Center for Hope: A Haven in San Antonio

Today (July 31), after an absence of three years, I had the privilege to become reacquainted with the outstanding Center for Hope programs in Bexar County, Texas. The brand new name for the Bexar County programs adopted just a day before my arrival—Center for Hope—seems highly appropriate for the wonderful work being undertaken in San Antonio.

Bexar County and the city of San Antonio have very important, large-scale goals: to create opportunities so that homeless persons can have a full life in the community; to help persons with mental health and substance use conditions avoid inappropriate criminal justice incarcerations; and to provide essential health services to adults with serious mental illness. The Haven for Hope for homeless persons, the behavioral health program for local law enforcement agencies, and the new, integrated, behavioral health-primary care program are models of excellence. Each has developed considerably since my last visit.

The Bexar County programs have anticipated several current national trends: the integration of mental health and substance use services; the integration of behavioral health and primary care; and the integration of behavioral health and primary care into police operations and into programs for homeless persons. We can learn a great deal from these Bexar County programs as we implement these same changes elsewhere.

All of these programs are preparing Bexar County for the upcoming implementation of the Affordable Care Act (ACA). Although the state of Texas has not yet made the decision to implement the optional ACA Medicaid Expansion, all Texas citizens between 100 and 133% of the Federal Poverty Level (FPL) will be eligible for health insurance under the Texas Affordable Insurance Marketplace beginning on January 1, with federal tax subsidies and reduced co-pays and deductibles. Importantly, many persons served by the Center for Hope will be eligible for this health insurance. The programs these newly insured persons will need already are in place and are available to serve them.

The Haven for Hope is a nationally-acclaimed, innovative program intended to return homeless persons to a full life in the community. The program has a very large capacity to support overnight accommodations either out-of-doors in a protected area or indoors. Meals are provided, including box lunches for those homeless persons who go out and work. Mental health and substance use services have been integrated into the program, and a primary care service facility is currently being added. Uniquely, job training is available on site, and longer-term residential arrangements are available nearby. Special programs also are available for homeless military veterans.

The county also operates a very successful jail diversion program for persons with mental health and substance use conditions. All twelve police authorities in Bexar County participate in the program. A hallmark of the program is Crisis Intervention Training (CIT) provided to all local police; this training has become nationally acclaimed, and is now offered to police personnel from throughout the United States. Like the Haven for Hope, a major purpose of the program is to engage participants in appropriate behavioral health care so that they can regain their lives in the community and not recidivate.

In 2012, the Center won the very first Healthcare Innovation Challenge Grant ever awarded by the federal Centers for Medicare and Medicaid Services (CMS). The purpose of the grant is to make primary care available to adults with serious mental illness, and to track the outcomes being achieved through this effort. Almost needless to say, the entire behavioral healthcare field is very proud of this achievement by the Center for Hope in a very difficult field of competition.

If you have the opportunity, please do visit the Center for Hope. I know that you will be as impressed as I was by all the amazing things being developed by Bexar County. The Riverwalk definitely is not the only thing to see in San Antonio!      

Our hats are off to Leon Evans, the Director of the Center for Hope, and to his wonderful staff. They are a precious national resource for behavioral healthcare.