and start.

Good morning.

Uh I I'm grateful for this opportunity to come and be able to speak on behalf of the community health workers.

Uh, just I know I have three minutes.

Um I'm prior military, served 30 years in the army, retired here in San Antonio.

Uh I'm also a former um uh member of the community health workers team with healthy neighborhoods, and so um I understand the importance of what community health workers do, and what it also does is it provides an opportunity for us to be able to communicate with those that are out within the various communities.

We do focus my area then was the east side of San Antonio, where a lot of the demographics there are people who really are in need of healthy food, and those areas in which they live are food deserts.

And so one of the things I did as a part of the community health work is trying to go in to help provide healthy food even at the grocery stores when they have the initiative where they try to put healthy uh fruits and vegetables within those department stores at the cost that they can afford, not jacking it up as they do in typically in those community uh grocery stores.

But one thing is important for us to know is that food is medicine, and so when we can provide them and help them to have healthy food where they can go outside their homes, their doors and pull out of their gardens uh things that they can cook versus having to run to the store and those other things, and we know that the things that we grow in our own gardens are more healthier than what we get in some of these stores.

And so for CHWs to be able to provide those options for them definitely makes a difference.

So the initiative that has been made with the project that they're having really makes a difference.

And so, again, if the city can support those efforts, it does make a difference.

And so when we talk about COVID, how the impact of those who were lost their lives, they were based on the mobilities that they had, and healthy food can help to help offset some of those healthy um impacts that they've had.

So we look forward to what will take place, and we pray that you guys will help to increase what's being done.

Thank you.

Thank you for your comments.

Uh Susie Schumann.

My name is Susie Schumann, and I serve as the Safety Net Director at United Way of San Antonio and Bear County, where our mission is to unite the community to identify and solve our most critical issues.

Together, we're working to ensure children are ready for school, youth are successful, individuals and families are self-sufficient, and our community is supported in times of crisis.

Our safety net impact area, services that foundation of our work, and the support system for the other three impact areas, ensuring that essential needs are met.

We provide um focus in three areas: economic stability, food security, and housing.

And economic stability, we're providing essential needs, both directly and alongside case management in food, ensuring access to food through food pantries and community distributions, and providing safe shelter and support for vulnerable populations.

We are grateful for our strong partnership with Metro Health to strengthen the food system through collaboration, education, and partnership and action.

Metro Health staff have served and continue to serve as advisors across our impact areas.

A special acknowledgement to Anna McNack and Daniel Jimenez for their invaluable contributions to our safety net.

They've also participated in a film that will inform our next request or proposal.

They've introduced Leah's Pantry to two of our food partners.

They've also led meaningful conversations with our partners focused on reducing food waste.

The resource center at Via Coronado and our United Way Family Resource Center Network work closely together.

Via Coronado always participates in our FRC events and consistently brings fresh fruit.

During the recent government shutdown, Fort Sam requested 12 baby bags for expecting and postpartum mothers via coordinado supplied diapers and formula, and the FRC provided baby hygiene items.

Many in our community are one emergency away from a crisis.

It could be our coworker, friend, or neighbor.

United Ways 211 helpline is one of only three 24 seven call centers in the state of Texas.

We invite you to visit our office and listen to calls.

211 is a powerful resource for your office and your constituents.

Visit TX.211 counts.org to see the top needs in your district.

In 2024, the top three needs in Bear County where housing, food, and utilities.

Join us at the homeless persons memorial service on Sunday, December 21st at 7 p.m.

as we honor the lives lost in 2025.

And we reaffirm our commitment to ensure everyone has a safe place to call home.

Our data is available on our website, and we appreciate the recent conversations we've had with your staff.

United Way is here to support you and your constituents.

Thank you for your time and your commitment to a stronger, more resilient community.

Thank you for your comments.

Hello.

Thanks for receiving or letting me be here.

My name is Alfredo Ortiz Aragon.

I'm a professor at the University of the Incarnate Ward.

And I've always I didn't come from the world of academia.

And uh I was fortunate to meet uh some community health workers and a broader team with healthy neighborhoods back in 2017.

Um we even the timing is good because we had a Thanksgiving together where we had uh one class with a P my PhD students at Healthy Neighborhoods, and then Healthy Neighborhoods community health workers came to our class for another uh exchange.

And my goal is always to get the community into the classroom and take the classroom in the community, and I found no more ideal partner than healthy neighborhoods to be able to do that over the years.

Um fast forward a little bit to uh 20 right around when the pandemic started, and we had an opportunity at Incarnate Word to pursue a grant with the Robert Wood Johnson Foundation uh community health and well-being.

And uh we partnered with it with Healthy Neighborhoods again.

They they brought in their own resources and time.

Uh we brought and they leveraged a lot of resources that we had, and we worked together for about three years uh working with communities to do just that to become their own researchers to try and address challenges that are important to them and to their broader communities.

A great example that I love is uh we worked with uh breastfeeding mothers on South and well, some of the neighborhoods where healthy neighborhoods works, and um we did went through a process of telling stories, hearing their experiences of uh breastfeeding during the pandemic.

And uh at a certain point in this process, we were using a photo voice process, which taking pictures, it's a way that allows community members to represent their knowledge in sophisticated ways without necessarily having to go through uh traditional research processes.

We they shared their pictures.

We were trying to figure out what are these resilient breastfeeding strategies during the pandemic.

And at a certain point, we realized the pictures weren't doing the trick.

And so working with uh with healthy neighborhoods, they were very keen to say, hey, we need to go slower, we need to pay more attention to what the community members want to say, and we need to ask them what should we do next.

And what we did was we ended up doing a much deeper storytelling process that includes cartooning and all kinds of cool things that allowed community experts, as we call them, to represent their knowledge in such high-level ways that they're influencing multiple other spaces.

We've presented the results of that with the community experts in multiple conferences and other spaces, and this beautiful cartoon-filled academic article is about ready to come out in about a month, which we're happy to share with you as well.

I'll just conclude by saying Healthy Neighborhoods isn't just meeting the community where they are, they're definitely doing that.

Their strategies are community first, community centered, and not health strategy centered, but rather where do you where do you start?

How can we meet you where you are?

And secondly, uh they're producing knowledge along the way.

They've learned so much about the intersection between uh community health, city.

They're part of their part of the fabric of the city, and we need to invest way more in these in these kinds of programs and not less.

Thank you.

Thank you for your comments.

Our final speaker is Molly.

What name did you say?

Molly.

Thank you for the coffee.

It's it comes very it comes in good handy.

It's like really cold outside.

Um, so I'm not representing the carnet word.

Um I'm actually calling and speaking about people that are dying in the streets right now.

They're fighting to stay alive, and it does not get cold until 32 degrees.

It actually does get cold in the 50s.

It kind of gets cold in the 60s, but really hyperthermia starts in the 50s.

Um y'all have this strange rule about not opening up warming 24 hour shelters until 32 degrees, and that pretty much tells me that the city wants the people to die on the streets.

Um, please prove me wrong.

Open up the 24 hour warning warming centers.

We have tons of community centers.

I'm jobless.

If you want to go ahead and staff someone, I need a job.

You can staff me.

I'll cloudly take the night shift.

Um, but we need a plate, a warming center for these folks that are fighting to stay alive.

Um, they're dying on the streets.

Um I don't know how else to beg.

Um the only thing that y'all are doing is a silly little, I think somebody already mentioned it.

Someone's gonna do a Mylan Park, recite all the people that died on our streets.

You know, it's like really that that's all Sam Ministries in the city is gonna do.

Just recite people's names left and right.

Oh, we feel so sad that you died.

You know, Patricia Lawrence, I'm so sorry that you jumped off the building because you didn't want to face another time of cold.

Um really what the city of San Antonio is gonna do.

Donating money to a drug city that people don't want to go to Haven for Hope, that's not the answer.

Um, Sam Ministry staff told me themselves on 410 that they are not taking new intakes.

That's what the staff at SAM Ministries told me.

You have a holiday in hotel that has an occupancy level of what 500, 400, and they're only at about 100, 150.

And the two ladies at Holl at SAM Ministries told me themselves that they are no longer taking new intakes.

What's that about?

What is that about?

Um I don't understand.

So y'all are donating money to agencies, you're paying money to SAM ministries to pay for the holiday and hotel rent, and yet you're not taking in new intakes.

I I'm not sure, I'm not understanding what that's about.

Um what can one do to get y'all's attention?

I mean, I know uh Councilman Mark White and Councilman Govito, I know y'all don't care because y'all signed a C CR to ask Eric Walsh and you know, to for more human sweeps.

Human sweeps is not the answer.

People are not getting sheltered from human sweeps.

That's all that results from your CCR that y'all signed, the five of y'all with Manny Palais is death.

And then you have a silly little annual ritual at Mylan Park.

That's all the things.

I mean, is that really what you want?

Just tell me the truth.

That's all they want to know.

Do you want them to die?

Thank you.

Thank you for your comments.

Anybody else sign up to speak?

We'll now move on to item number one, Metro Health update regarding healthy neighborhoods program.

And I believe Marjorie White or Claude, presenting.

Okay.

Good morning, uh, members of the community health committee.

Uh, thank you for this opportunity.

Uh again, I'm um Dr.

Claude Jacob.

Along with the Department of Human Services, uh, we will provide two briefings today.

Uh, first on mental health health leading neighborhoods program, and then on the teen mental health survey.

Uh but to kick off, I have some exciting news to share.

I'm proud to announce that uh the San Antonio Mentor Health District has received official notice of its reaccreditation status.

Woo-hoo, as recognized by the Public Health Accreditation Board.

This national designation affirms the department's continued commitment to meeting the highest standards for public health practice and service delivery.

For additional context, just know that nationally one in four local health departments across the United States is FAB accredited.

Currently, there are a total of eight uh local health departments here in Texas that are accredited out of uh 73 statewide.

So I really want to thank the city manager, councilman's uh council members Galvan and Castillo for participating in a required site visit that was held at the end of October.

And I really want to send a special shout out to our fantastic team at Metro Health, especially Audrey Avila, who serves as our accreditation coordinator for helping to anchor this effort at the department to ensure compliance with FAB's requirements.

So, with that, now I'll introduce today's presentation.

Um, during our October 23rd presentation, we provided an overview of the Medicaid 1115 waiver program and highlighted our constraints expected at the end of this fiscal year.

We also provided an overview of the diabetes program, which is an example of a key program that will be impacted by the lapse and funding by the end of the next fiscal year of this fiscal year.

With the expiration of this funding stream, the operational impact to Metro Health will be the loss of approximately $8 million and about 80 staff by the end of uh September of 2026.

There are eight different programs and a number of cross-cutting teams that have been implemented for over a decade, and today we'll feature one of those programs.

So the Healthy Neighborhoods Program has been operating since 2012 and remains one of our strongest community-based initiatives.

This program is funded through the city's general fund, the Medicaid 1115 waiver, the Centers for Disease Control and Prevention, and uh USDA grants.

Despite funding challenges, healthy neighborhoods continues to be nationally recognized, including uh earlier this year, uh, the 2025 designation as a promising practice as recognized by the National Association of County and City Health Officials.

The second presentation will feature the Teen Mental Health Survey, which is co-administered by the Department of Human Services.

This effort began in 2021, believe it or not, during the pandemic, when the youth commission and Project Worth Teen ambassadors came together to better understand how the pandemic was affecting youth mental health.

So the survey provides valuable insights into the experiences of 12 to 19 year olds helping guide mental health programming and resource allocation.

So at this time, I'll introduce our assistant director, Marjorie White to present an update on healthy neighborhoods immediately following our chief mental health officer Jesse Higgins and Rebecca Flores, education program administrator at DHS will present an update on the Teen Mental Health Survey, and we'll be available to uh answer any questions following the presentations.

Thank you.

Marjorie Good morning.

As Dr.

Jacob stated, my name is Marjorie White.

I serve as the assistant director for the community health and safety division.

It is such a delight to share with you one of our most innovative programs at the health department, healthy neighborhoods.

In this presentation, I will provide an overview of the background of this program, including where and how we work, how we use the asset-based community development model to drive meaningful health improvements and the challenges and opportunities we've encountered along the way.

Our why healthy neighborhoods began in 2013 under the 1115 Medicaid waiver as a health promotion initiative.

What made it unique from the start is our commitment to hiring from communities that we were going to serve.

Together, these team members developed their guiding why, which states, we believe that all families deserve healthy neighborhoods, and they possess the assets needed to create positive change.

This guiding principle centers the work around community inclusion and recognizing that residents are the true experts of their lived experiences.

The Healthy Neighborhoods became the first mental health program to fully embrace the idea of community health workers as the ideal model for engaging communities on health topics.

Today, this program remains the largest CHW program with about 18 CHWs.

The program is structured into three interconnected branches, leveraging their unique strengths to serve the community more effectively.

First, beginning with our community connectors.

This team is comprised of neighborhood-based CHWs, where each are assigned to a specific neighborhood.

These neighborhoods were selected based on both historical disinvestments and the presence of strong community assets, such as the people, the places, and organizations ready for collaborative and health focused interventions.

Our REACH program states for racial and ethnic approaches to community health.

Through funding through the Centers for Disease Control and Prevention, we were able to expand this team to include REACH.

This added a team focused on policy, systems, and environmental change across the east, south, and west corridors of this community.

Their work includes improving nutrition standards in food pantries, offering incentives like double up food bucks to make healthier options more accessible through the Healthy Corner Store Initiative, enhancing physical environments to promote activity, supporting early child care centers and adopting evidence-based health guidelines, and also our resource center at Via Coronado.

In 2023, Healthy Neighborhoods launched a first of its kind resource center located on the south side of San Antonio.

This center addresses both immediate safety net needs and long-term food security while also supporting chronic disease prevention.

Together, these branches represent a comprehensive community-led approach to public health with CHWs leading the way.

How we work.

CHWs meet people where they are in the community, whether it's community centers, churches, outdoor spaces, but they offer education on nutrition, gardening, and fitness for all ability levels.

And they also serve as community liaison.

The CHWs takes the pulse of the community and serve as a bridge between residents and public health.

One acts one example is during the COVID response.

It was the Healthy Neighborhoods team that played a vital role in every aspect of that response, while also providing critical feedback to the department about community perceptions, concerns, and innovations.

Our CHWs have the autonomy to co-create public health interventions in partnership with community, bringing residents' ideas to life.

So where we work.

These are long-term investments where CHWs are embedded in the community, attending the neighborhood meetings, supporting events, and bringing in resources and education identified by these residents.

The yellow stars on the map indicate locations where our teaching gardens are located.

These serve as regional hubs for health promotion promotional classes that connect nutrition and fitness education with gardening.

They're located at the Salinas Wick Clinic, Vehicle Coronado Resource Center, and Pecan Valley Wick Clinic.

Another unique aspect of healthy neighbors is the use of asset-based community development framework.

On the left, you see a needs-based approach, which focuses primarily on problems and deficits, as you see here, child abuse, teen mothers, gang members, delinquency, addiction, all of the above.

In contrast, our ABCD recognizes the strengths already present in a community.

Its people, its places and organizations.

Residents are seen as collaborators and agents of change, with public health playing a supportive role to amplify their ideas.

To work together, we must first build trust, and that begins by recognizing and honoring the good that is already present.

Asset mapping is a key step to asset-based community development framework.

It's the hands-on process of discovering who is present in the community and what motivates them to take action.

The image on the right is a real asset map from the Los Jardines community, which is in between District 5 and 6.

It shows the people, the community health workers connected to, and how residents are connected to one another.

Our CHWs are trusted messengers in their community and natural connectors, linking people with shared interests and goals.

We also have resident leaders, these individuals with broad social networks who are especially skilled at spreading information, and then our residents who also become change agents using their relationships, talents, and lived experiences to drive transformation.

This interconnectedness is also known as social network.

Healthy neighborhoods actually recently completed a study looking at a social network analysis to explore how these connections influence health outcomes.

The findings confirm what we already knew.

A connected community is a healthier community.

People with more relationships in their neighborhood are statistically more likely to report better health than those with few or no connections.

And now for the REACH program, which added a powerful layer of evidence-based, sustainable and community-driven strategies focused on policy, systems, and environmental change, which goes beyond these one-time events or programs.

These type of programs are foundational to long-term health improvements, sustainable even when key individuals move on, logically linked to measurable health outcomes, and capable of influencing both individual behaviors and the physical environment.

The images here highlight our work in early child care centers, supporting healthy development from the start, public engagement to improve spaces for safe physical activity, our fruit and vegetable voucher programs, food pantry enhancements, which promotes client choice and dignity.

These efforts aim to reduce health disparities in communities across San Antonio's East, West, and South Side.

Our special sauce.

This unique blend that makes healthy neighborhoods so effective in creating community-led neighborhood-specific, evidence-based, long-lasting positive change.

One powerful example is the garden at Bethel AME Church, located just steps from their food pantry on the east side.

This garden was installed together by Bethel AME, Gardopia Gardens, and our Healthy Neighborhoods program.

The food grown here goes directly to the community, showcasing the strength of a local food system and the many hands that come together to nurture and care for their neighbors.

This also came out of that same special sauce we talked about earlier.

This was once a vacant building.

It was preserved by community members who envisioned what it could be.

We are so grateful that the community entrusted our healthy neighborhoods program to help bring this vision to life.

Today, the center provides immediate food assistance, a welcoming space for community gatherings, classes and preventive health services that support long-term food and health security.

Currently, the center serves around 300 unique individuals per month.

It's a testament of both what trust built over time and the ongoing need for support and services in the community.

In terms of outcomes, here's a brief overview of the many people and the program that the program has served this last fiscal year.

As you can see, 1,087 children were enrolled in centers where best practice for health promotion that our healthy neighborhoods program assisted with.

17,160 residents served were served by food pantries with enhanced nutrition policies and practices.

We have more than 50 corner stores recognized as our healthy corner store initiative for stocking fresh fruits and vegetables.

And for one of the healthy corner stores, we offer double up food bucks discount, and we had 19,127 transactions.

For our resource center via Coronado this past year, we served 1,240 unique persons and offered 447 health education classes, just to name a few.

Beyond the data, there's stories behind all of this.

In chronic disease prevention, it's often difficult to measure how many heart attacks we prevented, how many people we prevented the onset of diabetes, but what we can measure is behavior changes.

This data is from the Camelot neighborhood, which was the CHW that was part of this was Miss Lisette Camtu, who recently retired.

She worked in this neighborhood for approximately 12 years.

And as you can see from the data, there was positive health outcomes from the work that was invested here.

Among the individuals she regularly engaged with, most reported adopting behaviors known to reduce the risk of heart disease and diabetes, which are both leading causes of death.

Many also shared personal stories about how the classes positively impacted their entire families.

This slide also shows the voices of our community members in regards to the work.

So one says, Tango Mucha Confianza, Gekon Las in Cenzanza, Deliset, Yo I Mi Familia, vamos para un futuro mejor.

This translates to I am very confident with Lizette's teachings.

My family and I are heading for a better future.

We also received quotes from some youth.

One said the food demos made me love cooking, and now I cook healthy dishes for my family.

Lizette helped to get my voice out there.

She connected us with resources that help my family.

Just to give you an idea of the impact of the work by this team.

The Healthy Neighborhoods program has received national recognition.

In 2019, they were designated as a model of practice by the National Association of County and City Health officials in 2019.

In 2025, very recent, our research center at Via Coronado was recognized as a promising practice.

These honors reflect the program's innovation, effectiveness, and commitment to community-led public health.

And now for the challenges and the opportunities.

Similar to the presentation with the diabetes program impacted by our waiver program, this program is also being impacted as well.

On the left side, you'll see what our current funding is as well as staffing and capacity.

As Claude indicated previously, the 1115 Medicaid waiver, we expect to exhaust all of those funds by September 30th, 2026.

So as you can see for this program, their budget would go from a little over 2.1 million to 1.3 million, which is a funding reduction of about 36%.

The staffing would go from 23 to 16, but please note that this reduction also includes majority of the leadership of this program.

In addition, this will also impact the capacity, the number of neighborhoods we serve, the number of classes we're able to offer, as well as the number of people we would reach.

And we estimate that the reduction would be between 35 and 50 percent.

And what's not listed here is the institutional knowledge that will be lost because many of these individuals have over a decade doing this work in the communities.

Opportunities.

So we are working to preserve the core elements of the program to remain vigilant for future growth, such as using asset-based community development model, using our community health workers as organizers, educators, and liaison, which is unique, effective, and worth protecting.

By maintaining this foundation, we ensure that when funding does become available again, that we are in position to apply.

In the meantime, the program is working to align with other city initiatives to remain relevant.

The resource center model is also being explored as a way to maintain deep ties in selected neighborhoods.

Should we need to scale back in others?

Our partnerships, many are also here today with us.

In addition to the partners that are listed on this slide, um, there are many other partners that are not pictured, which include our neighborhood housing associations, informal community groups, and trusted local leaders.

Everyone is really feeling the strain of the national disinvestment of public health.

Cities and states across the country are grappling with budget shortfalls.

And we know what happens when there's a disinvestment in public health.

The burden often shifts to the individual as well as healthcare systems.

And our hearts goes to all of us who are working with less, but doing trying to do the best that they can to meet the need.

If you all can all please stand here in the audience today, are Kathy Shields, our public health administrator, Anna Macnack, our health program manager, Nora Vargas, our outreach supervisor for the community connectors, Chong Min Fu Saw Snow, who's our reach grant coordinator, and Daniel Jimenez, our resource center coordinator, and many of our CHWs that serve this community.

Can you give them a round of applause?

It is an honor to be their assistant director.

This concludes our presentation.

Thank you.

Thank you so much, Marjorie, for the presentation.

Thank you for everyone for all the work that you do day in and day out for this program.

For my colleagues, we want to start with questions or comments.

Or counselor White, if you want to start.

Sure.

If you're ready, you're up.

Come on, you know you want you know you want to go first.

Okay, I'll go first.

Thank you, Chair.

Uh thank you so much for this presentation.

I thought you were spot on in that residence.

We we know our neighborhoods best, you know, not only on the needs of it, um, but we know whose speeds on our streets, we know who the connectors are, like you were you were mentioning earlier, and we also know the people who may need some help.

So thank you so much for all of that research that you all were doing.

Um, I had a quick so some quick logistical questions.

Why were these neighborhoods selected?

And also kind of a double question what are there plans to expand to other neighborhoods?

I know the last slides talked about some of the um budget constraints, but just curious.

No, absolutely.

Um, the original neighborhoods were selected because of how health outcomes in these communities.

Okay, and so that was their original um way that we approached the 10 communities that we worked with eventually.

But then over time, as we were able to um get more funding to expand, we were able to expand to other communities as well.

But looking at health outcomes in these original 10 neighborhoods have very poor health outcomes, as well as historical disinvestments for a variety of reasons in these communities, and also there were people there who were who wanted to have change.

Yeah, and so that's very helpful when we're able to partner with the community to address what their needs are, but also the assets and figure out ways to expand upon that.

Yeah, and and thank you for that.

So basically, what I'm hearing is expansion is dependent upon budget.

Absolutely, and as you saw from that one slide, um, once we get to October 1st, if we're unable to sustain funding or find additional funding for this program, it will we will face a reduction in the number of neighborhoods, capacity, yeah, et cetera.

Well, and and I think you know, especially through the um impact stories, especially the one like the food demos made me love cooking and show you know how she how she can make a healthy or this person, I'm not sure if it's he or she can make healthy dinners for their family, and I think that's kind of where the rubber meets the road, right?

Because you know, um, I'll take me for instance.

Used to live on the north side, now I live in Woodland Lake, and you see what a food desert, certain parts of town are.

You know, I have the luxury of being able to drive to other places, but for a lot of people who don't have those options, you see the very stark reality of living um in certain neighborhoods in the city.

I had a question also on the 50s stores participating in healthy corner store programs.

What does that look like?

The healthy corner stores?

So we work in communities where there's um food swamps, um, food desers as well, and we partner with the corner store to provide fresh vegetables and fruits in that corner store.

Um recently we we're kind of transitioning to do more double up food books where individuals who have SNAP, they'll um double up food books match it dollar to dollar to make it more affordable and give them more for their money.

And so that's ensuring that we have access to um healthy options in these corner stores that may be the grocery store for the community.

Nice.

Yeah, I love that.

Um it was it reminds me of like um when I used to work at USAA, um, you know, you have your spending, but you could literally get a salmon salad for the same cost as two tacos, you know, and so I think incentivizing that uh healthy food like that uh really goes a long way.

Um on the impact stories, how are we tracking long-term outcomes uh to see how we're moving the needle through uh generations?

I'll bring up um Anna Mac.

Who's the program manager to provide more insight?

Hi, Anna Macnack.

Um yeah, we do a variety of kind of research methods in order to see how the programs doing.

We do a lot of stories.

Um we've done a lot of videos in the past to show the impact of the ways that we're doing different programs in partnership with community members.

Um the long long-term health outcomes is a is a challenge to measure, but we're hoping at the resource center at Via Cornado will give us that opportunity as many people are kind of coming back to the same spot.

So each year we do a variety of qualitative and quantitative measures just to check in to make sure that we're on the right track and meeting the community's needs.

Yeah, and we could take this offline, but I'd love to like for me and the team to sort through that data with you.

You know, I'm just curious about what that looks like and um and how how we can uh sustain it, you know.

Going to slides 16 and 17.

I I understand how reductions are tough.

Um and you know, we we want to continue again.

To me, this is a lot of where the rubber meets the road on on moving the needle for San Antonio.

Um is there ways that we're uh exploring partnerships with nonprofits or community orgs to continue to do this work?

You know, I mean, our budget constraints are our budget constraints, but I'm wondering if there's ways that we could partner with like uh garden opia, beat aids, community care or other nonprofits who can help with with some of the stuff.

No, absolutely.

We're actually in the process of our strategic planning for all of our waiver funded um programs, and that's part of it.

What are the partners?

If this goes away, who can pick it up?

Um, or how can we better collaborate to um expand reach in some shape or form?

So we are in the process of doing that.

Okay, sounds good.

Um and I know our council offices obviously have access to well, so do you all um a lot of nonprofits?

But if there's ways that we could put our heads together about that around that, you know, because again, uh this work is crucial.

So thank you so much.

Thank you.

Thank you.

Thank you, Chair.

Council Roy.

Yeah, thanks, Chair.

Um councilwoman touched on it a little bit.

Long-term success, short-term success.

How are we measuring uh the success of the program?

I definitely would say um through our engagement with our community partners.

Um what we also look at are like what are some of the resident um projects that the folks are working on that's promoting health in their different communities.

We look at um healthy corner stores, how are we expanding that?

How many folks are actually using double up food books to increase the the number of healthy options that they're purchasing?

Um qualitative work from surveys and focus groups that also helps us to determine whether or not we're being effective.

But I'm gonna turn it over to Do we have data?

Do we have numbers on some of these things as to how many people are are being served?

Yeah, we shared a lot of the numbers about how many people are being served, and then we use a variety of methods to see how different pieces of our program is impacting the community because of the variety of work that we're doing, we'll hone in on different areas.

For example, we recently did uh a study on the double up food bucks participant experience to learn more about how double up food bucks impacts families, and happy to share that report.

It um it really sheds light on just the power of being able to provide that those extra funds for additional fruits and vegetables impacts the variety of fruits and vegetables being purchased, the quantity of fruits and vegetables being purchased, and thinking about those trade-offs that people are making when they're thinking about buying food or other resources or utilities, it showed uh very positive results.

So it depends on which aspect of the program, but evaluation is always a part of what we're doing, and happy to provide any additional documentation on that.

It looks like we've got budgeted um a little over 640 grand for the program in fiscal year 2027, right?

Um which is about half of the little less than half of the program's total funding.

Correct.

Is there um is there a plan to get less dependent on on the general fund moving forward, or is this program always going to require significant general fund funding?

General fund okay, you want to take it on.

Thank you, Councilman.

I would say that this um what we offer here is at least a snapshot of the programs that will be disrupted by the lapse of the Medicaid 1115 waiver.

I would say that each program is unique.

Um, for this one in particular, it's not only the general fund, it's also the offset from the Medicaid 1115 waiver, the CDC, as well as the USDA grant.

So I would say we're assessing this.

What we intend to do here is at least let you know about the fragility of these programs, the impacts of what we've seen over the last decade.

Um, but this is not unique.

And so what we've offered here, at least through these uh different uh scenarios is just so you're aware more aware of some of the programs and what we've done over the course of the last few years.

Um we understand the constraints on the general fund.

Sure.

And would you say that I mean we're looking at almost 1.4 million that's gonna be spent on the program in 2027?

What percentage of that is direct community impact versus uh administrative?

We can provide some more detail about the breakdown.

Okay.

Um I think I think that's really it.

I I appreciate I appreciate y'all's work and uh obviously this this helps a bunch of folks, and so um thank you for the presentation.

Thank you, Council.

Thank you.

Council Rika Steele.

Thank you, Chair.

Thank you, Dr.

Jacob, Marjorie, and the entire Metro Health team, as well as to the members of public uh who gave public comment today to express the importance and impact of this program.

Uh what we know, and as stated by one of the public commenters, right, is that we know the people on the ground are those with the solutions, and we should follow their lead.

And I think that's what's important about Promotora's community health workers is working from an asset mindset rather than a deficit mindset.

And it makes me think about the historic West Side Neighborhood Association, which is my neighborhood, uh, and it's when in our city's most uh economically divested zip code in communities, and what we start our community meetings off with is what I love about the historic West Side, right?

Uh oftentimes folks come in with their negative perceptions because we have public housing, low-income housing, uh working class families, but we start off our meetings about what we love about our community because we know we are an asset.

Um, we just need support and investment and uh care from folks beyond our neighborhood.

Um but with that being said, uh, I think what you all have highlighted in terms of the potential reductions.

Has Metro House had conversations in terms of what are the non-negotiables, what are the areas in which we don't intend to reduce uh if we don't identify additional funding sources to help support the program.

Thank you, councilwoman.

Again, we're going through that exercise now, and what we're sharing here with you is a premier about some of the uh most impacted programs.

So we featured a diabetes program in October.

You're hearing about healthy neighborhoods, so just know that uh we're uh analyzing the impacts now.

Uh we already have placeholders in terms of our budget planning process for FY27.

So this is intended to be a data point for this group as we have an acknowledgement ongoing constraints uh impacting other programs at the department.

Yes, and what I'd offered to my colleagues in terms of how we can continue to identify opportunities, right?

I think there's always value in revisiting RCPS policy uh and the ways in which we can fund these really important vital programs to our community members.

Uh, as you mentioned in your in your presentation, Margie, right?

We know we're going to see draft impacts all throughout the community and how that's going to overall impact working families economically, right?

If you don't have access to healthy foods, fitness programming, how that can potentially impact diabetes, hypertension, so much more.

But something to highlight within the presentation are some of the impact stories, right?

And how this program has helped improve health behaviors, particularly around uh reducing access to sugar intake at 60%, which is huge.

Less added salt, 58%, which is also huge as well, less saturated fats at 67%, and so on and so forth, with ways that this program have helped improve the health for San Antonio families.

So extremely grateful for that work.

I don't think it's something that we can afford to divest in.

I understand it's there's financial constraints and there's uh federal uh funding that's out of our hands, but we do have a responsibility to work a budget that reflects the needs of San Antonio residents.

And I believe that continuing to invest in this program uh helps reflect the needs of our community members.

And in terms of something that I would like to learn more about, right, is I really value the example presented in terms of the vacant lot and community taking ownership and then partnering uh with Metro Health to activate it and turn it to uh a farm.

Um I'd like to learn more about that.

Uh and I think that goes hand in hand with our crime prevention plan as well.

Um so I'd like to see how we can continue to support the implementation of that component as well.

Uh, because not only is it helping tackling like the community public health component, but also uh, as you know, the intersection with public safety as well.

Um so those are all my my comments and questions, and I think uh council has a huge task to ensure that we don't see the reduction of the community health workers out in our districts.

Um because with that being said, right, this is a program that's high hiring everyday people uh with expertise and relationships, which is really hard to find in resume.

Uh so I don't think we can afford to lose any community health workers.

Thank you.

Again, what you see here is an example of looking at the glass being half full.

So it's really about the assets, the resources in community, and how we can do a better job protecting all those in that jurisdiction or in that neighborhood or in that part of the city.

So just now I applaud the team.

It's been a uh a yeoman's task over the decade.

Uh and this is one of many um programs that will be impacted.

So for this morning, we wanted to give you a little bit more insight about what we've done, what the team has done on the ground with the partners on the ground, but at the same time, signal to you about our fragility uh in the outuse.

So we know that this funding stream is on borrowed time.

So this is really intended to be one example, and the analysis continues.

Yes, and lastly, I just wanted to uh thank your team and Dr.

Julius as well for the diabetes fair that was over at Monterey Park.

There were so many families.

Uh he got the the dancing started and got me out there.

Um but it was just a lot of fun and great to hear such positive feedback from community about when's the next one, right?

Um so just really grateful for your team uh and everyone out on the ground doing the work.

Fantastic.

Thank you.

Thank you, Chair.

Thank you.

Had a couple quick questions and just kind of conversation points to think about this.

One of the things uh that I think is really important is the, you know, we talked about what could happen with uh funding's not there next year, uh, where folks will go.

The institutional knowledge that could be lost uh from the community health workers that are currently employed doing this work every single day, where do they end up?

I know the exercise is still going on, but I did I don't know if through the exercise so far we have identified what opportunities are available because my concern and constant critique is that uh if the job opportunities are not there in the community, if the pay rate is not the same, if the employment benefits are not the same, do we lose those folks completely?

And if so, um I think it's just critical that our city does continue to do that work, right?

To be able to be that kind of facility to be that home base for the folks to do this work every single day.

Uh if there's not valid or equal uh opportunities on the communities.

Do we have any data on that or identification of that so far about what kind of opportunities there are?

Thank you, Councilman.

Not not at this time again.

This is uh uh analysis in progress.

Um we appreciate the commentary, we'll make a note about but looks like anything else.

This dovetails with other conversations around um fiscal impacts over the course of the coming year.

Yeah.

Thank you for that.

And I think it it's just that's another important part that stays in my head about, you know, we can always say that hopefully a partner takes us on, but if there's an ability for the the partner to actually afford to do so, inability to them to pay the benefits that we offer here at the city, then we lose those folks who are doing this work already because this is the place where it can be done in the most effective way, right?

In partnership, yes.

But also with a deliberate funding effort.

I think about other cities that are doing public health uh uh workforce cores, right, to build those kind of things out.

I know that work's being done currently here as well in uh different ways.

And it's just uh uh the purpose there is that with the city's able to take it on, right?

We're able to do the social services compared to any other entity here or any other two nationally too.

Um so I'll just leave that there.

Um I do appreciate the comments about some of the requests for data as well.

Uh I know there's different kind of qualitative data we're looking at.

Something that I would like to see is the um what kind of casework or kind of uh requests for support for the community is requested, um, whether it's related to food security or related to public safety, or through the vacant lots or other kinds of things, what kind of things are being asked about and how is how are those uh being addressed by community health workers and other partners to then kind of shape the the change there, right?

We address the vacant lot, and therefore we now have an effect a deliberate effect on legal dumping or whatever it is, right?

Uh we have a change here on food access and making sure healthy access is early food access is there, and so we're seeing a reduction in sugar.

How does that affect the youth in the household who's now at school able to maybe focus more?

Whatever the data point is there.

I know it's a longer kind of analysis that has to be done, uh, but I would love to see some of those things because I think it's it's helpful for us to kind of put in perspective a bit of how this impacts our life long versus our kind of assumptions about lead sugar, great, and if we know that's great.

But also, right, we can see the multiplier after that, right?

Uh students are going to school more, folks are able to maybe uh get job places for a different reason or whatever it is, right?

Less less hospitalization visits.

I think those would be really helpful uh to show as well, um, not only in the the now, but in the future too.

What could it be like if we were to scale this up?

Could we expect to see a significant reduction in hospitalization visits and therefore cost savings on our end and taxpayer and completely uh with university health uh visits too?

Anyway, that's a long way to say those are some things I would love to see uh some of those, especially in terms of the cost savings.

I think that's always really important here that always the upstream, right?

We do the upstream, we save money down the end in both healthcare outcomes and in public safety outcomes and in taxpayer outcomes.

Um last thing I wanted to ask was about specific programming uh in each neighborhood.

Do we have a kind of a breakdown of what things are being done in each neighborhood?

We have composites um and we can put together.

I know that we've asked uh in the past you've asked about different programs across districts.

So we'll see what we currently have specific to the healthy neighborhoods program.

Yeah, and we can put something a little bit more uh robust together.

Cool, that'd be great.

Last oh for last thing.

Um would love to see also the uh demographics if possible of folks who are being touched by the community health workers.

Is it more seniors?

Is it more youth?

Is it more mixed of both?

What kind of families with disabilities, whatever it is, if there's some of that information, that'd be interesting to see too.

Um just to kind of review.

Okay, we can work on that as well.

But thank you all again for the work that you do every single day, and I always appreciate it going to the Los Arginus Neighborhood Association meetings and seeing the one about community health workers incredible work there every single day.

Um, and has been doing it for such a long time too.

I know the community is always excited to talk with you about all the different things that are going on in your world as well as in their world, right, with the folks that you're interacting with every single day.

So thank you to everything that everyone does on the team, but also especially for the folks in the west side of district six.

Thank you so much.

All right, thank you.

Any last questions or comments from colleagues?

Great.

Moving on to item number two, Metal Health and DHS briefing on the teen mental health survey.

Let me see who's coming up.

Rebecca Flores and Jesse Higgins.

Good morning.

I'm Rebecca Flores, the education program administrator.

Um we have some special guests, but before I call them up, I just kind of want to briefly go over the agenda for today.

Um, so our special guests, we have representatives from the San Antonio Youth Commission and the Project Worth Teen Ambassadors.

Um, then I'm gonna give a summary of the 2022 to 2024 teen mental health surveys.

Um, and then I'm gonna turn it over to Jesse, and she's gonna do a deeper dive into the data of what we're seeing in the community, and again, COSA's youth mental health initiatives.

So, with that, I would like to turn it over to our special guests.

All right, uh hi, my name is Robert Jimenez, representing District 7 on the San Antonio Youth Commission.

And I'm a senior at TMI Episcopal, and I'm here to talk about the importance of the teen mental health survey and youth mental health in San Antonio.

Uh, we can all agree that mental health is a reflection of our environment.

And the teen mental health survey really gives a good representation of how the city is doing with mental health among teens.

And it brings to light the often overlooked causes, symptoms, and coping mechanisms of what teens are going through.

With the information provided in the survey, the city can assess what resources they need to allocate to better support the youth in San Antonio.

As a teen, I see through not only myself but in other people my age the effects of peer pressure, bullying, political, and economic stress.

The survey is needed now more than ever, with increasing stresses impacting everyone, but especially the youth.

Um good morning.

And thank you for giving me the opportunity to speak today.

My name is Natalie Salcedo, and I'm here with the teen ambassadors.

I am a teen investor, sorry.

And I'm here representing District 6 to share why this survey and the topic of mental health matters so much to many in our city.

First, about the survey.

This survey is important because it gives young people a real voice.

A lot of the time, decisions about youth are made without fully understanding what we're actually experiencing.

By collecting honest feedback directly from us, the survey helps identify what's working, what's missing, and what support students feel they need.

It turns our experiences into data that adults and leaders can use to make informed choices.

Second, why mental health resources matter for teens?

Right now, so many teens are dealing with stress, anxiety, and depression and pressure both in and out of school, but not everyone has access to the support they need.

Mental health resources aren't just about treating problems.

They help us build healthy coping skills, stay connected, and feel supported before things get worse.

When teens feel safe and cared for, we do better academically, socially, and personally.

Having these resources truly makes a difference in our ability to succeed.

As our city leaders, your support can help make sure that the findings from the survey turn into real changes, like increasing access to counseling, promoting mental health education, and creating safe spaces for young people to ask for help.

Even small steps can have a huge impact on students in District 6 and across the city.

Thank you for your time and for listening to this perspective of young people.

We appreciate your support and partnership in helping prioritize teen mental health.

Any members of your family here as well today, or anyone?

Awesome.

Well, just to say to the parent, thank you for raising a credible leader here.

And for the parents who are not here, thank you for raising incredible leaders regardless.

Uh who do this work every single day as youth, uh, I'd be remiss to note, right?

The work that I started doing as well personally, started in high school to get involved in some of this work that we do every single day.

So you never know where you may end up, and not only down the line, but even shortly down the line too.

Um, because the leader that the work that you're doing now will continue to grow, and people are looking to you for the answers as well as the solutions, as well as the work to do together.

So thank you again, and thank you for our departments for investing in our youth here in our city.

Anyway, carry on, Rebecca.

Well, thank you, Natalie and Robert.

I'm kind of nervous to go after them because they did such a good job, but luckily they're still gonna be with us if y'all have any questions for them after the end of our presentation.

Um, before I begin discussing what we learned from the Teen Mental Health Survey, I want to share a little bit about how the idea started.

It was the fall of 2021, and we were having our normal Saturday youth commission meeting.

Um, zero problems getting our youth to talk, but something my team my former teacher uh hat came into play, and we noticed that something was off with our youth that Saturday.

So instead of sticking to the agenda, so cover your ear city clerk's office, um, we allowed the commission members to share with us what was on their minds.

Although it was concerning to hear all of the challenges they were facing as a person who was brought up during a time when talking about mental health was taboo, um, it was refreshing to hear the commission members being so honest about what they what they and their friends were experiencing during the pandemic.

And that's how basically the idea came about of how the mental health we wanted to better understand what the health challenges were in teens in San Antonio.

The San Antonio Youth Commission joined forces with Project Worth ambassadors to create the first survey made by youth for youth, released on the city's SA Speak Up platform.

I also want to add that besides capturing what they were hearing and feeling, they also wanted to better understand what resources youth 12 to 19 wanted to see in our community.

The survey was reviewed by mental health experts, translated into five languages.

It was also reviewed to ensure the literacy level of the text was appropriate for the audience.

This may have been the first survey written by teens, but I dare say that it was as professional as any other survey we have published on the SA Speak Up platform.

In 2022, we received a total of 1,047 responses to the survey.

Of this amount, 846 of the surveys were valid and used in this analysis.

I will give a high-level summary of the findings of the 2022 survey, and if you're interested, we can send you a more detailed analysis.

Participants noted several challenges with mental health.

When asked about a variety of depressive traits, 37% stated an inability to perform day-to-day tasks.

49% stated feeling helpless, hopeless, numb, or like nothing matters.

And 24% indicated use of smoking, vaping, or using drugs.

Females reported higher struggles compared to their male counterparts.

While LGBTQ and gender diverse youth reported 20% points higher compared to their heterosexual counterparts when reporting the inability to perform day-to-day tasks and feeling helpless, hopeless, numb, or like nothing matters.

When examining the results by Wraith ethnicity, although we didn't have enough responses to be statistically significant, Asian Americans reported the high highest rates of inability to perform day-to-day tasks and feeling helpless, hopeless, numb, numb, or like nothing matters.

Which, as you may recall, we were in the middle of the pandemic, and the anti-Asian sentiments and hate crimes were kind of prevalent, and obviously they were having an impact on our Asian American youth.

When asked about whether they have suicidal ideations, LBGTQ plus, gender diverse, and Asian Americans' youth reported higher proportions than their subpopulations.

Over 50% of gender diverse and LBGTQ youth, and 45% of Asian American youth reported suicidal ideations compared to 28% of all participants.

In addition, LBG, LBGTQ plus and gender diverse youth reported higher percentages of harming themselves compared to other subpopulations.

On average, 26% of youth reported these tendencies.

So still very high in our general population.

A staggering 17% of youth reported they did not feel comfortable talking to anyone about their mental health challenges.

Most youth reported they did not have a trusted adult at school to talk about their mental health challenges.

When asked where they go for mental health support, overwhelmingly youth reported a preference to talk to their friends.

The survey also revealed that besides their friends, the top teen mental health outlets were music, sports, gaming, and art.

The teens wanted more mental health resources in school, and that's no surprise because that's where they spend their most of their time.

The survey could not have come at a better time.

City Council and City Leadership were developing plans on how our community would invest in the American Rescue Plan Act funds during this period.

After hearing from CECE and Project Work members, the Community Health and Environment Committee, which was their precursor to this committee, recommended $18 million be allocated to youth mental health programs.

The committee also allocated 100,000 to the San Antonio Youth Commission, with the only guidance from council was that they'd be if the funds be used to positively impact teen mental health and learning environments.

And they went to work and kept us very busy.

With their 100,000 investments, CECE members supported Teen Mental Health First Aid training, which focuses on helping youth identify and support mental health challenges they observe in their friends.

This addressed the survey's findings that a majority of teens turned to their friends for mental health support.

They also sponsored Teens Day SA, an event held in the spring that brought together youth organizations throughout San Antonio and provided outlets for youth to learn more about mental health resources and offered fun activities youth had identified as de-stressors in the survey.

Perhaps the most impactful, CECE offered teachers, counselors, and student groups an opportunity to apply for microgrants of up to $3,000 for projects to positively impact teen mental health and learning environments.

They received 147 proposals, and they created a committee that reviewed every single one of them.

Although they did dedicated most of their 100,000 to supporting these microgrants, they were only able to award 27 projects and funded at least one project in every single council district.

As you can see from the slide, I have some photos there, and I kept adding more and more and more.

So thank you to whoever helped clean that up.

But you can kind of see some of the projects that they funded, school gardens, their animal therapy before standardized testing, covering the cost of counselors to attend the American Counseling Association conference so they could better support their students at schools.

I could go on and on and on and on.

Let's just say after this process, I was ready to turn over the keys of the city and have the youth kind of run it for us.

It was just an amazing process.

CEC and Project Worth members decided this first SA Speak Up youth survey should serve as a baseline to track the mental health outcomes of youth in San Antonio.

So in 2023, the second survey was issued.

The slide says the data was inconclusive.

That's just a nice way to say we experienced some technical difficulties on the back end of the survey, and unfortunately, we were unable to verify which responses were valid.

In 2024, we addressed the technical issues and issued the third survey.

Although participants continued to experience challenges with mental health, there was promising decreases in stated struggles when compared to 2022 survey.

And this indicated that the investment the city, county, and school districts made in youth mental health programs was having an impact.

When asked about a variety of depressive traits, 25% stated an inability to perform day-to-day tasks, down from 37% in 2022.

36% stated that they felt helpless, hopeless, numb, or like nothing matters, down from 49%.

And 10% 10% stated they smoke, vaped, or use drugs, down from 24% in 2022.

While a higher percentage of LG LGBTQ kids reported experiencing depressive traits than their straight heterosexual counterparts, there was a decrease in all categories for them.

When examining results by wraiths and ignites, all categories reported a decrease also, except those who selected another option not listed here, or I prefer not to answer.

So I'm finished with my remarks, and we're now gonna turn it over to Jesse Higgins who will go discuss what mental health professionals are actually seeing and how the city continues to support mental health for youth.

Thanks.

Good morning, Chair and members of the community health committee.

My name is Jesse Higgins, and I'm the chief mental health officer.

I'm happy to be here today with you alongside Rebecca, Robert, and Natalie.

One of the best parts of my job is getting to bear witness to the amazing work that's uh done in our community, and I have a great picture that I like this proud aunt that I just took of these two while they're presenting to you all.

Um it's truly such a privilege to be here.

Um I'm incredibly proud of the care, thoughtfulness, and effort that Project Worth and the Youth Commission and city staff put into the teen mental health survey.

The response rate alone is impressive.

We have some other community data that I'd like to show you so that we can better understand the landscape of our community.

I want to acknowledge that these slides will talk about self-injury and suicide attempts for adults and children, and while this information is heavy, there are glimmers of hope.

This slide comes from the Texas Department of State Health Services and shows the emergency department visits for females and males under the age of 18 in Bear County.

You can see that self-harm or self-injury is a diagnosis experienced more frequently by girls, and that there was a large increase in 2021.

The good news is that in 2023, the rate for both boys and girls was lower than it was in 2019.

We find encouragement in these numbers trending downward.

On this slide, we have specific data from 2022 and 2023.

This data is hospital discharge rates for suicidal ideation and attempts in Bear County for all ages, and then zooms in on youth ages 14 through 18.

You can see that compared to the first column of all ages, teens aged 14 through 18 in Bear County have a much higher rate of suicidal ideation and suicide attempts.

Although we are seeing some of these community-wide indicators and indicators in the two teen mental health surveys trending in a better direction, we still recognize that self-harm, suicidal ideation, and suicide attempts are the reality that many young people in our community are struggling with.

We also know that for children, suicide is the second highest cause of death after accidents.

We've got to keep up with the life-saving work of talking about mental health and providing access to services.

One more indicator that I like for us to keep our eye on.

This slide shows SAPD's mental health 911 calls from 2019 to 2024.

Through the pandemic, we had a pretty significant increase in 911 mental health calls.

And as we continue to destigmatize mental health needs and offer a response like SA Core, I think that we'll continue to have a high call volume.

These numbers seem to have stabilized and are actually decreasing slightly.

For 2025, we are trending closer to 29,000.

I'm hopeful that this data point shows that our community is finding its footing and a new baseline, and that people are perhaps becoming aware of programs that can help them in a crisis and also before it becomes a crisis.

I'd like to point out that there's many different ways to show data like this, and this is pure call volume, which shows the weight on our 911 call center.

This does not show calls in light of the population increase we've seen over the last few years, and with that population increase in mind, these numbers would actually show a steeper decrease.

So what do we do about this?

We've heard the need from our commissioners and ambassadors.

We've heard from the youth in the community, and we have access to data that we cannot ignore.

One resource that has become increasingly important is the two school-based mental health service contracts that we have through the general fund.

These contracts are commun are awarded to communities and schools and the mobile mental wellness collaborative.

These contractors provide counseling, case management, basic needs, leadership programming, and staff professional development to the districts they serve.

They serve the districts of East Central, Edgewood, Harlandale, Judson, Northeast, North Side, San Antonio, South SAN, and South Side.

And we expect that they will serve at least 650 clients in fiscal year 2026.

We are thankful that council allocated an additional 150,000 in funding for both 2026 and 2027.

The landscape of school-based services will change this year as all of ARPA funds in the community will be exhausted.

We are working with community partners in Bear County to monitor the impact of this funding ending.

The school community is also in the midst of working out the implementation of Texas Senate Bill 12, which went into effect on September 1st of this year.

This bill impacts which services a school may provide to students without parental consent.

We are hearing from districts and partners that there is confusion and inconsistency in how schools are understanding this bill.

One more initiative that I want to make sure you're aware of is the Bare Area School Safety and Mental Health Summit.

As we were thinking about the impact of the relationships built through ARPA contracts and the needs of the community, last year we hosted the first annual Bear Area School Safety and Mental Health Summit.

This was a collaborative effort with Metro Health, Bear County, Region 20, and communities and schools.

At the summit last year, we had over 150 people in attendance representing school districts, charter schools, nonprofits, hospitals, philanthropy, law enforcement, criminal justice, elected officials, the Texas School Safety Center, HHSC, the Office of Homeland Security, the FBI, and the Secret Service.

This year on November 3rd, we hosted the second annual School Safety and Mental Health Summit with over 200 people registered.

The objectives of the summit are to understand that mental health of school-age children is a public health priority, to strengthen school safety by supporting a comprehensive system of care which includes mental health, and to identify next steps.

One of the next steps identified from the first summit was a tech was a Texas Capital Advocacy Day, which we attended and spoke at this year in February.

We were pleased to see that the school safety allotment that was established but not funded in 2023, was funded this year in 2025, and most importantly, it also includes psychological safety, which acknowledges that mental health services, training, and awareness are key to students feeling safe in schools.

Highlights from a summit this year included a panel of students, a legislative policy review, which did a deep dive into SB12 and other policy changes out of the 89th legislature, a data review and spotlights on collaborations in our community that are successful.

We're already working on plans for the third annual summit next year.

Thank you so much for giving us the opportunity to present to you today.

I truly believe that anything we do for youth, even if it's crisis services, is work in a sacred upstream space.

Working with children to help them better understand themselves and the world around them is a beautiful way to invest in the future of our community.

We're all available to answer any questions that you have.

Thank you.

Thank you so much.

Just move to council conversation.

Thank you, Chair.

Thank you so much to the youth commission and all the work around here.

This is obviously an important topic, and it's awesome to see us organized in this fashion and really helping us articulate what the status is for the youth in our city.

I just wanted to give a quick shout out to Robert Jimenez.

Thank you so much for being appointed and quickly jumping to leadership role and all of your efforts there.

It's awesome that you're representing D7.

And this the second quick note is something that we've brought up again and again, and I I feel it's applicable to this conversation, and that is that when we call 911, any resident calls 911, we should have a mental health option.

This is done in other cities.

The SA core team does great work, but we want to make sure that if teens or any resident is experiencing a mental health crisis that they're connected to to help quickly.

And so just again want to push for us to figure out what logistics we need to do to make a mental health option when when residents are calling 911 a reality.

Thank you.

Councilor White.

Yes.

So quickly on the on the survey summary, it looks like 2024, uh some of the depressive traits are down, right?

So are we is the conclusion there that it was COVID that made these things spike and now we're getting back to normal?

Like do these represent sort of pre-COVID numbers?

They're not at pre-COVID numbers.

And I think that one of the things, and that's why I always bring up that 911 um call volume slide, is that when we destigmatize things and when we say if you need help, ask for it, and we have services for you, we're going to see an increase in talking about it, an increase in sort of like admitting that we're struggling, and an increase in access or asking for services.

And so we do see, I mean, we know that children are resilient, um, more resilient than adults.

And so we do see um folks recovering and getting a little bit better, but I would say it's it's also an um a testament to what the city and and community and services have been invested in over that course.

So it's not to pre-COVID numbers, um, but it is getting a little bit better.

How much higher than pre-COVID numbers are we?

We'll have to go back and look.

We may not have we won't have the exact same data points because we don't have the teen mental health survey from before COVID.

But we can definitely do a deeper dive into pre-COVID and post-numbers.

Yeah, it'd be interesting to see what it was before.

We also struggle with children data that we don't have as much access to data on kids as we do on adults.

Yeah, and and you say these are down over the last two years due to the efforts of the city.

So we have, I guess, metrics to so that we can say that.

Sure.

I have um let me show you our ARPA results.

Um, so this is the results of the 20 youth mental health contracts that we had through ARPA.

Um, served over 6,000 um kids, and um, you can see that of the 54% of those 6,000 that got four or more sessions, we saw 52% um reporting a decrease in depressive symptoms, and 44% reporting an increase in well-being.

And so the services that we invested in did and do help people for sure.

Okay.

Um, my last question is uh the memo on this one says data has been utilized to allocate resources, but it doesn't say what resources, how much money or or what we've changed because of the survey.

Do you have any of that information?

Sure.

So um one of the things is how the ARPA um it largely shaped how the ARPA dollars were spent and um that first survey did.

Um it also uh I mean we've we concentrated on community-based services.

We um also concentrated on a few service, some of these contracts helped um train teens to be able to better um understand what their peers were going through.

That important data point that that teens want to talk to teens.

Um, and so making sure that a tenth grader can understand that information that they may being told by their peer and also know when to bring in an adult and how to you know address that with their peer.

Um, we also the many grants that the youth commission gave out, that was a huge part.

Um, and then also the um the change in this year's budget, I think largely not just from the teen mental health survey, but came out of the youth uh budget town hall where mental health was identified as one of the priorities of teens in our community.

Okay.

All right, thanks, Chair.

Thank you.

Councilor Castillo.

Thank you, Chair.

Uh thank you, uh Jesse and Rebecca for the presentation as well as uh to Natalie and for Robert for your leadership.

I'm always uh grateful to see young folks uh at the podium uh expressing what not just your generation needs, but what the city of San Antonio should be advocating for.

So just thank you all so much.

Very proud of you all at your age.

I could never stand up to a podium and speak in front of folks, so just uh thank you, and we're really proud of you all.

Uh, in terms of the presentation today, there's a couple of alarming metrics in here, uh, particularly around uh the suicidal ideation and self-harm, particularly for LGBTQ youth and gender diverse.

I believe this is more uh than a cry for help.

I believe it's a call of action for the City of San Antonio to stand uh uh alongside our LGBTQ youth uh beyond uh you know Pride Month.

Uh what that looks like, I think it's worth having conversation with the youth commission and the organizations doing around doing the work to see how we can continue to better support uh our LGBTQ youth.

Um, you know, with that, I had an opportunity about two years ago to do a ride along with an EMS, and one of those visits was a response to uh a suicide, right?

So it's something that we know uh folks in public safety are responding to, but there's a need uh as Jesse mentioned to destigmatize the the need for uh asking for help and also presenting what resources are available to folks.

Another metric worth highlighting, and I think something that council should hone in on is the one in four teens that um have said that their family struggles cover covering their basic needs uh sometimes is something that uh sits with them.

And I think when we're having conversations about affordable housing, utility rates, uh livable wages with city um supported contracts, that we have a responsibility to make sure that we're supporting San Antonio families with each of those pillars because it's our youth uh that are going to school or not going to school and are going to municipal court for Transey Court that are sitting with those struggles that their parents are facing.

Uh now an area that I'm proud of is one the work of Judge O'Bleto, right?

Connecting our families to resources, making sure that it's taking a holistic approach, connecting our families to the resources that they need.

Um, but also the work of the youth commission in the public safety committee uh with uh Melody, we had a conversation about how we can mitigate youth violence and support youth here in the city.

And some of the recommendations is the work that the youth commission uh has initiated through the hundred thousand dollar uh pilot, right?

Which is creating uh these uh calming centers within their schools and connecting our kids to meditation resources and our teachers.

So uh you all are really leading the way, uh, and it's up to council to invest and implement those recommendations.

But there's plenty of work, uh grateful for the work of course Rebecca and Jesse on this really important issue.

And again, right, when we look at the trends connecting to youth violence in particular, we're seeing an increase.

Uh so I think we have a responsibility to invest in this pillar because it's our future workforce.

Uh and then if we're allowing folks to enter the justice system, right?

There's more barriers to housing, workforce opportunities, so on and so forth.

So uh I believe this is where the work is, and thank you all so much for leading uh in this initiative.

Those are all my comments.

Thank you, Chair.

Thank you, Councilman.

And at 11 30, 11 39 a.m.

Uh on December 2nd, we will now adjoin the community health meeting.

Thank you.

Thank you, Alex.