In this spotlight series, meet members doing great work to improve the health and well-being of communities across the country. They'll offer insight into their efforts to partner with health care, address the social determinants of health, and more.

Mary E. Garr
President and CEO
Family Service
San Antonio, TX 

Mary Garr is an experienced leader with three decades of diverse roles in several industries including health care, city management, nonprofits, and the military. She is the president and CEO of Family Service where she leads the organization in providing a broad array of services that empower individuals, transform families, and strengthens the health of communities by addressing the social determinants of health, which directly impact peoples’ lives based on where they live, learn, work, play, and age.

Learn more about the process Family Service went through to reframe its organizational culture and services through the lens of the social determinants of health in this webinar Sept. 16 from 2-3 p.m. CT.

Tell us about your community and the populations you serve?

We serve in 14 counties across Texas, the largest one being Bexar County and the city of San Antonio, which is the 7th largest city in the United States. Although a growing city and considered one of the best places to live in, San Antonio has been labeled the most economically segregated city in America, and has the highest poverty rate out of the 25 largest metropolitan areas. It is majority Hispanic due to its proximity to the border, with strong bicultural and business ties to Mexico and influences throughout Latin America. Approximately, one in five people live in poverty. Educational attainment is also low compared to other metropolitan areas, leading to challenges in income and asset building. San Antonio also has high rates of obesity, diabetes, and other health morbidities, all tied to barriers caused by social determinants of health factors that affect quality of life, health, and mortality rates.

Family Service provides programs and services for individuals and families, babies to older adults. In 2019, it served almost 80% Hispanic, reflecting the communities in which we primarily work, 11% Anglo, and 8% African American. Over 80% of our clients earn less than $25,000, almost half earn less than $10,000, and 30% earn less than $5,000.

How long have you been working to improve the health and well-being in communities through your health impact work? How has your work evolved over time?

Family Service started in 1903, at that point in time, working to provide financial assistance to those in need. Over the decades, it has evolved to meet the needs of the communities it serves in, resulting in Family Service organically evolving to address social determinants of health, without realizing at the time that it was doing so. It added in behavioral health services after WWII, social and community support services in the 1970s, education services and supports in the 1990s and 2000s, and other economic stability programs in the 2000s, along with neighborhood supports. Family Service has also been serving in multiple rural counties for over 20 years, where resources are scarcer than in a large metropolitan area.

Our focus now is specifically to address the impacts that barriers caused by social determinants of health and adverse childhood experiences have on peoples’ lives, and we work to break the intergenerational cycles of poverty, family violence and dysfunctionality, lack of educational attainment and life potential, so that we can help individuals and their families move forward in transforming their lives, achieve life success, and thus strengthen their health and the health of their communities.

We have been addressing social equity issues from the beginning. And through our participation in the Alliance's social equity learning opportunities and our involvement in both the United Way and the San Antonio Area Foundation's Advancing Equity initiatives, we have enabled our agency to keep social equity at the forefront of our services in addressing social equity and inequality in our community. Our participation in the Change in Mind Institute of the Alliance for Strong Families and Communities, the Robert Woods Johnson Foundation, and the Palix Foundation was essential in our agency's implementation of best practices in applying trauma-informed care and neuroscience within our agency services.

What are you most proud of?

We are proud that we are a deep-rooted, trusted agent in the communities in which we serve, and that we are known for improving lives, providing respect and dignity without judgment, and that we are a partner of choice for many other public and private organizations desiring to collaborate in this work. We are in this for the long game because we know change is generational, not short term.

We are proud of our long-term strategy and dedication to our community by addressing the social determinants of health. Our Social Determinants of Health Framework, mirrored from Healthy People, includes economic stability, education, health & health care, neighborhood supports, and social & community engagement. The Social Determinants of Health Framework allowed us to provide a narrative for our programs and their impacts on the communities we serve. It also enabled us to better implement trauma-informed care, neuroscience, and adverse childhood experiences into every facet of our work, only improving how we serve our communities.

We have continued our work on integrating the social determinants of health and trauma-informed care into our community. Family Service is a charter member of the South Texas Trauma-Informed Care Consortium (STTICC), and we head the Family Support Services group. Through our work with STTICC, and other community partners, we are creating a comprehensive trauma-informed community for children, families, and providers through education, outreach, and training. We are also working with the San Antonio Health Advisory Board to create a Social Determinants of Health Consortium to break down community silos and create more comprehensive approaches to addressing barriers caused by social determinants of health in our communities.

What is your number one challenge in efforts to partner with health care?

We struggle with the misaligned funding incentives in our country that fund direct healthcare systems which are addressing the impact of downstream health and that do not appreciate or understand the role of social services organizations that are truly a part of the healthcare spectrum, specifically, upstream health. We need more investment up front to prevent, reduce, mitigate, or eliminate health problems caused by social determinants of health barriers, and those investments should not be given to the hospital systems that are now trying to create ways to obtain funding to address them. They would be better served to partner with organizations that work closely with populations with the high chronic healthcare issues that are affected by the social determinants of health. Healthcare funds should be looked at to include both upstream and downstream funding, not as two separate silos that do not cross.

How has COVID-19 affected your work to improve health and well-being?

We have continued to provide all of our services and programs this entire time. We did have to pivot some programs to online platforms, e.g. our school-based Head Start programs became online classrooms, and we added telehealth options for our behavioral health programs. We also moved some of our other programs to online platforms. We started telephone check-ins and supports as well. However, we never dropped below providing one-third of our programs face-to-face, as we had many clients who did not have online access or were otherwise unable to access our services online. Some of our programs, e.g. our Seniors (Older Adults) Program, and our supervised visitations and neutral exchanges (KidShare), required office-based and in-home services, following all safety guidelines. In some of our programs, we had to focus on addressing immediate needs that became urgent due to job losses or reduced work hours of clients, but we have continued to provide the long-term supports and sustainability that our clients need for the long term, which is the reason why they came to us in the first place.

How do you measure the impact your organization makes on the health and well being of your community?

Family Service is assessing the social determinants of health at the point of intake for each client. Integrating the social determinants of health and adverse childhood experiences questions into our client intake has not only allowed us to better serve clients’ immediate and long-term needs, it also allowed us to create an individualized case management plan for their specific situations with a trauma-informed care lens. Year one, Family Service will be measuring the number of referrals and successful linkages clients are receiving to multiple services, both internal and external, to needed resources that go further to ensure clients are accessing services that address their identified social determinants of health and stabilize their well-being. Year two, Family Service will begin measuring clients’ journeys through services and positive impacts of change that influence longer-term stabilization and success.

Family Service’s commitment and investment in measuring success is demonstrated through our integration into community efforts for tracking data and impact; we are an essential member of several collaboratives in San Antonio working to impact many of the community-level health indicators. Family Service is a member of SA2020 which measures our community's results on 36 measures in 11 focus areas including education, family violence, housing, health, economy, etc. We are a member of three United Way Impact Councils that are each addressing specific measures in our community based on safe, stable families & social equity, quality early childhood education, and successful students. Within the Successful Student Impact Council, in collaboration with our fellow issue council members, Family Service is measuring the impacts of our own youth service programs to demonstrate impacts upon our youth participants' attendance, grades, behaviors, timely graduation, and college readiness for comparison and analysis to our community's levels for the same measurements. Within the Ready Children's Impact Council, in collaboration with our fellow issue council members, Family Service is providing services to improve young children's social-emotional learning status, kindergarten readiness, and parental involvement in their development of early literacy skills, including measuring our client changes as well as monitoring our community equity, diversity, and inclusion scores, measuring kindergarten readiness scores, and early literacy.

The overall health and well-being of our community should be a joint effort across sectors. By assessing the different social determinants of health and individuals’ barriers and opportunities affecting their quality of life, health, and life potential, our private and public organizations can work together to address the challenges of our community. 

Join the Health Alliance Peer Exchange Group

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Download New Report on Member Partnerships with Health Care

The Alliance recently released a new report that sheds light on the scope, benefits, and challenges of partnerships between health care entities and organizations in the Alliance network. This report is based on a comprehensive request for information (RFI) conducted by the Alliance in 2019 to gain insight on how to support collaboration between health care and community-based human services organizations. Download the executive summary or full report.