Southwest Texas Crisis Collaborative

The Southwest Texas Crisis Collaborative (STCC) is an effort focused on ending ineffective utilization of services for the safety net population at the intersection of mental illness, homelessness, and high utilization in Southwest Texas. STCC is committed to improvement by developing a comprehensive, integrated crisis system across all major public payors, hospital providers, philanthropy, public safety (Fire/EMS and Law Enforcement) and behavioral health providers.

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STCC Programs

Patients who are placed into emergency detention by law enforcement for their acute psychiatric needs and are medically stable are navigated to the appropriate psychiatric facility versus area emergency departments. This system change has decompressed local emergency departments, where psychiatric patients were often boarded for hours awaiting a more appropriate facility. All behavioral health facilities with inpatient beds are reporting their diversion status, and MEDCOM, a 24/7 dispatch center currently routing all trauma patients in the region, is now routing medically stable psychiatric patients to an appropriate facility.

The Psychiatric Emergency Services System of Care (PES) was created to provide a safe environment for adult mental health patients presenting to acute care emergency departments who require timely mental health evaluations. The purpose is to decompress the overcrowding of mental health patients in emergency departments. Patients at PES can stay up to 48 hours and the PES facility provides immediate psychiatric evaluations, clinical assessments, and linkage to the next appropriate level of care. The model not only creates the opportunity to provide PES beds at a facility within Bexar County but is intended to enhance access to outpatient services at the Local Mental Health Authority, the Center for Health Care Services (CHCS).

Combining the efforts of the PES System of Care and Law Enforcement Navigation, Southwest Texas Regional Advisory Council (STRAC) and The Center for Health Care Services (CHCS) have embedded licensed clinicians in MEDCOM 24/7 to assist in facilitating interfacility transfer requests to the identified contracted bed facilities. The MEDCOM Clinician can assist in determining whether the patient would benefit from PES, inpatient treatment, or potentially avoid admission all together and be connected back to an assigned treatment team for follow up. All Contract Beds in Bexar County are managed by the MEDCOM Clinician through a standardized process called Contract Bed Navigation. The goal of Contract Bed Navigation is to quickly and efficiently move patients to the best location for their stabilization and ongoing care.

The Program for Intensive Care Coordination (PICC) is a collaborative program with the San Antonio Police Department (SAPD) Mental Health Unit, San Antonio Fire Department (SAFD) Mobile Integrated Health and the Center for Health Care Services (CHCS) aimed at reducing Emergency Detention Orders (EDO’s). By focusing on persons identified as high utilizers (6 or more EDOs in a 12-month period) we aim to reduce the utilization and impact on 911 and hospital systems by addressing psychiatric and social needs through intensive case management and collaboration with the community thereby reducing the need for emergency services.

A multidisciplinary team comprised of the San Antonio Fire Department (SAFD), San Antonio Police Department (SAPD), and The Center for Healthcare Services (CHCS) that responds to mental health related 911 calls in the San Antonio Police Department Central service area. The goal of the response is to provide the least restrictive method of resolving the crisis. This team routinely provides resources and follow-up services to the community in lieu of transporting them to a facility, however the option of transportation is an option if a higher level of care if deemed necessary.

SMART multidisciplinary response team comprised of the Bexar County Sherriff’s Office (BCSO), multiple Bexar County EMS Providers and The Center for Healthcare Services (CHCS) that responds to mental health related 911 calls in Bexar County. The goal of the response is to provide the least restrictive method of resolving the crisis. This team routinely provides resources and follow-up services to the community in lieu of transporting them to a facility, however the option of transportation is an option if a higher level of care if deemed necessary.

An overnight medical clinic located on the Haven for Hope campus which is staffed by San Antonio Fire Department EMS Mobile Integrated Healthcare. The primary goal of this clinic is to provide medical support onsite, and when applicable, preventing the transport to a local hospital, and enhancing continuity of care by directly referring to CentroMed, San Antonio’s Federally Qualified Health Center which has a daytime clinic, located on the campus of Haven for Hope.

Since 1963 Crosspoint has been providing outpatient and residential services to primarily veteran and justice involved Bexar County residents. In 2018, Crosspoint opened a behavioral health program that provides transitional living support services for men and women with behavioral health and/or substance use disorders, in need of post-crisis stabilization. Residents residing at Crosspoint can receive up to 120 days of services and outpatient treatment services are provided onsite that include psychiatric care, employment services, group and individual counseling, and case management to residents.

The Southwest Texas Regional Advisory Council (STRAC) MEDCOM hosts the Domestic Violence Navigation service line 24/7 to ensure the correspondence from law enforcement to victim advocacy is established upon identification of a high-risk lethality case due to domestic violence. The navigation line increases the utilization of evidence-based lethality tools used by law enforcement and healthcare providers, and follow-up services are provided to victims of domestic violence by Bexar County Sheriff’s Office (BCSO) Crime Victim Advocates, the City of San Antonio (COSA) Violence Prevention Case Managers, and/or Family Violence Prevention Services (FVPS).

Through the Psychiatric Emergency Services System of Care (PES), the Southwest Texas Regional Advisory Council (STRAC) and The Center for Health Care Services (CHCS) have also embedded Hospital Liaisons at the PES facilities that provide aggressive referral, linkage, and transition to the next level of care, in partnership with PES facilities and MEDCOM Clinicians. Included is a Transitional Liaison who conducts post-discharge engagement services and provides interim case management until the patients’ first follow-up appointment post-discharge.

In an effort to create a structure to enable robust data sharing, certain STRAC covered entities members have elected to form an Organized Health Care Arrangement (OHCA) pursuant to HIPAA. Covered entities which have executed an OHCA Participation Agreement and Business Associate Agreement, may share information through the OHCA in support and in furtherance of designated specific community-health focused initiatives.


Signatories as of 2022:

  • Southwest Texas Regional Advisory Council
  • Bexar County Hospital District
  • Methodist Health Care System of San Antonio
  • Christus Santa Rosa Health SystemBaptist Health System
  • Methodist Healthcare Ministries of South Texas
  • San Antonio State Hospital
  • San Antonio Behavioral Healthcare Hospital
  • San Antonio Council on Alcohol and Drug Awareness
  • The Center for Health Care Services
  • CentroMed
  • The City of San Antonio
  • Alamo Area Council of Governments
  • University of Texas Health San Antonio
  • New Season
  • Clarity Child Guidance Center
  • Acadian Ambulance Service
  • Bexar County ESD No. 2
  • Bexar County ESD No. 7

Committees and Workgroups

Behavioral Health Committee
Chair: Dr. Sally Taylor, MD
Meets: Second Wednesday, Monthly
10:00AM - 12:00PM
Behavioral Health Medical Directors Roundtable
Co-Chairs: Jason Miller, MD
Rene Olvera, MD
Meets: Quarterly
6:30PM - 8:00PM
Benefits Specialist Tiger Team
Chair: Steve Dane
Meets: Third Tuesday, Monthly
2:00PM - 3:00PM
Child and Adolescent Mental Health Tiger Team
Chair: Brad Benoit, MSHCM
Meets: Third Thursday, Monthly
9:00AM - 10:00AM
Foster Care Stakeholders
Chair: Jessica Knudsen, LCSW, FACHE
Meets: First Tuesday, Monthly
11:00AM - 12:00PM
Intellectual and Development Disability-Mental Health Tiger Team
Co-Chairs: Virginia Charles, M.Ed., LPC-S
Justin Botter, M.Ed.
Meets: Third Wednesday, Monthly
2:00PM - 3:00PM
OHCA Advisory Board
Chair: Eric Epley, EMT-P
Meets: Quarterly
STCC Steering Committee
Chair: Eric Epley, EMT-P
Meets: Second Wednesday, Monthly
8:00AM - 9:30AM
Substance Use Tiger Team
Co-Chairs: Gilbert Gonzales
Jessie Higgins, MA, LPC, LMFT
Meets: First Tuesday, Monthly
3:00PM - 4:30PM

STCC Resources

TitleCategoriesCreation DateLinkhf:doc_categories
PI Case Review FormSeptember 1, 2023form
STCC White PaperJune 19, 2023quick-reference
STCC Partner OrganizationsJune 19, 2023quick-reference
Integrated System of CareJune 16, 2023quick-reference
LMHA Services within STRAC RegionDecember 11, 2017map
Alameda County PES ResearchApril 26, 2017study
Bexar County Mental Health ReportSeptember 1, 2016study
Trinity Study: Healthcare for HomelessDecember 2, 2015study