All right.

The time is now 10.02 a.m.

on this Tuesday, uh, April 7, 2026, and the community health committee will now be called to order.

Madam Clerk, will you please call the roll?

Councilmember Castillo.

Councilmember Aldarete Gavito.

Councilmember Mesa Gonzalez.

Councilmember White.

Chair Galban.

Sir, we have a quorum.

Thank you so much.

Uh, first things first.

Uh, any corrections to the minutes?

If not, can I get motion to approve?

All those in favor?

Aye.

Any opposed?

Any abstentions?

Moving along.

All right.

Heading to public comment.

We have three folks stand up to speak.

Um, number first one, we'll have three minutes with all three minutes.

Um, we have first up Frederick uh Kurtois.

Apologies I mispronounce your name.

Thank you.

Morning.

Yep.

Good morning.

My name is uh Frederick Courtois.

I'm the executive director for uh San Antonio Nexus Connection.

Our mission is to promote, develop, and pilot sustainable street outreach modalities in substance use and community health in general.

I am a social worker here in San Antonio with over 20 years of experience in outreach here in San Antonio abroad and in Mexico.

I am here today because our work in HIV prevention and substance use has been shaped for seven years by San Antonio's commitment to the Fast Track Cities Initiative.

That commitment is more necessary now than ever.

San Antonio was the first city in Texas to join, and it decided then to lead the state in that effort.

I've had the honor of presenting some of San Antonio's work at three Fast Track Cities International Conferences.

Over the past few years, Metro Health has done something quite remarkable through small grants and sustained relationship building.

It has grown a network of what I see as community health first responders across this city.

Um before the crisis becomes a 911 call, who build the kind of trust that clinics cannot manufacture in the midst of a crisis.

That network is real.

It exists because COSA chose to invest in it through microgrants that seemed overtly ambitious at the time.

San Antonio Nexus Connection was among those recipients, and it is at a point of and it is a point of pride that Sansi never interrupted its services throughout the COVID-19 epidemic.

That network is now aligned with the community health improvement plan and its behavioral health priorities, setting the foundation for a larger vision.

There is no community health improvement plan without first revisiting the policies that improve or prevent health.

At present, with federal public health infrastructure under pressure, that insight has become the argument for why San Antonio cannot wait for anyone else to lead.

Together, we have started developing a way to collect more precise data, democratize it so it serves the people who generate it, and build the professional infrastructure this workforce has never had.

So San Antonio emerges as a model for communities seeking to improve health among the most invisible of its residents.

At a time I have 15 seconds to go.

At a time of political and funding vacuum.

San Antonio still has an opportunity to lead, not because we have the most resources.

But because we had the vision to start early.

And the relationships to go forward.

Thank you very much.

Thank you so much for your comments.

Next up, we have Jack Finger.

Well, Mr.

Chairman, other members of the committee.

For the record, my name is Jack M.

Finger.

Yes.

Today you're going to speak on deal with item number four.

That's an update on the uh immigrants here in San Antonio.

You know, um my question is.

Well, I look at your backup documents, and it said that uh as many as immigrants accounted for 21% plus of the population growth in the San Antonio metro area in only five years.

Five years.

21%.

That's a whole fifth.

From 2018 to 2023.

No, that's that's quite a bunch.

Now the question is, are they all from near neighboring states?

Or are they mostly from south of the border or parts thereof?

Um I have a big problem with that.

You know that you're gonna say, well, Jack, they're just asylum seekers.

Okay.

Do you know what the percentage is of asylum seekers, so-called asylum seekers that fail to show up for their hearings?

Ninety percent.

And I guess you folks probably already knew that.

Here's another statistic I wonder if you knew.

Yes.

The uh ask someone from representative from the police department, ask them in the Bear County jail.

What percentage of the inmates are uh illegal aliens?

Yeah, ask them sometime.

Is it take a while guess?

Is it 10 percent?

15.

Uh try 23 percent of the inmates in the jail are here illegally.

Um it puts kind of puts the lie to the idea that they're just honest, hardworking people who just want to uh get a a chance at living in the United States.

No, uh you also want to ask the question just how many what you say they're they're adding to our tax base here in San Antonio.

Well, they add and then they subtract.

By that I'm asking you what percentage actually use our hospitals and fail to pay any bills in that regard.

What percentage use our education system, our schools and so forth, and do not pay their fair share in this regard.

No, uh you folks have determined that we are an asylum asylum city, uh sanctuary city, either officially or unofficially, that's still the case.

And uh we the honest guys who pay the freight on all this stuff, we get a little upset, a little angry that you our leaders are not really doing anything about it.

Thank you.

Thank you for the next person.

We have Mary Fisk.

Good morning, Mr.

Chairman and members of the committee.

Uh I am Mary Beth Fisk, and I serve as the CEO of the Ecumenical Center, nonprofit here in San Antonio that has served our city for over 60 years.

Uh we are here today to make comment on one of the presentations coming later in trauma-informed care.

We were selected to be the certifying body and the certificate certification program and developed the program several years ago through leadership and largely that the city had provided.

Um we have uh successfully done so in the sense of developing a network of systems.

You'll hear more about that in the presentation to follow.

I just wanted to highlight what the ecumenical center has done.

Uh, part of developing a certification program has meant that we needed to develop the standards and the domains and the process by which an organization could go from interest in trauma-informed care certification to becoming certified.

Um, and uh there are many organizations, so many of the city organizations as well that have achieved this milestone, and so we're grateful for that.

Um we also have now three levels of certification, level one, two, and three.

And we've also had a great interest for outside of just San Antonio from other cities, other organizations that find that this is a very valuable resource.

So I just wanted to take a quick moment to say that the Ecumedical Center is humbled and grateful for the pull the opportunity to partner with our colleagues with the city and uh the county and our consortium.

And I feel like the work has been uh well recognized and can will continue to grow.

Thank you so much.

Thank you.

All right.

Well, those all the folks that are send up public comments.

Um we'll move into item number two, the Healthy Bear Community Health Improvement Plan, and I believe presentations by Claude.

Go ahead, Dr.

Thank you, uh Councilman Galvine.

Just a point of order.

We do have um two other um speakers that we do have their public uh comments in writing.

So would you want them to speak or did you want me to go ahead and with the presentation?

In terms of public comment or just for the presentation.

Uh I don't have them send up, but if they're they're welcome to to come up.

Okay.

Come on up.

So um we have Elizabeth Lutz, uh, Liz Lutz from the um Bear County Health Collaborative.

Okay.

Good morning.

I just wanted to say thank you for giving us an opportunity, and I apologize for the misunderstanding on the sign up.

But um I'm joined by my uh executive committee board member uh Dr.

Ursalazar, who is um also our steering committee chair uh and helps uh support and organize the community health improvement plan as well as the community health needs assessment.

Dr.

Salasan.

Thank you, Liz.

Well, good morning, everyone.

Put my readers on because I'm at that stage.

Well, good morning, and uh I'd like to thank you for the opportunity to be here today, Liz and I.

Uh, we'd like to briefly uh ground us uh on the role of the health collaborative and how this partnership supports the health of our community.

Uh in terms of who we are, the health collaborative is a cross-sector partnership.

Our membership includes hospitals, health systems, metro health, academic institutions, uh, community-based organizations, funders, uh, community health workers, ACA navigators who help residents connect uh people to coverage and care.

I share this because breath matters.

Improving community health is not something any organization can do by themselves.

It requires alignment across those who generate data, deliver care, shape policy, and work directly with residents every day.

In partnership with Metro Health, uh, we lead the community health needs assessment or the Chennai and the Community Health Improvement Plan or CHIP.

The Chennai is where we listen and we learn.

It is grounded in data, informed by lived experience and strengthened by analytic support from community information now, which is part of the UT Health Houston School of Public Health.

And as I often say, data is not just often is not just about numbers, it is about meaning.

Behind every data point is a person, a family, a neighborhood, a community.

What we are seeing reflects what many of you here in our districts in terms of uh the recent assessment, ongoing mental health challenges, continued economic pressure following the pandemic, declines in preventative care, and widening disparities, especially among youth, older adults, uh, persons with disabilities, and the economically economically fragile.

These are not isolated issues.

They reflect deeper conditions, shaping health long before someone enters a clinic.

And so we see the health the community health needs assessment as the starting point for how we respond to opportunities.

And from there, we move into the community health improvement plan where partners come together to align and share priorities and strategies.

It is also about shared stewardship.

I think we would all be in agreement that this work is far too big for any one organization to carry.

It requires public health expertise, community trust and engagement, strong data, and a long-term commitment.

And it requires partnership.

And the only way this can work and has worked is through shared stewardship.

Our series committee reflects that, bringing together hospital, academic, public health nonprofit leaders to align around data, commit to shared strategies, and hold each other accountable.

We would like to recognize the Center for Policy and Health Improvement as well and Metro Health for their continued role because they play a critical role in bridging city priorities with community needs, through results-based accountability, engagement, coalition building, and policy expertise.

Helping ensure this work translates into coordinated action.

This work helps to reduce silos, ensures that we learn through the China, translates into coordinated action across systems.

We also want to highlight that San Antonio will host the American Public Health Association's annual meeting exposition this fall in November.

This gathering will bring together thousands of public health professionals to our city under the theme Together We Thrive, Health Across the Life Span.

That theme aligns directly with this work because health is shaped across the lifespan and it is shaped together, together across sectors, across systems, and together with community and even in challenging times, that collective effort gives us optimism.

In closing, thank you to the community health committee and to the city of San Antonio for supporting this shared structure and roadmap.

Ultimately, this work is about ensuring that every person in our community has the opportunity to live a healthy life at every stage of that life.

Thank you.

Thank you.

Thank you.

Okay.

Thank you for that adjustment.

Good morning.

Thank you for the opportunity to provide today's briefing.

Again, happy National Public Health Week to one at all.

Special shout out and thanks to Dr.

Wu and her team that anchors this work at the Center for Policy and Health Improvement.

So the highlights of what I'll cover today is really you've heard from Dr.

Salazar.

Again, these are highlights about the community health improvement plan, also known as the CHIP, and uh quick commercial about National Public Health Week events taking place this week.

Um, just know that the context of this.

Um, I know that this is uh the six year anniversary of the of the um pandemic.

We have been applying lessons learned since then and more immediately thinking about the reallocation of resources to support efforts like this on the ground.

But just know that San Antonio is a community with a 20-year gap in life expectancy between the northwest and southeast sides of town.

Root causes include generational poverty, structural racism, including redlining and social factors like the lack of transportation, insurance, child care, and even knowing when you need access to health care.

So, what can we do about it?

Uh, we truly believe that all deserve an opportunity for optimal health and well-being.

And just know that the community health improvement plan is a community-centered health approach for overcoming these obstacles here in our local community.

So, our department, again, as I've shared here, we are proud that we are nationally accredited local health department.

Just know that this is a voluntary process nationwide.

One in four local health departments across the United States has this designation.

Here in Texas, there are eight other health local health departments that have been recognized by the public health accreditation board, also known as FAB.

And just know that it does my heart good.

I do serve as a member of the board of directors, and just know that this is a product, the community health improvement plan and the community health needs assessments, which are requirements for that designation.

So this allows us an opportunity to create a shared roadmap for action and accountability, as you've heard mentioned by local hospitals, our uh department on the ground, and community-based organizations.

Uh, keep in mind that this is not a replacement of organizational plans, but it allows it allows us to have a guide to align and better coordinate our local efforts.

So we do have convening Hamauer as a department, and this is an opportunity for us to ensure the connections across our networks.

So, with the Chennai, which you've heard again, this is completed every three years.

It's based on data surveys, focus groups, and key informant interviews.

As you've heard from Dr.

Salazar, the Chennai is a comprehensive data report.

Most recently was released this past fall.

Key findings were that a community is far from recovered from the pandemic with mental health needs still evident.

Uh, just know that food insecurity, housing costs, and a lack of living wage jobs and low education rates demand our attention.

And just know that on a positive note, we continue to see decreases in teen pregnancy as well as a drop in violent crime, which again, these findings and details mirrored national trends.

Again, I do want to thank the team at CI Now, led by Dr.

Laura McKearn for anchoring the work and the development for this community health needs assessment.

To the CHIP, uh, just know that the complement to the assessment is the action plan.

Just know that this is conducted every three to six years, and it's based on not only the data but also community input.

Uh, it's organized in these uh priorities, indicators, strategies, and it has a list of uh partners on the ground as well as metrics.

And again, I'll talk more about what we'll be sharing as we uh roll out the chip uh coming to a theater near you.

Just know that this allows us to demonstrate the alignment of our efforts across sectors, and it's anchored to the local networks.

Just know that nationally accredited health departments are required to have a chip, and just know that the complement to that, where there are states that are uh nationally accredited, they also have a state health improvement plan.

Um, so just know that that's a complement to the CHIP.

Just know, as you've heard, we do collaborate with the uh the health collaborative, and it's a core coordinated plan with participation for our spectrum of partners that include community-based organizations as well as the city and the county and our partners in act in uh academia.

The health collaborative also helps to coordinate our initial tier of work groups for each of the four priority areas, which I'll quickly walk through.

One note just know that the current CHIP we have codified from 2024, and this will serve as a guide over these coming years.

So the next chip won't be released until 2029 when we reconcile our process with the new assessment that will be conducted, and then we'll have that action plan.

So for now, we stay the course and I'll walk you through at least our process for codifying this chip.

As you've heard mentioned, the CHIP process is used as a results-based accountability framework.

Just know that our steering committee reviewed existing strategies that included our SA forward plan and the SHIP as and came up across with four focus areas.

Each work group then created strategies and chose population-wide metrics or indicators.

Just a gentle reminder that during the last years of the pandemic, we did release a citywide plan that allowed us to have at least a focus on the conditions that we saw that worsened during the pandemic.

Those priorities included access to care, data, food insecurity, health equity, mental health, and violence prevention.

The complement to that, the housing improvement plan focused on major areas such as coordinating housing systems, increasing city investment, expanding affordable housing production, protecting neighborhoods, and ensuring public accountability.

Again, this is an opportunity to show the alignment of our efforts.

And just note that the indicators represented by the largest oval in this graphic track the well-being of the entire population.

So they are slow to change but important to monitor for the big picture of how we're working collectively.

So with that, I'm just going to quickly walk through, just know these are the four priority areas around behavioral health, food insecurity, housing stability, and prenatal care.

Again, I'll briefly highlight these, uh, share a sample of metrics and key partnerships that support the implementation of each priority area.

So again, details are available in the actual plan that was released, uh, the 2024 CHIP.

Just know that our first area is on behavioral health and well and mental well-being.

When people use community-based mental health care, that reduces crises that strain law enforcement and emergency departments.

While we do have a list of partners, key partners on at the bottom of the slide, just know that this work is anchored to the Center for Health Care Services and as well as Strack, the Southwest Texas Regional Advisory Council and designated working groups, as well as the Bear County Behavioral Health Unit.

And just know that because it takes available to do this work, this is an opportunity for us to at least uh draw more attention and show the alignment of our efforts.

Uh just know that as one example to strengthen the capacity and effectiveness of the mental health workforce.

The work group is developing standardized training, field work practices, and quality benchmarks for our outreach staff who connect people to mental health care and other services.

Again, the report has the longer list of key partners, but you have the short list at least shown on the slide of our community-based organizations who are doing this work each and every day.

The second example is uh will again on food insecurity.

Just note that a well-nourished community is a more productive, stable, and resilient community.

In this example, we reference the work of the Health Equity Network partners who have trained 16 new SNAP navigators for our community.

Just know that while for the second strategy listed here in terms of increasing uh locations, just know that both the mission marquees farmers market and the nourished seeds farmers market at Confluence Park now accept double up food bucks, which means you can double the produce for the same amount of SNAP dollars.

Just know that our key partners include the San Antonio Food Bank and the World Heritage Office.

Again, more than 30 community partners helped to undergird this work.

And the sample metric is around reducing the percentage of Bear County residents who experience food insecurity.

Again, the initial metric was for 2027, and we're looking at adjusting that to 2029.

Housing and stability or housing stability, just know that the third focus area focuses on this social determinant around safe, stable, and affordable housing supports, which undergirds physical and mental health.

Children who grow up in a stable housing have better long-term outcomes.

This example is really showing the collaborations with the school districts and nonprofits who are aligning with the goals of NAHS NAHS NHSD, the neighborhood housing services department, as well as homeless services and close to home, creating cross-sector coordination to prevent evictions.

This work can consist of distributing eviction helpline numbers and tenants' rights into information on the front lines or building support to hold housing finance corporations accountable and joining housing is health campaign.

Again, this is a citywide initiative, and I want to thank again our partners on the ground.

You see a short list of the partners listed on this slide.

Just know that the longer list is included in the report.

And lastly, again, in terms of these uh four areas, we have prenatal care as a focus area.

Good prenatal care improves birth outcomes across demographics, ensuring that all children start life with the best chance to thrive.

Just know that these sample strategies are around screening um uh early interventions as well as using shared data systems and partnering to track progress.

Uh this metric is really about increasing the percentage of pregnancies receiving prenatal care.

Again, we saw this uh condition exacerbated during the pandemic.

We have more than 17 community partners, including University Health and United Way SA.

And just know that uh this example here, the work group will track uh their aggregated outcomes to identify gaps in our community.

For example, when referrals are made, did the pregnant woman obtain services, what was the wait time, uh, were their needs met.

Just know while this may seem incremental in scope, it's really significant to state the course as we make uh some progress, especially uh the experience that we had on the ground during the pandemic.

So, with that, um, as you've heard from Dr.

Salazar, we've gone through some internal restructuring, and I do want to applaud the team for helping us to establish uh this capability within the department.

Again, we call it the Center for Policy and Health Improvement.

Clearly, we recognize that the CHIP goals can't be met by any single organization.

As I've shared here, it takes a village to do this work.

Public health can guide the process, but progress happens when hospitals, schools, nonprofits, businesses, residents, and policymakers all take responsibility for their part and track results together.

Again, our public health framework is organizing these 10 essential services.

So if you look at Essential Service 4, which is about strengthening and mobilizing partnerships, or we look at Essential Service 5, which is really about having a plan and sticking with it, just know that the CHIP allows us to make sure that we're not working in silos and not duplicating efforts.

And we realize that uh not investing in short-term fixes alone allows us to at least show steady progress over time.

So just know that depending on the partners' needs, we've anchored this work to uh what we call the Center for Policy and Health Improvement, and we offer we can offer many grants to support data collection or pilot projects or provide technical assistance, coordination, systems change, and data information sharing.

I also want to acknowledge and thank the San Antonio Area Foundation for their support in this endeavor as they have been a partner part and parcel for rolling this process out and anchoring the work to the Center for Policy and Health Improvement.

Again, that team led by Dr.

Wu and her incredible staff.

So just know that we um are uh proud of this work.

I mentioned the center.

Um, just know that it's not your typical brick and mortar program.

It did require some internal restructuring and staff reassignments and realignments.

Just know that their work to coordinate these cross-sector implementation alliance with the chief public health strategist framework, uh, which is also called public health 3.0, and that's about uh having access to timely data, uh, making sure that we invest in more robust partnerships, and it's about having and implementing this culture of quality improvement at the department.

So the work builds out our whole community's public health infrastructure and capacity to address persistent health challenges.

And it's cost effective.

Um, when we connect the dots across the CHIP priorities, we see a focus on prevention, which is by design, preventing mental health crises, child hunger, homelessness, chronic illness, and poor mental and infant outcomes.

And just know that for every dollar spent on public health, 14 dollars are saved.

So, this unit, in terms of the funding, given our fiscal fragility and uh experiences we've had this past year, it does require us to be even more intentional with how we braid funding.

And so I really want to thank the city.

I want to thank the city manager, I want to thank council for allowing us at least anchor alliance share of this work to the general fund, but the compliment is also dovetails with external funding, and for this unit in particular, it's supported by the opioid settlement dollars, as well as contribution from uh the health collaborative and uh some components that are supported by the Medicaid 1115 waiver.

So timeline as I wrap up.

Just know that coming to a theater near you, we are designing a dashboard so that we can report out study progress.

Uh, that will be made available later this fall.

Just know that by the end of the month, you'll have at least the first pass of our report.

And so we are committed to at least generating an annual report.

And uh as again, as I shared earlier, we are reconciling a process so that the next community health needs assessment will be conducted in fall of 2028, and the next CHIP will be released in spring of 2029.

Again, we'll be reporting out in terms of indicators, policy recommendations, strategies, and acknowledging the ongoing uh contributions by key partners.

So now to the commercial, and then I'll wrap up.

So every year, as I mentioned, the first full week of April, uh communities across the country joined the American Public Health Association, also known as APHA, to celebrate National Public Health Week.

It's a time to honor the contributions of public health and spotlight issues shaping the nation the health of our nation.

So we've been doing this for more than 30 years, and APHA has led this effort.

Full disclosure, I do serve as a member of APHA's executive board, and I want to at least uh share how proud I am that we are elevating the visibility, the look, the feel, the sophistication of what happens, and we are celebrating in unison with other partners across the city, and just know that the national theme this year is ready set action, and it calls on every person in our community to look back at the progress we've made and look forward to the steps needed for an even healthier future.

This is being celebrated this week.

We kicked off yesterday with the public health summit.

Uh again, thanks to the county and our partners at uh UTSA.

Uh we had an incredible event uh yesterday on UTSA's campus.

And we do have uh activities taking place this week, and I just wanted to at least signal out um tomorrow, not tomorrow, Thursday, uh Thursday, April 9th.

Um, we will be at uh Rosedale Park from 3 to 6 p.m.

And this is again one of the signature events uh that we help to support.

This event will feature information on programs and resources.

Attendees can learn more about our metro health programs and other uh coastal departments and community partners.

Other activities include food samplings, uh fresh produce bags, music, fiesta medals, and more.

And this is uh free to the general public, so no cost.

And so with that, just want to say how much I appreciate this opportunity.

Happy National Public Health Week.

Uh just know that later this month we'll also be releasing our Metro Health Annual Report, which is something that we brought to council, and so you'll see that, and it'll be posted on our website as well, just uh talking about highlights of what we've done this past fiscal year.

That concludes my report.

Thank you so much, Dr.

Jacob.

And of course, happy National Public Health Week.

Very excited to see all the things that y'all will be doing this week, and of course, that you do year-round, uh, but a special highlight uh going on now.

So thank you again for all the work y'all do.

Uh would anyone like to start with uh questions or comments?

Council Member Alderate Govito?

Uh well, thank you.

Thanks for that presentation.

Sorry.

Now now, of course, my iPad is giving me issues.

Um really quick, Claudia you mentioned um or Dr.

Jacob, you mentioned that there are a lot of different organizations helping out.

So who's who's are we is Metro Health taking the leadership role and kind of holding them accountable?

So uh thank you for the question.

So I would say that tied to the implementation of the chip is what I'm assuming.

You're asking, yes, we have a number of organizations that are partnering with us.

They participate in different work groups, they're anchored to the network of the health collaborative, uh, so it covers a spectrum of uh healthcare institutions, nonprofit organizations, uh academic partners, and so we have the full list, and they're tied to each of the priority areas.

Um so, yes, uh, we are a convener of sorts, and so what we've committed is to make sure that we provide some operational support, but it also dovetails with the uh interests and the priorities as recognized by our partners.

Okay, so so then the reporting of information goes back to you all, and we put that information together.

I'm wondering then who also takes um who's taking the role in in kind of driving to the metrics.

Is really, I mean, I mean we have to do that too.

I know it's a little hard and uh it's difficult because of some of the problems that we're we're dealing with, and it's also difficult to measure and track these things too.

So I'm just curious.

To your point, yes, it is a heavy lift, which is why, again, as a nationally accredited health department, we are committed to this task, not just to check the box, but to make sure that we align our efforts to demonstrate improved impacts in community.

Um it does take long-term investments to do this, which is why uh the federal agencies, again, the CDC, the Centers for Disease Control and Prevention, they uh again a few years ago uh released some funding to allow us to have this capacity and infrastructure.

So it allows us uh to lean in a bit more to your point.

So the work groups, that's where the magic happens, and we are committed to report out, which is why later this year you'll see a dashboard, yeah, and we can show the progress over time.

Yeah, I'm definitely looking forward to to that dashboard.

Um and I and I'm glad that we're gonna be reporting it out on on it.

I just also wondered too how we can um, you know.

Again, as I mentioned, I think it's especially with these problems, it's very difficult to drive to a number, but at the same time, too, we still need to drive to a number, right?

We want to see reductions in in a lot of this uh in a lot of these areas.

Do you all know?

I I and I saw the um improvement, I guess, in teen pregnancy.

Do we know what that's attributed to or to the decrease in teen pregnancy?

So yes, uh we've noticed that trend.

Um I can tell you in sheer concrete numbers of what we saw.

Again, this is looking at the uh decrease from 23.7 per uh hundred per thousand adolescents in 2019 down to um a pregnancy rate of one 18.3% per hundred that per thousand, not per thousand, as reported in 2023.

So we saw that change over the course of a four-year window.

Um we can only attribute it to the fact that we have leaned in a bit more working with our direct service providers.

Um we have uh elevated at least the visibility in terms of primary prevention and education.

So it's not one task, one activity, it's the consolation of efforts that we've seen on the ground.

Yeah, and so uh what uh two two quick more uh questions.

When can we expect that dashboard?

Uh by fall.

By fall.

And then also too, I'm wondering like if we're to see like how we saw the decrease in teen pregnancy, and you were saying it's because y'all leaned into your efforts.

If we are notating maybe on the dashboard or somewhere, the strategies that are working.

Because again, like I'm I'm saying, I think it's difficult to drive to number, but we these are numbers we actually do need to drive to, right?

And so I can understand how it's difficult to capture, but I'm also wondering how we um obviously I know funding is important, but I'm wondering how we just get aggressive and and say, you know, these are the things we tried that maybe we didn't see a decrease in our numbers.

Um we didn't see the outcomes that we were expecting, but these are the strategies that we absolutely did see an outcome, and so we need to uh keep our foot on the gas on those things.

Oh sorry, Dr.

Wu.

Go ahead.

I didn't see I'm gonna invite Dr.

Wood at the moment.

Yes, okay.

Come on.

So we used to have um uh San Antonio teen pregnancy collaborative, and like with the work that we're talking about, with the current focus areas, that was collective impact, um, which is where we are the well for teen pregnant never mind.

I'm not gonna go into the detail of the different groups that were backbones, but the backbone um is the brain.

I mean it's not the brain, the background.

The backbone is the backbone, it's not the brain, right?

So the the um the group itself, uh the c it we convene, we have uh we keep people's eye on the metric, right?

We we will help them check in and and see what's are we making a difference?

But really it it is the the magic happens in all of these groups having that shared metric together, communicating frequently about it.

Um and uh there are a few other things, you know, up sometimes you get to people get people so aligned that they're applying for grants together, right?

So there are different foundational parts of collective impact, and and that's what our team specializes in is making sure that we're as faithful to that model as possible, and that's evidence-based and has worked for all kinds of problems.

Yeah, definitely, and I do think, and you know, obviously we're gonna be going into city um budget discussions, and we do know that money's tight, but you know, and I've said it before, you know, when our our budget, our city budget is not meant to be all things to all people.

It isn't, right?

We have our core services, metro health is a core service.

So to me, you know, I I'd want for my colleagues and I to think about instead of spreading city funds so thin that we're not moving the needle on anything.

What if we were to concentrate our city funds on efforts like this where we can actually move the needle on something, you know, and and so it's a different way of thinking because you know, people are so used to saying yes to all the groups, but I do think that if we were to be strategic about the the minimum the the our budget dollars, we could actually see me the needle move on on some of these problems that y'all um are focused on.

So thank you for your efforts.

I know it's it's difficult to track and capture the the metrics on this, but I do think it's extremely important.

So really appreciate all y'all's efforts.

Thank you.

Thank you.

Thank you, Councilman.

Anyone else?

Any questions or comments?

Could you mess with Gonzalez?

Thank you.

Just um quick wanted uh thank you for all the work that you're doing at Metro Health, you and your team, Dr.

Wu and your team.

Um I I really want to highlight the behavioral health and mental well-being piece because normalizing that uh help seeking and reducing the stigmatism, I think is so crucial.

Um we hear it from we're having a teen mental health summit in District 8 at the middle of April, um, because we see it on the news all the time, right?

Kids are running away, going missing, killing themselves by suicide.

Um, and I think um our youth more than when I was a kid are more open about it and upfront about the issues that they're dealing with.

So, just really uh want to support everything, but that mental health piece is such a crucial uh piece for me.

Um and it means we've got over 60 community partners just based on the slides alone.

I'm sure there's more.

So this really is a village and it takes a team effort.

Um the many grants, what how are those how do those come to be?

What are what's the guidelines for those many grants?

How many are there?

Who do they, right?

Who who applies?

All right.

I'm gonna invite Dr.

Wu back to the mic, then just to talk a little bit about these mini grants.

So through a competitive process, we find a partner, which uh currently is the San Antonio Area Foundation, and they uh help us to push the money through to multiple small organizations in a way that's more easily than we can do through through city processes.

So they align their work with the four areas, and the mini grants sometimes are like you can imagine for an organization, a small organization like I'm talking about.

It's a challenge to collect the data that Councilwoman Alderati Gavito was talking about.

Sometimes you know that takes uh staff labor that you know it it may require another FTE.

Sometimes it's a matter of um just having a system, right?

For for tracking the data.

So the the organizations propose what they would would spend the money on, and then um uh with the help of the area foundation and some panels.

I don't know if Shelly moved up.

Shelley does this a little bit more day to day.

So you're gonna stop me and tell me if I'm saying anything wrong.

So far, so good.

Okay.

Um so yes, as long as they're aligning their work, um, and they've expressed how they're going to be spending the grant money.

Um, that that's a rough outline, but we also have somebody who can explain that even better than me.

That's an A.

Good job, Dr.

Booth.

All right, right, you're good.

Okay, thank you so much.

Um, and then on the community and Ford feedback loops.

Have we seen that already in action?

I guess those feedback loops, and sharing can you is there an example of that?

I would just say, in short, through the work of the working groups, that's why we have representatives from different organizations to make sure that we keep our ear to the ground and we get this information.

So the reason that we're rolling out the dashboard is to make sure that we communicate out the progress over time.

So you'll get a first uh tier in terms of our progress to date later this month, but the dashboard itself will be released later this fall.

Okay, thank you so much.

Thank you for all your work.

Council member Castillo.

Thank you, Chair.

Thank you, Dr.

Jacob, for the presentation, as well as to all the stakeholders that participate with the healthcare improvement plan.

Uh, a number of moving pieces.

I first wanted to thank your leadership, Dr.

Jacob.

I'm thinking about uh just the wealth of events that your team puts together and the amount of people it brings out to participate.

And what's really important to highlight that it's up, it's essentially a teach-in, right?

That you're facilitating through fun events and information.

Uh, and this is something that we receive a lot of positive feedback from constituents, right?

I'm thinking about the community baby shower where residents uh go through uh specific booths, interact with different organizations to get connected to information and knowledge, uh, and then they receive something that they need at the end, right?

Um, so it's just uh a really impactful model that you all implement, and I really just value that approach uh and love to see the events all throughout the city that y'all facilitate, and um only Dr.

Julius could get me to do the bunny hop and line dance uh and it's at a Metro Health event, right?

And I think that's very telling uh just uh the amount of uh impact that you all have.

Um so just wanted to highlight that event, but then work our way through the priorities uh in terms of food security, right?

This is something that I'm always grateful to see that each budget we continue to invest in the healthy corner stores.

Um, this is such a great impact, and of course, partnering with the Department of Human Services for some of the classes that are taught at senior centers.

Uh, it's always great to visit senior centers and they're sharing that that's one of their favorite um classes, right?

Is when they're being taught how to eat healthy, and then also they're oftentimes provided uh with food, a healthy bag of vegetables to go home and make gazel or whatever the case may be.

Uh, and I wanted to share and thank Dr.

Wu and the team for the health fair that we had in District 5.

That event we received so much positive feedback from constituents, and they asked for more.

They're like, Can you do this with housing?

Can you do this with infrastructure?

It was very informative, and they walked away uh sharing that they learned so much about public health.

And what they really valued is that we had conversations on issues that are typically stigmatized, right?

We talked about addiction, STIs, and folks were uh well equipped with information.

Uh and they asked for more teach-in similar to that.

So just wanted to thank your team.

There was a lot of value and impact, and we also believe uh the vegetable bags that your team donated also brought a lot of folks out, right?

Just demonstrating that need and the interconnectedness of uh of mental health, food security, and then of course, discussing the issues that matter the most.

Uh, and I really value the the plan, and as you stated, uh Dr.

Jacob, right?

That housing is also health care, and it's one of those key indicators in terms of how a kid's going to show up to school the next day, right?

Ensuring that they have a roof and healthy food, so on and so forth.

And I'm thinking about Melody uh Miranda who gave public comment, who shared her story, who's a public housing tenant who shared that prior to living uh at the Amazon court, she was unhoused, right?

Her and her family run housed, and public housing provided her the stability to now graduate, and now she's thinking about law school, right?

And what she wants to do is come when she graduates is represent tenants, right?

Um, that have been wrongfully evicted, so on and so forth.

So I think it demonstrates uh the importance of housing stability.

Uh and I was looking at some of the recommendations, right?

And appreciate that you all highlighted, of course, not duplicating efforts, but leaning into the strategic housing implementation plan, right?

Let's do what that plan's recommending, uh, which highlights um the importance to the rehabilitation of public housing.

Uh and we know it's just a key uh component to our overall housing ecosystem that if you remove it and you replace it with vouchers, right?

Vouchers aren't necessarily bad, but when you're removing and replacing, and we know vouchers aren't being used because there aren't sufficient landlords accepting those vouchers, you're then creating a problem, right?

Um so I just appreciate that the ship has highlighted uh the importance for us to preserve uh that public housing, and it's also um key to just overall housing stability.

Um the housing component within y'all's plan also mentions the need to have a coordinated effort in terms of mitigating evictions.

Uh and Texas housers also has highlighted that uh as a need for us to improve overall housing stability and public health.

So um just great to see the coordination and just highlighting those intersections, but ultimately it takes uh working collaboratively with the partners doing that work.

Uh and this plan makes me think about a lot of the coordination done with um our uh housing partners in terms of those providing permanent supportive care.

They meet, convene, talk about the issues, talk about uh where there's needs to be coordination in terms of applying for grants so folks aren't competing for the same dollars.

Um but um just grateful to see that that coordination continues to happen with public health.

Uh and then I wanted to move on to behavioral, and I have more comments than questions, Dr.

Jacob.

Um, but uh just wanted to highlight with the behavioral mental health.

Just wanted to thank Jesse Higgins uh for the work that she does, right?

And also the intersection of addiction and HIV testing uh and doing those coordinated outreach efforts to tackle the issue uh as as hard as we can and being intentional with the opioid settlement dollars.

So um just really grateful to see the coordination.

Uh I I also believe um share the similar sentiment, right?

That as we navigate budget conversations, how can we um you know prioritize the nonprofits that are already working in coordination with the city uh in a strategic manner to tackle these public health issues, I think is would be a approach of value for council to consider.

Um, but just wanted to end with just appreciate the work that you are doing.

As you've stated, it's going to take community and all stakeholders to make sure that we're making the greatest impact.

Um, and I would love to get with uh some of the the organizations that are doing the work because I think there's a lot of opportunity for uh council to also work and collaborate and amplify the work that you're doing to have a greater impact.

So just really grateful for Dr.

Jacob and the entire mental health team.

Thank thank you for those comments again.

You'll hear from uh Jesse Higgins in the next presentation.

Just know that that's a unit that was established because of the commitment of the city again to lean in more.

So we do have an office of mental health and resilience at the department, analogous now to the Center for Policy and Health Improvement.

So a lot of this we've re-engineered, but it's really to be a better resource to our partners out there.

So thank you for that acknowledgement.

And it allows us to be a connector and a catalyst to our to our shared community in our shared community.

Wonderful.

Thank you, Dr.

Jacob.

Thank you, Chair.

Well, thank you so much, Councilman Ricostio.

I couldn't say any better than that, so I'm not gonna try to, but know that the sentiment is also there from all of us here.

Um quick thing I I wanted to add was um, well, I really appreciate the dashboard at the end.

I think that was discussed.

Um, just gonna understand a bit more of those long-term trends too, to the point, right?

A lot of these improvements that we're making uh are incremental, but of course they're very meaningful.

You know, it's a small percentage, but of course, those are number, there's a significant number of people behind all that, right?

It's not just uh we're trying to do a little bit here and there, it's expanding uh healthcare opportunities people is expanding food security to thousands of people.

And so understanding that a bit more would be helpful through the dashboard and also through future presentations and conversations like this to understand a bit more that these things are cumulative, right?

Right.

Building from 2022 all the way out until 2029.

Understanding that it's gonna be helpful too.

So if we can get some uh the long-term trends, that'd be helpful too.

I know that in some of the the actual reports themselves.

Um, and of course, we all snapshots each time, 2021, 2022, depending on what studies done.

Uh beginning that information would be helpful uh going forward.

So I think Council Mr.

Govito's point about how can we really leverage uh some of our dollars here to see where our programs are doing the largest impacts possible.

Uh so we can continue to build on that.

Um I think those are all my comments.

Frankly, just again, I think it's all the work that you're doing in partnership.

Again, this is an entire uh ecosystem that needs to be bolstered and supported as we continue to move the move through this.

To understand how we can leverage uh their programs as well.

It's not always just on us at the city.

We know there's also things that we do take on, others don't.

And so understanding that a bit too will be helpful to say how can we continue to support this initiative that is the only one in this in this field doing that, right?

Uh, because without it, we may not have that impact at all.

Uh could worsen in certain areas, whether it's a food security or oral care or uh housing stability, et cetera.

Um so again, thank you for the work y'all do and for all the partnerships you've created, and happy to lean in in anywhere that uh partners would also want to talk to about talk to us about what they they're working on within this field.

So thank you.

Thank you.

Again, really proud of the work of the team and the support of our partners.

We're leading innovative model health department, and it shows so again, happy National Public Health Week and uh let us know how we can be a service.

Thank you, Dr.

Jacob.

All right.

Next we have item number three.

Uh leave the trauma informed care, if I'm not mistaken.

Yes, overview and update on trauma-informed care by Jesse Higgins.

Yeah, good morning.

Thank you for having me.

We're so excited to be here as part of the work that the health department is doing, but also um as part of the celebration for National Public Health Week.

Uh, I'm Jesse Higgins, I'm the chief mental health officer, and I'm here to talk specifically about the principles of trauma-informed care and how we use those to build resilience in our community and in our workplace.

So, in this presentation, we'll talk about ACEs or adverse childhood experiences.

We'll define trauma-informed care and the application to our workplace, and we'll review the trauma-informed certification process.

Adverse childhood experiences or ACEs are traumatic events that occur in childhood.

Examples include experiencing violence, abuse, or neglect, and witnessing violence in the home or community.

Also included are aspects of a person's childhood environment that can undermine their sense of safety, stability, and bonding.

Examples can include growing up in a house in a household with substance use, mental illness, instability due to parental separation, or instability due to household members being in jail or prison.

ACES can have lasting effects on health and well-being in childhood and into adulthood.

These traumatic childhood experiences can increase likelihood of engaging in unhealthy behaviors like a lack of physical activity, smoking, or using substances or missing work, and can even increase the risk of serious physical and mental health diagnoses throughout the lifespan.

Increased risk of heart disease, cancer, stroke, and other physical health issues can be associated with a higher rate at adverse childhood experiences.

Every five years, we are able to access a specialized set of data from the CDC's behavioral risk factor surveillance system.

We hope to have 2025 ACEs data later this year in October.

This data is last available from 2020, and you can see it's not where we want it to be.

One in five adults were sexually abused at home as a child, and one in three adults experience three or more adverse childhood experiences at home as a child.

Furthermore, when we look not just at an individual's experience, which in this graphic is represented by the oh, I think sorry, mystic mystified, uh, which in this graphic is represented by the tree, but also at the community that the individual grew up in, represented here by the soil.

We see the full picture of experiences and environment that shapes each person.

Acknowledging the difficulties that our residents have endured, both individual and systemic, allows us to create policies that affect change in both environments and experiences.

It's important to recognize the data about Bear County represents real people, and not only are these people our community who we serve here at the city, but they are also us.

Our workforce is deserving of compassion and understanding as well.

This is where the vision for a trauma informed COSA workforce came about.

Learning, implementing, and eventually becoming certified in trauma informed principles and practices creates a cultural shift in our workplace and how we interact with our community.

Metro Health Center of Excellence for Trauma Informed Care supports city departments as they make strides to implement trauma-informed principles and obtain a level one foundational trauma informed organizational certification.

We have two staff members who support departments as they form guide teams, provide training, and work to change policies and procedures to align with the principles of trauma informed care.

You heard from Mary Beth Fisk, the CEO of the Ecumenical Center, and they are the certifying body that conducts desk reviews of the policies and procedures, site visits, and certification of organizations in our departments.

We promote five principles of trauma informed care safety, choice, collaboration, trustworthiness, and empowerment.

Safety provides physical and emotional safety, security and accessibility.

Choice allows for autonomy, flexibility, and creativity to be used in the workplace.

Collaboration gives staff a role in planning and evaluating their own roles, and staff are treated as experts in their own experience.

Trustworthiness provides staff with information, role clarity, and clear expectations.

Empowerment and viol and provide staff with an atmosphere that allows individuals to feel respected, validated, and affirmed.

A trauma informed workplace increases staff morale, allows staff to function optimally and utilize their strengths, reduces the expense of hiring and onboarding new employees by increasing retention, participation, and job satisfaction, and embraces empathy and compassion in daily interactions.

Each department that achieves a level one certification goes through these five steps.

Metro Health Center of Excellence for Trauma Informed Care is available to assist departments through this process, and currently we have 14 departments in the pipeline.

And we're very proud of the six departments that have been certified.

It's important that I point out that our police and fire departments are the first and only in the country in their fields to have a departmental certification of this kind.

We are immensely proud of these six departments, which are large in staff, but also large in impact in the community for prioritizing this work.

I also want to highlight the work of our community partners.

The South Texas Trauma Informed Care Consortium is made up of nonprofits and public organizations with a vision for a trauma-informed Bear County.

The Institute for Trauma Informed Care at University Hospital provides training to organizations seeking certification or education and awareness on trauma-informed care.

And the Ecumenical Center staffs the Center for Trauma Informed Certification and is a certifying entity for trauma-informed organizations throughout the community, not just city departments.

Right now, more than 40 different organizations across our community have achieved the level one certification, with that many as well in Q.

As I wrap up, I have one more quick highlight for you.

A vital way that Metro Health has implemented trauma-informed care in our department is through our trauma-informed mentors program.

Each year, 60 plus Metro Health staff, which is about 10% of our staff, serve as mentors that provide resources and learning opportunities to their programs, promote and model trauma-informed principles in the workplace, and share and implement ideas to enhance our workplace culture and environment.

These folks are mostly frontline staff and are spreading resilience through their participation in this program.

Thank you so much for your time today, and I'm here to answer any questions that you may have.

Thank you so much, Jesse.

Any comments from my council colleagues.

Thank you, Jesse.

This oh, sorry.

This was a good presentation.

You know, uh last week at ACES and I had the privilege of hosting Child Safe and to help them kick off their cardboard kids campaign.

And you know, during the CEO's comments, I was shocked to hear about the number of kids in San Antonio who have died from child abuse.

And you know, I used to serve on the Bear County Child Welfare Board, and you know, we were looking and obviously learning about all these things when we were looking at inter-recidivism.

We know that hurt kids grow up to be hurt adults, you know, and this and the cycle continues.

So I'm really proud of the city's efforts to make sure that we are trauma that there's trauma-informed care.

And actually, uh a couple weeks ago we we were doing a walk with uh former mayor hardwork at Harborger Park, and we saw all the parks and rec department getting their training at the over there in their big conference room.

So that was kind of cool too.

Um really quick on slide number five with the with the ACEs in Bear County and our numbers being what they are.

I mean, I'm definitely glad that we're focusing focusing on trauma informed care, but I mean I'm I'm curious like how we attack these numbers, you know.

I and they're hard.

Um but I I'm curious.

I mean, yeah, this is so sad that we're so high on the list, and I'm wondering what concerted efforts we have, if any, to bring those numbers down and looking at other cities' best practices.

I mean, sure, we have poverty, but so does Houston, right?

And so there's I'm I'm yeah, I'm wondering what we're doing about that.

Right.

So these numbers are overwhelming.

Um, that's one of the reasons why I show them to you so that we keep in our mind what we're doing and why we're doing it.

Um, I would argue that we are approaching this through all and lots of different efforts that the city is doing.

Um I can think about you know, all of the work that we're doing in substance use, we're trying to chip away at this.

All of the work that our domestic violence team is is doing is chipping away at this.

Um strengthening families.

Um I I even think about the way that we fund youth mental health services, and we've chosen intentionally to the fund them through schools so that kids have an opportunity at school, maybe away from a family member that's hurting them to access services and care there.

Um, and so this is definitely in the top of our mind when we're when we're doing um policy.

Um I think some really cool things that we've done through our actual trauma informed care teams is um or through our trauma informed care like principals.

Um there was a great uh initiative a couple years ago where each police substation uh worked with their domestic violence advocates that work in Metro Health who brought in our trauma informed mentors and they put in an interview room in each substation where people centering around people's experience of domestic violence.

Um but anyone who needs a quiet private place for an interview room to have that um done in private, those interviews were happening somewhat haphazardly in a lobby or maybe even in a room that was just not built for that.

And these interviews interview rooms are beautiful, they have soft lighting, they have a table, like a low table for kids to be playing at um where the adult can talk to the police, um, just a totally different approach.

And so um everything that we're doing is really trying to chip away at this.

Um, and I'll can I'll continue to bring these statistics up because we have to keep these in the front of our mind.

Yeah, yeah, we definitely do, and yeah, and it it is helpful to see you know different actions that we're taking, um, you know, like those interview interview rooms too.

But I'm also wondering as I mentioned in the last presentation.

I mean, yeah, that when we talk about our core services, I mean, this is it.

And so I'm thinking out loud, but you know, awareness campaigns or anything like that on how we can chip away at this.

And I'm I I think that we need to um obviously keep doing the work that we're doing, but also at the same time, um a two-pronged approach of how we hit the reset button and say, okay, maybe we're maybe we need to be trying something different in San Antonio because if these are in Bear County, because um these we can't be okay with these numbers and you know, pulling in different best practices from other cities to see how we um make it dent in these numbers.

And I and I would say that this effort to be more aware, promote, and also literally change principles, policies, procedures, and culture is part of that hitting the reset button.

When um this initiative was really launched in 2018 and then 2019, um, and then has sustained through all of the changes that nonprofits and health care and public health endured during COVID.

We're still hitting that reset button.

That's and this is gonna take a long time to turn this ship.

Sounds good.

Thank you.

Thank you.

Thank you, Councilman.

Any other questions, comments?

Councilman Messi Gonzalez.

Yeah, quick um highlighting, just thank you for for your efforts and what your team is doing.

Um, we know that trauma shows up everywhere, whether it's in schools or uh public safety systems or housing challenges.

So I appreciate the plan prioritizing prevention and versus enforcement or um emergency responses.

Um I I had a question on I guess on the level one, how many levels are there?

There's three levels.

Okay.

So um, and it's to the Icumenical Center's credit that they have developed this.

And so level one is fully developed, level two is developed, and I think you guys are in the process of developing level three.

We've they've already got two people in level three in the pipeline, not at the city but in the community.

Okay.

And so are we are is our goal to get to a level three?

So each department will have to be working towards that with the ecumenical center.

I'm sorry.

Okay, and I'm I'm glad to see there's six departments already certified, and um fire department and uh police department were the are the first two you said in the cut in the state.

No, the first and only in the country who have gotten this type of certification.

And then they have mentors within those departments as well.

They have um maybe not a mentor program, but more of a guide team that was the one that sort of shepherded the department their department through the process.

And then you have 14 in the pipeline you said.

Yes, ma'am.

Okay.

Um I think those are all my questions or highlights really.

Thank you so much.

Yeah, thank you.

Thank you, councilman.

Councilwoman Castille.

Thank you, Chair.

Thank you, Jesse, for the presentation.

I I think looking at slide five, I'd be curious to see where Bear County stands with other peer counties, and then also understanding the ways in which they may have uh community courts, like what is that investment look like within their community court system, as well as which have geodiversion systems, right?

And how can those potentially impact uh those exposed to substance abuse uh and experiencing um mental illness, and then of course having a household member that's been incarcerated.

Uh, because of course these numbers are very alarming, but I would like to understand in terms of other counties where we stand and uh where they may be investing countywide, uh, that we may not be uh doing just yet here in Bear County.

Um just wanted to also commend uh you and your team for the certified departments.

Can you help me understand?

Like, is this something that a department uh opts into, or does Metro Health encourage they participate in terms of getting the certification?

Yes, so it's um we have offered our technical support with the Center of Excellence for Trauma Informed Care to all departments, and um we have um worked on engaging all departments.

I've presented at department heads our you know our our meetings and so the the all of the departments are pretty aware of this.

It's um it's been on those departments to take us up on that.

Wonderful, and I believe the Kirk's office uh participated in that, right?

So that's really exciting.

They're almost finished there.

Wonderful, that's exciting.

They will, I'm sure of it.

Great, and I think there would be value, right?

Um, and I'll I'll speak to Amin.

I believe like with development services or code compliance officers participating.

I think there's a lot of value in having uh more folks participate, right?

And I'm thinking about our constituent services team, how can we also participate?

So, just uh thank you so much for this presentation and of course uh leading the way when it comes to this really important and compassionate work and um I identifying and highlighting rather that you know uh our our police department and fire department are the only in the country to have uh be trauma-informed certified is is really uh impressive.

So just grateful for your leadership and of course the Metro Health team.

Thank you so much.

All right, thank you, Chair.

Thank you.

Councilwoman Mr.

Gonzalez.

Yeah, I just wanted to second the councilwoman's point on the uh diversion center and community courts.

I'd like to see that breakdown.

I think that would be helpful.

And then I guess as far as um yeah, where we fall with other counties specifically.

Yep, I will see if we have access to that data, and then I'll definitely maybe see if Maria Vargas can help.

I mean, I know she's done a lot of research on the diversion centers in the other cities.

Thank you.

Um similarly, I think on that point, right?

Any more that we can look into that kind of comparison of different programming that attacks the root of the issue.

Of course, I know we as you mentioned before, we have a ton of programs here.

Understanding I think the scale of them too would be interesting to see comparatively to other cities, whether it's on uh youth programming related to um after school programs or workforce uh programs or uh summer engagement uh activities, looking at public health or public mental health clinics as well.

Um, those are of course, I think a bit far in between different cities, but still seeing where those are at, how that drives different numbers down there.

Um the other one I think maybe it's a bit uh I don't know what the right word is for this one, but maybe uh tangenti.

I don't think so.

Think about child care and even crisis nursery access, right?

I know the ACE you listened to before on slide five, had talked a bit more about intermittent partner violence and such.

Uh of course, I'm assuming within further uh ACs there's of course child abuse, et cetera.

Um understanding a bit more too what that looks like and how that impacts families on both the child abuse uh portion, but even beyond that, right?

The other kind of household uh issues that may be taking place.

Um I think the scale of those programs would be helpful too versus just the implementation of them, um, just so we can kind of compare and contrast.

Um again, I think similar to the last presentation, what uh a bolstered uh efforts would look like here with city, county, etc.

Um, to potentially reduce some of these uh issues and other larger issues, right?

I think about, of course, the uh one of the deeper rooted ones with all these is related to poverty and how those exasperate how that poverty exacerbates some of these.

Um not the main reason, but can be a bit of an exacerbating point for a lot of these uh these issues.

Um, one last question I had um was related to uh the adoption of trauma-informed care or the certifications within the departments.

Um, very excited to see the departments that have already taken on and the ones that are still working on them.

Um that's very excited to see that we have such uh such an expansive role within that.

Um do we have any um satisfaction rates that we kind of look at with either employees and or residents who are now receiving services after the certification and what that what that change looks like.

That's a good question.

We do a survey after the training.

Um Metro Health has three hours of recorded training that either people can take individually or um what you saw um councilman uh Aldorata Gavito was um one of our staff giving that training to parks and being able to like debrief with them after.

Um and so we do have a a sort of like check-in after that, and and we have really high marks on that, but I'm not sure that we've had any sort of overarching um survey that would be tied directly to this.

We do try to look at our um city employee survey every time that it's given, and we pull out a few questions in that to try and look at if city employees feel like they're they don't know that it's the trauma-informed questions, but that they're experiencing a trauma-informed workplace.

Um, so I could try and look into that a little bit more.

Yeah, I think that'd be helpful.

Even looking at retention rates right and those kind of things that were mentioned on slide eight, uh understanding a bit more about that.

But then also, right, the user experience too from residents.

Um, if we see any differentials, I think to your point about the example about SAPD and Metro Health collaborating on the rustic violence proportion.

I would bet, right, that that increased the opportunity for uh individuals to express more about what's going on situation, um, provide more details potentially than what it used to be, right?

So understanding maybe those changes if we can see that within any departments that have instituted uh new practices based on the trauma-informed care and how that's changed their I don't know if outcomes is the right word, but some of their experience with uh our residents.

I would be interested in seeing if we can evaluate that anyway.

But thank you.

Those are all mine.

Uh, thank you again for all the work y'all are doing and for uh strengthening our departments, frankly, uh, to be a bit uh better service-oriented to our employees as well as to our larger community and making sure that we're attacking the root of some of these issues here and ensuring that we have a quality workplace uh throughout the city.

So thank you again.

Thank you.

Any last comments or questions?

Great.

All right, moving into our last item, at number four, the updated report on the impact of immigrants on San Antonio's growth and economy, and we have Dr.

Matha.

Good morning, Chairman Galvan and members of the community health committee.

Uh, I am Dr.

Jennifer Matha, director of the compliance opportunity and access department.

We are here today to provide a briefing on the demographic and economic contributions of immigrants in the San Antonio metro area, otherwise known as the DESE report.

I am joined today by Chelsea Kramer from the American Immigration Council, who will present key findings of the DESI report.

At the time the data was collected, San Antonio was home to more than 344,000 immigrant residents.

This report allows us to see the important contributions immigrant residents make to our area and help us to ensure they have fair access to city services so they and that all residents are effectively served.

So a little bit about the background.

In 2019, New Americans in San Antonio was our first report that was completed through a great gateways to growth challenge grant, led by the city's first immigration liaison.

The report established baseline immigrant data that guided the development of the Office of the Immigration Liaison's programming and ensured that we were aligned with other major cities that were conducting similar analyses.

This report also fulfills the city council resolution adopted on February 12th, 2026, calling for an economic economic report on the contributions and impact of immigrants in San Antonio and Bear County.

We hope this briefing provides you with an understanding of the impact that immigrants have in our area and that it can be used to support ongoing policy development and strategies to ensure our immigrant residents are included in our city.

Now I would like to introduce Chelsea Kramer.

Kramer, excuse me.

Chelsea serves as a Texas state organizer for the American Immigration Council and leads the Texas for Economic Growth Coalition.

Chelsea.

Thank you.

Thank you all for having me here today.

I'm going to go over this presentation.

If you have any questions during it, feel free to raise your hand and stop me, or we can wait to the end.

Okay, so where are we at?

Here we go.

So who we are.

So the American Immigration Council focused on research, policy, and education.

So we were founded in 1987, so about the same time when our comprehensive immigration reform was last done in the United States, so it's pretty old.

We are the sister organization to the American Immigration Lawyers Association.

We work at the federal, state, and local level.

Our role here is really to provide credible data-driven insights to inform decision making and not just debate.

So we hope that this report is going to fulfill that for y'all and give you all a more holistic view of your community here in San Antonio.

So before I jump into this data, I do want to briefly ground us in what this report is and also what it isn't.

So this report was developed to support the city of San Antonio and local stakeholders as you continue investing in your full community.

It's based primarily on the American community survey data from 2018 and 2023, along with supplemental data on refugee arrivals and workforce trends.

And importantly, for the purpose of this report, it's important for us to define how we are defining an immigrant for this report.

So when we say immigrants, we are using your broad definition, which includes naturalized citizens, green card holders, temporary visas holders, refugees, asylums, and the undocumented population.

So essentially, when we're saying immigrant, it's anyone born outside the United States to non-citizen parents.

So this is really a full picture of your foreign-born population here in San Antonio, and our goal here is simple.

We want to give you clear data-driven understanding understanding of who is who is contributing to your economy here, where your growth is coming from, and how that connects to the workforce and economic development conversations.

So let's get into our numbers here.

So as mentioned, um, in 2023, there were about 344,000 immigrants living in San Antonio metro area.

And importantly, that is about 12.7% of your population.

And I ask you to please remember that number, 12.7%, because we're going to be coming back to that in several slides.

That is slightly below the national average, which you can see is at 14.3%, and it's also below the Texas, the statewide average, which is uh 17%.

And it's also, I would like to level set here, this is not a niche population, you know, over 10% of your population here in the San Antonio metro area are immigrants, and so this is a very meaningful part of your population, which is why these discussions are so important.

So on population growth, this is where this really becomes very, very important, and this is why we're here gathered here today.

The immigrant population grew faster than your overall population, and 21.6% of that population growth in the region was driven by immigrants.

So, said simply, a meaningful share of the San Antonio's growth is being driven by immigrants, and that matters from everything from workforce planning to housing to infrastructure planning, everything you've been speaking about today as well.

So moving on to countries of origin.

I don't think this would be a surprise to anyone living in the city, but the majority of your immigrants are coming from Mexico, but we're also seeing increasing diversity when you have immigrants also coming from India, Philippines, Honduras, and Venezuela.

Of course, among others, what those are your top immigrant populations.

And this reflects obviously long-standing regional ties, but also new and evolving migration patterns that we're seeing not just here in San Antonio, but across Texas and across the United States.

So this is where we really get into some of the economic impact data.

So let me double check here.

Yeah, there we go.

So spending power and taxes.

This is where I think the data gets probably the most compelling.

So your immigrant households here in the San Antonio Metro, they generate 12.6 billion dollars in total income, and that's 9.6 billion dollars in spending power, and again, that's only here in the San Antonio Metro, and nearly $3 billion in combined federal, state, and local taxes.

So from a business perspective, and this is a significant consumer base, especially, and a significant contributor to public revenues.

So when we look at our immigrants are more likely to be a working age, this reflects how immigrant populations tend to be younger as well.

And so we're seeing that your immigrants are at 78.2% of more likely to be in that working age, and so that's important when you're looking at a workforce or economic perspective.

And so that's important when you're looking at a workforce or economic perspective.

So contributions to social programs.

Here in the San Antonio metro area, that's 1.2 billion dollars to Social Security in 2023 and 314 million dollars to Medicare in 2023.

These are significant numbers.

Again, I just wanted to highlight that this is only 12.7% of your population.

And access to health care.

This is, I think an important conversation to be having because you'll see there's large differences in healthcare coverage between immigrants and your US-born populations.

These are influenced by a lot of different factors.

As you can imagine, industry of employment is a big one, access to employer-sponsored insurance, and of course, there are always language and systematic barriers as well.

For local leaders, this is less about the statistic itself and more about where gaps exist and y'all thinking through about how to address them.

So your immigrants in your key industries here in the metro area.

Immigrants are high heavily represented in your construction, manufacturing, hospitality, and professional services.

These are industries that we consider foundational for regional economy.

And these are also often the ones that are experiencing the highest workforce shortages, which is hence why we see a lot of immigrants in these in these places.

And this isn't just special to San Antonio, we see this across Texas and across the country as well.

Immigrants tend to be in these industries.

Oh, we want to go back really fast on the manufacturing jobs.

One to note, one stat that's important to highlight is that immigrants helped create or preserve 15,800 manufacturing jobs in the region, which really means that without this workforce, some of those jobs may not exist here.

And this is about economic retention, not just participation, and that's at the bottom of that slide that I just wanted to highlight there.

Moving on to labor force.

So while immigrants again are only 12.7% of your population, their import their impact to the workforce is quite significant.

They are the key to keeping your labor market functioning here, as we see that 15.8% of your employed labor force here in the San Antonio Metro are immigrants.

And again, that shows that they are punching well above their weight there.

And this is especially in sectors where employers are struggling to find workers.

Again, industries like construction and hospitality that we already noted as having a large amount of immigrant employees.

On entrepreneurship, I think this is a very compelling SAT as well.

So again, 12% of your population are immigrants, but yet immigrants make up over 24% of your entrepreneurs, and they are 72.5% more likely to start a business here in San Antonio.

That translates to over 31,000 entrepreneurs here in the metro area, and they generate over 791 million dollars in business income annually.

So they're not just filling jobs, they're also creating them and not just creating jobs for immigrants but creating jobs for all the residents here in the San Antonio Metro.

Moving on to the education.

Education is a key part of the long-term workforce pipeline.

I myself do a ton of work in that workforce pathways type work, and I think this slide really helps reinforce that connection between immigrant communities and the future of workforce development, and especially as we're thinking through workforce pipelines.

And so I think what we're seeing here, I think, especially when you're looking at the less than a high school high school education, you see that 31.5% of your immigrants don't have that.

This is less of a problem in my eyes, it's more of an opportunity.

So we should be looking at these stats as opportunities for better engagement and helping to increase that workforce that you have here in the city.

And when we talk about international students in the metro area, there are about 2,071 international students in the region, and they're contributing over 40 million dollars to your economy, supporting over 600 jobs, and from a business perspective, they are your future high-skill workers.

So really the question becomes how you're able to retain them here in your metro area.

You don't want to educate them here and then then go somewhere else.

And that kind of harkens back to why we're here today is the importance of a welcoming community.

How do you attract the best and best and brightest talent from around the world?

You make sure that immigrants want to come to your community, live here and stay here and build their families.

Which brings us to our housing.

So immigrants are investing in your community long term, as you can see in this slide with over 60% of your immigrants owning homes worth 27.1 billion dollars in property value and over 750 million dollars in annual rent.

And I think this really helps you reflect on helps reflect the stability investment and again that long-term community presence that the immigrants have here in the community.

And moving on to naturalization.

So this is just to highlight another opportunity for you for here in the city.

So there are about 134,000 naturalized citizens, with about 51,000 of them eligible to naturalize today.

And so what we know is that when individuals do go through that naturalization process, their income increases and their economic participation increases.

And so you're gonna see that consumer spending actually go up.

And there's also a big ROI for the companies that employ naturalized citizens' citizens versus just green card holders as well.

I think it's around 9% that we see an income bump after someone naturalizes.

So these are just a couple of items just to keep in mind as you think through different policies at the city level.

When we're talking about refugees, um, they make up certainly a much smaller portion of the population here in the city at only 2.5%, but they represent both those humanitarian commitments and they also but they represent both humanitarian commitments and economic contributions over time.

So small number compared to other cities in the state, um, but still not insignificant.

Here's a little bit more refugee data.

So from fiscal years 2021 through 2024, nearly 4,400 refugees and special immigrant visa rifles.

Um this wouldn't surprise anyone who follows the news, but 64% of those were from Afghanistan, and then on down on down the line to your 3.3% from Guatemala.

Um these individuals are you know, they're entering your communities, they're joining the workforce, and they're contributing at both the local and um their local and state level in real time.

So with that, I will end my presentation.

Happy to take questions and comments.

If I don't have the answers, I promise I know someone that does.

I have colleagues that are also listening in, taking notes that are liaison with our research team as well.

So well, thank you so much.

Uh, do we have any comments or questions from the committee?

If not, Council, I'd have to go.

Thank you, Chair.

I come on for a second.

Thank you, Chelsea and Dr.

Matha for uh your work and leadership uh and for the presentation.

Um more comment than question, right?

I think in terms of the trend of the the workforce and with the where we see our immigrant community working in terms of industry.

When I see construction, general service, manufacturing, hospitality.

I think about the cultural uh fabric of the city of San Antonio, right?

When we're talking ready to work and conversations with our sister cities, we're talking about bringing manufacturing jobs here to San Antonio, and we know that our economy heavily relies on the hospitality industry.

Uh, and I really appreciate um uh how you emphasize or to me there was an emphasis on our full community, right?

Uh, and when I look at uh where our uh immigrant neighbors work, right?

It's in the same place, and it's what's uh building our city's economy in terms of hospitality and manufacturing.

So appreciate the the data and uh how specific you all get and uh appreciate highlighting in terms of taxes that are paid and spending uh within the San Antonio economy that we're seeing from our immigrant community.

Um, but just really appreciate this data.

I think it's going to be helpful as we discuss ready to work uh and uh also have our housing conversations uh in particularly I'm gonna I'm gonna go back to uh public housing because when we look at the refugees um uh here in San Antonio, particularly right within our Afghan community, they're housed uh in public housing, right?

So if you remove that, you're then again creating an issue not just for our refugee community members but also our community members, uh our full community, as you stated.

Uh so just really appreciate those uh statistics that you provided.

Thank you, Chair.

Thank you, Councilman Kelserberry, other things.

Thank you, Chair.

Um, thank you, uh Dr.

Mata and Chelsea for this information.

Um it was it was really, really good.

I I do also appreciate the um economic impact that you highlighted of the immigrant community in San Antonio.

I know Councilman Castillo has done a lot, and I think it that it just emphasizes our need to uh continue to push to make sure that our immigrant neighbors are taken care of, especially right now, um, because it is just such a tricky time.

I think um one of the the interesting things was I appreciated the stat about 24.4% of them being entrepreneurs because like you said, um they are creating jobs here.

Um, and so uh it's an important step for us to know uh and and highlight.

And so, you know, I I thought this no questions, I thought all of this information was great, but definitely appreciate the lens of showing the economic impact that they have in San Antonio, and also to you know, in in terms of our workforce, our population.

I mean, if we want if San Antonio wants to continue um to go to the next level, that they are definitely the the immigrant community is so much a part of our city's success.

So really appreciate it.

Thank you.

Yeah, absolutely.

I mean, we live in a global community now, and everyone is um vying for that talent and that workforce, and so you're competing against all of your sister cities or neighbors um in other states, and so that's why these discussions are so important.

So you have a better, more full understanding.

Thank you, Councilman.

And thank you again for the presentation.

Uh always grateful to see this kind of ongoing work that we've uh been doing for years already, right?

Looking at how uh again, as Council of Castillo mentioned, as you mentioned as well, our full community is impacting uh our larger economy.

Um thing I want to uh want to note, right, is uh it's unfortunate that there's uh conversations or comments made in general about who's deserving of what kind of care, who's deserving of being a part of our larger community.

And I would I always think about, and I think we already know this, many of us, but slides 11 through 13, frankly, um talk about how uh immigrants in our community more often than not contribute more uh to programs that uh American citizens use um than they do themselves.

I think it's always an important note to make there when we look at the healthcare component in particular, right?

We're seeing very clearly um whether it's in private or public uh care that uh immigrants who are paying into it often do not receive those benefits at all.

Um, and that's something that's you know, there's different debate on that uh ideologically, but I think one thing is clear when folks more folks are sick, more folks uh also get sick as well.

Uh disease spreads through people not gonna be able to access care when there's fear of not being able to access care, not being able to go to school, not being able to join the workforce, et cetera.

Uh, when there's fear, when there's mistreatment, when there's unreported mistreatment to those things uh because of your uh reporting it, um it's worse for everybody.

So as far as I lay those points flat there and just kind of mention them.

Um, this is a question I think for both uh for Chelsea and Dr.

Matha.

Can you talk a bit about um how the Office of Immigration Affairs works to assist refugees and immigrants to effectively settle in our community and how that's kind of changed over time, and in particular, what kind of barriers are there when folks who are already here um are trying to find ways to effectively settle in our community and contribute the way that we just discussed.

Thank you for the question, Councilman.

Uh currently we are working on an immigrant inclusion plan, which we are using the results of this survey to create immigrant inclusion training to help city departments further um include immigrants in our city services.

We also uh have a call-in line where immigrants who are seeking help can call in and we uh track them to the appropriate either city service or local group that can help them as well.

We have relationships with many local nonprofits.

We are happy that we also have um relationships with the local councilates, especially the councilate of Mexico.

Um could you repeat some of the question?

I missed a little bit of it.

Yeah, just uh generally, right, talking a bit about um how we help folks uh settle who are already here, make sure they're plugged into education or healthcare resources, and then what are the barriers to some of that too?

I think a lot about the refugee community in particular, right?

When we talk about uh when uh I think we had a presentation here a couple uh years ago um we talked about uh the plot of Afghanistan from the war then, having folks come here and what those barriers were to receive services needed to actually effectively settle.

So just kind of asking that generally.

Right, right.

And I think some of the barriers that we've seen is simply not knowing that city uh services are available to all-city residents.

I think that's step one.

Step two is also them understanding that we do have language access services to help them uh communicate with city employees.

Also, some of the barriers that we've seen is that you know, given the political times and what's going on in in the community, immigrants are seeking uh support, right, from many different organizations.

So we are there to help them find that support, and I think that's the biggest one right now is helping uh immigrants find those support services that they need.

Thank you for that.

That's helpful.

Um I think one last thing, I don't know if this is evaluated with this uh uh study or even within our own work with economic development and/or with Office of American Affairs.

We're talking a little bit about um, you know, when changes to our state and federal uh immigration actions take place.

Do we see impacts to our economy in terms of the construction industry or the manufacturing industry or even to housing development, right?

Like, do we see a direct impact related to that?

I I will let Chelsea answer that question.

Yeah, I can speak to the trends that are happening statewide right now and a lot of the discussions that are happening in the backrooms of many members of Congress's offices and state leaders as well.

Um, we're definitely seeing the negative impacts.

We're seeing it most acutely in the valley right now, especially in the construction industry, like they're seeing where people are not showing up to work at all, um, or they're fearing going to a home depot to go shopping, um, just because they might be profiled and and their day disrupted, or if they're an undocumented immigrant, they'd be detained.

And so we're seeing those economic impacts happening, especially in the southern part of the state, and it's starting to bleed up.

And so we know that the governor has actually invited folks to come have those discussions with him to have a better understanding of what's happening on the ground and how these enforcement only policies are impacting our communities across Texas.

And so I don't have specific numbers for here in San Antonio, obviously, but if it's impacting one community, you know it's eventually going to impact another.

And I think it more speaks to um, you know, are you making sure that your community is welcoming and attracting talent of all types?

Because even if there is uh enforcement only policy that is potentially anti-immigrant, um, and even though you may think it's only focused on the undocumented population or um you know refugees or asylumes or whatever population you throw in there, it is also going to negatively impact your legal immigration as well.

So your high-skilled talent, like your H1B holders or your doctors, your dentists, your lawyers, your researchers, um, the folks that you want in those high-paying jobs to help um you know develop more jobs underneath them as well.

And so I think it's important to think of it through that lens too.

Thank you for that.

That's helpful.

It was just a general question around that, right?

As we're looking at uh where uh immigrants are uh really uh striving in different economic sectors, how that can impact us overall when we see different laws shift and change, even in healthcare, right?

Who who are able to serve uh larger residents and make sure that we're all staying healthy.

Um that was the last point there.

Uh any other comments or questions from my colleagues?

Well, thank you so much again for the presentations.

Uh I think it's everybody who presented today uh at 11 39 a.m.

The community health committee will come to a close and officially adjourned.