Bexar County has shifted duty for jail consumption psychological well being and substance use screenings from the Middle for Well being Care Companies to College Well being, ending a six-year contract and consolidating medical and behavioral well being assessments underneath one supplier for the primary time because the Justice Consumption and Evaluation Annex opened in late 2018.
Earlier than the change, CHCS carried out psychological well being screenings and College Well being oversaw medical consumption inside the ability. As soon as detainees had been transferred into the jail, College Well being assumed duty for each medical and behavioral well being remedy.
In October 2023, Bexar County’s Workplace of Prison Justice commissioned a examine by the College of Texas Well being Science Middle at Houston to guage how effectively the annex processed detainees and diverted people with behavioral well being or substance use wants into remedy packages.
The examine, led by Dr. Alexander Testa, introduced its findings in February, it discovered fragmented communication, inconsistent information sharing and overlapping duties among the many a number of companies working contained in the annex.
Primarily based on the findings Testa and his group beneficial consolidating screening and remedy underneath one supplier or, alternatively, establishing a coordinated course of that integrates behavioral well being assessments into the medical consumption already carried out by College Well being.
After reviewing the suggestions, Bexar County’s Division of Public Well being started exploring methods to deal with suggestions and strengthen the county’s diversion efforts.
“We had been considering, what does that imply for the suppliers which can be there?” stated Bexar County Public Well being Director Dr. Andrea Guerrero. “College Well being offers the bodily companies within the JIAA, however additionally they are the psychological well being suppliers as soon as somebody strikes over to the jail. College Well being is current and might carry out each the medical and behavioral well being items, however CHCS can not carry out each roles, and so the logical conclusion was that College Well being can be higher suited to supply each capabilities.”
Bexar County Public Well being started making its advice to vary suppliers to the county in August earlier than it was accredited for the 2026 fiscal 12 months finances on Sept. 9.
College Well being President and CEO Edward Banos described the change as a part of a broader effort to enhance continuity of care.
“I see this as a possibility the place we do see that there’s a higher continuity of care within the sense that we’re going to do these assessments on consumption after which in the event that they do want required psychiatric companies, they’ll both get that offered by us within the jail or go to a different applicable facility,” Banos stated. ”However after they do come again to the jail, it’s all going to be on one medical file.”
Banos stated conversations with the county in regards to the potential transition started months earlier than the contract change, when officers reached out to find out whether or not College Well being might take over consumption companies if the prevailing settlement with CHCS was not renewed.
The change, nevertheless, got here as a shock for CHCS after years of operating the annex’s psychological well being screenings, stated CHCS President and CEO Jelynne LeBlanc Jamison.
The native psychological well being authority contracted by the state didn’t know a change in supplier was being thought-about.
“We had been conscious that Dr. Testa from the College of Texas College of Public Well being at Houston carried out this analysis of the operations on the JIAA, and for months we engaged Bexar County to attempt to perceive what the findings had been and the way they had been going to reply,” stated Jamison. “A lot to our shock, we had been notified the day earlier than the county went to Commissioners Court docket to advocate that they contract with College Well being for JIAA evaluation companies.”
Jamison stated CHCS reviewed the report after discovering a replica on-line and invited Testa to current his findings to the company’s board after the change in contract had been introduced.
“He referenced that within the JIAA there’s no systemic course of, there’s no apparent the first step or step two, individuals are moved round based mostly on availability and there’s no complete system for individuals to be processed,” she stated. “After he shared that, our board agreed with the advice that I made to them that, you recognize, Bexar County has quite a bit to repair and it’s in all probability okay that we’re not there.”
CHCS ended its position within the annex on Sept. 30, the ultimate day of its contract; all however two workers members had been reassigned to different packages. College Well being started conducting screenings on Oct. 1. With no transitional interval in place, Bexar Public Well being assisted in staffing the annex as College Well being educated 11 new positions.
“CHCS left. They weren’t serving to out within the transition. They only left. However Dr. Guerrero and her workers on the county, actually helped,” Banos stated. “They had been dedicated to creating certain that we now have all of the workers up and operating. I’d say, kudos to the county for selecting up a contract that appeared to have ended moderately abruptly.”
Banos stated College Well being is predicted to take over staffing absolutely by Nov. 10.
Guerrero stated the choice to consolidate screenings was mentioned with each companies previous to the finances approval. “We knowledgeable CHCS previous to the primary court docket date the place we made the primary presentation in August,“ she stated.
She emphasised that CHCS stays a crucial associate within the county’s behavioral well being community.
“We nonetheless worth CHCS as a associate — they’re the native psychological well being authority, which by statute fills a really important position in offering care to the neighborhood,” Guerrero-Guajardo stated. “Psychological well being assessments on the JIAA are the one portion of that contract that has been transitioned over to College Well being, particularly to streamline that course of and enhance diversions.”
CHCS continues to function different psychological well being packages for the county, together with the jail-based competency restoration initiative and assisted outpatient remedy for the courts. Jamison stated CHCS will proceed specializing in these efforts in addition to increasing diversion choices outdoors the jail.
“We proceed to supply all the outpatient companies that we had been offering earlier than,” she stated. “I’ve had some very profitable and optimistic conversations with the neighborhood in regards to the want for a diversion middle and a number of assist for asking the board of managers at UH to think about making a psychiatric hospital a precedence for Bexar County. So I’m hopeful that these conversations will proceed.”
Whereas Jamison acknowledged the county’s intent to streamline operations on the annex, she questioned whether or not a change in supplier would deal with structural points recognized within the UTHealth examine.
“I feel they’re viewing the truth that we’re not there as streamlining the method, however I feel we’ll simply have to attend to see if that’s truly taking place,” she stated. “In the event that they don’t deal with the expertise and software program upgrades, in the event that they don’t deal with the staffing, in the event that they don’t deal with the management in control of that facility and the coordination required, then none of it should matter. It actually received’t matter.”
