Community Health Committee Meeting: Oral Health Program & Greenway Trail System (Feb. 2, 2026)
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All right.
The time is now 10.02 a.m.
on February 2nd, 2026, and we'll call the community health meeting to order.
Councilmember Castillo.
Councilmember Alarete Cabito.
Here.
Councilmember Mesa Gonzalez.
Councilmember White.
Chair Gavon.
Here.
Chair, we have quorum.
Thank you so much.
All right, first thing we gotta do is the approval of the minutes.
Are there any corrections to the minutes?
All right, can I get a motion to approve?
Absolutely.
All right, great.
Uh all those in favor to approve the minute, say aye.
Aye.
Aye.
Any opposed?
Any abstentions?
Great.
Motion passes.
All right.
First thing we have public comment.
We have a couple speakers signed up to speak.
Each person will get three minutes to speak, and so we'll start with uh Beatrice Hicks.
Good morning.
Um City Council members.
My name is Beatrice Hicks, and I'm in a retired associate professor at the UT Health San Antonio.
I served in the Department of Dental Hygiene there for 34 years.
In 2006, I was very fortunate enough to be a part of collaborative grant with the Department of Health and Human Services who awarded us $300,000 to the Department of Dental Hygiene, Parent Child Incorporated, and the Metropolitan Health District.
And the reason for that was to develop and implement a culturally sensitive pediatric practice dental model for Head Start programs.
The collaborators established a model incorporated preventive services such as dental screening for our varnish applications and oral health programs for parents, family support workers, and Head Start teachers.
An extensive case management system was also developed.
This management system provides oral health case managers who pave the way for children to gain access with Bear County dentists to provide treatment for urgent or routine dental care and as well as to find a dental home for the children.
A key part of the work involves identifying and breaking down treatment barriers.
This program helps break down those walls one by one to restore a child back to health.
Many of the children who are seen come from low socioeconomic households and may or may not qualify for Medicaid benefits.
And even if they qualify, we have found that they do not tap in or utilize the services.
This program was later expanded to include the Miles of Smile Sealant Program, and this program models and mirrors the Head Start program and provides sealant services to school-age children.
Dental sealants are preventive service in which a plastic coating is placed on the chewing surface of the teeth to prevent future cavities in children.
Both programs include mandatory rotations for both dental students and dental hygiene students at the UT School of Dentistry.
This offers chance for the students to provide the preventive services, screenings, the fluoride vinyl treatments with the children.
Students learn how to recognize childhood cavities along with the opportunity to experience firsthand the disparities in their own city.
These programs serves thousands of children in Bear County each year.
The goals of the program is to strengthen health, development, and long-term opportunities of Texas children.
Oral health is much more than dental care.
It shapes how children eat, how they speak, learn, socialize, and thrive.
It influences school readiness, family well-being, chronic disease prevention, and the broader foundations of lifelong health.
Yet its impact many times is often overlooked in conversations when we talk about child well-being.
The programs meet the needs of our community and an essential component of whole child health.
It is my hope that you can understand the impact that these programs have on Bear County and the critical role it helps in proving a child's overall health.
Thank you for your attention.
Thank you so much.
Our next speaker is Lydia Almare.
Good morning, Chairperson and members of the council.
My name is Lydia Almaris, and for 51 years from thank you.
From January 1974 to July 2025, I had the privilege of serving the children and families of the Head Start Early Head Start program as a nursing and family and community specialists.
For five decades, I witnessed firsthand what poverty looks like in the eyes of a child.
And I also witness and hope and hope looks what hope looks like because of the partnership, like the one we have with Metro Health Oral Health Program.
Head Start's mission is to provide comprehensive high-quality services to children from low-income families.
Oral health is not just one of those services, it is one of the most urgent.
And for decades, Metro Health Oral Health Program has been the heartbeat of that mission.
Every year we worked side by side to make sure children had access to continuous dental care.
Metro dental professionals reviewed every child's health status, helped us ensure they were up to date on screenings, and guided us through the early periodic screening diagnosis and treatment requirements.
They didn't just show up, they partnered, they taught, and they supported us.
When dental clinics were scheduled at our schools, Metro Dental staff trained our family service workers, supported our teachers, and reviewed every constant form and made sure every detail was correct so children were safe and parents were informed.
On clinic days, they treated each other with patience, gentleness, and dignity.
At the end of the day, parents walked away with answers, resources, and a path forward.
But what touched me most was everything they did beyond the clinics.
They attended parent meetings.
They gave out their personal contact information.
They met with families one-on-one, even over Zoom when a parent was worried or confused.
They sat on our mental advisory committee and shared outcomes, updates, and guidance.
They were present, not just as professionals, but as partners.
In my 51 years, I have seen children who could not drink coal milk, coal milk because their teeth hurt too much.
I have I have held three-year-olds who cried from pain.
No child should ever fear.
And every time Metro Dental Professional stepped in with compassion skill and a genuine love for these children.
So I'm asking truly from the bottom of my heart that you continue the contract with the Metro Oral and Health Program.
The children of Head Start are counting on you.
They need you, and they deserve the care this partnership provides.
Thank you for your time and for caring for the children who need us the most.
Thank you.
Thank you so much.
Our final speaker is David Singleton.
Good morning.
I'm David Singleton.
I'm a retired dentist.
I've had a dental practice in District 10 for 24 years.
Within that time also, I worked part-time uh with these programs and actually was a part-time dentist uh for the city.
Um so I've been an intimately involved in the program, hands-on with these children.
We've seen the kids from pre-K all the way up to third grade, and they come in many times it's the first time they've ever even seen a dentist as they come in to us.
We go into the schools, uh, we have all the supplies that we need, the equipment, uh, we seat them down, uh, I examine their teeth.
I look in there and I notice so often the many decay teeth that they have.
Uh it's very sad.
Uh I see big holes in the teeth, and evidently the many times the parents are just not aware of the huge problem that exists.
I'll ask the kid, the child, are you in pain?
And they're just a little six-year-old kid.
Uh-huh.
But if I had not asked them, they wouldn't even tell me because they don't know that this chronic pain is something that they're not supposed to have.
So it's, and we are able to deal with that.
We see infections, and we get them to a dentist to get them a dental home, and uh most and they help them to get on Medicaid if that's where they need.
So I just can't overemphasize the crucial importance of what this program means.
And in fact, this is this program is the only entity that's available for these children in the city of San Antonio.
Nobody else can do what we're able to do.
Just the nature of decay, which I'm sure many of y'all are aware of, but the fact is once a tooth gets a decay, it does not go away.
It does not remain the same, it gets worse and worse, and eventually reaches the point where there is pain or there is infection, and it affects the whole health of the child.
By getting these kids into the uh dentist where these it's treated, it's really a life-changing thing for them.
And a lot of times parents will think, well, it's just a little baby tooth.
Well, the problem is a baby tooth that gets infected affects the permanent tooth that's down underneath.
So they like I say, it's it's a life-changing thing.
We had two years of COVID where we were not able to treat these children, and when we came back after those two years, it's it was so disrupting for us to see such an increase in the decay and how bad it was.
So I just pray that you provide the essential needs of this program that it can continue.
It's just it's essential.
And there's a lot of things that I know that the city is responsible for, and many, many otherwise, there's a lot of their health issues.
But this is something we're talking about pain, we're talking about infection, we're talking about life-changing things that we're able to do.
Nobody else can do it.
Thanks very much.
Thank you.
Those are the speakers that signed up to speak today.
Um with the Great Public Climate.
We'll now move to item two, uh, which is an overview and update of the oral health program for mental health.
Go ahead, Clark.
I don't really get to do that often, so all right, there we go.
All right.
Good morning.
Uh community health committee members.
Uh, I'm Dr.
Jacob from uh the nationally accredited Metro Health and appreciate the opportunity to provide an update about our oral health program as a follow-up to the uh commentary from our guest speakers.
As you know, uh you we kicked off our series last October to provide examples of programs that most directly impacted by the lapse of the Medicaid 1115 waiver reserve funding, uh, which will expire at the end of the fiscal year in September of this year.
The previous examples uh for our presentations included an overview of the diabetes program as well as our healthy neighborhoods program as we address the looming fiscal constraints experienced by our team as well as partners on the ground.
So uh I'll briefly talk about the state of oral health.
We'll talk about uh the program itself and implications and next steps.
Just know that I'll provide this overview, and I am joined by members of our team and our clinical uh our dental clinical director, Dr.
Uh, Rebecca Davenport.
A special shout out to uh Norma Sufuentes, who is our administrator for our maternal infant child and adolescent health section, one of our largest sections at the department, as well as Meredith Howe, who is the program manager for the oral health program, and a special shout out as well to assistant director Marjorie White, who oversees the division for community health and safety.
So, with this, uh zooming out for a few slides, then I'll uh talk about the program itself.
Um, Healthy People 2030, this was developed by the U.S.
Department of Health and Human Services.
It measures the nation's progress in critical areas across a spectrum of health issues, including oral health.
Uh the leading health indicator is about increasing the use of oral health care, the oral health care system.
And these are highlights of some of the data available reflected in that 10-year plan and the benchmarks.
Just know that the data represent 10-year targets across a myriad of different categories.
While the most recent national data used to establish these targets predate the pandemic, there are uh few examples of the indicators reflected, mostly focusing on ages three to nineteen.
So this is a quick snapshot.
Just know that as you've heard, tooth decay, also referred to as cavities or caries, are the most common chronic infectious disease, chronic disease that is preventable amongst uh children ages five to seventeen.
Untreated tooth decay, as you've heard uh from our uh speakers, can lead to pain and infection affecting children's overall well-being as and having lifelong health impacts.
Uh, this, while this is uh a side-by-side looking at uh national data set, uh statewide survey here in Texas as well as our program.
Just know that the slide shows a snapshot of the prevalence of untreated tooth decay.
This is an attempt to provide a picture based on the available data uh from a few data sources that include a national data set, a statewide survey administered as well as the most complete school year for our oral health program.
Just know that the national data showed that one in six across the United States, ages uh six through nine had uh uh were screened and showed untreated tooth decay.
The statewide survey here in Texas showed that one in four uh third graders that were screened at that time.
Again, this goes back uh in the 2022-2023 survey, and on the ground here in uh San Antonio, uh tied to our oral health program, we showed that a third of the third graders that were screened showed untreated tooth decay.
Just know that while this slide shows a prevalence based on the participants in our program, this speaks to our focus and intentionality for reaching the intended students and those of highest need.
So just know that this is not only a local conundrum.
Just know nationally we recognize there are many barriers to children and their families accessing oral health care both nationally and locally.
On this slide, we have a few examples.
So dental care is expensive, especially for non-Medicaid eligible families.
Many families with the children's health insurance plan program still cannot afford the dental treatment that they need.
For many families, this is due to inexperience navigating the health care system or not understanding that Medicaid and CHIP can cover help cover dental care or not knowing that who their child's assigned dental home is or even being unsure how to communicate the need for an appointment.
Financial hardships, such as a single income household where a day of mixed work, or pay, or family unable to earn enough money to provide basic essentials such as food or housing, health care, including dental care, often become secondary unless it's an emergency.
The lack of education, again, on the importance of primary and baby teeth, as you've heard from Dr.
Singleton, and just know that past experiences, whether it's fear of visiting a dentist or parents having fears of themselves, which in turn they're fearful to take their child in for treatment.
So now the local context of our efforts here in San Antonio.
As you've heard from our from our speakers, just know that over 50 years on the ground, our oral health program and health has existed for five decades.
And as you can imagine, the landscape has changed dramatically over the decades.
Just know as you've heard about the linkages to Head Start.
Believe it or not, we used to bus clients to our clinics to receive preventative and restorative services.
And back in the 90s, we're able to bill Medicaid and CHIP at that time for non-Medaid CHIP children who would uh build a grantor for reimbursement.
Um around 2006, our partnerships evolved.
And this is part of the story here as we talk about the value of these investments in this program.
Our team on the ground began on site mobile clinics at Head Start sites under a collaborative grant with UT Health and our team and the Parent Child Inc.
or PCI.
Staff were using, believe it or not, their own vehicles, uh, and with an agreement with the Caring Foundation of Texas, we provided uh van care for Metro Health use.
Just know that over the years that we've evolved in what we have today, um, we have the oral health program, which is uh really focused on improving overall health by providing oral health services, increasing access to dental care for uninsured and underinsured families, and providing evidence-based oral health education.
Um just know that this triple aim, so the work is rooted in the uh the Institute for Healthcare Improvements Triple AIM framework focusing on improving individuals' access to care and care experience, improving population health, and reducing costs.
With that, the work is guided by the having the right patients focusing on uh the most vulnerable in our community, the right service or intervening with preventive care, such as applying fluoride varnish or placing sealants, and at the right time, anchoring to school-based settings to make it most convenient for students and their parents.
So, in the next segment, I'll highlight some of the services which you've heard already about the oral health exams, varnish, the sealants, the case management, the referrals, and I'll walk you through uh three main components of the program.
But I want to give you a snapshot of how we're we're funded.
So, just know this is a quick quick snapshot.
The left side of the table reflects three main categories of funding, the Medicaid 1115 waiver, some external grants, as well as support from the general fund.
So uh 1.4 million dollars anchored to the Medicaid waiver.
Again, this is uh over a decade in the making.
We've had uh some grants uh that amount to about a quarter of the support for the program itself, and then uh some anchored support from the general fund, which amounts to about 16% of the program's overall budget.
The pie chart on the right that shows you the program components.
So I'll briefly highlight the Healthy Smiles program, our head start and early head start, and you can see at least the operational support anchoring this work out in community.
So, to take a deeper dive into our initiative, starting with the oral health services for Head Start and Early Head Start.
This program component accounts for nearly a quarter of the program budget.
Special thanks and shout out to our partners at DHS for co-administering this program component over the years.
The oral health program serves children six weeks to five years old, enrolled in Head Start and Early Head Start through COSA's Department of Human Services, Avance Family Services Association, and Parent Child Inc.
Services for Head Start and Early Head Start include a limited oral health exam to evaluate the child's oral health status and identify areas of concern, fluoride varnish application, and oral health education.
The team travels to the facilities and set up mobile dental equipment on site so that children do not have to leave school nor parents miss work to receive services.
And aligning with the Head Start Protocol and the Recommended Standard for Preventive Care, Head Start and Early Head Start Children are provided an oral health exam and fluoride biannually, spring and fall, which also assures the Head Start children receive fluoride at the intervals recommended by the American Academy of Pediatric Dentistry.
So just know that our goal is to ensure that all children who receive preventive services in our clinics have continued access to dental care.
It's hard to see down on the bottom right, but just know that February is also National Children's Dental Health Month.
And so, thanks to our partners with uh DHS, the Head Start program, we celebrate and promote uh this each February by conducting an art contest.
Winners are selected by a panel of Head Start or O Health staff, and their artwork is included in a calendar.
Winners also receive an oral health gift back gift basket to include an electric toothbrush and other helpful resources.
So we celebrate early, but just know that that activity is happening thanks to our partners on the ground.
The second example, Miles of Smiles, again, this is the largest component of our program.
Um we have uh nearly a million dollars or about 39% of the overall program budget.
The Miles and Smiles Oral Health Clinic services are provided at participating uh elementary schools across eight school districts.
It serves pre-K or non-Head Start to third grade primarily, but sometimes fourth to seventh graders, as well as dependent on the school, as this is an opportune time to seal permanent molars.
Our dentists also provide oral evaluations in the Smiles of Smiles clinics along with fluoride varnish application, oral health education, and with the addition of the dental salutant application to prevent cavities on the molars or the back teeth administered by our team of dental hygienists.
Just know that uh part all participants and parents receive a report form outlining the findings of their child's exam along with the resources parents of the children identified with urgent need are contacted by phone as a follow-up to their visit.
The last example are all of uh the program is also a recipient of Title V Maternal Child Health Block Grant or MCH block grant, receiving funding to assist children ages six months to 17 years old who are under or insured or uninsured.
In partnership with UT Health, the School of Dentistry, the Pediatric Department, qualifying families receive access to dental care paid through the Title V funding, no cost to the families.
The qualification is based on household income and the number of family members.
Just know that the referrals for the Title V financial assistance not only come from participants in our mobile dental clinics through Head Start and Early Head Start and Miles and Smiles program, but also through our community-based referrals and inquiries.
Year over year, the need for access to care is so substantial that the state funds alone are exhausted very quickly with demand far outpacing our capacity.
And just know that uh in the past program year, in collaboration with the uh UT School of Dentistry, we provided Title V eligible dental services to over 800 children through this funding, as well as additional support provided by the waiver and the general fund.
So, as you can see, uh, this may be a little difficult to read, but just know that this heat map shows the oral health program provides uh preventive services in elementary schools and Head Start facilities in every council district across the city, as well as home some schools and Head Start centers across the Greater Bear County.
Due to eligibility criteria and the school district size, many of the schools we visit are centrally located, as well as the Head Start and Early Head Start locations.
Uh just past program year, there were over 17,000 participants served in the last uh school year across the county.
The highest number were served in district five, the lowest number were served in district eight, which correlates with the number of sites across districts as well as the areas of highest need across the city and the county.
Other school districts and charter schools have asked for partnerships, including Judson High School, and we can provide you with a listing of the sites within your respective districts if you're interested.
So, with that, uh of the uh 17,000 children we reached uh in the past uh school year.
Um, again, uh one-third of the children screened had decay that had been treated at the time of their exam, whereas uh a third showed decay that had not yet been treated or untreated.
Keep in mind that treated and untreated decay can be and often is co-occurring, meaning that many children we encounter have already had dental work done or and have also had new or active cavities that need treatment.
About 5% of children screened had signs of urgent dental need, meaning severe tooth decay and/or abscess or infection at the time of their exam.
This level of decay results in increased pain and lower quality of life for most children that are experiencing it.
As you can see, there are some districts that have higher percentages of children with urgent needs.
Just know that the oral health program has been in operation for many years and has made great strides to reduce the prevalence of tooth decay among children in our city.
Inevitably, many of these barriers to care still persist.
As you heard, uh the impacts of the pandemic.
Um and we found an increase in the number of children with decay and urgent needs, and we're still uh assessing the impacts of that uh on the ground.
So I do have uh this is a very short video just to show the team in action, and then I'll complete my presentation.
So if we could oh no, okay.
We'll send it out to you all.
So we do have at least a way for you to see the before and after and the impacts of the work in community, but just know that uh it's something that you can view at your leisure.
We'll send it out to you all.
So let me end by saying that uh at our current funding level, we have been um uh we know that the funding for the Medicaid 1115 waiver will end as of September 30th of this year.
Uh we know that um most of the positions, again, 35 of the 39 positions that support both clinical and administrative functions of the program are supported by the waiver, as is the uh entirety of the smiles miles of smiles operational budget, which provides services to elementary age school age youth uh most at risk for cavities.
Just know that while uh um the work continues in terms of our planning, additional detailed work on the operational impact of the funding reduction is ongoing as the team evaluates the different options for sustaining or sunsetting components of the program again given the substantial change expected after this fiscal year with the expiration of these rever reserve funds.
Just know that this analysis will be presented as part of the FY27 budget planning process, which will be shared with full council.
So uh we remain proud of the team's innovation, dedication, and overall resilience, especially over the course of the past uh decades.
Um despite these looming fiscal constraints, we remain deeply committed to the needs of area residents as we respond to the national conundrum and the instability of funding.
I want to thank you for this time.
Uh myself and other members of the oral health program are available to answer any questions that you may have.
Thank you, Claude.
All right.
Uh we want to start with the council or committee conversation.
Anyone want to start first?
Council White.
Thank you, Chair.
Um Claude, thanks for the presentation.
Uh just want to note um strong support for uh for the program.
Um it's really meeting kids where they are, like we saw in the schools and the early childhood centers, and um there are um hundreds of of kids in um district ten that are that are benefiting from the program, and so um really really pleased that um we're we're supporting it.
Um just quick questions on if we've identified uh replacement funding in the to the extent that some of these other funding sources um leave us.
Thank you for the question.
So this is one of uh three examples of the same with diabetes program, the healthy neighborhoods program.
No, we have not identified replacement funding as you can imagine uh with the impacts of the new administration as we're looking at the changes to funding streams.
Uh, we're making the case for the impacts of the program on the ground, but now as of yet, no, we have not identified replacement funding.
We're looking for different options for other funding streams, but this is really uh way for you to see the impacts of the waiver as well as the other support of external funds that we've leveraged over the years.
Okay.
And it looked like the general fund was um, I didn't write it down, but somewhere around around 400,000 out of the out of the uh Yes, sir.
Out of the 2.5 million.
So if the waiver goes, it's about a million million four that has to be found, right?
That is correct.
Okay.
Um I guess some work's gonna be done between now and uh when we pass the budget this coming year to see if there's more funding available.
That is correct.
So for now, this is uh uh snapshot so you can see the impacts and uh this dovetails with the broader FY27 budget.
Are there other grants and things like that that are out there?
We're shaking every tree.
Um it is this is not the only program, but just know that even funders are trying to reset where they're allocating or reallocating dollars for different initiatives.
Yeah.
Well, this this is one of those programs that I think really um it's making a difference in in children's health learning and and uh overall well-being.
And so um, you know, dollars are dollars are certainly tight, uh, but to the extent that we can uh support the program in a reasonable way.
Thanks.
Thank you.
Thank you.
Uh Councilman Messi Gonzalez.
Thank you for the presentation.
Uh just a few questions.
Do we partner with pre-K for SA on this initiative?
We do partner with uh pre-K for SA.
Just had start.
Oh, sorry.
We do partner with just Head Start.
Is there an opportunity to partner with pre-K for SA or Okay?
There's always an opportunity, yes, to partner with Pre-K for SA or invite any other partners.
Yeah, I think I mean just that seems like a like an obvious partnership to me, so I hope we can set something up there.
I know the numbers in District 8 are rather low.
Um, I don't think it's because the need isn't there, um, but just have to be extra creative, I guess, on who we who we connect with in those communities, and so we do have a pre-K for SA facility and in District 8 off medical, so I hope that um you know a partnership is possible there.
And I also noticed the um even though they are on the lower end district eight, there's still the highest percentage of urgent need.
I didn't um if if I don't know if anyone can help kind of explain that or something.
I'm gonna invite Dr.
Davenport to shed some light on what we're seeing on the ground, especially with those uh children of highest need in district eight.
Yes, so please keep in mind that the programs that we connect with, it there's specific districts and specific head start and early head start programs that we connect with within those school districts.
A school has to be a Title I school for us to go to them.
So if your district has very few Title One schools, that's gonna be why we don't have a connection with them.
However, those schools obviously you can see where we are where we are needed.
If the numbers that we're seeing in your area are so high, we're getting to those kids that are most needy, right?
So even if you look at our percentages of versus the state of Texas overall, that's because the state of Texas is looking at every kid, right?
So they're taking a snapshot of a general overview.
We are only looking at those kids that are in those Title I schools that have been identified as having the greatest need.
So that's why our percentages look so much greater.
Yeah, no, I understand that.
I I guess um I just wanted to know if there was a I guess I'm just flagging the and it could be because the percentage of urgent need was in district eight, even though we had the smallest amount of and there are some schools where there's large immigrant populations in those areas, and that is one of those that we see have a lot of urgence because they haven't had access to health care.
They also haven't grown up with community water fluoridation, which has helped those teeth be healthier overall.
So those are some of the impacts that you might see in your district.
Yeah, definitely in my district.
Um I'm wondering if there's any opportunity for the department to go out to some of the nonprofits that do a lot of work with our immigrant population and refugee population in district eight uh to give them a no pun intended, but give them a head start of the programs in the schools because the more education they have around what programs even are in the school itself, it's helpful.
So we have a mosque in district eight.
I think that means we've got a thousand folks that go every week, so it would just be one of those um places I think we could communicate or work with them.
Yeah.
That would require more money.
Um we would love to expand that that speaking to the microphone.
But just know to your point, um, this is an opportunity.
Uh you've heard about the evolution of the program over the years.
Uh one of the core tenants of our discipline is about mobilizing and strengthening partnerships on the ground.
So we're open to suggestions.
Every district's a little different, but we appreciate the uh the suggestions for us.
Yeah, and we'll be happy to share um contact and and connect y'all because it is really you know the most important part of health care really does start in the mouth.
We've got dentists here that would say that and agree because that then leads to diabetes, and we have a you know high percentage of diabetes in our community, so it really does start start there, and I believe in that.
So, however, we can be helpful um to connect you in district eight, um, know that you have someone here.
And just a quick thank you to the the folks that came to speak.
Um, thank you for the work that you did.
It's close to probably 80 years of service amongst the three of y'all, which is a huge accomplishment.
So thank you for um volunteering your time um and your practice to uh the kids in San Antonio.
That those are all my questions.
Thank you.
Thank you.
Thanks, Council Azar Te Govito.
Thank you.
Um, also did also want to thank the um folks who came out to speak.
Thank you, y'all's um input was valuable.
Um, you know, yeah, we know that most kids still need help brushing their teeth until the age of eight.
I was curious though on slides three or four on um the number of treat uh treated.
How have we seen these numbers change over time for the city?
Thank you.
That's a great question.
Um so what we saw prior to the pandemic is we we had been operating for a long time.
We were seeing those numbers slowly go down, and we were seeing our urgents go down.
They had stayed around about three percent, and we were getting down closer to about 2.7% post pandemic.
Um, because the kids their diet was different, their habits were different, they weren't going out to the community, so maybe they weren't brushing their teeth because they weren't gonna be breathing in people's faces, right?
We came back from COVID, and not only did our urgence increase, but our urgence became more urgent.
So instead of a child having one abscess, they would have an abscess on each side.
So when you when it hurts on this side, you eat on this side.
Well, now you don't have a good site to even eat on.
So we have seen, you know, was we got we're sitting around three percent down to about 2.7.
That now we're about 4.6% urgent cases.
So, yes, we've seen a drastic, and that also our population is ever increasing, right?
So yeah, because I I definitely wanted to still, yeah, that thank you for that explanation.
That makes sense.
You know, I I want us to I would hope that we get back on that downward trend that we're making a dent in this issue for our kiddos.
I'm also curious on how much of the budget is going to uh either marketing or informational material, you know, for kids to if they're gonna get something sweet, eat chocolate instead of like gummy worms or you know, whatever.
Um how much are we doing uh of that?
We can we can provide a breakdown again.
Uh primary prevention, it's really around educating.
Um so we work hand in hand with our partners, the staff, um, but in terms of the dollar amount, we can pull that up for you then in terms of what we've allocated specific to marketing.
Yeah, and then also, too.
I mean, I was thinking through yeah, you know, partner kind of piggybacking off of what councilwoman Mesa Gonzalez said.
However, we could be helpful because obviously the council offices have different events and um tons of opportunities to be sharing uh this type of information with with our residents.
So um we want to make sure to do that, and then um yeah, that's those are all my questions and comments.
Thank you.
Thank you, Chair.
Thank you.
Council Rick Castile.
Thank you, Chair, and thank you, Dr.
Jacob, for the presentation, as well as to David, Lydia, and Beatrice for highlighting the importance of this program.
Uh I appreciate this briefing, and I'm hopeful that as we move forward with the next budget conversation, that this remains a priority uh to where we don't have to see any reductions and that we can potentially expand the program uh into pre-K for essay, so on and so forth.
Um this is just uh really important work that's being done as my colleagues have highlighted, right?
This is where it starts when it comes to overall health.
Uh and you know, coupled with that, I believe in April um with SNAP benefits, there's some change, there's going to be changes in which the type of items you can purchase, so you can no longer purchase uh very sugary drinks and or candy bars.
Um so I'm hopeful with those changes, we'll also see a reduction in kids uh with untreated tooth decay.
Um but until then, right, until we see those results, we have to continue to invest in this program.
So appreciate this briefing and look forward to continuing to advocate that we um maintain, if not increase the funding given the budget deficit and the removal um of the potential gap that we are going to see because this program's going to end.
Um, but just thank you, Dr.
Jacob, and thank you, Chair.
Councilman Mr.
Gonzalo, do you still have a question?
Oh, I just I was curious, did this come up or the tabletop exercise?
Rebut, sorry, sorry.
Did this come up in the tabletop exercise?
That y'all completed or so um you'll get a formal briefing in a few weeks, but just know that we're looking at different programs.
Um, so we have uh a short list.
Um is this in there?
Uh I'll put it in if it's oh there we go.
Hi, thank you, council member for the question.
Mine is just another on the interim assistant city manager.
So, yes, this was part of the tabletop exercise.
Uh, we looked at health grants, uh human human services grant as well as housing and homeless grants.
So the this is a little bit different because this funding is going away a hundred percent.
Um the other scenarios that we ran were 50 percent, but you'll see that as part of the report that we'll be providing in uh February.
Okay, awesome.
Thank you.
Thank you.
Uh I had a couple quick questions.
Um I know for the Miles and Smiles program, I think that one was is really interesting.
Do we know how many schools um we're serving with that program?
We can also get in a follow-up memo, but so we have over 200 sites, so we can give you the breakdown of uh how many schools exactly.
So we know that a third of the coastal site, the uh early head start uh sites are anchored to COSA, but we'll get you the number of schools served by miles and smiles.
Great.
Uh and how often are services provided there?
I know in the Head Start one is biannually, but in non-head start ones are there different schedules, or is it also twice a year?
I'll have Dr.
Dev North clarifying.
Our our head start and early head start are twice a year, and our miles of smiles right now.
We have funding that allows us to do one.
Our goal would be to have a second one, which would allow us then to be able to see which of those things have resolved and which things have gotten worse.
Got it.
Thank you.
Um I'd be interested to see even just a memo uh to the education opportunities committee just about how this particular program, and well, all of them, miles and smiles, but also the entire oral health program impacts uh student achievement, if that's anything that we can really tie to.
I don't know if we have that data in any sense, but we wish it to see if we could.
Cool.
Um for both of the programs, or I guess for the entire oral health program, are there any specific ones uh that uh help meet the entire household's uh dental care, or is it just the individual children?
Do you mind repeating the question?
Yeah, I was wondering, I guess for each of the oral health programs listed today.
Um, do any of them uh impact the entire household uh dental needs, or is it just specifically the children enrolled?
So our Title V program, once one member of that family is enrolled there, it goes for all of the children that are in that household.
And what we do also share is information to help connect adults.
So if their parents are grandparents, we're not providing those exams in Florida, but we are connecting them with the resources that are available within our city for them to receive that.
Got it.
I think that's one of the big follow-ups I was wanting to know with all of these was that what's the connection to long-term care.
I know we do the referral process, but do we have any data on folks who are enrolled fully and have stayed with it for a while uh with our external partners, whether it's adults or children?
I guess maybe adults to make the most sense.
No, we um uh we don't gather all of that.
Okay, but uh we can at least take another look at what we do currently have.
Okay.
That'd be great.
So I just think about a lot, right?
That we're doing those services directly.
I think it's a primary mission, and then of course the educational aspect, but once the kids age out of Medicaid or chip, uh, or I guess of CHIP or Title V, where do they go next, right?
And if they're able to continue to get the dental care and ideally, I think we try to keep it there, and I hope it does, and I anticipate it will because it's more education directly to them, that maybe more than ever before.
But just want to see if there's any trend line there.
I'm really supportive of Council Member Ador de Gavito's point about the kind of year-to-year change.
Um, I know it's within children, but also looking at adults too.
Um, I know Council Robert Castillo often mentions about uh the connection of ready to work there and the employment relationship uh with dental care, and so just trying to see what that would look like uh from our program over time.
You make a good point about the continuum of care, but just know that nationally the studies look at the correlation between carries and absenteeism or asthma rates and absenteeism.
So we'll drill down and see what we have access to, but point well taken.
Thank you.
Uh one of the last questions I had was just um do we have any any data, including from our partners about how the oral health program is helping identify other link diseases that Council Messi Gonzalez mentioned, diabetes, cardiovascular, et cetera.
No, clearly the mouth is connected to the rest of the body, and so we can look at some of the correlations, but for now we're really looking at the oral health program focus on pediatric population, but we could look at how these are correlated with other diseases that we see here.
That'd be great in our community.
Thank you.
Those are all my questions.
So thank you all so much.
Fantastic.
Thank you.
We'll go to item three, uh, which is updating current status and ongoing implementation of the Howard Pete Greenwells traceless trail system.
The homework good morning, everybody.
My name is Homer Garcia, Parks Director.
And today's presentation will be provided by Brandon Ross, who leads our capital program.
But I want to provide a huge highlights to kind of tee this up and see where we're going.
Um so the Howard W Peak Greenway Trail System, uh, as we stand right now, is more than a quarter century in the making.
So you just kind of let that resonate a little bit.
We have more than 100 miles of trails with the ultimate vision, much like loop 1604, that will entire all of San Antonio uh seamlessly connecting citywide across every council district.
Um by the numbers, uh, you know, we do have a slide in the upcoming presentation that talks about funding.
But originally, this program was supported with a sales tax selection dating to 2000.
And over the course of that period, uh 190 million dollars has come in to the city for the build-out of this trail network.
And then moving and pivoting away from sales tax.
And so the River Authority, their role in this tri-party ILA, they effectively function as project manager for the county.
And then, of course, on our end, we're working hand in hand doing plan reviews, just making sure that the trail network itself, regardless of how it's funded or designed, looks seamless to the community and how it functions.
And all of the OM is with the city of San Antonio.
So they build the trails, we own them, we continue to operate them.
So I'll kind of let that be the backdrop to the presentation that Brandon will walk through.
And thank you for the opportunity.
Thank you for the introduction, Homer.
My name is Brandon Ross.
I'm the Capital Programs Manager for the Parks and Recreation Department.
And I've had the privilege of working on the Greenway Trails Program now for uh 20 years and have really enjoyed my participation in it.
So I'll start with uh the next slide.
Uh let me see.
So approximately 1998, Howard Peake and his colleagues on the city council at that time began to uh drum up support for the idea of building a network of hike and bike trails along uh primarily Salado Creek, Leon Creek, Medina River, and the San Antonio River.
And uh so that built some support.
They were able to get the word out and um get it on the ballot for 2000.
And so at in 2000, that was the um that was the first sales tax election.
I'll go to the next slide.
Um the first sales tax election was 2000 that provided um 20 million dollars, and each of the sales tax elections that followed in 2005, 2010, and 2015 were passed with large majorities.
Um we got 45 million in 2005, 45 million in 2010, and then 80 million in 2015.
So the total amount of sales tax we've collected uh over the history of the program has been 190 million.
In 2021, that's when the Bear County uh program was initiated that included these, it included a large package of capital improvements, but specifically included 83.4 million dollars uh to be contributed from the county to the program to hike and bike trails on the Howard W Peak system.
And then in 2022, that was the first year that uh the program was funded by the bond, uh 22 bond uh provided 103.5 million dollars to continue the extension of the program.
So generally speaking, the mission of the program is all about quality of life for the city of San Antonio residents and visitors.
Uh but there are specific goals that we have, and that is to uh expand and provide recreational opportunities and opportunities for people to spend time in the outdoors.
Um that has a great deal to do with public health because of course, physical fitness and uh mental well-being and being able to connect with nature.
Uh, we have preserved uh a lot of acres of open space and and the connection of the riparian habitat along the floodplains is essential to the health of our ecosystems along the creeks.
We've provided for wildlife habitat expansions, and we are also trying to connect in with all of the other opportunities that hike uh pedestrians and bicyclists have within the network of the city system, like the street system, uh be it bike lanes, uh sidewalks, and so forth.
And then we also uh as we buy property as we continue and as we continue to grow our uh investment in the creekways, it offers the opportunity for our stormwater management group to be able to go in and do the floodplain maintenance that they need to do.
So the design objectives for the program are to provide for user friendliness and safety.
Uh that includes a wide trail so that two-way traffic can occur, um the signage, mile markers, and user-friendly um directional signage and information, uh, connections and and to destinations to many neighborhoods so that the access to the trail system is very convenient for the residents of San Antonio, and also to have trailheads where people can go and park to get into the trail system.
Our operating hours are sunrise to sunset, and so we don't have a whole lot of lights.
The only lights that we have on the trails currently are at the trailhead parking areas, although we are looking to potentially do some experimentation with some lighting along the west side creeks.
Uh environmental sustainability include low impact development principles, so trying to treat water quality as the runoff occurs from our parking areas and trails to use native landscape materials like cedar and limestone and things that are locally sourced, so we don't have to import a lot of those materials to preserve as much tree canopy as possible and even to expand it with tree plantings to protect the geology of the creeks to alleviate any kind of dumping or off-roading.
We try to control the access to these places so there's not a lot of infiltration by vehicles, and then we try to remove invasive species wherever we can and propagate the native species to San Antonio like oak and cedar elm and those kinds of things.
So currently we have over a hundred and three point uh hundred and three miles of trail that are completed.
We've purchased over 1,700 acres of creekways.
Um, and by the way, that that's that doesn't include the parks.
Um the creeks do go through a lot of the major parks in San Antonio, like Martin Luther King Park, Opie Schnabel Park, and so forth.
Um the 1,700 acres that we've acquired have been in excess of that.
And by the way, I will mention as well that many of those acres have been donated, and so those acquisitions, of course, are greatly appreciated.
Um we have 12.3 miles that are currently in construction.
We've got 30 miles that are currently in design and another seven miles that are planned.
So once we build the trails coming online piece by piece, um the park police patrol the trails for safety.
We've actually got kind of a multi-tiered um safety system starting with park police and SAPD, and then we have a trail stewards program, which is essentially um parks employees, their part-time parks employees that ride their bicycles.
You can see the picture.
Um they carry water, first aid kits, they're CPR trained and so forth, so that they can help people along the trails and give them direction and so forth like that.
And then our park operation group, um, they do um the continuing maintenance of the greenway trails, um, be it crack repairs of the trails or replacements of signage.
Um we mow both sides of the trail, like within four feet of the edge of the trail, and then of course the stormwater operation operations group, which is housed in public works.
They do the maintenance of the creekways on a five-year rotating system where they go in and remove trash and woody debris and so forth to keep the floodplain uh moving to have drainage within the creeks.
So here are some images just to kind of highlight um some of the trail systems.
The Salato Creek Greenway Trail has 34 miles of trail.
Leon Creek Greenway Trail System has 26 and a half miles of trail.
The West Side Creeks have approximately 12 miles of trails that connect into the San Antonio River.
And then the Medina River Greenway Trail system has 17.6 miles of trails, and then there are also tributaries that flow into these major creekways that comprise another 13 miles of trail.
So it's a lot of hike and bike trails, and we've been fortunate enough to be able to connect some of them together.
We've got the Leon and Salato that are now connected at Eisenhower Park.
We've connected the Medina River Greenway Trail System to the San Antonio Mission Reach, and we're continuing to make those connections and fill those gaps as we realize the vision of completing that circle around the city.
And then there's some images here of some of the different amenities that we have at our trailheads.
We've got drinking fountains with bottle fillers, we have bike repair kits, we've got shade structures, signage, butterfly gardens, lid features, and then some public art as well.
So that concludes my presentation, and I'd be happy to answer any questions.
All right, thank you so much.
Anyone uh want to start with their comments?
Councilor White.
Thank you, Chair.
Um thank you for the for the presentation.
Um my folks love the trails uh in District 10, as I'm sure they do uh in every district and uh connecting neighborhoods and parks along the creekways give you know residents a great place to get outside and and be active and connect with each other.
Um we've got the Salado Creek Greenway specifically comes to mind in District 10, and and again our folks really really enjoy it.
Um as we continue to expand the system, um how are we planning for long-term maintenance uh and operations, especially considering that the budget is tight?
Well, I mean, I I would just say we have um a report that we give each budget cycle where we talk about the upcoming improvements that are gonna be coming online, and we have requests, of course, to city council for um increases in staffing and equipment and those kinds of things.
And so that's I think gonna continue to be um the source that we use in terms of trying to get the the dollars to support the maintenance and operations of the greenway trails into the future from general fund?
Yes, sir.
Are there are there any other potential avenues for dollars?
Not that I'm aware of in Homer.
I you know, I'm getting a no from Homer, so at this point.
That's it, it's just general fund.
Yes.
Um what about safety measures for uh for trail users?
Lighting, signage, things like that out there?
Yes, sir.
We've got lighting at the at the trailheads, we have um emergency call boxes that we've installed at many of the trailheads and along the trails.
Um we have of course uh the the signs that that give information on how to stay safe.
We've got basically tips on how to how to stay safe when you're using the greenway.
So specifically related to like using you know your cell phone, having plenty of water with you when you go out, using sunscreen and using a hat and those kinds of things, but also just we we've got our mile and quarter mile marker system, which is tied to the 911 dispatch.
So if anybody's in distress or gets a broken leg or anything of that nature, then they can basically use that as a reference if they need to call 911.
Okay.
I think that's all I have, Chair.
Thanks.
Thank you.
Councilmember Alder Govito.
Thank you.
Uh thanks so much.
I um my comments are fairly similar.
Can we can we use uh bond funding?
Can we um set aside some or can we plan to start uh looking at a bond allocation to continue progress on the the greenway trail?
I mean I think it's probably worth looking at, but I I know there are belief are legal limitations for what we can use capital, like what capital dollars and the bond dollars, what they can be used for.
Okay, but certainly I think we we'd be interested in maybe looking into that, Homer.
Yes, good morning.
And in your great, so right now the ONM excuse me for um the greenway trails, it is supported by our general fund.
We are looking to the next bond to continue the build out of this greenway trail system in particular, and I'll highlight one uh critical connector uh in um district four, but it's that connection through the port.
That's more than seven miles through the in the 22 bond, it was very intentional by the bond committee to design only and then build it out in a future bond.
So we are looking at the bond to continue the investment on the capital side.
Um right now we have not had any discussions about using that for an ONM, but in the context of this, I mean, we've got notes, and and Brandon is correct.
I I will defer to uh bond council and what ultimately those dollars can be used for.
I am of the opinion is primary capital, not ON, but it's good discussion.
Yeah, absolutely.
And and I I probably should have been more clear.
That's what I meant for us to further expand on the trail using uh a bond allocation for that because I mean I think honestly, our our greenway trail is one of like the biggest highlights in of San Antonio.
You know, I mean, people love it, people are constantly using it.
I I know I say this all the time, but access to green space is so important, not uh for people's physical health, but also their mental health.
So um any way that we could further expand on it, I'm all in on um the other the other thing, and I know that y'all have heard me mention it before, it came up a couple times at my monthly coffees with the councilwoman.
It came up a couple times at my monthly coffees with the councilman, it is trail safety, not necessarily people keeping themselves like hydrated and stuff, but just not getting attacked, right?
And so we've seen a couple of horrible instances over the past year or two, and we want people to take um advantage of the greenway trails, but it's it's difficult when they see these headlines, right?
And so um, you know, so however we can amp up um park police or whoever to to just stay active on the greenway trail.
Um I think that that would be extremely important.
I mean, I know I use the trail system all the time, and I have hardly ever seen anybody out there patrolling.
So um I think it's you know, if as long as a cyclist or a runner is seeing some sort of safety component every blue moon, then I think that that that really goes a long way.
Um of the other things too, uh, and I I think that y'all had mentioned this um as well.
There still seems to be some confusion with res uh from residents, so I'm not sure how we can um do an awareness campaign.
But if something were to happen on the greenway trail, trying to get police to go to that exact spot um has been difficult.
You know, sometimes they hit they've uh residents have provided the feedback of police are asking them what marker they're at, and they're like, I don't know, or you know, where they got in.
So we just want to make sure that our police are fully informed of how to get to someone quickly on the trail.
So that way they're not left going back and forth uh when they when they need help.
Um those are all my comments, but other than that, I mean, we all love the trails.
Thanks.
Thank you.
Thank you.
Councilor Messi Gonzalez.
Uh just a quick comment.
Uh thank you for the presentation and you know, continue to support the Greenway Trail system.
Uh District 8 residents, really everyone in the city, but uh I know that district eight residents really use them recreationally, but also um, you know, it's really a mental health uh place, right, for you to go to.
I know the trails were very popular during COVID times, uh, just really get people out and um and so that was helpful.
I'm supporting the Greenways currently by utilizing my uh CIP dollars to install plumb plumbed restrooms at the Valero Trailhead.
Um, so recommend um my colleagues to do the same.
Thank you so much.
Counselor Castillo.
Thank you, Chair, and thank you for the presentation.
Pleased to hear that there's opportunity with the proposed bond ticks for expanding this um with a newly redistricted part um with the Martinez Trail, uh the Farilla's community is very excited about that project being completed.
Um so pleased to see that that's moving along there.
Um, but also um what I've heard uh in terms of uh proposed projects.
I know you mentioned Port San Antonio and uh funding dollars for planning, and now right I think there's opportunity for that extension.
Uh there's a lot of um district five residents that uh want to get to the port, and there's no bus that will take you there, and I think a trail and um that expansion can help get folks to all the amenities that the port has to offer as well to the employees that work there as well.
Um, but um, similar to my colleagues, uh appreciate this briefing.
Glad to see things are moving along again, particularly with the Westside Creeks, uh, and then of course the memorial expansion with between St.
Mary's University and Memorial High School.
Um, the residents are very eager and excited um to utilize those new expansions.
So thank you so much for the presentation.
Thank you, Chair.
Thank you.
Uh I had a couple questions as well.
Uh I think well, before we get into that, one big thing I wanted to know.
Well, let me do the pleasantries first.
I want to say I really appreciate having a trail right at our field office at Tesla.
It makes it a lot easier for all of us at the uh office on Mondays and Fridays uh to when we finish eating, take a quick lap.
Uh try to stay focused for the rest of the day.
Uh so that's really helpful.
And I know I see a lot of my uh residents uh walking along there and they'll catch me working late on the evenings there or on the weekends too when they're using it recreationally.
And it goes all the district eight, which I'm always shocked when residents tell me how they bikes from Utah Side down and it came by um because it's just uh incredibly a far place to go uh from that spot.
But I'm glad that they're there and encouraging and enabling that uh physical activity for our residents.
Um I would like to, I know Council Aldertage of Vito brought up um a little bit about the safety components and just kind of the how we make it all blend together.
I know some of our residents talked about that as well.
And so I wonder if it's worthwhile.
We can talk about this offline as well, but to bring back to committee, maybe even some larger conversations about how we're looking at a long-term plan for uh safety there.
I know we talked about the experimental lighting components, but seeing you know what kind of needs would be there or could be there at scale, uh similarly the kind of uh park police needs there along the the route, even the bathroom component that Messi Gonzalez brought up, I think is also maybe not part of safety, but a little bit about just usability of it all, right?
And so we can talk more about that later on, but I think that'd be worthwhile to kind of talk about the long-term vision, of course, once the park is or the trails are completed, what else we're doing to continue uh sprucing them up.
Okay, good.
Um and on that note, uh I know we talked about different sources of funding.
How much funding is exactly needed to complete the entire system?
I don't know if we have that dollar amount right now.
So we we're we're pretty well off in terms of how much the community has has contributed so far, but there is some funding that we still need, specifically related to the port San Antonio piece.
And there are others that we're currently designing that we're hoping to have shovel ready for the 2027 bond that we would then hope to be able to get that funded through the 27 bond.
So, you know, it it kind of depends on how things shake out with the funding availability.
You know, if it were um a larger bond, we can certainly use all the money that we can get to continue to enhance the system, but it's gonna be a probably a minimum of maybe 40 million dollars, 50 million dollars just to do the essentials.
So that would be the expansion of the Port San Antonio, which is probably gonna be 30 million dollars, and then the continuation of building the projects that are shovel ready, which is probably gonna come to close to 20, 30 million dollars.
So it just depends.
And you know, if if we had more than that, certainly we can use every dollar that we get.
There are lots of opportunities out there for parks expansion and green white expansion.
Got it.
So that 40 to 50 million dollars would cover and say the port one, but also the other expansions listed for the trails and parkers.
It depends on again, the availability.
Right.
If we find that there's 60 million dollars available, we're gonna spend every dollar.
And most of those dollars, probably close to all those dollars, are gonna be for shovel ready projects that we've already prepared to get that capital funding.
Okay, great.
I think it would just be helpful to just kind of see it broken down, and that can come during the bond conversations, of course.
I know it will.
So just having those broken down one.
So we can also see uh where exactly those funding would be going towards.
Um is there any way, and maybe this is also the later conversation with the bond, but uh do we know how much of our drainage needs can be couped drainage needs can be coupled with our trail creation?
Yeah, I mean it's it's more passive drainage than anything because of the fact that we're preserving the land and allowing the flood waters to continue to flow.
Um we don't do really any stormwater improvements with the greenway trails.
We try to basically be like a zero footprint when we go in and build the hike and bike trails.
So we're not really doing a whole lot.
I mean, we we try to do whatever drainage um uh treatments that we need to do in terms of when we build parking areas and trails and so forth, but it's really very on a very small scale.
The larger question of the flood conveyance and so forth is is really more of a capital delivery department and public works operation.
Okay.
Thank you for that.
Um last couple things I was gonna ask was about um I know we have this current map here and the kind of trying to get to that end.
Uh are we looking at any future expansions uh later on beyond this kind of map as it currently stands?
I'm mainly asking because I know residents uh who live near Government Canyon in my in my district or even throughout uh kind of along 151, 410, and 1604 are always asking for ways that they can connect their neighborhoods to the trail a bit better.
Um again, I know I'm asking for additional next step after all the things, but are there any plans on that?
Uh absolutely we're looking everywhere we can.
Um, there are opportunities, especially on um the the Holotus Creek system that flows into Kaliber Creek.
There are other opportunities on the tributary to other tributaries of Leon Creek and Salato Creek.
There are also easement areas that we have that we can build trails.
And you know, we we also are looking at street level connections that we can build between the trails.
Um so connecting, for instance, the downtown area with Salado Creek, uh, also looking at the greater the Great Springs project uh vision to connect the trail system in San Antonio with uh other trails that go north to Austin.
And so there are lots of opportunities for expansion.
And again, you know, we we will use every dollar that we can get to continue to explore those opportunities to tie into more neighborhoods, serve more San Antonio and uh serve more of San Antonio with uh access points and trails everywhere.
Good.
Thank you.
And then one last thing, and I'll give uh go to my colleagues.
One last question I had was about, I know we were talking a little bit earlier, Councilor White brought up the kind of operations and maintenance of it, um, and just the kind of growing needs, right?
As we continue to expand this system.
It's a similar vein of that, but I also think it's just uh worthwhile, potentially could be a worthwhile opportunity.
I don't know how much parks um does it building a volunteer base similar to the way Sarah does with the River Warriors.
I know that's a different set of the trail, right?
Um, but I just been interested in seeing what there what ways there could be to involve even local ISDs or uh our seniors through the SAIS program um or many of the other kind of resources that we have to bring people to get in touch with the trails, not just to use them, but also to maintain or help create, uh, even in small forms.
Um I just think there's a lot of value in the kind of skills that you learn in doing that, but also even the connection closer to nature and even the the point of public safety, right?
Trying to get a better feel of what these trails are like, finding people who are also passionate about them that you can walk along the trail with.
Was there any has there been any kind of conversation around a volunteer at large program?
Absolutely, and that's been integral actually to our system for a very many long years.
Okay.
Um there, I I skipped the bullet on accident, but we actually have a trail watch stewards uh trail watch volunteers program that has over just 70 members.
We also have um connections to River Aid, and so Basura Bash, as you can imagine, a lot of what Basura Bash targets is along the creeks where we have trails.
And so yes, we we have a lot of partnerships that way, and and there are volunteer programs that we utilize.
Great.
Well, thank you for that.
Uh those are all my questions.
Council of Messi Gonzalez, and maybe had some follow-ups.
Yeah, I just uh quick question.
I was wondering if um if we've ever kind of had a conversation around uh trailhead parking passes, you know, folks that come and from outside of the city.
Um I know there's trailheads and other cities and states that charge a small fee, and I think it's a fee that most people don't mind paying for.
So I'm just curious.
Well, so uh no, that's actually not something we've looked at before, but I mean, you know, there's no bad idea.
So um you know, I would say this uh getting into the trail system is extremely easy.
Yeah.
Um even if you don't go to a parking lot for the residents especially that live near these trails, many of them have gates that back straight up to the trails.
So, you know, there there are a lot of opportunities for people to get into the system.
I don't think we can ever start you know uh be able to control everybody coming in, but certainly the people who utilize the parking.
I mean, that you know is something we could potentially control, but it would have to be with some kind of gate system and an investment um to try to collect those those dollars.
Okay, well, love uh any further conversation about that.
Just again, I don't think it's I'm we don't like to pay for things, but I think this might be something that folks might be willing to pay a little bit of money for.
So thank you.
Thank you.
Any other last comments from my colleagues?
Um little quick comment.
I love you.
I don't like that idea.
Thank you.
We continue workshopping ideas through committee, so no worries.
All right.
Well, I think that's all the questions and comments on this idol, so thank you so much.
Um at this time at 1115 a.m.
Uh the meeting is now adjourned.
So quote
Community Health Committee Meeting: Oral Health Program & Greenway Trail System (Feb. 2, 2026)
This meeting of the Community Health Committee was called to order at 10:02 AM on February 2, 2026, with a quorum present (Councilmembers Castillo, Alarete Cabito, Mesa Gonzalez, White, and Chair Gavon). The committee focused on two major items: a critical update on the Metro Health Oral Health Program facing a funding cliff, and an overview of the completed and planned sections of the Howard P. Peak Greenway Trail System.
Consent Calendar
- The meeting minutes from the previous session were approved unanimously by voice vote.
Public Comments & Testimony
Three speakers advocated for the continuation of the Metro Health Oral Health Program.
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Beatrice Hicks, a retired UT Health San Antonio associate professor, detailed the history and success of a collaborative grant that created a culturally sensitive pediatric dental model for Head Start, emphasizing the program's role in breaking down barriers for low-income families.
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Lydia Almare, a retired Head Start specialist with 51 years of service, described the partnership as the heartbeat of the Head Start mission. She pleaded with the committee to continue the contract, stating the children of Head Start are counting on them.
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David Singleton, a retired dentist who worked for the city on these programs, stated the program is the only entity available for these children in the city of San Antonio. He described the severe pain, infections, and systemic health impacts he witnessed, particularly noting the devastating increase in decay after the COVID-19 pandemic.
Discussion Items
### Oral Health Program Overview and Update
Dr. Jacob from Metro Health presented this item as part of a series on programs impacted by the impending September 2026 expiration of the Medicaid 1115 Waiver reserve funding.
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Funding Breakdown: The oral health program has a total budget of $2.5 million, with $1.4 million coming from the expiring waiver, approximately $625,000 from external grants, and $400,000 (16%) from the General Fund. A total of 35 out of 39 staff positions are supported by the waiver.
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Scale of Need: Tooth decay is the most common chronic infectious disease in children. Data presented showed untreated tooth decay prevalence: 1 in 6 children nationally, 1 in 4 in Texas, and 1 in 3 of the children screened in the city program. Post-COVID, urgent dental needs spiked from 2.7% to 4.6%.
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Program Components:
- Head Start/Early Head Start (24% of budget): Provides biannual exams and fluoride varnish to children 6 weeks to 5 years old.
- Miles of Smiles (39% of budget): Mobile school-based clinics serving Pre-K to 3rd grade across 200+ sites and 8 school districts. Over 17,000 children were served last year.
- Title V MCH Block Grant: A partnership with UT Health School of Dentistry providing dental care to over 800 uninsured children annually, with demand far outpacing capacity.
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Councilmember Positions and Questions:
- Councilmember White expressed strong support for the program, stating it meets kids where they are. He asked if replacement funding had been identified; Dr. Jacob confirmed it had not, and the program's fate is part of the FY27 budget planning process.
- Councilmember Mesa Gonzalez noted the program serves her district (8) the least but found the highest percentage of urgent need there. She suggested expanding partnerships to Pre-K 4 SA and local immigrant/refugee nonprofits.
- Councilmember Alarete Cabito thanked the speakers and asked for trend data (which showed worsening conditions post-COVID). She offered council offices as distribution points for educational materials.
- Councilmember Castillo voiced hope that the program would be prioritized in the upcoming budget to avoid reductions and allow potential expansion.
- Chair Gavon requested specific data on the number of schools served (200+), the frequency of Miles of Smiles visits (currently once yearly, goal is biannual), and follow-up data on long-term care and links to chronic diseases. She also suggested a memo on the program's impact on student achievement.
### Howard P. Peak Greenway Trail System Update
Homer Garcia (Parks Director) and Brandon Ross (Capital Programs Manager) provided the update.
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System Overview: The trail system is over a quarter-century old, with over 100 miles of trails completed, connecting all council districts. It is a massive public investment funded by $190 million in sales tax, $83.4 million from Bexar County, and $103.5 million from the 2022 Bond.
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Current Status: 103 miles are complete, with 12.3 miles in construction, 30 miles in design, and 7 miles planned. Over 1,700 acres of creekway land have been preserved.
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Future Funding: An estimated $40-50 million is needed to complete essential projects, with the Port San Antonio connector ($30M) identified as a top priority for the next bond.
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Maintenance and Safety: Operations and maintenance are funded entirely by the General Fund, a growing challenge. Safety features include Park Police, Trail Stewards, lighting at trailheads, and a mile marker system integrated with 911 dispatch.
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Councilmember Positions and Questions:
- Councilmember White praised the trails and raised concerns about long-term maintenance funding given budget constraints. He asked about safety measures.
- Councilmember Alarete Cabito stressed the trails' importance for physical and mental health. She raised significant concerns about trail safety (violence) and the functionality of the 911 mile marker system, requesting better patrolling and public awareness.
- Councilmember Mesa Gonzalez supported the expansion and used her CIP funds for restroom improvements. She proposed implementing trailhead parking passes for non-residents as a potential new revenue stream.
- Councilmember Castillo highlighted the importance of the Port San Antonio connector for District 5, calling it a critical link for employment and amenities.
- Chair Gavon requested a dedicated committee discussion on long-term safety strategies (lighting, police presence) and maintenance funding models. She also inquired about volunteer programs (Trail Watch Stewards, Basura Bash) and future expansions like the Great Springs Project. No consensus was reached on parking passes, as one member explicitly opposed the idea.
Key Outcomes
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Oral Health Program: The committee did not take a formal vote on funding but expressed unanimous, strong support. The impending gap from the Medicaid 1115 Waiver was clearly established. The program will be a key consideration in the FY27 budget process. Multiple data requests were made to strengthen the case for continued investment.
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Greenway Trail System: The update was accepted. The committee agreed to hold a future discussion on comprehensive trail safety and sustainable maintenance funding. The Port San Antonio connector was confirmed as a top priority for the 2027 bond program.
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Meeting Adjourned: The meeting was adjourned at 11:15 AM.
Meeting Transcript
All right. The time is now 10.02 a.m. on February 2nd, 2026, and we'll call the community health meeting to order. Councilmember Castillo. Councilmember Alarete Cabito. Here. Councilmember Mesa Gonzalez. Councilmember White. Chair Gavon. Here. Chair, we have quorum. Thank you so much. All right, first thing we gotta do is the approval of the minutes. Are there any corrections to the minutes? All right, can I get a motion to approve? Absolutely. All right, great. Uh all those in favor to approve the minute, say aye. Aye. Aye. Any opposed? Any abstentions? Great. Motion passes. All right. First thing we have public comment. We have a couple speakers signed up to speak. Each person will get three minutes to speak, and so we'll start with uh Beatrice Hicks. Good morning. Um City Council members. My name is Beatrice Hicks, and I'm in a retired associate professor at the UT Health San Antonio. I served in the Department of Dental Hygiene there for 34 years. In 2006, I was very fortunate enough to be a part of collaborative grant with the Department of Health and Human Services who awarded us $300,000 to the Department of Dental Hygiene, Parent Child Incorporated, and the Metropolitan Health District. And the reason for that was to develop and implement a culturally sensitive pediatric practice dental model for Head Start programs. The collaborators established a model incorporated preventive services such as dental screening for our varnish applications and oral health programs for parents, family support workers, and Head Start teachers. An extensive case management system was also developed. This management system provides oral health case managers who pave the way for children to gain access with Bear County dentists to provide treatment for urgent or routine dental care and as well as to find a dental home for the children. A key part of the work involves identifying and breaking down treatment barriers. This program helps break down those walls one by one to restore a child back to health. Many of the children who are seen come from low socioeconomic households and may or may not qualify for Medicaid benefits. And even if they qualify, we have found that they do not tap in or utilize the services. This program was later expanded to include the Miles of Smile Sealant Program, and this program models and mirrors the Head Start program and provides sealant services to school-age children. Dental sealants are preventive service in which a plastic coating is placed on the chewing surface of the teeth to prevent future cavities in children. Both programs include mandatory rotations for both dental students and dental hygiene students at the UT School of Dentistry. This offers chance for the students to provide the preventive services, screenings, the fluoride vinyl treatments with the children. Students learn how to recognize childhood cavities along with the opportunity to experience firsthand the disparities in their own city. These programs serves thousands of children in Bear County each year. The goals of the program is to strengthen health, development, and long-term opportunities of Texas children. Oral health is much more than dental care. It shapes how children eat, how they speak, learn, socialize, and thrive.
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