Providing full care and wrap-around services for people with disabilities

Helping those with disabilities find connection

Marc Jastrebski and Sam West are good friends with a special bond. They’re both passionate about sports, they love their families deeply and they understand the fear and challenges that can arise from a routine doctor’s visit or dental appointment. They also both have Down syndrome.

For some people with disabilities, finding specialized, supportive care can be challenging, especially when the experience itself is highly traumatic for the patient.

“We were overdue for blood work because it was so awful that I just kept putting it off,” said Becky West, Sam’s mom. “It was so hard for him and hard for me and hard for everybody involved that we would just keep procrastinating getting it done, which is not OK.”

That’s when they found Practice Without Pressure, a program that works with individuals with disabilities to obtain medical, dental or personal care services, without the use of force or restraint. Marc is an employee at Practice Without Pressure, and is also the reason it exists. His mother Deborah Jastrebski founded the program more than 20 years ago, in order to create a better care experience for her son. Now, Marc helps others through the process, like his friend Sam.

“It's very touching as a parent to know that somebody has put all this time and effort into helping Sam deal with something traumatic in a way that's not traumatic and that he looks forward to coming,” Becky said. “There’s no tears, there’s no fear and that’s been a really amazing thing.”

Practice Without Pressure is part of the new Multi-Assistance Center (MAC) at Morgan’s Wonderland in San Antonio. It’s a one-stop shop for people with disabilities and their families. The nonprofit brings together more than 30 community-based organizations under one roof to create simpler, more accessible solutions for both medical and non-medical services.

The UnitedHealthcare Community Plan of Texas invested $5 million into The MAC to help support its Employment Support Center and the Practice Without Pressure program. This is part of an integrated service approach to remove two socioeconomic barriers for people with special needs: Access to health care and stable employment.

“The MAC means finding a collaborative home,” said Patricia Longoria, executive director of community engagement for the UnitedHealthcare Community Plan of Texas. “It means accessing medical and non-medical services in one area, and it means being able to be proactive in their care.”

Practice Without Pressure is a key component of what makes the MAC special, touching on multiple clinical entry points for people with disabilities – even with something as simple as a blood draw or a dental cleaning.

“It gives them the time they need to be able to participate in their appointments without being fearful of restraint or unnecessary sedation,” said Tina Galindo, manager of Practice Without Pressure at the MAC. “We really put that person first and we really help them understand that we are trying to help them participate but not at the expense of their own self-esteem, their own emotional health and mental health.”

It’s this compassion that allows Practice Without Pressure to drive better care outcomes for people with disabilities. 

“It may even be something as simple as preventive care, but when you have anxiety or other concerns as part of your disability, that's basic preventive care that you could be foregoing,” Patricia said. “So from the perspective of a health plan, this allows us to help our members become proactive in their care.”

For Deb and Marc, seeing the vision and genesis of a concept built at their family’s kitchen table come to life inside the MAC has been beyond incredible. What started as a mother’s wish for a better care experience for her son will now help countless others on a grand scale.

“I almost don’t have the words,” Deb said. “It’s that deep for me. It’s just so powerful.”

For more on the Multi-Assistance Center at Morgan’s Wonderland or Practice Without Pressure, visit

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