SAN ANTONIO  - Even though San Antonio is the nation's seventh largest city, CHRISTUS Children's assessments about six years ago indicated that families were often having to leave the metropolitan area to obtain vital pediatric specialty care for their kids.

Since identifying the dearth of these services as a pressing concern, CHRISTUS Children's has been implementing a strategic plan to grow six focus areas that it calls its pillars of excellence and to build up related multidisciplinary teams and wraparound services. In recent years, the hospital also has been finding ways to share its expertise with other hospitals — particularly those in rural areas — to further improve care access.

The result is that more San Antonio, and South and Central Texas kids and their families have been able to obtain the services they need close to home, according to Cris Daskevich, CEO of CHRISTUS Children's and senior vice president of pediatric and maternal services for CHRISTUS Health. She says that for the women's and children's hospital, "it is about being a leader and having the courage as an institution to invest in the people and programs that are necessary in providing accessible, comprehensive care."

She says that in San Antonio and South Texas "no one else has invested and created access to pediatric subspecialty and high-risk maternal care like CHRISTUS Children's. No one has built near the network that we have."

Daskevich shared her insights on CHRISTUS Children's growth during a breakout panel at the 2025 American Hospital Association Rural Health Care Leadership Conference last month in San Antonio and during a follow-up interview with Catholic Health World.

Growing population, lagging pediatric specialty services
CHRISTUS Children's is part of CHRISTUS Health, which traces its roots to the 1869 founding of the Santa Rosa Infirmary in downtown San Antonio by the Sisters of Charity of the Incarnate Word. CHRISTUS Health operates more than 60 acute care hospitals, with 10 located across Central and South Texas.

CHRISTUS Santa Rosa Ministry established the Children's Hospital of San Antonio as a free-standing pediatric hospital in 2012, and Daskevich joined as CEO in 2018. The facility was rebranded as CHRISTUS Children's in 2023 "to better reflect its network of comprehensive maternal and pediatric services," says Daskevich.

Currently CHRISTUS Children's encompasses the flagship pediatric medical center in downtown San Antonio and a network of freestanding emergency centers; multispecialty, maternal and pediatric clinics; outpatient rehabilitation centers; and mobile clinics.

Daskevich says CHRISTUS Children's developed and implemented its strategic expansion plan around 2020 after recognizing that there had been significant population growth in San Antonio and surrounding communities, but that pediatric specialty care services had not kept up with the increase. A 2022 community health needs assessment showed the population of Bexar County, where San Antonio is located, grew nearly 6% between 2015 and 2019, to more than 2 million. Adjacent Comal and Hays counties are two of the fastest growing counties in the nation.

Daskevich adds that beyond responding to the population increase, a key reason CHRISTUS Children's has prioritized increasing access to high-risk maternal and pediatric services in San Antonio and South Texas is that there is a sizable segment of the population that is socioeconomically disadvantaged. Those vulnerable patients and families encounter numerous barriers in accessing care, especially when they must travel outside their region to do so.

Daskevich says in their planning and implementation, CHRISTUS Children's leaders have been asking themselves, "How do we keep our patients and their families in their communities when they can't afford to leave San Antonio? This is vital to our mission. We have built our ministry here — we don't want people to have to leave."

Pillars
CHRISTUS Children's expansion has been organized mainly around six pillars of excellence:

• Center for Surgical Innovation
• Maternal and Fetal Care Center
• Heart Center
• Center for Neurosciences
• Cancer Center
• Mission and Ministry

For each of the clinical centers, the pediatric hospital has been greatly expanding the scope of maternal and pediatric services by building out the infrastructure and by hiring clinical experts and support staff. The hospital has increased these services not just at the downtown campus but also at a widening network of outpatient multispecialty clinics. CHRISTUS Children's is addressing emerging gaps in care by increasing the number of maternal and pediatric subspecialists practicing in each of the pillar focus areas. And it has been increasing the wraparound services for each pillar, including from child life specialists, dieticians, occupational and physical therapists, geneticists, pharmacists and social workers.

In partnership with Baylor College of Medicine, CHRISTUS Children's also is a teaching hospital that has been expanding its areas of training and education as it has built out this network. The facility supports training programs for pediatric residents, fellows, nurses, rehab therapists, child life specialists and pharmacists.

Daskevich emphasizes that CHRISTUS Children's has relied heavily on local philanthropy to support the growth of many of its services. CHRISTUS Children's Foundation is now in the silent phase of its largest capital campaign to date to generate more funds to invest in physician experts, staff positions, specialized programming and equipment — and not just in "bricks and mortar," says Daskevich.

Help for socioeconomic needs
Daskevich notes that part of CHRISTUS Children's work has been to address the many socioeconomic needs that San Antonio and South Texas families are facing.

The 2022 community health needs assessment says the proportion of households in Bexar County that are "asset limited, income constrained, and employed" — or working poor — rose steadily between 2010 and 2018, to about 35% of the population. They and other vulnerable populations have housing, transportation, food and other needs that the pediatric hospital recognizes must be addressed in tandem with medical needs through partnerships with other community-based not-for-profits.

For example, as part of its expansion work, CHRISTUS Children's partners with the state of Texas to manage and operate eight women, infants and children clinics across San Antonio and surrounding communities. At these clinics, women and families can access consultants, case managers and nutrition counselors. They also receive help in applying for Medicaid, the Supplemental Nutrition Assistance Program and other aid.

Rural care
An additional area of focus in recent years has been bolstering health care services for kids in rural areas of South Texas. Daskevich notes that there are about 30 million pediatric emergency department visits each year in the United States. More than 80% of those children receive that care in a facility that is not a children's hospital. And, of that subset, more than 90% are seen in lower-volume emergency departments such as those in rural areas. In many cases, these rural emergency departments do not have kid-friendly or pediatric-specific equipment, nor do their clinicians usually have training specific to treating pediatric patients.

To help address this concern, CHRISTUS Children's is undertaking a pediatric emergency department readiness program. A CHRISTUS Children's team partners with rural facilities in the region and visits the sites in-person to assess how well prepared their emergency departments are for pediatric patients and what gaps exist.

Working with the emergency departments, the CHRISTUS Children's team then puts together a program for addressing the gaps. This might include providing virtual training for the rural clinicians or inviting them to a CHRISTUS Children's facility to learn how to adjust clinical practices to the physiologies of kids to allow for real-life simulation, teaching and training. In the near future, CHRISTUS Children's will pilot a telemedicine connection with the rural facility so that the pediatric hospital's pediatric specialists can provide on-demand consultation on patient treatment.

Additionally, CHRISTUS Children's is using a grant from a South Texas donor to roll out a pediatric emergency fellowship training program that also will support the pediatric readiness initiative for rural hospitals.

Describing the work during the February AHA rural health conference, Daskevich said, "We want to focus on how to leverage our pediatric expertise at CHRISTUS Children's for our hospital partners across San Antonio and South and Central Texas. This way, we can keep patients and their families in the most appropriate care setting — hopefully closer to home."

When it comes to all this effort around care access and expansion, Daskevich tells Catholic Health World, "this is our obligation and our legacy to our community."