[00:00:07]
          >> GALVAN: ALL RIGHT. THE TIME IS NOW 10:02 A.M. ON THIS TUESDAY, APRIL 7TH, 2026. THE COMMUNITY HEALTH COMMITTEE WILL NOW BE CALLED TO CORD. MADAM CLERK, WILL YOU PLEASE CALL THE ROLL? 
          [Approval of Minutes
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MUCH. FIRST THINGS FIRST, ANY CORRECTIONS TO THE MINUTES? IF NOT CAN I GET A MOTION TO APPROVE? ALL THOSE IN FAVOR? AYE? ANY OPPOSED, ANY ABSTENTIONS? 
          [Public Comments
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MOVING ALONG. ALL RIGHT, HEADING TO PUBLIC COMMENT, WE HAVE THREE FOLKS SIGNED UP TO SPEAK. THE FIRST ONE WILL HAVE THREE MINUTES, YOU WILL ALL HAVE THREE MINUTES. WE HAVE FIRST UP FREDERICK. I APOLOGIZE IF I 
          MISPRONOUNCED YOUR NAME. >> THANK YOU. MORNING. 
          GOOD MORNING. MY NAME IS FREDERICK, THE EXECUTIVE DIRECTOR FOR 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 I WORK IN HIV PREVENTION AND SUBSTANCE USE HAS BEEN SHAPED BY SEVEN YEARS BY SAN ANTONIO'S COMMITMENT FOR 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, METRORAPID HAS DONE SOMETHING -- METRO HEALTH HAS DONE SOMETHING QUITE REMARKABLE, THROUGH SMALL GRANTS AND SUSTAINED RELATIONSHIP BUILDING, IT HAS GROWN A NETWORK MUCH WHAT I SEE AS COMMUNITY HEALTH FIRST RESPONDERS ACROSS THIS CITY. PEOPLE WHO GO WHERE SYSTEMS DON'T, WHO SHOW UP 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 EXIST BECAUSE CASA CHOSE TO INVEST IN IT THROUGH MICROGRANTS THAT SEEMS -- SEEMED OVERLY AMBITIOUS AT THE TIME. SAN ANTONIO NEXUS CONNECTION WAS AMONG THOSE RECIPIENTS AND IT IS A POINT OF PRIDE THAT SAN ANTONIO NEVER INTERRUPTED ITS SERVICES THROUGHOUT THE COVID-19 EPIDEMIC. 
          THAT NETWORK IS NOW ALIGNED WITH THE COMMUNITY HEALTH IMPROVEMENT PLAN AND ITS BEHAVIORAL HEALTH PRIORITY. SETTING THE FOUNDATION FOR A LARGER VISION. 
          I WANT TO SAY THAT THE CREATION OF THE CENTER FOR POLICY AND HEALTH IMPROVEMENTS WAS A VISIONARY ACT. THERE IS NO COMMUNITY HEALTH IMPROVEMENT PLAN WITHOUT FIRST REVISITING THE POLICIES THAT IMPROVE OR PREVENT HEALTH. AT PRESENT WITH FEDERAL PUBLIC HEALTH INFRASTRUCTURE AND THE PRESSURE, THAT INSIGHT HAS BECOME THE ARGUMENT FOR WHY SAN ANTONIO CANNOT WAIT FOR ANYONE ELSE TO LEAD. WE HAVE REACHED ACROSS THE ATLANTIC TO PARTNERS IN SCOTLAND WHO HAVE BUILT SIMILAR INFRASTRUCTURE IN RESPONSE TO THEIR OWN PUBLIC HEALTH CRISIS. TOGETHER WE HAVE STARTED DEVELOPING A WAY TO COLLECT MORE PRECISE DATA, DEMOCRATIES IT SO IT SERVES THE PEOPLE WHO GENERATE IT AND PROVIDE THE INFRASTRUCTURE THIS WORKFORCE HAS EVER HAD. THIS IS NOT A PILOT PROGRAM, IT IS NOT AN EXPERIMENT, IT IS THE NEXT CHAPTER OF WORK OUR CITY AND NETWORK OF COMMUNITY PARTNERS HAVE ALREADY STARTED. THE PEOPLE DOING THIS WORK EVERYDAY ON THE STREETS, UNDER THE BRIDGES, IN THE ENCAMPMENTS -- [BUZZER] -- THEY ARE CARRYING KNOWLEDGE THAT THIS CITY NEEDS. 
          AND SELF-IMPROVEMENT PROVIDE SO SAN ANTONIO EMERGES AS A MODEL FOR COMMUNITIES SEEKING TO IMPROVE HEALTH AMONG THE MOST INVISIBLE OF ITS RESIDENTS. 
          >> GALVAN: THANK YOU SO MUCH. >> OUT OF TIME? 
          [00:05:01]
          I HAVE 15 SECONDS. >> GALVAN: GO FOR IT. >> AT A TIME OF A POLITICAL AND FUNDING VACUUM. SAN ANTONIO STILL HAS AN OPPORTUNITY TO LEAD, NOT BECAUSE WE HAVE THE MOST RESOURCES, BUT BECAUSE WE HAVE THE VISION TO START EARLY AND THE RELATIONSHIPS TO GO FURTHER. THANK YOU VERY MUCH. 
          >> GALVAN: THANK YOU SO MUCH FOR YOUR COMMENTS. NEXT UP WE HAVE JACK FINGER. 
          >> 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 4, IT'S AN UPDATE ON THE IMMIGRANTS HERE IN SAN ANTONIO. YOU KNOW, MY QUESTION IS -- WELL, I LOOK AT YOUR BACKUP DOCUMENTS AND IT SAID 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. YOU KNOW, THAT'S QUITE A BUNCH. 
          NOW, THE QUESTION IS ARE THEY ALL FROM NEIGHBORING STATES OR ARE THEY MOSTLY FROM SOUTH OF THE BORDER OR PARTS THEREOF? I HAVE A BIG PROBLEM WITH THAT. YOU'RE GOING TO SAY JACK, THEY'RE JUST ASYLUM SEEKERS. 
          OKAY. DO YOU KNOW WHAT THE PERCENTAGE OF ASYLUM SEEKERS THAT FAILS TO SHOW UP FOR THEIR HEARINGS? 90%. 
          I GUESS YOU FOLKS PROBABLY ALREADY KNEW THAT. AND HERE'S ANOTHER STATISTIC I WONDERED IF YOU KNEW. YES. ASK A REPRESENTATIVE FROM THE POLICE DEPARTMENT, ASK THEM IN THE BEXAR COUNTY JAIL, WHAT PERCENTAGE OF THE INMATES ARE ILLEGAL ALIENS. ASK THEM SOME TIME. TAKE A WILD GUESS, IS IT 10%, 15? TRY 23% OF THE INMATES IN THE JAIL ARE HERE ILLEGALLY. 
          THAT KIND OF PUTS A LIE TO THE IDEA THAT THEY'RE JUST HONEST, HARD WORKING PEOPLE WHO JUST WANT TO GET A CHANCE AT LIVING IN THE UNITED STATES. 
          NO. YOU ALSO WANT TO ASK THE QUESTION, JUST HOW MANY -- YOU SAY THEY'RE ADDING TO OUR TAX BASE 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. YOU FOLKS HAVE DETERMINED THAT WE ARE AN ASYLUM CITY, A SANCTUARY CITY, EITHER OFFICIALLY OR UNOFFICIALLY, THAT'S STILL THE CASE. AND WE, THE HONEST GUYS WHO PAY THE FREIGHT ON ALL THIS STUFF, WE GET A LITTLE UPSET UPSET, A LITTLE ANGRY THAT YOU ARE, OUR LEADERS, ARE NOT DOING ANYTHING ABOUT IT. [BUZZER]. THANK YOU. 
          >> GALVAN: THANK YOU. FOR THE NEXT PERSON WE HAVE MARY FISK. 
          >> GOOD MORNING, MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE. 
          I AM MARY BETH FISK AND I SERVE AS THE CEO OF THE [INDISCERNIBLE] CENTER, A NON-PROFIT HERE IN SAN ANTONIO THAT HAS SERVED OUR CITY FOR OVER 60 YEARS. 
          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 CERTIFICATION PROGRAM AND DEVELOP THE PROGRAM SEVERAL YEARS AGO THROUGH LEADERSHIP AND LARGELY THAT THE CITY HAD PROVIDED. WE HAVE SUCCESSFULLY DONE SO IN THE SENSE OF DEVELOPING A NETWORK OF SYSTEMS. YOU WILL HEAR MORE ABOUT THAT IN THE PRESENTATION TO FOLLOW. I JUST WANTED TO HIGHLIGHT WHAT THE CENTER HAS DONE. 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. AND THERE ARE MANY ORGANIZATIONS, MANY OF THE ORGANIZATIONS AS WELL THAT HAVE ACHIEVED THIS MILESTONE. SO WE'RE GRATEFUL FOR THAT. WE ALSO HAVE NOW THREE LEVELS OF CERTIFICATION, LEVEL ONE, TWO AND THREE. AND WE'VE ALSO HAD A GREAT 
          [00:10:09]
INTEREST FROM OUTSIDE OF 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 CENTER IS HUMBLE AND GRATEFUL FOR THE OPPORTUNITY TO PARTNER WITH OUR COLLEAGUES, WITH THE CITY AND THE COUNTY AND OUR CONSORTIUM, AND I FEEL LIKE THE WORK HAS BEEN WELL RECOGNIZED AND WILL CONTINUE 
          TO GROW. THANK YOU SO MUCH. >> GALVAN: THANK YOU. 
          [Briefing and Possible Action on
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ALL RIGHT. THOSE ARE ALL THE FOLKS WHO ARE SIGNED UP FOR PUBLIC COMMENT. WE'LL MOVE INTO ITEM NUMBER 2, THE HEALTHY BEXAR COMMUNITY HEALTH IMPROVEMENT PLAN, AND I BELIEVE THE PRESENTATION IS BY CLAUDE. 
          GO AHEAD, DOCTOR. >> THANK YOU, COUNCILMAN GALVAN. 
          JUST A POINT OF ORDER, WE DO HAVE TWO OTHER SPEAKERS AND WE DO HAVE THEIR PUBLIC COMMENTS IN WRITING. SO WOULD YOU WANT THEM TO SPEAK OR DID YOU WANT ME TO 
          GO AHEAD A WITH THE PRESENTATION? >> GALVAN: IN TERMS OF 
          PUBLIC COMMENT OR JUST FOR THE PRESENTATION? >> PUBLIC COMMENT. 
          >> GALVAN: I DON'T HAVE THEM SIGNED UP. THEY'RE WELCOME TO COME UP. 
          >> SO WE HAVE ELIZABETH LUTZ FROM THE BEXAR COUNTY HEALTH COLLABORATIVE. 
          >> GOOD MORNING. I JUST WANT IT HADED TO SAY THANK YOU FOR GIVING US AN OPPORTUNITY. I APOLOGIZE FOR THE MISUNDERSTANDING ON THE SIGN-UP. I'M JOINED BY MY EXECUTIVE COMMITTEE BOARD MEMBER DR. SALAZAR, WHO IS ALSO OUR STEERING COMMITTEE CHAIR AND HELPS TO SUPPORT AND ORGANIZE THE COMMUNITY HEALTH PLAN AS WELL AS THE NEEDS ASSESSMENT. 
          DR. SALAZAR. >> THANK YOU, LIZ. GOOD MORNING EVERYONE. 
          I'LL PUT MY READERS ON BECAUSE I'M AT THAT STAGE. WELL, GOOD MORNING. 
          AND I'D LIKE TO THANK YOU FOR THE OPPORTUNITY TO BE HERE TODAY, LIZ AND I. 
          WE'D LIKE TO BRIEFLY GROUND US ON THE ROLE OF THE HEALTH COLLABORATIVE AND HOW IT HELPS SUPPORT OUR COMMUNITY, IN TERMS OF WHO WE ARE, THE COLLABORATIVE IS A CROSS-SECTOR PARTNERSHIP. OUR MEMBERSHIP INCLUDES HOSPITALS, HEALTH SYSTEMS, METRO HEALTH, ACADEMIC INSTITUTIONS, ORGANIZATIONS, COMMUNITY HEALTH WORKERS, ACA NAVIGATORS WHO HELP RESIDENTS CONNECT PEOPLE TO COVERAGE AND CARE. 
          I SHARE THIS BECAUSE BREATH MATTERS, IMPROVING COMMUNITY HEALTH IS NOT SOMETHING THAT ANY ORGANIZATION CAN DO BY THEMSELVES. IT REQUIRES ALIGNMENT ACROSS THOSE WHO GENERATE DATA, DELIVER CARE, SHAPE POLICY AND WORK DIRECTLY WITH RESIDENTS EVERYDAY. IN PARTNERSHIP WITH METRO HEALTH WE LEAD THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH IMPROVEMENT PLAN OR CHIP. 
          IT IS WHERE WE LISTEN AND LEARN. IT IS GROUNDED IN DATA, PERFORMED BY EXPERIENCE AND STRENGTHENED BY ANALYTICS SUPPORT FROM COMMUNICATION INFORMATION NOW, WHICH IS PART OF THE UT SCHOOL OF PUBLIC HEALTH. 
          IT IS NOT JUST ABOUT NUMBERS, IT IS ABOUT MEETING. 
          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 THE RECENT ASSESSMENT, ONGOING MENTAL HEALTH CHALLENGES, CONTINUED ECONOMIC PRESSURE FOLLOWING THE PANDEMIC, DECLINES IN PREVENTIVE CARE, AND WIDENING DISAPARTS ESPECIALLY AMONG YOUTH, OLDER ADULTS, PERSONS WITH DISABILITIES AND THE ECONOMICALLY FRAGILE. THESE ARE NOT ISOLATED ISSUES. 
          THEY REFLECT DEEPER CONDITIONS SHAPING HEALTH LONG BEFORE SOMEONE ENTERS A CLINIC. SO WE SEE THE COMMUNITY HEALTH NEEDS ASSESSMENT AS A 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 THE LONG-TERM COMMITMENT. AND IT REQUIRES [INDISCERNIBLE] AND THE ONLY WAY THIS CAN WORK AND HAS WORKED IS THROUGH SHARED STEWARDSHIP. 
          OUR STEERING COMMITTEE DOES THAT, BRINGING TOGETHER PUBLIC HEALTH, NON-PROFIT LEADERS TO ALIGN AROUND DATA, COMMIT TO SHARED STRATEGIES AND HOLD EACH OTHER ACCOUNTABLE. WE WOULD LIKE TO RECOGNIZE THE CENTER FOR QUALITY IMPROVEMENT AS WELL AND METRO HEALTH BECAUSE THEY PLAY A CRITICAL ROLE IN BRIDGING PRIORITIES THROUGH COMMUNITY NEEDS, ENGAGEMENT, COALITION BUILDING AND EXPERTISE. HELPING MAKE SURE THIS TRANSLATES INTO COORDINATED ACTION. THIS WORK HELPS TO REDUCE SILOS, ENSURE THAT IT IS COORDINATED ACTION ACROSS SYSTEMS. SAN ANTONIO WILL HOST THE ANNUAL MEETING AND 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. 
          [00:15:04]
[BUZZER] THAT THEME ALIGNS DIRECTLY WITH THIS WORK BECAUSE HEALTH IS SHAPED ACROSS A LIFE-SPAN AND SHAPED TOGETHER, TOGETHER ACROSS SECTORS, SYSTEMS AND TOGETHER WITH COMMUNITY AND EVEN IN CHALLENGING TIMES THAT COLLECTIVE EFFORT GIVES US OPTIMISM. IN CLOSING THANK YOU TO THE COMMUNITY AND THE CITY OF SAN ANTONIO FOR SUPPORTING THE STRUCTURE AND ROADMAP. IT ULTIMATELY SHOWS THAT EVERYONE IN OUR COMMUNITY HAS AN OPPORTUNITY TO LIVE A HEALTHY LIFE AT EVERY STAGE 
          OF THAT LIFE. THANK YOU. >> GALVAN: THANK YOU. 
          >> THANK YOU FOR THAT ADJUSTMENT. GOOD MORNING. 
          THANK YOU FOR THE COMMUNITY TO PROVIDE TODAY'S BRIEFING. IF AGAIN, HAPPY NATIONAL PUBLIC HEALTH WEEK TO ONE AND ALL. SPECIAL SHOUT OUT TO DR. WU AND THIS TEAM THAT IS AT THE CENTER FOR HEALTH AND QUALITY IMPROVEMENT. 
          WHAT YOU HEARD FROM DR. SALAZAR, AGAIN, THESE ARE HIGHLIGHTS ABOUT THE COMMUNITY HEALTH IMPROVEMENT PLAN KNOWN AS THE CHIP AND A QUICK COMMERCIAL ABOUT NATIONAL PUBLIC HEALTH EVENTS TAKING PLACE THIS WEEK. 
          JUST KNOW THAT THE CONTEXT OF THIS, THAT THIS IS THE SIX-YEAR ANNIVERSARY OF THE 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. 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 RED RED LINING AND SOCIAL FACTORS LIKE THE LACK OF TRANSPORTATION, INSURANCE, CHILDCARE AND EVEN KNOWING WHEN YOU NEED ACCESS TO HEALTH CARE. 
          SO WHAT CAN WE DO ABOUT IT? 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 A NATIONALLY ACCREDITED LOCAL HEALTH DEPARTMENT. JUST KNOW THAT THIS IS A VOLUNTARY PROCESS. 
          NATION-WIDE ONE IN FOUR HEALTH DEPARTMENTS ACROSS THE STATE HAS THIS DESIGNATION. HERE IN TEXAS THERE ARE EIGHT OTHER LOCAL HEALTH DEPARTMENTS THAT HAVE BEEN RECOGNIZED BY THE PUBLIC HEALTH ACCREDITATION BOARD. 
          JUST KNOW THAT IT DOES MY HEART GOOD. I SERVE AS A MEMBER OF THE BOARD OF DIRECTORS AND JUST KNOW THAT THIS IS A PRODUCT, THE COMMUNITY IMPROVEMENT PLAN AND THE COMMUNITY HEALTH NEEDS ASSESSMENT 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 HOSPITALS ON THE GROUPED AND COMMUNITY-BASED ORGANIZATIONS. KEEP IN MIND THAT THIS IS NOT A REPLACEMENT OF ORGANIZATIONAL PLAN, BUT IT ALLOWS US TO HAVE A GUIDE TO ALIGN AND BETTER COORDINATE OUR LOCAL EFFORTS. SO WE DO HAVE [INDISCERNIBLE] AS A DEPARTMENT AND THIS IS AN OPPORTUNITY FOR US TO ENSURE THE CONNECTIONS ACROSS OUR NETWORKS. SO WITH THIS IS BASED ON FOCUS GROUPS AND INTERVIEWS. 
          IT IS A COMPREHENSIVE DATA REPORT. MOST RECENTLY IT WAS RELEASED THIS PAST FALL. KEY FINDINGS WERE THAT COMMUNITY IS FAR FROM RECOVERED FROM THE PANDEMIC WHICH MENTAL HEALTH NEEDS STILL EVIDENT. 
          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. I DO WANT TO THANK THE TEAM AT CI NOW FOR ANCHORING THE WORK AND DEVELOPMENT FOR THIS COMMUNITY HEALTH NEEDS ASSESSMENT. 
          TO THE CHIP, JUST KNOW THAT THE COMPLEMENT TO THE ASSESSMENT IS THE ACTION PLAN. JUST KNOW THIS IS CONDUCTED EVERY THREE TO SIX YEARS AND IT'S BASED ON NOT ONLY THE DATA, BUT ALSO COMMUNITY INPUT TO ORGANIZE THESE PRIORITIES, INDICATORS, STRATEGIES AND IT HAS A LIST OF PARTNERS ON THE GROUND AS WELL AS METRICS. AGAIN I'LL TALK MORE ABOUT -- WE'LL BE SHARING AS WE ROLL OUT THE -- COMING TO A THEATER NEAR YOU. JUST KNOW THIS ALLOWS US TO DEMONSTRATE THE ALIGNMENT OF OUR EFFORTS ACROSS SECRETARIERS AND IS 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 NATIONALLY ACCREDITED, THEY ALSO HAVE A STATE HEALTH IMPROVEMENT PLAN, SO JUST KNOW THAT THAT'S A CLEMENT TO THE CHIP. 
          WITH DO COOPERATE WITH THE HEALTH COLLABORATIVE AND IT IS WITH PARTNERS THAT INCLUDE COMMUNITY-BASED ORGANIZATIONS AS WELL AS THE CITY AND THE COUNTY AND OUR PARTNERS IN ACADEMIA. THE HEALTH COLLABORATIVE ALSO HELPS TO COORDINATE OUR INITIALS HERE OF WORK GROUPS FOR EACH OF THE FOUR PRIORITY AREAS, WHICH I'LL 
          [00:20:03]
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 CONDUCT AND THEN WE'LL HAVE THAT ACTION PLAN. 
          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 CHAMPIONSHIP PROCESS IS USED AS A RESULTS BASED ACCOUNTABILITY FRAMEWORK. JUST KNOW THAT OUR COMMITTEE REVIEWED EXISTING STRATEGIES THAT INCLUDED OUR SA FORWARD PLAN AND THE SHIP 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 LOST 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 I'LL 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 INSTABILITY AND PRENATAL CARE. AGAIN, I'LL BRIEFLY HIGHLIGHT THESE, SHARE A SAMPLE OF METRICS AND KEY PARTNERSHIPS THAT SUPPORT THE IMPLEMENTATION. 
          SO AGAIN, DETAILS ARE AVAILABLE IN THE ACTUAL PLAN THAT WAS RELEASED, THE 2024 CHIP. JUST KNOW THAT OUR FIRST SATISFACTORY ON BEHAVIOR HEALTH AND MENTAL WELL-BEING. WHEN PEOPLE USE COMMUNITY-BASED MENTAL HEALTH CARE THAT REDUCES CRISIS THAT STRAIN LAW ENFORCEMENT AND EMERGENCY DEPARTMENTS. WHILE WE DO HAVE A LIST OF KEY PARTNERS ON THE BOTTOM OF THE SLIDE, JUST KNOW THAT THIS WORK IS ANCHORED TO THE CENTERS FOR HEALTH CARE SERVICES AS WELL AS TRACK THE SOUTHWEST TEXAS REGIONAL ADVISORY COUNCIL AND DESIGNATED WORKING GROUPS AS WELL AS THE BEXAR COUNTY ONE WAY OR THE OTHER HEALTH UNIT AND KNOW THAT BECAUSE IT TAKES A VILLAGE TO DO THIS WORK, THIS IS AN OPPORTUNITY FOR US TO AT LEAST DRAW MORE ATTENTION AND SHOW THE ALIGNMENT OF OUR EFFORTS. JUST KNOW THAT ONE EXAMPLE TO STRENGTHEN THE CAPACITY AND EFFECTIVENESS OF THE MENTAL HEALTH WORKFORCE, THE WORK GROUP IS DEVELOPING STANDARDIZED TRAINING, FIELD WORK TO OUR STAFF WHO CONNECT PEOPLE TO HEALTH CARE AND OTHER SERVICES. AGAIN, THE REPORT HAS THE LONGER LIST OF KEY PARTNERS, BUT YOU YOU HAVE THE SHORT LIST SHOWN ON THE SLIDE OF OUR COMMUNITY-BASED ORGANIZATIONS WHO ARE DOING THIS WORK EACH AND EVERYDAY. SECOND EXAMPLE IS AGAIN ON FOOD INSECURITY. JUST KNOW THAT A WELL NOURISHED COMMUNITY IS A STABLE AND PRODUCTIVE COMMUNITY N THIS EXAMPLE WE SHOW THE HEALTH EQUITY PARTNERS WHO HAVE TRAINED 16 NEW SNAP NAVIGATORS FOR OUR COMMUNITY. 
          JUST KNOW THAT FOR THE SECOND STRATEGY LISTED HERE IN TERMS OF INCREASING LOCATIONS, JUST KNOW THAT BOTH THE MISSION MARQUEE'S FARMERS MARKET AND THE NOURISH SEEDS FARMERS MARKET 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 WORLD HERITAGE OFFICE. 
          AGAIN, MORE THAN 30 COMMUNITY PARTNERS HELP TO UNDERGIRD THIS WORK AND THE SAMPLE MEASURE IS REDUCING THE NUMBER OF BEXAR COUNTY RESIDENTS WHO EXPERIENCE FOOD INSECURITY. THIS IS FOR 2027 AND WE'RE LOOKING AT ADJUSTING THAT TO 2029. HOUSING INSTABILITY OR HOUSING STABLE. 
          THE THIRD FOCUS AREA THAT FOCUSES ON THE SOCIAL DETERMINANT AROUND SAFE, STABLE AND AFFORDABLE HOUSING SUPPORTS WHICH UNDERGIRDS PHYSICAL AND MENTAL HEALTH. CHILDREN WHO GROW UP IN STABLE HOUSING HAVE BETTER LONG-TERM OUTCOMES. THIS EXAMPLE IS REALLY SHOWING THE COLLABORATIONS WITH THE SCHOOL DISTRICTS AND NON-PROFITS WHO ARE ALIGNING WITH THE GOALS OF NAHSD, 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 AND HELPLINE NUMBERS AND TENANTS' RIGHTS INTO INFORMATION ON THE FRONT LINES OR BUILDING SUPPORT TO HOLD HOUSING, FINANCE CORPORATIONS ACCOUNTABLE AND JOINING HOUSING'S HEALTH CAMPAIGN. THIS IS A CITYWIDE INITIATIVE AND I WANT TO 
          [00:25:02]
THANK AGAIN OUR PARTNERS ON THE GROUND. YOU WILL SEE A SHORT LIST OF THE PARTNERS LISTED ON THE SLIDE. JUST KNOW THAT THE LONGER LIST IS INCLUDED IN THE REPORT. AND LASTLY, AGAIN IN TERMS OF THESE 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 THE SAMPLE STRATEGIES ARE AROUND SCREENING, EARLY INTERVENTIONS AS WELL AS USING SHARED DATA SYSTEMS AND PARTNERING TO TRACK PROGRESS. 
          THIS METRIC IS REALLY ABOUT INCREASING THE PERCENTAGE OF PREGNANCIES, RECEIVING PRENATAL CARE. AGAIN, WE SAW THIS CONDITION EXACERBATED DURING THE PANDEMIC. WE HAVE MORE THAN 17 COMMUNITY PARTNERS, INCLUDING UNIVERSITY HEALTH AND UNITED WAY SA, AND JUST KNOW THAT THIS EXAMPLE HERE, THE WORK GROUP WILL TRACK THEIR AGGREGATED OUTCOMES TO IDENTIFY GAPS IN OUR COMMUNITY. FOR EXAMPLE, WHEN REFERRALS ARE MADE TO THE PREGNANT WOMAN OBTAIN SERVICE, WHAT WAS THE WAIT TIME, WERE THERE NEEDS MET? JUST KNOW WHILE THIS MAY SEEM INCREMENTAL IN SCOPE IT'S SIGNIFICANT TO STAY THE COURSE AS WE MAKE PROGRESS, ESPECIALLY THE EXPERIENCE OF ON THE GROUND IN PANDEMIC. 
          WITH THAT AS YOU'VE HEARD FROM DR. SALAZAR WE'VE GONE THROUGH SOME INTERNAL RESTRUCTURING AND I WANT TO APPLAUD THE TEAM FOR HELPING US TO ESTABLISH 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 AND SCHOOLS, NON-PROFITS, BUSINESSES, RESIDENTS, AND POLICYMAKERS ALL TAKE RESPONSIBILITY FOR THEIR PART AND TRACK RESULTS TOGETHER. AGAIN, OUR PUBLIC HEALTH FRAMEWORK IS ORGANIZED INTO 10 ESSENTIAL SERVICES. IF YOU LOOK AT ESSENTIAL SERVICE 4, WHICH IS ABOUT STRENGTH THING AND MOBILIZING PARTNERSHIP AND SERVICE 5 WHICH IS ABOUT HAVING A PLAN AND STICKING WITH IT, KNOW THAT THE CHIP ALLOWS US TO MAKE SURE THAT WE'RE NOT WORKING IN SILOS AND NOT DUPLICATING EFFORTS AND WE REALIZE THAT NOT INVESTING IN SHORT-TERM FIXES ALONE ALLOWS US TO AT LEAST SHOW STEADY PROGRESS OVER TIME. JUST KNOW THAT DEPENDING ON THE PARTNERS' NEEDS WE'VE ANCHORED THIS WORK TO WHAT WE CALL THE CENTER FOR POLICY AND HEALTH IMPROVEMENT AND WE CAN OFFER A MINI GRANT 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, THE TEAM LED BY DR. WU AND HER INCREDIBLE STAFF. 
          JUST KNOW THAT WE ARE PROUD OF THIS WORK. I MENTIONED THE CENTER. 
          JUST KNOW THAT IT'S NOT YOUR TYPICAL BRICK AND MORTAR PROGRAM. 
          IT DID REQUIRE SOME INTERNAL RESTRUCTURING AND STAFF REASSIGNMENTS AND REALIGNED. 
          JUST KNOW THAT THEIR WORK TO COORDINATE THESE CROSS-SECTOR IMPLEMENTATION ALIGNS WITH THE CHIEF PUBLIC HEALTH STRATEGIES FRAMEWORK, WHICH IS ALSO CALLED PUBLIC HEALTH 3.0 AND IT'S BEING ACCESS TO TIMELY DATA, MAKING SURE WE INVEST IN MORE ROBUST PARTNERSHIPS AND HAVING AND IMPLEMENTING THIS IMPROVEMENT AT THE DEPARTMENT. THE WORK BUILDS OUT OUR WHOLE COMMUNITY'S PUBLIC HEALTH INFRASTRUCTURE AND CAPACITY AND TO ADDRESS PERSISTENT HEALTH CHALLENGES. AND IT'S COST EFFECTIVE. WHEN WE CONNECT THE DOTS ACROSS THE CHIP PRIORITIES WE SEE A FOCUS ON PRESENTATION, WHICH IS BY DESIGN. PREVENTING MENTAL HEALTH CRISIS, CHILD HUNGER, HOMELESSNESS, CHRONIC ILLNESS AND POOR INFANT OUTCOMES. 
          AND JUST KNOW FOR EVERY DOLLAR SPENT ON PUBLIC HEALTH, $14 ARE SAVED. 
          SO THIS UNIT IN TERMS OF THE FUNDING, GIVEN OUR FISCAL FRAGILITY WE'VE HAD THIS YEAR IT REQUIRES US TO BE MORE INTENTIONAL ON HOW WE USE FUNDING. 
          I WANT TO THANK THE CITY MANAGER AND COUNCIL FOR ALLOWING US TO AT LEAST ANCHOR THE LION'S SHARE OF THIS WORK FOR THE GENERAL FUND, BUT THE COMPLEMENT ALSO DOVETAILS WITH EXTERNAL FUNDING AND FOR THIS UNIT IN PARTICULAR IT'S AUDIO]. ... FROM THE HEALTH COLLABORATIVE AND SOME COMPONENTS THAT ARE SUPPORTED BY THE MEDICARE WAIVER. 
          COMING TO A THAT'S NEAR YOU, WE ARE DESIGNING A DASHBOARD SO THAT WE CAN REPORT OUT THE STEADY PROGRESS. 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 AS I SHARED EARLIER, WE ARE RECONCILING A PROCESS SO THAT THE NEXT COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE CONDUCTED IN THE FALL OF 2028 AND THE NEXT CHIP WILL BE EYELESSED IN SPRING OF 2029. 
          AGAIN, WE'LL BE REPORTING OUT IN TERMS OF INDICATORS, POLICY RECOMMENDATIONS, STRATEGIES AND ACKNOWLEDGING THE ONGOING CONTRIBUTIONS BY KEY PARTNERS. 
          SO NOW TO THE COMMERCIAL AND THEN I'LL WRAP UP. EVERY YEAR AS I MENTIONED, 
          [00:30:04]
THE FIRST FULL WEEK OF APRIL, COMMUNITIES ACROSS THE COUNTRY JOIN 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 HEALTH OF OUR NATION. 
          SO WE'VE BEEN DOING THIS FOR MORE THAN 30 YEARS AND APH LED THIS EFFORT. 
          FULL DISCLOSURE, I DO SERVE AS A MEMBER OF THE EXECUTIVE BOARD AND I WANT TO AT LEAST 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. 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 A PUBLIC HEALTH SUMMIT. 
          AGAIN, THANKS TO THE COUNTY AND OUR PARTNERS AT UTSA. WE HAD AN INCREDIBLE EVENT YESTERDAY ON IT IS A'S CAMPUS AND WE DO HAVE ACTIVITIES TAKING PLACE THIS WEEK. I JUST WANTED TO AT LEAST SIGNAL OUT TOMORROW -- NOT TOMORROW, THURSDAY. THURSDAY, APRIL 9TH, WE WILL BE AT ROSEDALE PARK FROM 3:00 TO 6:00 P.M. AND THIS IS AGAIN ONE OF THE SIGNATURE EVENTS 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 DEPARTMENTS AND COMMUNITY PARTNERS. OTHER ACTIVITIES INCLUDE FOOD SAMPLINGS, FRESH PRODUCE BAGS, MUSIC, FIESTA AND MORE. 
          THIS IS FREE TO THE GENERAL PUBLIC SO NO COST. SO WITH THAT I WANT TO SAY HOW MUCH I APPRECIATE THIS OPPORTUNITY. HAPPY NATIONAL PUBLIC HEALTH WEEK. JUST KNOW THAT LATER THIS MONTH METRO HEALTH ANNUAL REPORT, WHICH IS SOMETHING THAT WE'VE BROAD BUREAUCRAT TO COUNCIL. YOU WILL SEE THAT AND IT WILL BE POSTED ON OUR WEBSITE AS WELL JUST TALKING ABOUT HIGHLIGHTS OF WHAT WE'VE DONE THIS PAST FISCAL 
          YEAR. THAT CONCLUDES MY REPORT. >> GALVAN: THANK YOU SO MUCH, DR. JACOB AND OF COURSE HAPPY NATIONAL PUBLIC HEALTH WEEK. 
          VERY HAPPY TO SEE ALL THE THINGS YOU'VE DONE THIS WEEK AND WHAT YOU DO YEAR-ROUND. 
          THANK YOU AGAIN FOR ALL THE WORK YOU DO. WOULD ANYONE LIKE TO START WITH QUESTIONS OR COMMENTS? COUNCILMEMBER ALDERETE GAVITO. 
          >> >> GAVITO: THANK YOU. THANKS FOR THAT PRESENTATION. NOW MY IPAD IS GIVING ME ISSUES. 
          REALLY QUICK, CLAUDE, YOU MENTIONED -- DR. JACOB, YOU MENTIONED THAT THERE ARE A LOT OF DIFFERENT ORGANIZATIONS HELPING OUT. SO IS METRO HEALTH TAKING 
          THE LEADERSHIP ROLE AND HOLDING THEM ACCOUNTABLE? >> 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 ANSWERED TO THE NETWORK OF THE HEALTH COLLABORATIVE, SO IT COVERS A SPECTRUM OF HEALTH CARE INSTITUTIONS, NON-PROFIT ORGANIZATIONS, ACADEMIC PARTNERS. SO WE HAVE THE FULL LIST AND THEY'RE TIED TO EACH OF THE PRIORITY AREAS. SO YES, WE ARE A CONVENER OF SORTS. SO WHAT WE'VE COMMITTED IS TO MAKE SURE THAT WE PROVIDE SOME OPERATIONAL SUPPORT, BUT IT ALSO DOVETAILS WITH THE INTEREST AND THE 
          PRIORITIES AS RECOGNIZED BY OUR PARTNERS. >> GAVITO: SO THE REPORTING OF INFORMATION GOES BACK TO YOU ALL AND WE PUT THAT INFORMATION TOGETHER. I'M WONDERING THEN WHO ALSO TAKES -- WHO IS TAKING THE ROLE IN KIND OF DRIVING THE METRICS? WE HAVE TO DO THAT TOO. 
          I KNOW IT'S A LITTLE HARD AND IT'S DIFFICULT BECAUSE OF SOME OF THE PROBLEMS THAT 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 AND COMMUNITY. 
          IT DOES TAKE LONG-TERM INVESTMENTS TO DO THIS, WHICH IS WHY THE FEDERAL AGENCIES, AGAIN, THE CDC, THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AGAIN, A FEW YEARS AGO RELEASED SOME FUNDING TO ALLOW US TO HAVE THIS CAPACITY AND INFRASTRUCTURE. SO IT ALLOWS US 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 WILL SEE A DASHBOARD AND WE CAN SHOW 
          THE PROGRESS OVER TIME. >> GAVITO: YEAH. I'M DEFINITELY LOOKING FORWARD TO THAT DASHBOARD. AND I'M GLAD THAT WE'RE GOING TO BE REPORTING OUT ON IT. I ALSO WANTED TO -- WONDERED HOW WE CAN -- AGAIN AS I MENTIONED, I THINK 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 A LOT OF THESE AREAS. 
          DO Y'ALL KNOW -- AND I SAW THE IMPROVEMENT, I GUESS, IN TEASPOON PREGNANCY. 
          [00:35:04]
DO WE KNOW WHAT THAT'S ATTRIBUTED TO, TO THE DECREASE IN TEEN PREGNANCY? 
          >> YES. WE'VE NOTICED THAT TREND. I CAN TELL YOU CLEAR CONCRETE NUMBERS OF WHAT WE SAW. THIS IS AGAIN LOOKING AT THE DECREASE FROM 23.7 PER THOUSAND ADOLESCENTS IN 2019 DOWN TO PREGNANCY RATE OF 18.3% PER THOUSAND AS REPORTED IN 2023. SO WE SAW THAT CHANGE OVER THE COURSE OF A FOUR-YEAR WINDOW. WE CAN ONLY ATTRIBUTE IT TO THE FACT THAT WE HAVE LEANED IN A BIT MORE WORKING WITH OUR DIRECT SERVICE PROVIDERS. WE HAVE ELEVATED AT LEAST THE VISIBILITY IN TERMS OF PRIMARY PREVENTION AND EDUCATION. SO IT'S NOT ONE TASK, ONE ACTIVITY. IT'S THE EFFORTS ON THE GROUND. 
          >> GAVITO: TWO QUICK QUESTIONS. WHEN CAN WE EXPECT THAT 
          DASHBOARD? >> BY FALL. >> GAVITO: AND ALSO TOO, I'M WONDERING LIKE IF WE'LL TO SEE HOW WE SAW THE DECREASE IN TEEN PREGNANCY AND YOU SAID IT'S BECAUSE YOU LEANED INTO CATEGORY 4 EFFORTS. 
          IF WE ARE NOTATING TO THE DASHBOARD OR SOMEWHERE THE STRATEGIES THAT ARE WORKING. 
          BECAUSE AGAIN LIKE I'M SAYING, I THINK IT'S DIFFICULT TO DRIVE TO A NUMBER, BUT 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 -- OBVIOUSLY I KNOW FUNDING IS IMPORTANT, BUT I'M WONDERING HOW WE JUST GET AGGRESSIVE AND SAY, YOU KNOW, THESE ARE THE THINGS WE TRIED THAT MAYBE WE DIDN'T SEE A DECREASE IN OUR NUMBERS, WE DIDN'T SEE THE OUTCOMES THAT WE WERE EXPECTING, BUT THESE ARE THE STRATEGIES THAT WE ABSOLUTELY DID SEE AN OUTCOME SO WE NEED TO KEEP OUR FOOT ON THE GAS FOR THOSE THINGS. 
          >> DR. WOO, I WU, I DIDN'T SEE . >> WE USED TO HAVE A SAN ANTONIO TEEN PREGNANCY COLLABORATIVE. AND LIKE WITH THE WORK THAT WE'RE TALKING ABOUT WITH THE CURRENT FOCUS AREAS, THAT WAS COLLECTIVE IMPACT, WHICH IS WHERE WE ARE -- WELL, FOR TEEN -- NEVER MIND. I'M NOT GOING TO GO INTO THE DETAIL OF THE DIFFERENT GROUPS THAT WERE BACK BONES. BUT THE BACKBONE IS THE BRAIN -- THE BACKBONE IS THE BACKBONE, IT'S NOT THE BRAIN, RIGHT? SO THE GROUP ITSELF, WE CONVENE, WE HAVE -- WE KEEP PEOPLE'S EYE ON THE METRIC. WE WILL HELP THEM CHECK IN AND SEE ARE WE MAKING A DIFFERENCE? BUT REALLY IT IS THE MAGIC HAPPENS IN ALL OF THESE GROUPS HAVING THAT SHARED METRIC TOGETHER, COMMUNICATING FREQUENTLY ABOUT IT. AND THERE ARE A FEW OTHER THINGS. SOMETIMES YOU GET PEOPLE SO ALIGNED THAT THEY'RE APPLYING FOR GRANTS TOGETHER, RIGHT? SO THERE ARE DIFFERENT FOUNDATIONAL PARTS OF COLLECTIVE IMPACT. 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 IT'S WORKED FOR ALL KINDS OF PROBLEMS. 
          >> GAVITO: DEFINITELY. AND I DO THINK, AND YOU KNOW, OBVIOUSLY WE'RE GOING TO BE GOING INTO CITY BUDGET DISCUSSIONS AND WE DO KNOW THAT MONEY IS TIGHT, BUT -- I'VE SAID IT BEFORE. OUR BUDGET, OUR CITY BUDGET IS NOT MEANT TO BE ALL THINGS TO ALL PEOPLE. IT ISN'T. WE HAVE OUR CORE SERVICES, METRO HEALTH IS A CORE SERVICE. TO ME I 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? SO IT'S A DIFFERENT WAY OF THINKING BECAUSE PEOPLE ARE SO USED TO SAYING YES TO ALL THE GROUPS, BUT I DO THINK THAT IF WE WERE TO BE STRATEGIC ABOUT THE -- OUR BUDGET DOLLARS, WE COULD ACTUALLY SEE THE NEEDLE MOVE ON SOME OF THESE PROBLEMS THAT Y'ALL ARE FOCUSED ON. SO THANK YOU FOR YOUR EFFORTS. I KNOW IT'S DIFFICULT TO TRACK AND CAPTURE THE METRICS ON THIS, BUT I DO THINK IT'S EXTREMELY IMPORTANT. 
          SO REALLY APPRECIATE ALL Y'ALL'S EFFORTS. THANK YOU. 
          >> THANK YOU. >> GALVAN: THANK YOU, COUNCILWOMAN. 
          ANYONE ELSE, ANY QUESTIONS OR COMMENTS? COUNCILMEMBER MEZA GONZÁLEZ? 
          >> GONZÁLEZ: THANK YOU. I QUICKLY WANTED TO THANK YOU FOR ALL THE WORK YOU'RE DOING AT METRO HEALTH, YOU AND YOUR TEAM, DR. WU U AND YOUR TEAM. 
          I REALLY WANT TO HIGHLIGHT THE BEHAVIORAL HEALTH AND MENTAL WELL-BEING PIECE BECAUSE NORMALIZING THAT HELP-SEEKING AND REDUCING THE STIGMATISMS SO CRUCIAL. 
          WE HEAR IT FROM -- WE'RE HAVING A TEAM MENTAL HEALTH SUMMIT IN DISTRICT 8 IN THE MIDDLE OF APRIL BECAUSE WE SEE IT ON THE NEWS ALL THE TIME, KIDS ARE RUNNING AWAY, GOING MISSING, KILLING THEMSELVES BY SUICIDE. AND I THINK OUR YOUTH MORE THAN WHEN I WAS A KID, ARE MORE OPEN ABOUT IT AND UP FRONT ABOUT THE ISSUES THAT THEY'RE DEALING WITH. SO JUST REALLY WANT TO SUPPORT EVERYTHING, BUT THAT 
          [00:40:06]
MENTAL HEALTH PIECE IS SUCH A CRUCIAL PIECE FOR ME. AND 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. ON THE MINI GRANTS, HOW ARE THOSE -- HOW DO THOSE COME TO BE? WHAT'S THE GUIDELINES FOR THOSE MINI GRANTS? HOW MANY ARE THERE? WHO DO THEY -- WHO APPLIES? 
          >> ALL RIGHT. I'M GOING TO INVITE DR. WU BACK TO THE MIC TO TALK 
          ABOUT THESE MINI GRANTS. FUR. >> SO THROUGH A COMPETITIVE PROCESS, WE FIND A PARTNER, WHICH CURRENTLY IS THE SAN ANTONIO AREA FOUNDATION, AND THEY HELP US TO PUSH THE MONEY TO MULTIPLE SMALL ORGANIZATIONS IN A WAY THAT'S MORE -- MORE EASILY THAN WE CAN DO THROUGH THE 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 AUDIT WAS ALDERETE GAVITO WAS TALKING ABOUT.  SOMETIMES THAT TAKES STAFF LABOR THAT IT MIGHT REQUIRE ANOTHER FTE. 
          SOMETIMES IT'S A MATTER OF JUST HAVING A SYSTEM, RIGHT, FOR TRACKING THE DATA. 
          SO THE ORGANIZATIONS PROPOSE WHAT THEY -- WHAT THEY WOULD SPEND THE MONEY ON AND THEN WITH THE HELP OF THE AREA FOUNDATION AND SOME PANELS -- SHELLY MOVED UP. 
          SHELLY DOES THIS A LITTLE MORE DAY-TO-DAY SO YOU'RE GOING TO STOP ME AND TELL ME IF I SAY ANYTHING WRONG. SO FAR SO GOOD? OKAY. 
          [LAUGHTER]. SO YES, AS LONG AS THEY'RE ALIGNING THEIR WORK AND THEY'VE EXPRESSED HOW THEY'RE GOING TO BE SPENDING THE GRANT MONEY THAT IS A ROUGH OUTLINE, BUT WE ALSO HAVE SOMEBODY WHO CAN EXPLAIN THAT EVEN BETTER 
          THAN ME. >> THAT'S A GOOD JOB, DR. WU, YOU'RE GOOD. 
          THANK YOU SO MUCH. AND THEN ON THE COMMUNITY AND FORWARD FEEDBACK LOOPS, HAVE WE SEEN THAT ALREADY IN ACTION, I GUESS, THOSE FEEDBACK LOOPS ENSURING -- 
          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 WE HAVE 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 TIER IN TERMS OF OUR PROGRESS TO DATE LATER THIS MONTH, BUT THE DASHBOARD ITSELF WILL BE 
          RELEASED LATER THIS FALL. >> GAVITO: OKAY. THANK YOU SO MUCH. 
          THANK YOU FOR ALL YOUR WORK. CALS COUNCILMEMBER CASTILLO. >> CASTILLO: THANK YOU TO YOU AND ALL THE STAKEHOLDERS WHO PARTICIPATE IN THE HEALTH PLAN. 
          A NUMBER OF MOVING PIECES. I WANTED TO THANK YOUR LEADERSHIP DR. JACOB. 
          I'M THINKING ABOUT JUST THE HEALTH OF EVENTS THAT YOUR TOMORROW PUTS TOGETHER AND THE AMOUNT OF PEOPLE IT BRINGS OUT TO PARTICIPATE. AND WHAT'S REALLY IMPORTANT TO HIGHLIGHT THAT IT'S ESSENTIALLY A TEACH-IN THAT YOU'RE FACILITATING THROUGH FUN EVENTS AND INFORMATION. AND THIS IS SOMETHING THAT WE RECEIVE A LOT OF POSITIVE FEEDBACK FROM CONSTITUENTS. I'M THINKING ABOUT THE COMMUNITY BABY SHOWER WHERE RESIDENTS GO THROUGH A SPECIFIC BOOTH, INTERACT WITH DIFFERENT ORGANIZATIONS TO GET CONNECTED TO INFORMATION AND KNOWLEDGE, AND THEN THEY RECEIVE SOMETHING THAT THEY NEED AT THE END, RIGHT? SO IT'S JUST A REALLY IMPACTFUL MODEL THAT YOU ALL IMPLEMENT AND I REALLY JUST VALUE THAT APPROACH AND LOVE TO SEE THE EVENTS ALL THROUGHOUT THE CITY THAT Y'ALL FACILITATE. 
          AND ONLY DR. JULIUS COULD GET ME TO DO THE BUNNY HOP AND LINE DANCE AND IT'S AT A METRO HEALTH EVENT. I THINK THAT'S VERY TELLING JUST THE AMOUNT OF IMPACT THAT YOU ALL HAVE. SO JUST WANTED TO HIGHLIGHT THAT EVENT, BUT THEN WORK OUR WAY THROUGH THE PRIORITIES IN TERMS OF FOOD SECURITY. 
          THIS IS SOMETHING THAT I'M ALWAYS GRATEFUL TO SEE THAT EACH BUDGET WE CONTINUE TO INVEST IN THE HEALTHY CORNER STORES. 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. IT'S ALWAYS GREAT TO VISIT SENIOR CENTERS AND THEY'RE SHARING THAT THAT'S ONE OF THEIR FAVORITE CLASSES, RIGHT, IS WHEN THEY'RE BEING TAUGHT HOW TO EAT HEALTHY AND ALSO THEY'RE OFTEN TIMES PROVIDED WITH FOOD, A HEALTHY BAG OF VEGETABLES TO GO HOME AND MAKE SOMETHING, WHATEVER THE CASE MAY BE. 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, WITH INFRASTRUCTURE? IT WAS VERY INFORMATIVE AND THEY WALKED AWAY SHARING THAT THEY LEARNED SO MUCH 
          [00:45:01]
ABOUT PUBLIC HEALTH AND WHAT THEY REALLY VALUED IS THAT WE HAD CONVERSATIONS ON ISSUES THAT ARE TYPICALLY STIGMATIZED. WE TALKED ABOUT ADDICTION, STIS AND FOLKS WERE WELL EQUIPPED WITH INFORMATION AND THEY ASKED FOR MORE TEACH-INS SIMILAR TO THAT. I WANTED TO THANK YOUR TEAM. THERE WAS A LOT OF VALUE AND IMPACT. AND WE ALSO BELIEVE THE VEGETABLE BAGS THAT YOUR TEAM DONATED ALSO BROUGHT A LOT OF FOLKS OUT, JUST DEMONSTRATING THAT NEED AND THE INTERCONNECTEDNESS OF MENTAL HEALTH, FOOD SECURITY AND OF COURSE DISCUSSING THE ISSUES THAT MATTER THE MOST. AND I REALLY VALUE THE PLAN AND AS YOU STATES, DR. JACOB, THAT HOUSING IS ALSO HEALTH CARE. AND IT'S ONE OF THOSE KEY INDICATORS IN TERMS OF HOW A KID IS GOING TO SHOW UP TO SCHOOL THE NEXT DAY, ENSURING THAT THEY HAVE A ROOF AND HEALTHY FOOD. SO ON AND SO FORTH. 
          AND I'M THINKING ABOUT MELODY MIRANDA WHO GAVE PUBLIC COMMENT WHO SHARED HER STORY, WHO IS A PUBLIC HOUSING TENANT WHO SHARED THAT PRIOR TO LIVING AT PUBLIC COURTS SHE WAS UNHOUSED. AND IT PROVIDED HER THE STABILITY TO GRADUATE AND NOW SHE'S THINKING ABOUT LAW SCHOOL AND WHAT SHE WANTS TO DO WHEN SHE GRADUATES IS REPRESENT TENANTS, RIGHT, THAT HAS BEEN WRONGFULLY EVICTED, SO ON AND SO FORTH. SO I THINK IT DEMONSTRATES THE IMPORTANCE OF HOUSING STABILITY. AND I WAS LOOKING AT SOME OF THE RECOMMENDATIONS, RIGHT, AND I APPRECIATE THAT YOU ALL HIGHLIGHTED -- OF COURSE NOT DUPLICATING EFFORTS, BUT LEANING INTO THE STRATEGIC HOUSING IMPLEMENTATION PLAN, DO WHAT THAT PLAN IS RECOMMENDING, WHICH HIGHLIGHTS THE IMPORTANCE TO THE REHABILITATION OF PUBLIC HOUSING. AND WE KNOW IT'S JUST A KEY COMPONENT TO OUR OVERALL HOUSING ECOSYSTEM THAT IF YOU REMOVE IT AND YOU REPLACE IT WITH VOUCHERS, VOUCHERS AREN'T NECESSARILY BAD, BUT WHEN YOU'RE REMOVING AND REPLACING AND WE KNOW VOUCHERS AFTERNOON BEING USED BECAUSE THERE AREN'T SUFFICIENT LANDLORDS ACCEPTING THE VOUCHERS, YOU'RE THEN CREATING A PROBLEM. 
          SO I JUST APPRECIATE THAT THE SHIP HAS HIGHLIGHTED THE IMPORTANCE FOR US TO PRESERVE THAT PUBLIC HOUSING AND IT'S ALSO KEY TO JUST OVERALL HOUSING STABILITY. 
          THE HOUSING COMPONENT WITHIN Y'ALL'S PLAN ALSO MENTIONS THE NEED TO HAVE A COORDINATED EFFORT IN TERMS OF MITIGATING EVICTIONS. AND TEXAS HOUSERS ALSO HAS HIGHLIGHTED THAT AS A NEED FOR US TO IMPROVE OVERALL HOUSING STABILITY AND PUBLIC HEALTH. SO IT'S GREAT TO SEE THE COORDINATION AND JUST HIGHLIGHTING THOSE INTERSECTIONS, BUT ULTIMATELY IT TAKES A WORKING COLLABORATIVELY WITH THE PARTNERS DOING THAT WORK. 
          AND THIS PLAN MAKES ME THINK ABOUT A LOT OF THE COORDINATION DONE WITH OUR HOUSING PARTNERS IN TERMS OF THOSE PROVIDING PERMANENT SUPPORTIVE CARE. 
          THEY MEET, CONVENE, TALK ABOUT THE ISSUES, TALK ABOUT WHERE THERE NEEDS TO BE COORDINATION IN TERMS OF APPLYING FOR GRANTS SO FOLKS AREN'T COMPETING FOR THE SAME DOLLARS, BUT JUST GRATEFUL TO SEE THAT THAT COORDINATION CONTINUES TO HAPPEN WITH PUBLIC HEALTH. AND THEN I WANTED TO MOVE ON TO BEHAVIORAL -- I HAVE MORE COMMENTS THAN QUESTIONS, DR. JAD TO HIGHLIGHT WITH THE BEHAVIORAL MENTAL HEALTH JUST WANTED TO THANK JESSE HIGGINS FOR THE WORK THAT SHE DOES, RIGHT, AND ALSO THE INTERSECTION OF ADDICTION AND HIV TESTING AND DOING THOSE COORDINATED OUTREACH EFFORTS TO TACKLE THE ISSUE AS HARD AS WE CAN AND BEING INTENTIONAL WITH THE OPIOID SETTLEMENT DOLLARS. SO JUST REALLY GRATEFUL TO SEE THE COORDINATION. I ALSO BELIEVE -- SHARE THE SIMILAR SENTIMENT THAT AS WE NAVIGATE BUDGET CONVERSATIONS HOW CAN WE PRIORITIZE THE NON-PROFITS THAT ARE ALREADY WORKING IN COORDINATION WITH THE CITY IN A STRATEGIC MANNER TO TACKLE THESE PUBLIC HEALTH ISSUES I THINK WOULD BE A [INDISCERNIBLE] FOR COUNCIL TO CONSIDER. I WANTED TO END WITH JUST APPRECIATE THE WORK THAT Y'ALL 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. 
          AND I WOULD LOVE TO GET WITH SOME OF THE ORGANIZATIONS THAT ARE DOING THE WORK BECAUSE I THINK THERE'S A LOT OF OPPORTUNITY FOR COUNCIL TO 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 METRO HEALTH TEAM. 
          >> THANK YOU FOR THOSE COMMENTS. AGAIN, YOU WILL HEAR FROM 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 RESILIENCE AT THE DEPARTMENT ANALOGOUS NOW TO THE CENTER FOR POLICY AND HEALTH IMPROVEMENT. 
          A LOT WE'VE ENGINEERED BUT IT'S TO BE A BETTER RESOURCE TO ON OUR PARTNERS. 
          THANK YOU FOR THAT ACKNOWLEDGMENT IT ALLOWS US TO BE A CATALYST IN OUR 
          SHARED COMMUNITY. >> CASTILLO: THANK YOU, DR. JACOB. 
          THANK YOU, CHAIR. >> GALVAN: THANK YOU SO MUCH, COUNCILMEMBER CASTILLO. I COULDN'T SAY IT ANY BETTER THAN THAT SO I'M NOT GOING TO TRY TO. KNOW THAT THE SENTIMENT IS THERE FROM ALL OF US HERE. 
          ONE QUICK THING I WANTED TO SHERIFF'S DEPARTMENT IS I REALLY APPRECIATE THE DASHBOARD AT THE END. I THINK THIS WAS DISCUSSED AND UNDERSTAND MORE THE LONG-TERM TRENDS TOO. A LOT OF THE IMPROVEMENTS ARE INCREMENTAL, BUT THEY'RE MEANINGFUL AND WE LOOK AT SOME OF THE NUMBERS HERE AND SEVERAL METRICS THAT WERE 
          [00:50:02]
PROVIDED IN THE PRESENTATIONS. IT'S A SMALL PERCENTAGE, BUT OF COURSE THERE'S A SIGNIFICANT NUMBER OF PEOPLE BEHIND ALL THAT. 
          IT'S NOT JUST WE'RE TRYING TO DO A LITTLE BIT HERE AND THERE. 
          IT'S EXPANDING HEALTH CARE OPPORTUNITIES, EXPANDING FOOD SECURITY TO THOUSANDS OF PEOPLE. UNDERSTANDING THAT MORE WILL BE HELPFUL THROUGH THE DASHBOARD AND ALSO THROUGH FUTURE PRESENTATIONS AND CONVERSATIONS LIKE THIS TO UNDERSTAND A BIT MORE THAT THESE THINGS ARE CUMULATIVE. 
          ... SOME OF THE ACTUAL REPORTS THEMSELVES. AND OF COURSE WE ALL KNOW DEPENDING ON WHEN THE STUDY IS DONE, THAT INFORMATION WOULD BE HELPFUL TO HER POINT ABOUT HOW CAN WE REALLY LEVERAGE SOME OF OUR DOLLARS HERE TO SEE WHERE OUR PROGRAMS ARE DOING THE LARGEST IMPACT AS POSSIBLE SO WE CONTINUE TO BUILD ON THAT. I THINK THOSE ARE ALL MY COMMENTS AND FRANKLY JUST AGAIN THANK YOU TO ALL THE WORK YOU'RE DOING IN PARTNERSHIP AGAIN AND THIS IS AN ENTIRE ECOSYSTEM THAT NEEDS TO BE BOLSTERED AND SUPPORTED AS YOU MOVE THROUGH THIS AND UNDERSTAND HOW TO LEVERAGE THEIR PROGRAMS AS WELL. 
          IT'S NOT ALWAYS JUST US AT THE CITY. THERE ARE THINGS THAT WE DO TAKE ON THAT OTHERS DON'T. UNDERSTANDING THAT TOO WOULD BE HELPFUL TO SAY HOW CAN WE GET THE SUPPORT OF THIS INITIATIVE. IT'S THE ONLY ONE IN THIS FIELD DOING THAT. WITHOUT IT WE MAY NOT HAVE THAT IMPACT AT ALL. 
          IT COULD BE WORSE IN CERTAIN AREAS, WHETHER IT'S FOOD INSECURITY OR ORAL CARE OR HOUSING STABILITY, ET CETERA. SO AGAIN, THANK YOU FOR THE WORK Y'ALL DO AND FOR ALL THE PARTNERSHIPS YOU'VE CREATED AND HAPPY TO LEAN IN ANYWHERE THAT PARTNERS WANT TO TALK TO US ABOUT THINGS THEY'RE WORKING ON WITHIN 
          THIS FIELD. THANK YOU. >> THANK YOU AGAIN. 
          REALLY PROUD OF THE WORK OF THE TEAM AND PARTNERS FOR LEADING INNOVATIVE HEALTH DEPARTMENT AND IT SHOWS. AGAIN, HAPPY NATIONAL PUBLIC HEALTH WEEK AND LET US KNOW 
          HOW WE CAN BE OF SERVICE. >> GALVAN: THANK YOU, DR. JACOB. 
          ALL RIGHT. NEXT WE HAVE ITEM NUMBER 3, UPDATE ON TRAUMA-INFORMED CARE IF I'M NOT MISTAKEN. YES. MS. HIGGINS. 
          >> THANK YOU FOR HAVING ME. WE'RE SO EXCITED TO BE HERE AS PART OF WORK THAT THE HEALTH DEPARTMENT IS DOING, BUT ALSO AS PART OF THE CELEBRATION FOR NATIONAL PUBLIC HEALTH WEEK. I'M JESSE HIGGINS, THE CHIEF MENTAL HEALTH OFFICER. 
          AND I'M HERE TO TALK SPECIFICALLY ABOUT THE PRINCIPLES OF TRAUMA-INFOMED CARE AND HOW WE USE THOSE TO BUILD RESILIENCE IN OUR COMMUNITY AND IN OUR WORKPLACE. IN THIS PRESENTATION WE'LL TALK ABOUT ACES OR ADVERSE CHILDHOOD EXPERIENCES. WE'LL TALK ABOUT 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 THROUGH 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 REQUEST INCLUDE GROWING UP 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 AFFECTS 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 LIFE-SPAN. 
          INCREASED RISK OF HEART DISEASE, CANCER, STROKE AND OTHER PHYSICAL HEALTH ISSUES CAN BE ASSOCIATED WITH THE HIGHER RATE OF ADVERSE CHILDHOOD EXPERIENCES. 
          EVERY FIVE YEARS WE ARE ABLE TO ACCESS THE SPECIALIZED SET OF DATA FROM THE CDC'S BEHAVIORAL RISK FACTOR FACE 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. 
          BEXAR COUNTY RATE OF ACES IS HIGHER IN TEXAS THAN ALL DOMAINS. 
          FROM THIS DATA WE SEE THAT ONE IN THREE BEXAR COUNTY ADULTS WERE EMOTIONALLY ABUSED A HOT HOME AS A CHILD. ONE IN FIVE ADULTS WERE ABUSED AT HOME AS A CHILD. ONE IN FIVE WERE SEXUALLY ABUSED AT HOME AS A CHILD AND ONE IN THREE ADULTS EXPERIENCED 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 -- SORRY, MISSED. WHICH IN THIS GRAPHIC IS REPRESENTED BY THE TREE, BUT ALSO AT THE COMMUNITY THAT THE INDIVIDUAL GREW UP IN REPRESENTED HERE 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 EFFECT CHANGE IN BOTH ENVIRONMENTS AND EXPERIENCES. IT'S IMPORTANT TO RECOGNIZE THE DATA ABOUT BEXAR COUNTY REPRESENTS REAL PEOPLE AND NOT ONLY ARE THESE PEOPLE A COMMUNITY WHO WE SERVE HERE 
          [00:55:04]
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. METRO HEALTH CENTER FOR EXCELLENCE SUPPORTS CITY DEPARTMENTS AS THEY MAKE STRIDES TO IMPLEMENT TRAUMA-INFORMED PRINCIPLES AND OBTAIN A LEVEL ONE TRAUMA-INFORMED 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, AND THEY ARE THE CERTIFYING BODY THAT CONDUCTS 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, TRUST WORTHINESS AND EMPOWERMENT. 
          ALLOWS FOR AUTONOMY AND FLEXIBILITY. COLLABORATION GIVES STAFF A ROLE IN PLANNING AND EVALUATING THEIR OWN ROLES. AND STAFF ARE TREATED AS EXPERTS. TRUST WORTHINESS PROVIDES STAFF WITH CLEAR EXPECTATIONS . EMPOWERMENT PROVIDES 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 EMPLOYEES, AND EMBRACES EMPATHY AND COMPASSION IN DAILY INTERACTIONS. EACH DEPARTMENT THAT ACHIEVES A LEVEL 1 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 ORGANIZATIONS WITH A VISION FOR A TRAUMA-INFORMED BEXAR 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 THERE'S A CERTIFYING ENTITY FOR ORGANIATIONS THROUGHOUT THE COMMUNITY, NOT JUST CITY DEPARTMENTS . RIGHT NOW MORE THAN 40 DIFFERENT ORGANIZATIONS ACROSS OUR COMMUNITY HAVE ACHIEVED THE LEVEL 1 CERTIFICATION WITH THAT MANY AS WELL IN QUEUE. AS I WRAP UP, I HAVE ONE QUICK HIGHLIGHT FOR YOU. A WAVE AT METRO HEALTH HAS IMPLEMENTED TRAUMA-INFORMED CARE IN OUR DEPARTMENT IS THROUGH OUR TRAUMA-INFORMED MENTOR'S PROGRAM. 
          EACH YEAR 60 STAFF, ABOUT 10% OF OUR STAFF, SERVE AS MENTORS THAT PROVIDE RESOURCES AND LEARNING OPPORTUNITIES, AND SHARE IDEAS. 
          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 YOU MAY HAVE. 
          >> GALVAN: THANK YOU SO MUCH, JESSIE. ANY COMMENTS? 
          COUNCILMEMBER ALDERETE GAVITO. >> GAVITO: THANK YOU, JESSIE. OH, SORRY. THIS WAS A GOOD PRESENTATION. YOU KNOW, LAST WEEK AT A SESSION I HAD THE PRIVILEGE OF HOSTING CHILD SAFE AND HELP THEM KICKOFF THEIR CARDBOARD KIDS CAMPAIGN. 
          DURING THE CEO'S COMMENTS I WAS SHOCKED TO HEAR ABOUT THE NUMBER OF KIDS IN SAN ANTONIO WHO HAVE DIED FROM CHILD ABUSE. YOU KNOW, I USED TO SERVE ON THE BEXAR COUNTY CHILD WELFARE BOARD AND WHEN WE WERE LOOKING AND LEARNING ABOUT ALL THESE THINGS -- WHEN WE WERE LOOKING AT INTRARECIDIVISM, WE KNOW HURT KIDS GROW UP TO BE HURT ADULTS AND THE CYCLE CONTINUES. 
          I'M PROUD OF THE CITY'S EFFORTS TO MAKE SURE THAT WE ARE -- THAT THERE'S TRAUMA-INFORMED CARE. AND ACTUALLY A COUPLE OF WEEKS AGO WE WERE DOING A WALK WITH FORMER MAYOR HARDBERGER AND WE SAW ALL THE PARKS AND REC DEPARTMENT 
          [01:00:04]
GETTING THEIR TRAINING OVER THERE IN THEIR BIG CONFERENCE ROOM. 
          THAT WAS KIND OF COOL TOO. REALLY QUICK, ON SLIDE NO. 5, WITH THE ACES IN BEXAR COUNTY AND OUR NUMBERS BEING WHAT THEY ARE -- I MEAN, I'M DEFINITELY GLAD THAT WE'RE FOCUSING ON TRAUMA-INFORMED CARE. I MEAN, I'M CURIOUS HOW WE ATTACK THESE NUMBERS. THEY'RE HARD BUT I'M CURIOUS. 
          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. SURE, WE HAVE POVERTY BUT SO DOES HOUSTON. I'M WONDERING WHAT WE'RE DOING ABOUT THAT. 
          >> RIGHT. SO THESE NUMBERS ARE OVERWHELMING. 
          THAT'S ONE OF THE REASONS WHY I SHOW THEM TO YOU SO THAT WE KEEP IN OUR MIND WHAT WE ARE DOING AND WHY WE'RE DOING IT. I WOULD ARGUE THAT WE ARE APPROACHING THIS THROUGH ALL AND LOTS OF DIFFERENT EFFORTS THAT THE CITY IS DOING. 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 DOING IS CHIPPING AWAY AT THIS. STRENGTHENING FAMILIES. I EVEN THINK ABOUT THE WAY THAT WE FUND MENTAL HEALTH YOUTH SERVICES AND WE FUND THEM THROUGH SCHOOLS SO MAYBE THEY HAVE AN OPPORTUNITY TO ACCESS SERVICES AND CARE THERE. 
          SO THIS IS DEFINITELY IN THE TOP OF OUR MIND WHEN WE'RE DOING POLICY. 
          I THINK SOME REALLY COOL THINGS THAT WE HAVE DONE THROUGH OUR ACTUAL TRAUMA-INFORMED CARE TEAMS IS -- OR THROUGH OUR TRAUMA-INFORMED CARE PRINCIPLES, THERE IS A GREAT INITIATIVE A COUPLE OF YEARS AGO WHERE EACH POLICE SUBSTATION 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, BUT ANYONE WHO NEEDS A QUIET, PRIVATE PLACE FOR AN INTERVIEW ROOM, TO HAVE THAT DONE IN PRIVATE. THOSE INTERVIEWS WERE HAPPENING SOMEWHAT HAPPEN HAZARDLY IN A LOBBY OR MAYBE IN A ROOM NOT BUILT FOR THAT. THESE INTERVIEW ROOMS ARE BEAUTIFUL. 
          THEY HAVE SOFT LIGHTING. THEY HAVE A LOW TABLE FOR KIDS TO BE PLAYING AT WHERE THE ADULT CAN TALK TO THE POLICE. JUST A TOTALLY DIFFERENT APPROACH. EVERYTHING THAT WE'RE DOING IS REALLY TRYING TO CHIP AWAY AT THIS. AND I'LL CONTINUE TO BRING THESE STATISTICS UP BECAUSE 
          WE HAVE TO KEEP THESE IN THE FRONT OF OUR MIND. >> GAVITO: YEAH. 
          YEAH, WE DEFINITELY DO. IT IS HELPFUL TO SEE, YOU SEE, U KNOW, DIFFERENT ACTIONS THAT WE'RE TAKING, LIKE THOSE INTERVIEW ROOMS TOO. BUT I'M ALSO WONDERING, AS I MENTIONED IN THE LAST PRESENTATION, WHEN WE TALK ABOUT OUR CORE SERVICES, 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. 
          I THINK WE NEED TO OBVIOUSLY KEEP DOING THE WORK THAT WE'RE DOING BUT ALSO AT THE SAME TIME, A TWO-PRONG APPROACH OF HOW WE HIT THE RESET BUTTON, MAYBE WE NEED TO BE TRYING SOMETHING DIFFERENT IN SAN ANTONIO, IN BEXAR COUNTY. 
          BECAUSE WE CAN'T BE OKAY WITH THESE NUMBERS AND PULLING IN DIFFERENT BEST PRACTICES FROM OTHER CITIES TO SEE HOW WE MAKE A DENT IN THESE NUMBERS. 
          >> I WOULD SAY THAT THIS EFFORT TO BE MORE AWARE AND ALSO LITERALLY CHANGE PRINCIPLES, POLICIES, PROCEDURES, AND CULTURE IS PART OF THAT HITTING THAT RESET BUTTON. WHEN THIS INITIATIVE WAS REALLY LAUNCHED IN 2018 AND 2019 AND HAS SUSTAINED THROUGH ALL THE CHANGES THAT NONPROFITS AND HEALTHCARE AND PUBLIC HEALTH ENDURED DURING COVID, WE'RE STILL HITTING THAT RESET BUTTON. 
          AND THIS IS GOING TO TAKE A LONG TIME TO TURN THE SHIP. >> GAVITO: SOUNDS GOOD. 
          THANK YOU. >> GALVAN: THANK YOU, COUNCILWOMAN. 
          ANY OTHER QUESTIONS? YOUR EFFORTS AND WHAT YOUR TEAM IS DOING. WE KNOW THAT TRAUMA SHOWS UP EVERYWHERE, WHETHER IT'S IN SCHOOLS OR PUBLIC SAFETY SYSTEMS OR HOUSING CHALLENGES. I APPRECIATE THE PLAN PRIORITIZING PREVENTION VERSUS ENFORCEMENT. I HAD A QUESTION ON -- I GUESS ON THE LEVEL 1. 
          [01:05:02]
          HOW MANY LEVELS ARE THERE? >> THERE'S THREE LEVELS. AND IT'S TO THE ECUMENICAL CENTER'S CREDIT THAT THEY DEVELOPED THIS. THEY'VE ALREADY GOT TWO 
          PEOPLE ON LEVEL 3 . >> GONZALEZ: IS OUR GOAL TO GET TO A LEVEL 3? 
          >> EACH DEPARTMENT WILL HAVE TO BE WORKING TOWARDS THAT WITH THE ECUMENICAL CENTER. 
          >> GONZALEZ: I'M GLAD TO SEE THERE'S SIX DEPARTMENTS ALREADY CERTIFIED. 
          POLICE AND FIRE WERE THE FIRST TWO IN THE STATE? >> NO, THE FIRST AND ONLY IN 
          THE COUNTRY WHO HAVE GOTTEN THIS TYPE OF CERTIFICATION. >> GONZALEZ: AND THEN THEY 
          HAVE MENTORS WITHIN THOSE DEPARTMENTS AS WELL? >> THEY HAVE -- MAYBE NOT A MENTOR PROGRAM BUT MORE OF A GUIDE TEAM THAT SHEPHERDED THEIR DEPARTMENT THROUGH THE 
          PROCESS. >> GONZALEZ: AND YOU HAVE 14 IN THE PIPELINE, YOU 
          SAID? >> YES, MA'AM. >> GONZALEZ: I THINK THOSE 
          ARE ALL MY HIGHLIGHTS. THANK YOU SO MUCH. >> GALVAN: THANK YOU, 
          COUNCILWOMAN. COUNCILWOMAN CASTILLO. >> CASTILLO: THANK YOU, CHAIR. THANK YOU, JESSIE FOR THE PRESENTATION. 
          I THINK, LOOKING AT SLIDE 5, I WOULD BE CURIOUS TO SEE WHERE BEXAR COUNTY STANDS WITH OTHER PEER COUNTIES. AND THEN ALSO UNDERSTANDING THE WAYS IN WHICH THEY MAY HAVE COMMUNITY COURTS, LIKE WHAT DOES THAT INVESTMENT LOOK LIKE WITHIN THEIR COMMUNITY COURT SYSTEM, AS WELL AS WHICH HAVE JAIL DIVERSION SYSTEMS AND HOW CAN THOSE POTENTIALLY IMPACT THOSE EXPOSED TO SUBSTANCE ABUSE AND EXPERIENCING MENTAL ILLNESS. AND THEN OF COURSE HAVING A HOUSEHOLD MEMBER THAT'S BEEN INCARCERATED. OF COURSE, THESE NUMBERS ARE VERY ALARMING BUT I WOULD LIKE TO UNDERSTAND IN TERMS OF OTHER COUNTIES WHERE WE STAND. 
          AND WHERE THEY MAY BE INVESTING COUNTY-WIDE THAT WE MAY NOT BE DOING HERE IN BEXAR COUNTY. JUST WANTING TO COMMEND YOU AND YOUR TEAM FOR THE CERTIFIED DEPARTMENTS. CAN YOU HELP ME UNDERSTAND, IS THIS SOMETHING THAT A DEPARTMENT OPTS INTO OR DOES METRO HEALTH ENCOURAGE THEY PARTICIPATE IN TERMS OF 
          GETTING THE CERTIFICATION? >> YES. SO WE HAVE OFFERED OUR TECHNICAL SUPPORT WITH THE CENTER FOR EXCELLENCE FOR TRAUMA-INFORMED CARE TO ALL DEPARTMENTS . AND WE HAVE WORKED ON ENGAGING ALL DEPARTMENTS. 
          I HAVE PRESENTED AT DEPARTMENT HEADS, OUR MEETINGS. 
          AND SO ALL OF THE DEPARTMENTS ARE PRETTY AWARE OF THIS. 
          IT'S BEEN ON THOSE DEPARTMENTS TO TAKE US UP ON THAT. 
          >> CASTILLO: WONDERFUL. I BELIEVE THE CLERK'S OFFICE PARTICIPATED IN THAT, RIGHT? 
          THAT'S REALLY EXCITING. >> THEY'RE ALMOST FINISHED. >> CASTILLO: WONDERFUL. 
          THAT'S EXCITING. >> 
          I'M SURE OF IT. >> CASTILLO: I THINK THERE WOULD BE VALUE -- I'LL SPEAK AMIN. I REALLY LIKE WHAT DEVELOPMENT SERVICES, OUR CODE COMPLIANCE OFFICERS ARE PARTICIPATING IN. I'M THINKING ABOUT OUR CONSTITUENT SERVICES TEAM, HOW WE CAN PARTICIPATE. JUST THANK YOU SO MUCH FOR THIS PRESENTATION AND OF COURSE LEADING THE WAY WHEN IT COMES TO THIS. 
          REALLY IMPORTANT AND COMPASSIONATE WORK AND IDENTIFYING AND HIGHLIGHTING THAT OUR POLICE DEPARTMENT AND FIRE DEPARTMENT ARE THE ONLY IN THE COUNTRY TO BE TRAUMA-INFORMED CERTIFIED. JUST GRATEFUL FOR YOUR 
          LEADERSHIP AND OF COURSE THE METRO HEALTH TEAM. >> THANK YOU SO MUCH. 
          >> CASTILLO: THANK YOU, CHAIR. >> GALVAN: COUNCILWOMAN 
          MEZA GONZALEZ. >> GONZALEZ: I WANTED TO SECOND THE COUNCILWOMAN'S POINT ON THE DIVERSION CENTER AND COMMUNITY COURTS. I WOULD LIKE TO SEE THAT BREAKDOWN. THAT WOULD BE HELPFUL. I GUESS AS FAR AS WHERE WE 
          FALL WITH OTHER COUNTIES, SPECIFICALLY. >> YEP. 
          I WILL SEE IF WE HAVE ACCESS TO THAT DATA AN THEN I WILL DEFINITELY MAYBE SEE IF MARIA VARGAS CAN HELP -- I KNOW SHE'S DONE A LOT OF RESEARCH ON THE DIVERSION 
          CENTERS IN OTHER CITIES. >> GALVAN: THANK YOU. SIMILARLY ON THAT POINT, ANY MORE THAT WE CAN LOOK INTO THAT COMPARISON OF DIFFERENT PROGRAMMING AUDIO]. WE HAVE A TON OF PROGRAMS HERE. 
          I THINK THE SCALE WOULD BE INTERESTING TOO, COMPARED TO OTHER CITIES. 
          WHETHER IT'S ON YOUTH PROGRAMMING, RELATED TO AFTER-SCHOOL PROGRAMS OR WORKFORCE PROGRAMS OR SUMMER ENGAGEMENT ACTIVITIES. LOOKING AT PUBLIC MENTAL HEALTH CLINICS AS WELL. THOSE ARE OF COURSE FAR BETWEEN DIFFERENT CITIES BUT SEEING WHERE THOSE ARE AT AND HOW THAT DRIVES DIFFERENT NUMBERS THERE. 
          THE OTHER ONE IS MAYBE A BIT TANGENTIAL, THINKING ABOUT CHILDCARE AND CRISIS NURSERY ACCESS. THE ACES THAT YOU LISTED ON SLIDE 5 TALKED ABOUT INTIMATE PARTNER VIOLENCE AND SUCH. OF COURSE ASSUMING WITHIN FURTHER ACES THERE'S CHILD ABUSE, ET CETERA. UNDERSTANDING MORE OF WHAT THAT LOOKS LIKE AND HOW THAT IMPACTS FAMILIES ON BOTH THE CHILD ABUSE PORTION BUT BEYOND THAT. HOUSEHOLD ISSUES TAKING PLACE. 
          [01:10:02]
UNDERSTANDING THE SCALE OF THOSE PROGRAMS WOULD BE HELPFUL TOO, VERSUS JUST THE IMPLEMENTATION OF THEM, JUST SO WE CAN COMPARE AND CONTRAST. 
          AGAIN, SIMILAR TO THE LAST PRESENTATION, WHAT BOLSTERED EFFORTS WOULD LOOK LIKE HERE WITH THE CITY AND COUNTY AND OTHER PARTNERS TO REDUCE SOME OF THESE ISSUES AND OTHER LARGER ISSUES. I THINK ONE OF THE DEEPER-ROOTED ONES IS RELATED TO POVERTY AND HOW THAT POVERTY EXACERBATES THESE -- NOT THE MAIN REASON BUT CAN BE A BIT OF AN EXACERBATING POINT FOR A LOT OF THESE ISSUES. 
          ONE LAST QUESTION I HAD WAS RELATED TO THE TRAUMA-INFORMED CARE -- OR THE CERTIFICATIONS WITHIN THE DEPARTMENTS. EXCITED TO SEE THE DEPARTMENTS THAT HAVE TAKEN IT ON. THAT'S VERY EXCITING TO SEE THAT WE HAVE SUCH AN EXPANSIVE ROLE WITHIN THAT. DO WE HAVE ANY SATISFACTION RATES THAT WE LOOK AT WITH EITHER EMPLOYEES AND/OR RESIDENTS WHO ARE NOW RECEIVING SERVICES AFTER THE CERTIFICATION AND WHAT THAT CHANGE LOOKS LIKE? 
          >> THAT'S A GOOD QUESTION. WE DO A SURVEY AFTER THE TRAINING. 
          METRO HEALTH HAS THREE HOURS OF RECORDED TRAINING THAT EITHER PEOPLE CAN TAKE INDIVIDUALLY OR WHAT YOU SAW COUNCILWOMAN ALDERETE GAVITO WAS ONE OF OUR STAFF GIVING THAT TRAINING TO PARKS AND BEING ABLE TO DEBRIEF WITH THEM AFTER. 
          AND SO WE DO HAVE A SORT OF CHECK-IN AFTER THAT. AND WE HAVE REALLY HIGH MARKS ON THAT. I'M NOT SURE WE HAVE HAD ANY SORT OF OVERARCHING SURVEY THAT WOULD BE TIED DIRECTLY TO THIS. WE DO TRY TO LOOK AT OUR CITY EMPLOYEE SURVEY EVERY TIME THAT IT'S GIVEN AND WE PULL OUT A FEW QUESTIONS IN THAT TO SEE IF CITY EMPLOYEES DON'T KNOW IT'S TRAUMA-INFORMED QUESTIONS BUT THEY ARE EXPERIENCING A TRAUMA-INFORMED WORKPLACE. I CAN TRY AND LOOK INTO THAT 
          MORE. >> GALVAN: EVEN LOOKING AT RETENTION RATES MENTIONED ON SLIDE 8. MORE ABOUT THAT. BUT ALSO THE USER EXPERIENCE TOO FROM RESIDENTS. IF WE SEE ANY DIFFERENTIALS -- THE EXAMPLE ABOUT SAPD AND METRO HEALTH COLLABORATING ON THE DOMESTIC VIOLENCE PORTION. 
          I WOULD BET THAT THAT INCREASED THE OPPORTUNITY FOR INDIVIDUALS TO EXPRESS MORE ABOUT WHAT'S GOING ON IN A SITUATION, PROVIDING MORE DETAILS THAN WHAT IT USED TO BE. UNDERSTANDING THOSE CHANGES, IF WE CAN SEE THAT WITHIN THE DEPARTMENTS THAT HAVE INSTITUTED NEW PRACTICES BASED ON THE TRAUMA-INFORMED CARE AND HOW THAT'S CHANGED THEIR EXPERIENCE WITH OUR RESIDENTS. 
          I WOULD BE INTERESTED IN SEEING IF WE COULD EVALUATE THAT. 
          THOSE ARE ALL MINE. THANK YOU FOR THE WORK YOU ARE DOING AND FOR STRENGTHENING OUR DEPARTMENTS TO BE OF BETTER SERVICE TO OUR EMPLOYEES AS WELL AS TO OUR LARGER COMMUNITY AND MAKE SURE WE'RE ATTACKING THE ROOT OF SOME OF THESE ISSUES AND MAKING SURE WE HAVE A QUALITY WORKPLACE THROUGHOUT THE CITY. ANY LAST COMMENTS OR QUESTIONS? GREAT. ALL RIGHT. MOVING INTO OUR LAST ITEM, NO. 4, THE UPDATED REPORT ON THE IMPACT OF IMMIGRANTS ON SAN ANTONIO'S GROWTH AND 
          ECONOMY. WE HAVE DR. MATA. >> GOOD MORNING, CHAIRMAN GALVAN AND MEMBERS OF THE COMMUNITY HEALTH COMMITTEE. I AM DR. JENNIFER MATA, DIRECTOR OF THE COMPLIANCE OPPORTUNITY AND ACCESS DEPARTMENT . 
          WE ARE HERE TODAY TO PROVIDE A BRIEFING ON IMMIGRANTS IN SAN ANTONIO METRO AREA, OTHERWISE KNOWN AS THE REPORT. 
          I AM JOINED BY CHELSEA WHO WILL PRESENT KEY FINDINGS OF THE 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 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. 
          IN 2025, WE COMMISSIONED THE AMERICAN IMMIGRATION COUNCIL TO UPDATE THE REPORT TO REFLECT POPULATION GROWTH AND DEMOGRAPHIC CHANGES IN OUR METRO AREA . 
          THIS REPORT ALSO FULFILLS THE CITY COUNCIL RESOLUTION ADOPTED ON FEBRUARY 12, 2026 CALLING FOR AN ECONOMIC REPORT ON THE CONTRIBUTIONS AND IMPACT OF IMMIGRANTS ON SAN ANTONIO AND BEXAR COUNTY. WE HOPE THIS BRIEFING PROVIDES YOU WITH AN UNDERSTANDING OF THE IMPACT IMMIGRANTS HAVE IN OUR AREA AND IT CAN BE USED TO SUPPORT ONGOING POLICY AND STRATEGIES TO MAKE SURE 
          [01:15:08]
IMMIGRANTS ARE INCLUDED IN OUR CITY. I WOULD LIKE TO INTRODUCE CHELSEA KRAMER. SHE SERVE AS A TEXAS STATE ORGANIZER AND LEADS THE TEXAS FOR ECONOMIC GROWTH COALITION . CHELSEA. 
          >> 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 UNTIL THE END. 
          SO WHERE ARE WE AT HERE? SO WHO WE ARE. SO THE AMERICAN IMMIGRATION COUNCIL FOCUSES ON RESEARCH, POLICY, AND EDUCATION. SO WE WERE FOUNDED IN 1987. 
          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 IS TO PROVIDE CREDIBLE DATA-DRIVEN INSIGHTS TO INFORM DECISION MAKING AND NOT JUST DEBATE. 
          WE HOPE THIS REPORT IS GOING TO FULFILL THAT FOR Y'ALL AND GIVE YOU A MORE HOLISTIC VIEW OF YOUR COMMUNITY HERE IN SAN ANTONIO. 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. IMPORTANTLY, FOR THE PURPOSE OF THIS REPORT, IT'S IMPORTANT FOR US TO DEFINE HOW WE ARE DEFINING AN IMMIGRANT. 
          WHEN WE SAY "IMMIGRANTS" WE ARE USING A BROADS DEFINITION WHICH INCLUDES NATURALIZED CITIZENS, GREEN CARDHOLDERS, REFUGEES, AND THE UNDOCUMENTED POPULATION. 
          IT'S ANYONE BORN OUT OF THE UNITED STATES TO NON-CITIZEN PARENTS . 
          THIS IS REALLY A FULL PICTURE OF YOUR FOREIGN-BORN POPULATION. 
          WE WANT TO GIVE YOU CLEAR DATA-DRIVEN UNDERSTANDING OF WHO IS CONTRIBUTING TO YOUR ECONOMY HERE, WHERE YOUR GROWTH IS COMING FROM, AND HOW THAT CONNECTS TO THE WORKFORCE AND ECONOMIC DEVELOPMENT CONVERSATIONS. LET'S GET INTO OUR NUMBERS HERE. AS MENTIONED, IN 2023, THERE WERE ABOUT 344,000 IMMIGRANTS LIVING IN SAN ANTONIO METRO AREA. THAT IS ABOUT 12.7% OF YOUR POPULATION. 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 IS AT 14.3%. 
          IT'S ALSO BELOW THE TEXAS, THE STATEWIDE AVERAGE, WHICH IS 17%. 
          I WOULD LIKE TO LEVEL SET HERE, THIS IS NOT A NORTH NICHE POPULATION, OVER 10% ARE IMMIGRANTS AND SO THIS IS A MEANINGFUL PART OF YOUR POPULATION, WHICH IS WHY THESE DISCUSSIONS ARE SO IMPORTANT. ON POPULATION GROWTH. 
          THIS IS WHERE THIS BECOMES VERY, VERY IMPORTANT AND THIS IS WHY WE ARE GATHERED HERE TODAY. THE IMMIGRANT POPULATION GREW FASTER THAN YOUR OVERALL POPULATION. 21.6% OF THAT POPULATION GROWTH IN THE REGION WAS DRIVEN BY IMMIGRANTS. 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 WE'RE SPEAKING ABOUT TODAY AS WELL. SO MOVING ON TO COUNTRIES OF ORIGIN. I DON'T THINK IT'S 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 THIS REFLECTS OBVIOUSLY LONGSTANDING REGIONAL TIES BUT NEW AND EVOLVING MIGRATION PATTERNS THAT WE'RE SEEING ACROSS SAN ANTONIO, TEXAS, AND THE UNITED STATES. 
          SO THIS IS WHERE WE REALLY GET INTO SOME OF THE ECONOMIC IMPACT DATA. 
          SO SPENDING POWER AND TAXES. THIS IS WHERE I THINK THE DATA GETS PROBABLY THE MOST COMPELLING. YOUR IMMIGRANT HOUSEHOLDS GENERATE $12.6 BILLION IN TOTAL INCOME. THAT'S $9.6 BILLION IN SPENDING POWER. 
          AGAIN, THAT'S ONLY HERE IN THE SAN ANTONIO METRO. NEARLY $3 BILLION IN COMBINED FEDERAL, STATE, AND LOCAL TAXES. FROM A BUSINESS PERSPECTIVE, 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 OF WORKING AGE. THIS REFLECTS HOW IMMIGRANT POPULATIONS TEND TO BE YOUNGER. YOUR IMMIGRANTS ARE 78-POINT 
          [01:20:04]
2% OF WORKING AGE . SO CONTRIBUTIONS TO SOCIAL PROGRAMS. HERE IN THE SAN ANTONIO METRO AREA, THAT'S $1.2 BILLION TO SOCIAL SECURITY IN 2023. AND $314 MILLION TO MEDICARE IN 2023. 
          THESE ARE SIGNIFICANT NUMBERS. AGAIN, I JUST WANTED TO HIGHLIGHT THIS IS ONLY 12.7% OF YOUR POPULATION. ACCESS TO HEALTHCARE. 
          THIS IS, I THINK, AN IMPORTANT CONVERSATION TO BE HAVING. 
          YOU'LL SEE THERE'S LARGE DIFFERENCES IN HEALTHCARE COVERAGE BETWEEN IMMIGRANTS AND YOUR U.S.-BORN POPULATIONS. THESE ARE INFLUENCED BY A LOT OF DIFFERENT FACTORS. INDUSTRY OF EMPLOYMENT IS A BIG ONE. 
          ACCESS BARRIERS AS WELL. FOR LOCAL LEADERS, THIS IS LESS ABOUT THE STATISTIC ITSELF AND MORE ABOUT WHERE GAPS EXIST AND Y'ALL THINKING THROUGH HOW TO ADDRESS THEM. YOUR IMMIGRANTS IN YOUR KEY INDUSTRIES HERE IN THE METRO AREA. IMMIGRANTS ARE HEAVILY REPRESENTED IN 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 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. MANUFACTURING JOBS. I WANTED TO NOTE ONE STAT IMPORTANT TO HIGHLIGHT IS THAT IMMIGRANTS HELP 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. THIS IS ABOUT ECONOMIC RETENTION, NOT JUST PARTICIPATION. THAT'S AT THE BOTTOM OF THE SLIDE. I JUST WANTED TO HIGHLIGHT THERE. 
          MOVING ON TO LABOR FORCE. SO WHILE IMMIGRANTS AGAIN ARE ONLY 12.7% OF YOUR POPULATION, 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 LABOR FORCE ARE IMMIGRANTS. THAT SHOWS THEY ARE PUNCHING WELL ABOVE THEIR WEIGHT THERE. THIS IS ESPECIALLY IN SECTORS WHERE EMPLOYERS ARE STRUGGLING TO FIND WORKERS. AGAIN, INDUSTRIES LIKE CONSTRUCTION AND HOSPITALITY THAT WE NOTED AS HAVING A LARGE AMOUNT OF IMMIGRANT EMPLOYEES. ON ENTREPRENEURSHIP, I THINK THIS IS A COMPELLING STAT AS WELL. 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 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 HELPS REINFORCE THAT CONNECTION BETWEEN IMMIGRANT COMMUNITIES AND THE FUTURE OF WORKFORCE DEVELOPMENT. AND ESPECIALLY AS WE'RE THINKING THROUGH WORKFORCE PIPELINES. I THINK WHAT WE'RE SEEING HERE, ESPECIALLY WHEN YOU'RE LOOKING AT THE LESS THAN HIGH SCHOOL EDUCATION, 31.5% OF YOUR IMMIGRANTS DON'T HAVE THAT. THIS IS LESS OF A PROBLEM IN MY EYES AS MORE OF AN OPPORTUNITY. 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 CONTRIBUTING $40 MILLION TO YOUR ECONOMY. SUPPORTING OVER 600 JOBS. 
          FROM A BUSINESS PERSPECTIVE, THEY ARE YOUR FUTURE HIGH-SKILLED WORKERS. 
          THE QUESTION BECOMES HOW ARE YOU ABLE TO RETAIN THEM HERE IN YOUR METRO AREA. 
          YOU DON'T WANT TO EDUCATE THEM HERE AND THEN GO SOMEWHERE ELSE. 
          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 BRIGHTEST TALENT FROM AROUND THE WORLD? YOU MAKE SURE THAT IMMIGRANTS WANT TO COME TO YOUR COMMUNITY, LIVE HERE, STAY HERE, AND BUILD THEIR FAMILIES. 
          WHICH BRINGS US TO HOUSING. 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 IN PROPERTY VALUE. AND OVER $750 MILLION IN ANNUAL RENT. I THINK THIS REALLY HELPS REFLECT THE STABILITY INVESTMENT AND THAT LONG-TERM COMMUNITY PRESENCE THAT THE IMMIGRANTS HAVE HERE IN THE COMMUNITY. MOVING ON TO NATURALIZATION. THIS IS JUST TO HIGHLIGHT 
          [01:25:04]
ANOTHER OPPORTUNITY FOR YOU FOR HERE IN THE CITY. THERE ARE ABOUT 134,000 NATURALIZED CITIZENS WITH ABOUT 51,000 OF THEM ELIGIBLE TO NATURALIZE TODAY. AND SO WE KNOW WHEN INDIVIDUALS DO GO THROUGH THAT NATURALIZATION PROCESS THEIR INCOME INCREASES AND THEIR ECONOMIC PARTICIPATION INCREASES. YOU'RE GOING TO SEE THAT CONSUMER SPENDING GO UP AND THERE'S ALSO A BIG ROI FOR THE COMPANIES THAT EMPLOY NATURALIZED CITIZENS. 
          I THINK IT'S AROUND 9% THAT WE SEE IN INCOME BUMP AFTER SOMEONE NATURALIZES. 
          THESE ARE JUST A COUPLE OF ITEMS TO KEEP IN MIND AS YOU THINK THROUGH DIFFERENT POLICIES AT THE CITY LEVEL. WHEN WE'RE TALKING ABOUT REFUGEES, 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 ECONOMIC CONTRIBUTIONS OVER TIME. SMALL NUMBER COMPARED TO OTHER CITIES IN THE STATE. BUT STILL NOT INSIGNIFICANT. HERE'S A LITTLE BIT MORE REFUGEE DATA. FROM FISCAL YEARS 2021 THROUGH 2024. 
          THIS WOULDN'T SURPRISE ANYONE WHO FOLLOWS THE NEWS, BUT 64% OF THOSE WERE FROM AFGHANISTAN AND THEN ON DOWN THE LINE TO YOUR 3.3% FROM GUATEMALA. 
          THESE INDIVIDUALS ARE ENTERING YOUR COMMUNITIES. THEY'RE JOINING THE WORKFORCE AND THEY'RE CONTRIBUTING AT BOTH THE LOCAL AND STATE LEVEL IN REALTIME. 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 ALSO LISTENING IN, TAKING NOTES THAT ARE A LIAISON WITH OUR RESEARCH TEAM AS WELL. 
          >> GALVAN: THANK YOU SO MUCH. DO WE HAVE ANY QUESTIONS FROM THE COMMUNITY? COUNCILMEMBER ALDERETE GAVITO. 
          CASTILLO. >> CASTILLO: THANK YOU, CHELSEA AND DR. MATA FOR YOUR WORK, LEADERSHIP, AND FOR THE PRESENTATION. MORE COMMENT THAN QUESTION. 
          I THINK IN TERMS OF THE TREND OF THE WORKFORCE AND WHERE WE SEE OUR IMMIGRANT COMMUNITY WORKING IN TERMS OF INDUSTRY. WHEN I SEE CONSTRUCTION, GENERAL SERVICE, MANUFACTURING, HOSPITALITY, I THINK ABOUT THE CULTURAL FABRIC OF THE CITY OF SAN ANTONIO. 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. I REALLY APPRECIATE HOW YOU EMPHASIZE -- TO ME THERE WAS AN EMPHASIS ON OUR FULL COMMUNITY. AND WHEN I LOOK AT WHERE OUR IMMIGRANT NEIGHBORS WORK, IT'S IN THE SAME PLACE HOSPITALITY AND MANUFACTURING. SO APPRECIATE THE DATA AND HOW SPECIFIC YOU ALL GET. APPRECIATE HIGHLIGHTING IN TERMS OF TAXES THAT ARE PAID AND SPENDING WITHIN THE SAN ANTONIO ECONOMY THAT WE'RE SEEING FROM OUR IMMIGRANT COMMUNITY. BUT JUST REALLY APPRECIATE THIS DATA. 
          I THINK IT'S GOING TO BE HELPFUL AS WE DISCUSS READY TO WORK AND ALSO HAVE OUR HOUSING CONVERSATIONS. IN PARTICULARLY, I'M GOING TO GO BACK TO PUBLIC HOUSING BECAUSE WHEN WE LOOK AT THE REFUGEES HERE IN SAN ANTONIO, PARTICULARLY WITHIN OUR AFGHAN COMMUNITY, THEY ARE HOUSED IN PUBLIC HOUSING. 
          IF YOU REMOVE THAT, YOU'RE CREATING AN ISSUE NOT JUST FOR OUR REFUGEE COMMUNITY MEMBERS BUT ALSO OUR COMMUNITY MEMBERS, OUR FULL COMMUNITY, AS YOU STATED. 
          JUST REALLY APPRECIATE THOSE STATISTICS THAT YOU PROVIDED. 
          THANK YOU, CHAIR. >> GALVAN: THANK YOU. COUNCILMEMBER ALDERETE 
          GAVITO. >> GAVITO: THANK YOU, CHAIR. 
          THANK YOU, DR. MATA AND CHELSEA FOR THIS INFORMATION. 
          IT WAS REALLY, REALLY GOOD. I DO ALSO APPRECIATE THE ECONOMIC IMPACT THAT YOU HIGHLIGHTED OF THE IMMIGRANT COMMUNITY IN SAN ANTONIO. I KNOW COUNCILWOMAN CASTILLO HAS DONE A LOT AND I THINK IT JUST EMPHASIZES OUR NEED TO CONTINUE TO PUSH TO MAKE SURE THAT OUR IMMIGRANT NEIGHBORS ARE TAKEN CARE OF, ESPECIALLY RIGHT NOW, BECAUSE IT IS SUCH A TRICKY TIME. I THINK ONE OF THE INTERESTING THINGS WAS APPRECIATED THE STAT ABOUT 24.4% OF THEM BEING ENTREPRENEURS. THEY ARE CREATING JOBS HERE AND SO IT'S AN IMPORTANT STEP FOR US TO KNOW AND HIGHLIGHT. SO, YOU KNOW, I THOUGHT -- NO QUESTIONS. I THOUGHT ALL OF THIS INFORMATION WAS GREAT BUT DEFINITELY APPRECIATE THE LENS OF SHOWING THE ECONOMIC IMPACT THEY HAVE IN SAN ANTONIO. AND ALSO IN TERMS OF OUR WORKFORCE, OUR POPULATION. 
          I MEAN, IF SAN ANTONIO WANTS TO CONTINUE TO GO TO THE NEXT LEVEL, THE IMMIGRANT 
          [01:30:03]
COMMUNITY IS SO MUCH A PART OF OUR CITY'S SUCCESS. REALLY APPRECIATE IT. 
          THANK YOU. >> YEAH. ABSOLUTELY. 
          WE LIVE IN A GLOBAL COMMUNITY NOW AND EVERYONE IS VYING FOR THAT TALENT AND THAT WORKFORCE. SO YOU'RE COMPETING AGAINST ALL OF YOUR SISTER CITIES, YOUR NEIGHBORS, AND OTHER STATES. THAT'S WHY THESE DISCUSSIONS ARE SO IMPORTANT SO WE HAVE A BETTER, MORE FULL UNDERSTANDING. 
          >> GALVAN: THANK YOU. THANK YOU AGAIN FOR THE PRESENTATION. 
          ALWAYS GRATEFUL TO SEE THIS ONGOING WORK WE HAVE BEEN DOING FOR YEARS AND LOOKING AT HOW OUR FULL COMMUNITY IS IMPACTING OUR LARGER ECONOMY. 
          ONE THING I WANT TO NOTE IS IT'S UNFORTUNATE THAT THERE'S CONVERSATIONS OR COMMENTS MADE IN GENERAL ABOUT WHO'S DESERVING OF WHAT KIND OF CARE AND WHO IS DESERVING OF BEING A PART OF OUR LARGER COMMUNITY. WHAT I ALWAYS THINK ABOUT -- AND I THINK WE KNOW THIS, BUT SLIDES 11 THROUGH 13 TALK ABOUT HOW IMMIGRANTS IN OUR COMMUNITY MORE OFTEN THAN NOT CONTRIBUTE MORE TO PROGRAMS THAT AMERICAN CITIZENS USE THAN THEY DO THEMSELVES. I THINK THAT'S ALWAYS AN IMPORTANT NOTE TO MAKE THERE WHEN WE LOOK AT THE HEALTHCARE COMPONENT, IN PARTICULAR. WE'RE SEEING VERY CLEARLY, WHETHER IT'S IN PRIVATE OR PUBLIC CARE, THAT IMMIGRANTS WHO ARE PAYING INTO IT OFTEN DO NOT RECEIVE THE BENEFITS AT ALL. THAT'S SOMETHING -- THERE'S DIFFERENT DEBATE ON THAT BUT ONE THING IS CLEAR, WHEN MORE FOLKS ARE SICK, MORE FOLKS ALSO GET SICK AS WELL. 
          DISEASE SPREADS THROUGH PEOPLE NOT BEING ABLE TO ACCESS CARE. 
          WHEN THERE'S FEAR OF NOT BEING ABLE TO ACCESS CARE, NOT BEING ABLE TO GO TO SCHOOL, JOIN THE WORKFORCE, ET CETERA. WHEN THERE'S FEAR, MISTREATMENT, UNREPORTED MISTREATMENT, BECAUSE IF YOU'RE REPORTING IT, IT'S WORSE FOR EVERYBODY. THIS IS A QUESTION I THINK FOR BOTH CHELSEA AND DR. MATA. YOU TALKED A BIT ABOUT HOW THE OFFICE OF IMMIGRATION AFFAIRS WORKS TO ASSIST OUR COMMUNITY AND HOW THAT HAS CHANGED OVER TIME. 
          PARTICULARLY, WHAT KIND OF BARRIERS ARE THERE? >> THANK YOU FOR THE QUESTION, COUNCILMAN . 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 INCLUDE IMMIGRANTS IN OUR CITY SERVICES. WE ALSO HAVE A CALL-IN LINE WHERE IMMIGRANTS WHO ARE SEEKING HELP CAN CALL IN AND WE 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 RELATIONSHIPS WITH THE LOCAL CONSULATES, ESPECIALLY THE CONSULATE OF MEXICO. COULD YOU REPEAT SOME OF THE 
          QUESTION? >> GALVAN: JUST TALKING ABOUT HOW WE HELP FOLKS SETTLE WHO ARE ALREADY HERE, MAKE SURE THEY ARE PLUGGED INTO EDUCATION OR HEALTHCARE RESOURCES. AND WHAT ARE THE BARRIERS TOO? I THINK A LOT ABOUT THE REFUGEE COMMUNITY WHEN WE TALK ABOUT -- I THINK WE HAD A PRESENTATION HERE A COUPLE OF YEARS AGO WHEN WE TALKED ABOUT AFGHANISTAN FROM THE 
          WAR THEN AND BARRIERS TO HELP FOLKS SETTLE. >> RIGHT. 
          I THINK SOME OF THE BARRIERS WE HAVE SEEN IS NOT KNOWING THAT CITY 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 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 THE COMMUNITY, IMMIGRANTS ARE SEEKING SUPPORT FROM MANY DIFFERENT ORGANIZATIONS. SO WE ARE THERE TO HELP THEM FIND THAT SUPPORT. I THINK THAT'S THE BIGGEST ONE RIGHT NOW IS HELPING IMMIGRANTS FIND THOSE SUPPORT SERVICES THAT THEY NEED. 
          >> GALVAN: THANK YOU FOR THAT. THAT'S HELPFUL. 
          I THINK ONE LAST THING -- I DON'T KNOW IF THIS WAS EVALUATED WITH THIS STUDY OR ECONOMIC DEVELOPMENT , BUT WHEN CHANGES TO OUR STATE AND FEDERAL ACTIONS TAKE PLACE DO WE SEE IMPACTS TO OUR ECONOMY IN TERMS OF CONSTRUCTION AND HOUSING? DO WE SEE AN IMPACT RELATED TO THAT? . 
          >> I CAN SPEAK TO THE TRENDS HAPPENING STATEWIDE AND A LOT OF THE DISCUSSIONS HAPPENING IN BACK ROOMS OF MANY MEMBERS OF CONGRESS OFFICES AND STATE LEADERS AS WELL. 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 OR THEY'RE FEARING GOING TO A HOME DEPOT TO GO SHOPPING. 
          JUST BECAUSE THEY MIGHT BE PROFILED AND THEIR DAY DISRUPTED OR IF THEY ARE AN 
          [01:35:04]
UNDOCUMENTED IMMIGRANT, THEY WOULD BE DETAINED. WE'RE SEEING THOSE ECONOMIC IMPACTS HAPPENING ESPECIALLY IN THE SOUTHERN PART OF THE STATE AND IT'S STARTING TO BLEED UP. WE KNOW THAT THE GOVERNOR HAS INVITED FOLKS TO 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. I DON'T HAVE SPECIFIC NUMBERS FOR HERE IN SAN ANTONIO BUT IF IT'S IMPACTING ONE COMMUNITY, YOU KNOW IT'S GOING TO EVENTUALLY IMPACT ANOTHER. AND I THINK IT MORE SPEAKS TO ARE YOU MAKING SURE THAT YOUR COMMUNITY IS WELCOMING AND ATTRACTING TALENT OF ALL TYPES. 
          BECAUSE EVEN IF THERE IS ENFORCEMENT-ONLY POLICY THAT IS POTENTIALLY ANTI-IMMIGRANT AND EVEN THOUGH YOU MAY THINK IT'S ONLY FOCUSED ON THE UNDOCUMENTED POPULATION OR REFUGEES OR WHATEVER POPULATION YOU THROW IN THERE, IT IS ALSO GOING TO NEGATIVELY IMPACT YOUR LEGAL IMMIGRATION AS WELL. 
          YOUR HIGH-SKILLED TALENT LIKE YOUR DOCTORS, YOUR DENTISTS, YOUR LAWYERS, YOUR RESEARCHERS. THE FOLKS THAT YOU WANT IN THOSE HIGH-PAYING JOBS TO HELP DEVELOP MORE JOBS UNDERNEATH THEM AS WELL. I THINK IT'S IMPORTANT TO 
          THINK OF IT THROUGH THAT LENS TOO. >> GALVAN: THANK YOU FOR THAT. THAT'S HELPFUL. IT'S JUST A GENERAL QUESTION AS WE'RE LOOKING AT WHERE IMMIGRANTS ARE REALLY STRIVING IN DIFFERENT ECONOMIC SECTORS, HOW THAT CAN IMPACT US. WE SEE LAWS CHANGE, EVEN IN HEALTHCARE. THAT WAS THE LAST POINT THERE. 
          ANY COMMENTS OR QUESTIONS FROM MY COLLEAGUES? THANK YOU SO MUCH FOR THE PRESENTATIONS. THANK YOU TO EVERYBODY WHO PRESENTED TODAY. 
          AT 11:39 A.M., THE COMMUNITY HEALTH COMMITTEE WILL COME TO A CLOSE AND OFFICIALLY
* This transcript was compiled from uncorrected Closed Captioning.