boyle heights : the wellness center case study

Preparedby:

DevelopingTheWellnessCenterAtTheHistoricGeneralHospital:

ACaseStudy

Contributors

JorjaLeap,Ph.D.LauraRivas,M.S.W./M.P.P.

LouisaLau

TheWellnessCenterrepresentsthededicationandeffortsofmanyindividuals.Itis,however,criticaltonotethatwithoutthevision,leadershipandinvestmentofSupervisorGloriaMolina,TheCaliforniaEndowmentandtheBoyleHeightscommunity,TheWellness

CenteratTheHistoricGeneralHospitalwouldnotbearealitytoday.Thiscasestudywaspossiblethankstothecommitmentandhardworkofmanyindividualsandorganizationsthatgenerouslysharedtheirtime,reflectionsandideas.Weappreciatethestafffrommanydifferentagenciesthatarecommittedtotheoverallwellnessofthe

BoyleHeightscommunityandbeyond.

October2014

TABLEOFCONTENTS

Introduction 1LiteratureReview 3 Community‐BasedProgrammingandAccessibility 3 ClientEmpowermentandAdvocacy 3 CulturalSensitivity 5 FocusonPreventiveCareandHealthPromotion 5HistoricGeneralHospital:AnOverview 6OpeningTheWellnessCenter 8 MissionandVision 14 TWCPhysicalSpace 15 Funding,Staffing,andAdministration 16 ServiceProvision 22PlaceMatters:BoyleHeights 26TheWellnessCenterCaseStudy 29 Methodology 29 IntervieweeDemographics 32 FirstMonthofOperations 33 KeySuccesses 36

KeyChallenges 41 TWCModel:MissingPieces,Future,andReplicability 49ReplicatingTWC:MLKJr.CommunityHospital 53 HistoryoftheMLKHospital 53 2015:TheNewMLKHospital 55 IncorporatingTWCModel 57Conclusion 58 WorksCited 62AppendixA:InterviewProtocol 65AppendixB:MLKGeneralHospitalExtendedCaseStudyMaterials 66

DevelopingTheWellnessCenterTheCaliforniaEndowment

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INTRODUCTION

Threeyearsago,recognizingthefutureneedtopromotewellnessandprovide

preventivehealthcareinthecommunitiessheserved,SupervisorGloriaMolinaenvisioned

thecreationofanall‐encompassinghealthresourcecenter.Inaremarkableexampleof

repurposing,itwasfurtherenvisionedthatthiscenterbehousedinanEastLosAngeles

communitylandmark–TheHistoricGeneralHospital.Afteranarduousplanningand

implementationprocessthatinvolvedcommunitymembers,stakeholdersandinvolved

localandnationalorganizations,TheWellnessCenteropeneditsdoorstotheresidentsof

BoyleHeightsinMarch2014.

ThiscasestudycarefullyexaminestherelationshipbetweenTheWellnessCenter

(TWC)andthecommunityitisdesignatedtoserve,usingaresearch‐basednarrativeto

chartitsdevelopmentalongsidethepotentialgrowthofresidentengagementwithinBoyle

Heights.Throughinterviewsandethnographicobservation,thecasestudyresearch

explorestheroleofresidents,stakeholders,andlocalofficialsinthevisioningprocess,the

thoughtsandactivitiesthataccompaniedthecreationofthecenter,andhowTWCis

positionedtorespondtotheongoingneedsofthisvibrantbutmarginalizedandunder‐

resourcedcommunity.Inaddition,thecasestudyoffersaninstructiveexampleofhow

TWCcontributestooverallindividualandcommunitywell‐beingwhileadvancingThe

CaliforniaEndowment(TCE)missionofbuildinghealthycommunitiesandtransforming

thewayinwhichcommunitiesandthehealthcaresystemthinkaboutandapproach

wellness.InterviewswithTWCstakeholdersandcommunityresidents,uncoveredThe

WellnessCenterresponsetocommunityneedsaswellasthesensitivityofitsservice


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providerstotheuniqueculturalconcernsofBoyleHeightsresidents.Theresearchprocess

focusedon:

1) HowTWCisstructuredtorespondtocommunityneeds.2) HowTWCadvanceshealthcareaccessandoverallwell‐beingofresidents.3) CommunityengagementinsupportingandenlargingTWCfunctioning.4) CommunityperceptionsandbeliefsregardingtheroleofTWCinfacilitating

communitywellness.5) Roleofcommunityengagementandparticipationinvisioning,executing,and

sustainingTWC. TheresearchwasstronglyguidedbythemissionandvisionofTWCandthe

operatingmodelofTCE,whichtogetherpositthatindividualhealthandcommunitywell‐

beingarebasedonmanyfactorsincludinghealthylifestyles,familydiet,positive

behaviors,andtheavailabilityofcommunityresourcestohelpwithbothpreventionand

earlydiseasedetectionandtreatment.Withitscollaborativeapproachtocombatingthe

epidemiclevelsofobesity,hypertension,cancer,andotherchronicdiseasesaffecting

marginalizedpopulations,thecasestudyworkedtocapturehowTWCisuniquely

positionedtoempowerresidentsandpatientstotakecontroloftheirownhealth,fostering

itsabilitytoimproveoverallhealthoutcomesforthecommunitythroughtheexpansionof

preventiveandresponsivecareservices.

TWCrepresentsthefirstcommunity‐basedwellnesscenterinEastLosAngeles,a

re‐imaginingofahistorichospitalsetting,anchoredinthecommunity.Mostimportantly,it

standsasanundertakingthathasactivelyengagedofficials,nonprofitorganizations,and

communitymembersinitsdesign,construction,andfunctioning.Thiscasestudywill

portrayhowTWCisanexampleofbothcommunity‐basedhealthcareandresident

engagement.


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LITERATUREREVIEW

Wellnessisdefinedbymultidimensionalconsiderationsincludingsocial,

occupational,spiritual,physical,intellectual,andemotional.1Thesedimensionsare

interrelated,interactive,andintegratedwithinanindividualorcommunitysystemof

functioning.2Traditionalwellnesscentersprovideadiverserangeofservices,thatmay

includefitness,nutritionanddiet,relaxation/meditation,mentalhealth,andeducation

withservicesdesignedtoimproveandpromoteindividualandcommunityhealth.An

analysisoftheliteraturerevealedseveraldominantthemesintheoperationand

effectivenessofwellnesscenters,includingcommunity‐basedprogramming,preventive

healthcare,clientempowerment,andculturalsensitivity.

Community‐BasedProgrammingandAccessibility

Anywellnesscenterprogrammingmustbeaccessibleandrelevanttocommunity

residentsinorderforthemtoseekservices.Thecenterswiththegreatestimpactare

locatedwithinthecommunitywherethoseinneedofserviceslive.Thisallowsresidents

optimalaccesstoresources,aswellasincreasedopportunitiesforself‐efficacyand

empowerment.Duetotheirintentionalanddirectintegrationintothecommunitiesthey

servecoupledwithserviceprovisionthatmeetsspecificneedsofthepopulationtheyare

serving,community‐basedprogramsprovetobeaneffectivemodelforoutreach.

ClientEmpowermentandAdvocacy

NykänenandSeppälä(2012)describehowpatientempowermentisintegraltothe

citizen‐centeredhealthcaremodelandcommunitywellness.Duetothefragmentationof1Suresh,Ravichandran,&Ganesan(2011)pg.17.2Berrylin(2008).Pg.19.


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healthcaretoday,patientsmustbepro‐activeinbothintegratingandtrackingthe

completenessoftheircare;theycannolongerexistaspassiveconsumersofservices.3

Increasedpatientempowermentcanultimatelyleadtoimprovedqualityofcare

managementthroughwiserandhealthierlifestylechoices,healthierbehaviors,better

diseasemanagement,improvedcarecoordination,andimprovedcarerecommendations.

Empowermentisalsoviewedashelpingtoreducehealthcarecosts,asclientsassume

moreresponsibilityfortheirhealth,theircommitmenttowellnessanddiseaseprevention

cutsdowncostssuchasunnecessaryorrepeatedhospitalvisits.4

Itisalsoclearthatthepresenceanduseofwellnesscentersleadstobothpolicyand

environmentalchangeevenwhileenhancingindividualandcommunitywellnessand

health.Theroleofadvocacyinwellnesscentersfocusedonpreventiondiffersfrom

traditionalmedicalcaresettings.Wellnesscentersdiffermarkedlyfromtraditional

facilitiesthatoftenposebarriersforlow‐incomepopulationsofcolor,whoareoftenweary

anddistrustfuloftraditionalcaresystems.Inthesecommunity‐basedcenters,clientsgain

asenseofempowermentandcontrolovertheirownhealthandwell‐beingandareinspired

toactonbehalfoftheirfamilies.Clientadvocacyisenhancedthroughtheinvolvementof

communityleaders,neighborhoodsocialnetworks,masscommunicationcampaignsin

theirnativelanguage,andgrassrootseducationtactics.5Afocusonassetsratherthan

deficitsempowersclientstoactontheirownbehalfandtomovemoreconfidentlythrough

thehealthcaresystem.

3Nykänen&Seppälä(2012)pg.118.4Nykänen&Seppälä(2012)pg.118.5Merzel&D’Affitti(2003)pg.558.


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CulturalSensitivity

AccordingtoAnderson(2005),effortstocreatemodelsforhealthservicesmust

takeintoaccounthowpeopleviewtheirowngeneralhealth,aswellashowthey

experiencesymptomsofpainandillnessandwhetherornottheyjudgetheirproblemsto

beofsufficientimportancetoseekprofessionalhelp.Infact,perceivedneedisnever

devoidofsocialcontext;perceivedneedisalargelysocialphenomenonandcanbe

explainedbyculture,socialstructuresandhealthbeliefs.6MerzelandD’Affitti(2003)cite

thefailureofprogramstoimpacthealthbehaviorsinvariouscommunitiesbecausethese

programsfocusedmainlyonindividuals,andwerenotsufficientlytailoredtoreach

populationsubgroups.Large‐scalehealtheducationoftendoesnotmakemorethana

modestimpact,primarilyduetothelackofspecificculturalconsiderations.7Incontrastto

traditionalhealthcaresettings,wellnesscentersconsiderculturalsensitivitytobe

fundamentalandservicesaregearedtowardtheneedsofthespecifictargetpopulation.

FocusonPreventiveCareandHealthPromotion

Researchontheeffectivenessofwellnesscentersalsoportraystheeffectivenessof

theirfocusonpreventiveservicesandhealthpromotionandeducationasopposedto

providingdirecthealthservices.Promotinghealthyeating,activelivingandanoverall

healthylifestyle,withanemphasisondiseaseprevention,cutsdownonhealthcarecostsby

eliminatingtheneedforunnecessaryhospitalizationsandemergencyroomvisits.

NykänenandSeppälä(2012)contendthatthecitizen‐centeredhealthcareparadigmrests

onpreventivecare,proactiveservices,andearlydetection/diagnosistoensurepatient’s

6Anderson(2005),pg.3.7Merzel&D’Affitti(2003),pg.569.


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wellnessmakesupastrategythatismorebeneficialandcosteffectivethanthe

managementofsymptoms,illnessandchronicdisease.8

HISTORICGENERALHOSPITAL:ANOVERVIEW

WhatisnowknownastheHistoricGeneralHospitalwasfirstopenedin1878,when

LosAngelesCounty(LAC)establisheda100‐bedroomhospitalonMissionRoadtoserve

theregion’sneedypopulation.9Sevenyearslater,in1885,theGeneralHospitalaffiliated

itselfwiththefive‐yearoldUniversityofSouthernCalifornia(USC)MedicalSchool,creating

a“longandprosperousacademicpartnership”.10Atthattime,theHospitalconsistedof

100bedsand47patients.Thissmallstructuresoonprovedinadequatetoservingits

targetpopulation.Asaresult,afterconstructionbeginningin1928,in1930,actressMary

Pickforddedicatedthe8‐toncornerstoneofanewLACGeneralHospitalonStateStreet.In

1933,themodernLosAngelesCountyHospital,affectionatelyreferredtoas“TheRock,”

finallyopened.ThenewhospitalfulfilledwhatthenSupervisorShawdeemedtobe“Los

AngelesCounty’sDutytotheNeedy”.11Thisonemillionsquarefootfacilitywouldserveas

abeaconofhope,settinganexemplarystandardforhighqualityhealthcarethatwas

providedtothecommunityforthenext75years.

8Nykänen&Seppälä(2012)pg.117.9SupervisorGloriaMolina,FirstDistrict.TheWellnessCenterattheHistoricGeneralHospital.10Ibid.11Ibid.


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Afteritsconstruction,theLomaLindaUniversityMedicalSchool,aswellasthe

CaliforniaCollegeofMedicinebecameinvolvedwiththehospitalbutlaterwithdrew.By

1968USCremainedtheonlymedicalschoolaffiliatedwithLosAngelesCountyHospital.12

Thatyear,theLACountyBoardofSupervisorsvotedtochangethenameofthehospitalto

LosAngelesCounty–UniversityofSouthernCalifornia(LAC‐USC)MedicalCenter“to

reflecttheacademicpartnershipthatwasheldbetweenthetwo.”13However,whilethe

partnershipendured,thehospitalbegantodeteriorate,ultimatelyfailingtomeet

earthquakeandfirecodesimplementedafterthe1994NorthridgeEarthquake.Asaresult,

therewasanunplannedandimmediateneedforarenovatedspacetohandlethepatients

intheaftermathofthedisaster.14

InNovember2008,a600‐bedstate‐of‐the‐artfacilityoperatingasthereplacement

hospitalopenedtothepublic.Thenewedificeconsistedofthreetowers–aclinictower,

diagnosticandtreatmenttower,andinpatienttower.Today,theLAC+USCMedicalCenter

12SupervisorGloriaMolina,FirstDistrict.TheWellnessCenterattheHistoricGeneralHospital.13HealthServices–LosAngelesCounty.LAC+USCMedicalCenter‐AboutUs.14SupervisorGloriaMolina,FirstDistrict.TheWellnessCenterattheHistoricGeneralHospital.


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servesasaLevel‐OnetraumacenteraswellasahubintheLosAngelesCounty‐based

healthcaresystem.Intotal,theLAC+USCMedicalCenterservesover10millionresidents

andcommunitymembers.15ItisoneofmostrecognizablebuildingsontheEastLos

AngelesCountyskyline,stillrepresentinghealthcareandhope.Asabeaconandholding

historiclandmarkstatus,thishistoricbuildingisnowhometotherecentlyopened

WellnessCenter.

OPENINGTHEWELLNESSCENTER

TWCistheproductofapublic‐privateandcommunitypartnershipbetweenThe

CaliforniaEndowment,theOfficeoftheFirstDistrictCountySupervisorGloriaMolina,the

LosAngelesCountyDepartmentsofHealthServices,PublicHealth,andMentalHealth,and

anumberofhealth‐mindednonprofit“tenant”organizations.Withalloftheentities

involved,theLAC‐USCMedicalCenter,anindependent501(c)(3)nonprofitorganization,

continuestoserveasapredominant,leadpartnerintheestablishmentofTheWellness

Center.

TheformerGeneralHospitalwaschosenasthesiteforTWCinresponsetothe

desireofCountyleaderstohonorandcontinuethelegacyofhealingthatwouldpromote

health,prevention,andcollaborationasitsmaingoals.16Basedonstakeholderinterviews

anddocumentreview,itwasclearthatthiseffortwasdrivenbySupervisorMolina’svision

ofcreatinganall‐encompassingresourceservicetobehousedinthepreviously

underutilizedGeneralHospital,transformingapreviouslyrecognizablemonumentinBoyle

Heightstoabeaconofhealthandopportunity.15HealthServices–LosAngelesCounty.LAC+USCMedicalCenter‐AboutUs.16Ybarra,Jennifer.(April30,2012).Memorandum:BoyleHeightsWellnessCenterattheHistoricGeneralHospital.Pg.1


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FromthetimethenewLAC‐USCMedicalCenterwasopenedin2008,the77,000

squarefootareaonthefirstflooroftheoldhospitalbuildingcomprisedvacantspace

ownedbyLosAngelesCounty.Thebuildingincludedoffices,meetingrooms,educational

space,anauditorium,acafeteria,andakitchen.Afterconveningastakeholdermeetings

andgarneringinputfromcommunitymembers,projectpartnersdecidedthatthefirstfloor

ofthebuildingprovidedthemostappropriatesettingtoachieveTWCgoals,offeringa

commonspacethatwouldbeidealforfacilitatingcollaborationbetweennonprofit

partners.Investedparties,withthehelpofTCEleadership,conductedaninformalneeds

assessmentofthesurroundingcommunities.Accordingtooneinterviewee,“Theprocess

wasnotasiterativeasitshouldhavebeen…therewasageneralsenseoftheareasofhighest

impact,”andserviceproviderswouldneedtomeettheseidentifiedservicegaps.

AsTWCwasdesigned,thesepartnerswouldbeworkingtogethertoperforma

broadrangeoffunctions.Astheyorganizedindifferentconfigurationsandcollaborations,

aidedbytheirofficesinthesamestructureandthecommonspace,theresidentpartners

couldeasilyworktodevelopprogramming,shareknowledgeandadvantageouspractices,

andcombathighlevelsofdiseases(suchasobesity,stroke,heartdisease,cancer)within

theEastLosAngelescommunity.17Withthisvision,TWCwouldserveasaco‐locatedand

collaborativemodel:agenciesarenotonlylocatedinunderoneroofbutarerequiredto

collaborateonprogramming.

17Ybarra,Jennifer.(April30,2012).Memorandum:BoyleHeightsWellnessCenterattheHistoricGeneralHospital.Pg.1.


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TWCwasinitiallyplannedasaprojectthatwouldbedevelopedinseveralphases

spanningfiveyears.However,earlyon,basedonresponsesfrompartnersandcommunity

members,itwasclearthatthismulti‐phase,multi‐yearplanwasnotgoingtowork.

Instead,planningactivitiescomposedaninitialphaseofpreparationinthespring2011,

withthebuildingcompletionandopeningslatedforlatefall2012.18Asapartofthisinitial

planningphase,start‐upactivitiesincludeda“requestforproposals”(RFP)processfor

WellnessCenterpartners.ThesepartnerswouldoperateundertheauspicesofTWCand

wouldexpandtheirservicestotheBoyleHeightscommunity.19Basedoncommunityinput,

andtoensurethatallpartnerorganizationswerealignedwiththepreviouslynotedneeds

assessmentconductedbyTWCplanningcommittee,theRFPrequiredthatallapplicants

demonstratethecapacitytoprovideculturallycompetentandlinguisticallyappropriate

programs.Additionally,agencieshadtoshowacommitmenttoreducingmedicalcosts

18Inourdocumentreview,thisinitialphasewasreferredtoas“PhaseI.”Forourpurposes,wehaveremovedthislanguagebecausesubsequentphaseswerenotclearlydelineated.19TWCCaseStatement.(November2013).Pg3.


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throughprevention‐basedserviceprovision.TheRFPrequiredallapplicantstoprovide

servicesinthefollowingareas:20

x ChronicDiseaseManagementx WellnessandPreventionx SupportiveServicesx CommunityBuildingActivities

TheRFPprocessattracted46applicants,andultimatelyledtotheselectionof14nonprofit

partners.

Theplanningphasealsofocusedonaspectsofbuildingproductionincluding

financing,construction,andinternalstructure.Inanattempttobeginprocessand

preliminaryoutcomeevaluationefforts,TheNonprofitNetworkconductedacapacity

assessmentfromfall2012thru2013.TheNetworkwashiredtosummarizeandarticulate

capacityissuesexperiencedbytheTWCprojectaswellasofferrecommendationsfor

movingforward,includingideasabouthowtoimplementitsstrategicplanoverthenext

threeyears.2122TheCapacityPlanmemothatTheNetworksubmittednotedthattheir

teamcompletedsurveysandinterviewsat“amomentintimebeforetenantshadfull

knowledgeoftheleasingterms…beforethetenantshadstartedmeaningfulwork

together.”23Informalinterviewsrevealedthatmanyindividualsfeltthiskepttheprocess

stuckin“planning.”However,therewerekeyoperationalconsiderationsand

20RequestforProposal.Rent‐FreeSpace:FirstFloorattheLosAngelesCountyWellnessCenterattheHistoricGeneralHospital.(2011).21TheNonprofitCentersNetwork.(March7,2013).Memo:WellnessCenterBusinessPlan:PartI,CapacityPlan.Pg.1.22TWCCaseStatement.(November2013).Pg.4.23TheNonprofitCentersNetwork.(March7,2013).Memo:WellnessCenterBusinessPlan:PartI,CapacityPlan.Pg.1


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recommendationsreportedinbothafinalmemoandBusinessPlanPowerPoint.These

included:2425

x NeedforMedicalDirectortointerfacewiththeHospitalto“establishclientflowandeducatethestaff”.

x Facilitationofclientreferralsiscrucialfordrivingvisitors.x Designadatacollectionstrategy.x Employinginformationtechnologysolutionsemployedbyother

nonprofits.x Enhanceoutreach/communityrelation’srole,marketing,andpromotion

efforts.x EnsureusageofTWCbyaddressingtransportationandaccessissues.x CollaborationamongthetenantsshouldbeTWC’sprimaryfocusand

shouldbefacilitatedbytheExecutiveDirectorwithclearexpectationsandtrust.

x Considerlong‐rangeplanninggoalsandfinancialsustainability.CollaboratingwithTheNetworktoensurethatTWCwasproperlypositionedtomeetthe

needsofthecommunityandensuringappropriateserviceprovisionwasanimportantstep.

Developmentwasinaconstantstateoffluxasleadershiplearnedthatbuilding

rehabilitationwouldtakeoneyear,ultimately;thisprocesstook2½years.Theopeningof

TheWellnessCenterhadtentativelybeenscheduledforDecember2012,butaccounts

indicatedthatitwaspushedbackasmanyasfourtimes.Afterbeingrepeatedlyand

consistentlydelayed,manyorganizationshadputthenotionofTWCasidetofocusoncore

programming.Fearingthattheprocesshadbecome“toomuchaboutthebuildingandnot

enoughaboutTWCprogramming,”theleadershipteamheldluncheons,meetings,and

presentationstokeepthetenantorganizationsinvestedintheproject.Thisdelayed

timelineprovedmostfrustratingforsmallerorganizationsthatweredependenton

securinggrantfundingpriortoopeningtheirWellnessCenterofficesforprogramming.24Ibid.Pg.2‐3.25TheNonprofitCentersNetwork.(March8,2013).PPTPresentation‐BusinessPlan:PartICapacityPlan.


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Tenantswereprovidedwithlittleknowledgeaboutthefacilitiestimeline,andwhenitwas

finallyannouncedthatitwas“timetomove‐in,”tenantswereill‐prepared.Duetolost

fundingasaresultofthedelays,manytenantshadnotfinalizednewprogrammatic

deliverablesorscopesorwork.Withoutacohortoffull‐timeCenterstaff,tenantswereleft

confused–theyhad“morequestionsthananswers.”Despitethesechallenges,themoveto

TWCproceeded.

Aftertwotothreeyearsofconstruction,buildingandadministrativedelays,tenants

movedinoverthespanofseveralweeksandoncetheyweresettledintheyhadagrand

openingcelebrationonMarch15,2014.Despitetenantsfeelingabitunsettled,thegrand

openingwastrulyatimeofgreatjoyandcelebration.Illustratingthatspirit,the

photographsabovedepictTWCsupportersatthefrontentranceofTheHistoricGeneral

HospitalandSupervisorMolinawatchingacookingdemonstrationinthebuilding’sshared

demonstrationkitchenfacilities.Throughouttheday,communitymembershadachance

meetwithandhearfromlocalofficialsandHospitalstaff,attendhealthycooking

demonstrations,andwatchlocalmusiciansandculturaldancers.Theywerealsoentered


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invariousdrawingstowinprizesandreceivegiveaways.Theeventtrulyembodied

Molina’scommitmenttohealthandwellnessintheBoyleHeightscommunity.Most

significantly,communitymembersinattendancesawfirsthandtheinvestmentsmadeon

behalfofcityofficials,LAC+USChealthcarepersonnel,andlocalandnationalnonprofit

organizations.Alongsideappreciatingthepublic‐privateinvestments,communitymembers

weretrulyengagedwiththemissionofTCEanditsBHCinitiatives,thecommunity,actively

talkingandlearningabouthealthyeatingandactivelivingandhowcriticalthesebehaviors

aretoensuringhealthandwellness.Residentswereempoweredtotakeadvantageofthe

culturallyandlinguisticallyappropriatehealthcareservicesandtoadvocatefortheneeds

oftheirfamilies.

MissionandVision

Thegrandopeningsymbolizedthemanyindividualsthatwereinvolvedincreating

themissionandvisionofTWC.Fromtheonset,inputfromcommunitymembers,local

officials,andWellnessCentertenantsandstaffhelpedtoshapeTWCmission:“toinspire

andempowerresidentsandpatientstotakecontroloftheirownhealthandwellbeingby

providingculturallysensitivewellnessandpreventionservicesandresourcesthatenable

prevention,addresstherootcauseofdiseaseandimprovehealthoutcomes.”26Accordingto

severalCenterpublications,thevisionisverybroadandinclusive,consistingofa

commitmenttothevalueslistedbelow:27

26TWC.(2014)AbouttheWellnessCenter.27TWCPartnersListandFactSheet.(December2013).Pg2.


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x Provideculturallysensitiveprogrammingtotheresidentsoftheareainordertoaddresstherootcausesofdiseaseprevalentinthecommunity.

x Enableresidents/patientstoempowerthemselvesandtoexerciseautonomyovertheirhealthandlives.

x SupporttheAffordableCareActbypromotingpreventivepracticesinordertoreducehealthcarecostsandpreventingunnecessaryhospitalreadmissions.

x Improvehealthoutcomesforthepatientsandcommunitybyexpandingpreventivecareservices.

x Encouragecollaborationamongnonprofitorganizationstoprovideprogrammingandservicesandeventstocommunityresidents.

x Attractcommunitydevelopmentandinvestmentinapredominantlyindigentpopulation.

x BecomeakeycomponentofanEastLosAngelesregionalintegratedhealthcaredeliverysystem.

TWCPhysicalSpace

TheCenterischaracterizedbyanexpansiveandinterestinglay‐out,whichis

depictedinFigure1below,includingthedisplayoftheproposedoutdoorspace.In

viewingthefloorplanitisimportanttonotethedemonstrationkitchen,thedancestudio,

andthetenantofficesalongwithsharedspace.28Eventually,theentireWellnessCenter

spacewillincorporateseveralsustainableandculturallyrelevantfeaturesincludingbut

notlimitedto:nativeplants,lowimpactdevelopment,publicart,andLEDlighting.After

thegrandopening,theentrancetoTWCwasmovedfromthefrontofthebuildingtothe

side.Althoughthismaynotbeasarchitecturallyconsonantwiththestructure,itwas

importanttomovetheentranceinordertomeetaccessibilitystandardsasoutlinedbythe

AmericanswithDisabilitiesAct.Theyellowarrowsinthegraphicbelowindicatethese

28TWCPresentation.(March2014).Slide8.


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twolocations.ParkingforTWCisinanearbystructureandisnotdisplayedonthemap

below.

1 Playground 5Performance

Space 9Restroom/Prgm

Office 13 MeditationArea2 Demo.Garden 6 Gazebo 10 Parking 14 TotArea3 SeatingArea 7 FitnessTrail 11 BikeRacks 15 ADARamp

4 SplashPad 8 HealingGarden 12NativePlantHabitat 16

Mayan/AztecElements

Figure1:TheWellnessCenterFloorPlan

Funding,Staffing,andAdministration

Insupportofthepublic‐privatepartnershipprovidingpreventiveservicestoa

communityinneed,localandnationalorganizationspledgedfundingforthemodelearlyin

theprocess.Start‐upfundingforfacilities,amenities,andbuildingtransformationwere


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estimatedat$14.4millionandthetablebelowoutlinesfundingsecuredasof2012.29

ThesecorporateandphilanthropicfundswouldcoverWi‐Fiaccess,staffsalaries,software

development,aswellasrenovationsandrepurposing.AdditionalfundsfromThe

CaliforniaEndowment,FirstDistrictOfficeandPropositionAgrantswerereceivedlater

andarenotdocumentedbelow.AsportrayedinTable1,abroadrangeoffunderswith

specificprogrammaticaimsinvestedinTWC.3031

Funders Purpose AmountCDCCommunity

TransformationGrant(administeredbyLACDPH)

ExecutiveDirectorSalary (75%excludingbenefits)

$475,00‐$500,000 over5years

TheCaliforniaEndowment Start‐upfunds$90,000‐$95,000

over1year

LAHealthCarePlanDevelopmentofWellnessCentercapacityassessment,business

plan,andstrategicplan$150,000 over1year

TheCaliforniaWellnessFoundation

Informationtechnologyassessment

$100,000 over6months

First5LA

Design/buildplayareaforchildren0‐5yearsonthesideof

theStatelot$280,000 for1year

Streetentrancetothebuilding

CaliforniaStateParksRehabilitate/repurposeoutdoorareassurroundingGeneral

Hospital$1.839million

FirstDistrictandCountyCEO’sOffice Rent‐freeofficespacetotenants $5.8million

LAC(transferredtoAmigosdelosRiosSpring2012) Outdoorrehabilitation $250,000

29NumbersintheTablebelowreflecttheamountoffundingavailablefromeachentityaccordingto2012‐1013reports.Beadvisedthatacrosspublications,thesenumbersvariedslightly.30TWCFunds(2012Overview),pg.1‐2.31TWCCaseStatement.(November2013).pg.2‐5.


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LAC(transferredtotheFoundationinSpring2012) Construction(Architecture) $250,000LAC(transferredtotheFoundationFall2012) Construction(ProjectManager) $150,000

LAC(transferredtotheFoundationinDecember2012)

Construction(DemolitionandRehabilitation)

$5.144million

Table1:TWCFunders

Withthissignificantinvestment,itisclearthattheadministrativeand

accountabilitystructureofTWCiscriticaltoitseffectivenessandfunctioning.Intheday‐

to‐dayadministrationofTWC,theExecutiveDirector,currentlyMs.NancyMullenax,is

accountabletotheLAC‐USCMedicalCenterFoundationBoardofDirectors.Itisthe

executivedirector’sresponsibilitytooverseethe“leadership,planning,fundraising,and

comprehensivemanagementoftheCenter.”32Additionally,theExecutiveDirectorisalsoin

chargeofthedevelopmentof“anoperatingandsustainabilityplan…aswellasacommon

evaluationsystemthatmeasuresWellnessCenterclientoutcomes.”Thisprocessis

exploredindetailaspartoftheanalysisbelow.Theadministrativestructureappearstobe

a“workinprogress.”Duringinterviewsthatwillbediscussedindetaillaterinthereport

severalindividualsexpressedtheirconcernthatmanyoftheseresponsibilitieshavenot

beenimplementedorsharedwithTWCtenants.Individualsalsopointedoutthattheroles

andresponsibilitiesofTWCstaffandtenantshaveneitherbeenagreeduponnorclearly

articulated.Figures2and3belowportraythecontrastbetweenthecurrentTWCstaffing

structureasofearly2014(developedbyLeapandAssociates)andtheproposedstructure

byTheNetwork,respectively.3334

32TWCCaseStatement.(November2013).33TWCDirectory.Pgs.1‐4.


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Figure2:CurrentTWCStaff(asofearly2014)Figure3:NonprofitCenter–ProposedStaffingModel

34TheNonprofitCentersNetwork.(March8,2013).PPTPresentation‐BusinessPlan:PartICapacityPlan.

© 2013 The NonprofitCenters Network & Tides 32

Staffing – Proposed

Medical Director Wellness Center Director

Program Manager Communications

& Fundraising (Staff or

Consultant)

Promotoras Information Technology

Administrative Support

Medical Foundation

President/CEO


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TheadministrativestructureofTWCcontinuestobeongoingchallenge.Fromthe

project’sinception,therehavebeenseveralinstancesofturnoverandstaffingchanges.In

ordertoprovidecomprehensiveservicesandconductcommunityoutreach,theCenter

continuestograpplewiththeneedformorefull‐timestaffwithclearrolesand

responsibilities.Inanefforttofillinsomeoftheseemploymentgapsandaddressvital

needs,TWCtenantworkgroupsleadtheprogrammaticdiscussionsbeforepermanent

personnelwerehired.Accordingtointerviewees,thetenantsoriginallycreatedand

staffedfourworkgroups:

1. Data

2. ProgramCollaboration

3. Promotoras

4. Operations

Aftersuggestionsfromkeypersonnel,afifthgroup,“Outreach,”wasdeveloped.

Theseworkgroupsmetforseveralmonthspriortothegrandopeningandcontinueto

evolve,focusedondefiningtheirrolesandresponsibilitieswithinthelargerTWC

framework.DuringtheplanningphaseandunderthedirectionoftheInterimExecutive

Director,JoannePineda,workgroupsflourished.Ms.Pineda,whooriginallyworkedasa

consultantontheprojectpriortoherappointmentasinterimdirector,didnothavethe

assistanceoffull‐timestaff.Forthelengthofher5‐monthtenurefromNovember2012–

March2013,shefacilitatedmonthlyprogrampartnermeetings.Toensurethattherewere

noduplicativeservices,allofthepartnersweresurveyedtodeterminetheircapacityand

primaryservicearea.ItiscriticaltonotethatpriortoNovember2012,muchofthework


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onTWChadbeenfocusedonfacilitiesandconstructionconcerns.However,withthe

introductionoffulltimeWellnessCenterstaffincludingthepermanentdirectorMs.

Mullenax,inthesecondhalfof2013,workgroupswerenolongerconsideredthedriving

forcebehindtheproject.Amidpressurestobeginoutreachandprogramming,tenantstaff

didnotfeelencouragedtoparticipateintheworkgroups,nordidtheyfeelthattheir

opinionswererespectedorvalued.Severalindividualswhowereintervieweddiscussed

howtheirworkgrouphadlaboredintensivelyandproposedseveralstructuralchanges

regardingrolesandresponsibilitiesthatwererepeatedlydismissed.Evennow,theroleof

theworkgroupscontinuestobeinfluxandpartofthedevelopingidentityofTWC,a

dynamicprocessthatismovingtowardsamorepositiveresolution.

Probablythemostsignificantexampleofhowtheworkgroupsandtenantpartners

arestrugglingtodefinethemselveswithinthecurrentstructureinvolvesthepromotoras.

Promotoras,orpatientnavigators,wereinitiallyhiredtoengageinoutreachwith

communityresidentsandtoreferthemtoresources.Thepromotorasassistindividualsin

maneuveringthroughthecurrenthealthcaresystemanditsvariouscomplexities.Aspart

oftheirefforts,promotoraswereresponsibleforbuildingrelationshipswithclients,

assistingresidentsinsigningupforhealthinsurance,andensuringthatprevention

screeningandfollowuptreatmentsareavailabletothoseinneed.However,nowtheirrole

withintheCenterisunclearandsometenantsfeelthattheyareactingas“glorified

secretaries.”Currenttenantsexpressedconcernthatpromotorashavenotbeengiven

propertrainingortoolstooverseetheCenter’scommonmessaging,distributionof

marketingmaterials,orcommunityoutreachefforts.


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ThetenantorganizationsarelistedinTable2below.Theseorganizationsare

housed,rent‐free,onthefirstfloorofTWC.35Theagenciesareexpectedtomeetthe

previouslyoutlinedRFPrequirementsandtocollaborateonhealthandwellness‐based

programmingefforts.Despitedifficulties,thisisauniqueandimportantmodel,withan

excitingdesignforserviceprovision.

AlmaFamilyServices EastLAYMCA MaternalandChildHealthAccess

AmericanDiabetesAssociation Jovenes,Inc. MexicanAmerican

OpportunityFoundation

AmericanHeartAssociation

LACareHealthPlan

FamilyResourceCenter

NationalMultipleSclerosisSociety

ArthritisFoundation

LACDepartmentofHealthService

NeighborhoodLegalServicesofLACounty

BuildingHealthyCommunities–Boyle

Heights

LACDepartmentofMentalHealth ProyectoJardin

EastLAWomen'sCenter LACDepartmentofPublicHealth

WorkerEducationandResourceCenter

Table2:WellnessCenterTenantOrganizations/ProgramPartners

ServiceProvision

Asanintegratedmodel,TWCwascreatedanddesignedtoprovideacomprehensive

rangeofservicessuchashealtheducation,supportprograms,healthyeatingandactive

livingbehaviorsforthecommunityviathenonprofitorganizationswithinTWC.36The

tenantorganizationslocatedwithintheWellnessCenterareworkingzealouslytoprovide

servicesforpredominantlyBoyleHeightsbasedclients,withanemphasisonimproving

35TWCCaseStatement.(November2013).Pg.436TWCCaseStatement.(November2013).Pg.3‐4.


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healthoutcomesforthecommunity,encouragingresidentstotakechargeoftheirown

wellnessandtolivehealthierlives.AspartofTWCmission,theyareallfocusedon

educatingthepublictoavoidandunderstandtherootcausesofdiseasewithinthe

communitywhileprovidingasafeopportunityforresidentstobeabletoexerciseand

participateincommunityevents.

TWCwasconsistentlydefinedbyindividualsinterviewed,participantsatthe

openingandinvolvedcommunitymembersasaone‐stopshopofhealthandsocialservices

resourcesfortheunderservedcommunityofBoyleHeights.Oncethecenterisrunningat

fullcapacity,andinmorepurposefulcollaborationwiththeHospitalandreferring

physicians,TWCtenantorganizationstaffhopetoprovideanewpathwaytoward

coordinatedandmanagedhealthcare.

TWCconnectstopatientsattheLAC‐USCMedicalCenterthroughareferralprocess.

Inordertoensurethatclientsareawareofthecomprehensivepreventiveservicesoffered

atTWC,LAC+USCphysiciansissuereferral,termed“WellnessandParkPrescriptions”to

theirpatients.37Thesereferralswillfacilitateengagement,helpingcommunitymembers

takeownershipoftheirownhealthandwell‐being.Basedontheclients’needs,referrals

willbemadetotheappropriateWellnessCenteragencies.Awiderangeofservicesis

providedbythetenantagenciesthroughself‐runandcollaborativeprograms.Such

servicesinclude,butarenotlimitedtowhatisportrayedinTable3below.38

37Ybarra,Jennifer.(April30,2012).Memorandum:BoyleHeightsWellnessCenterattheHistoricGeneralHospital.Pg.1.38TWCSummaryofServices.(February10,2014).Pgs.1‐11.


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ServiceAreas ExamplesofServicesProvided

MentalHealthServices/Support

Groups

AlmaFamilyServices:Griefandlossgroupsaswellasindividual,family,andgroupcounseling.

SeniorServices

MexicanAmericanOpportunityFoundation:SeniorHispanicInformationAssistanceProgram(SHIAS)connectsnon‐Englishspeakingseniorstostateandcommunitybasedservicesthatincreaseandaidinbuildingself‐sufficiencyandimprovedqualityoflifeincludingmedicalcounseling,caregiversupport,copingwithdisease,andexercisesclasses.

DisabilityServicesArthritisFoundation:WalkwithEaseincludesstretching,healtheducation,strengtheningexercise,andmotivationalstrategiesforindividualswitharthritis.Thisprogramisdesignedtodecreasepainanddepression,increaseincreasingphysicalactivityandwalkingdistance.

DiabetesPreventionandManagement

AmericanDiabetesAssociation:Diabetes‐RelatedInformationandEducationisforindividualswhowouldliketoknowhowtopreventdiabetes,andwillassistthoselivingwithdiabeteswithdailyself‐managementforthepreventionofcomplicationsrelatedtodiabetes.

HeartHealthServicesAmericanHeartAssociation:AlcanzaTuMetaisafour‐monthprogramthatfocusesonbloodpressuremanagement.Participantslearnhowtocontroltheirbloodpressurebyadoptinghealthierbehaviorsandfollowingmedication.

AdvicefromNurses LACountyDepartmentofPublicHealth:AskANurseSessionsarescheduledwithPublicHealthnursestoansweranyhealth‐relatedquestionsanddiscussconcerns

ServicesforSexuallyTransmittedInfections

EastLAWomen’sCenter:WomenandFamiliesLivingwithHIVprovidescomprehensiveandculturallysensitive,individualizedservicestowomenandtheirfamilieswhoareaffectedbyHIV/AIDS.Aimstoprovideresourcesandaccesstohealthservices,improveoverallqualityoflifeforwomenandtheirfamilies,strengthenfamilyrelationships,improvephysical,emotional,andmentalwell‐being,andimprovenaturalsupportnetworks.

EmergencyPreparedness

L.A.CareHealthPlanFamilyResourceCenter:RedCrossFirstAid,CPR(cardiopulmonaryresuscitation)andAED(automatedexternaldefibrillator)trainingandcertificationtomeettheneedsofworkplaceresponders,professionalrescuers,schoolstaffs,professionalrespondersandhealthcareproviders,andthegeneralpublic

DiseasePreventionLACountyDepartmentofPublicHealth:DiseasePreventionClassesaboutsexuallytransmittedinfections/safesex,FoodBorneIllnesses,ChildrenandAdultImmunizations,FluPrevention,Tuberculosis,Pertussis,andotherpublichealthdiseasepreventiontopics.

Legal/Immigration/HousingRights

NeighborhoodLegalServicesofLACounty:Medical‐LegalCommunityPartnership(MLCP)allowspatientstoreceiveone‐on‐onesupportandlegalcounselfromanadvocateonsite.Informationforhousingandimmigrationrightsalsoprovided.

HealthAdvocacyMaternalandChildHealthAccess:Providesoutreachtouninsured/underinsuredindividualsandfamiliestoincreaseenrollmentintofreeandlowcosthealthcoverageprograms.ProvidesassistanceforindividualsenrollinginCalFresh.

HealthcareBenefits/InsuranceServices

L.A.CareHealthPlanFamilyResourceCenter:Provideeducationandassistancetofamiliesaboutfreeandlow‐costhealthinsuranceoptions,includingCoveredCA.


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CommunityOrganizing/Advocacy

BuildingHealthyCommunities–BoyleHeights:Providesupportto14BuildingHealthyCommunitieswiththegoalofimprovingemploymentopportunities,education,housing,neighborhoodsafety,unhealthyenvironmentalconditions,andaccesstohealthyfoods.

ViolencePreventionEastLAWomen’sCenter:AllMyRelationshipsProgramisaviolencepreventionprogramforteenagers,includinga12‐weekyouthleadershipdevelopmentprogramandpeer‐to‐peertraining.

Nutrition/HealthyEating

AmericanDiabetesAssociation:Foodpreparationclassesfordiabeticsandindividualsatriskofdiabetes,teachparticipantshowtopreparefoodsinhealthierways,portionsize,andhealthychoicesoutsidethehome.

PhysicalTherapy NationalMultipleSclerosisSociety:Providesphysical/occupationaltherapyprogramswithgroupexerciseclasses.

ComputerLiteracy EastLAWeingartYMCA:YouthInstituteoffersprogramsforcareerandcollegereadiness,learninggraphicdesign,digitalmedia,webdesign,andmoviemaking.

Fitness/PhysicalActivity MaternalandChildHealthAccess:BestBabiesCollaborative/PrenatalOutreachoffersawalkingclub.

Maternal/ChildHealth MaternalandChildHealthAccess:BestBabiesCollaborativeprovides2‐yearcaremanagement,homevisits,extrafood,walkingclub,andbreastfeedingsupport.

WorkTraining/Vocational

Rehabilitation

WorkerEducation&ResourceCenter:Healthcarecareercounselingforcareerssuchasmedicalassistant,homehealthaide,diagnostictechnicians,etc.Alsoofferscomputerliteracyclassestoprepareforsuchcareers.

Promotoras EastLosAngelesWomen’sCenter:Trainingsforpromotorasconcentratingondomesticviolence,sexualviolence,andHIV.

Meditation/Relaxation ArthritisFoundation:TaiChiclassestohelpwithrelaxation.

Gardening ProyectoJardín:Offersfoodpreparationdemonstrationsandguidedtoursofthegarden.

Literacy L.A.CareHealthPlanFamilyResourceCenter:LapReadisanearlyeducationprogramforchildren0‐5yearsold.Childrenhavefunreading,singing,anddoartsandcraftstogether.

PublicEducationCampaigns

LACountyDepartmentofPublicHealth:Publiceducationcampaigntopicsincludereducinginjuries,violenceprevention,reducingtobaccouseandexposure,activeliving,andhealthyeating.

Table3:ServiceAreasandServiceProvision


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PLACEMATTERS:BOYLEHEIGHTS

TogainafullunderstandingoftheimpactofTheWellnessCenteronthehealthand

well‐beingofcommunityresidents,itiscrucialtotakeacloserlookattheBoyleHeights

community.ThisvibrantanddiverseneighborhoodislocatedintheheartoftheLos

AngelesBasin,directlyeastofdowntownLosAngeles.Itsgeographicarea,aswellasthe

locationofTWC,isdepictedinthemapprovidedbelowinFigure4.

Figure4:MapofBoyleHeights(withTWCInset)

BoyleHeightsisanold,historicallysignificantneighborhoodinEastLosAngeles

populatedwithapproximately90,000residents;itischaracterizedbyastrongcommunity

andculturalidentity.39Forover40years,BoyleHeightshasbeenthehomeofoneofthe

largestChicano/MexicanpopulationsintheUnitedStates.40ManyBoyleHeightsresidents

speakSpanishaswellasEnglish,includingthenewerSpanish‐speakingimmigrants39BHCConnect:BuildingHealthCommunities:“BoyleHeightsCommunity”.40TheWellnessCenter.Website.


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arrivingfromCentralAmerica.Thecommunitycontinuestograpplewithpersistently

elevatednumbersofhighschooldropouts,thepresenceandimpactofgangs,violence,and

teenpregnancy.Despitethepersistenceofthesechallenges,thecommunityalsopossesses

multipleassetsandstrengths.TheCaliforniaHealthyInterviewSurveydetailsother

criticaldemographicinformationforBoyleHeightsisportrayedbelow:4142

x 98%Latino(vs.51%inLACounty)x 1%White(vs.24%inLACounty)x 1%AfricanAmerican(vs.8%inLACounty)x 68.8%ofthepopulationhavelessthanahighschooldiplomax 32.8%livebelowthepovertylinex 62%low‐incomehouseholds(vs.44%inLACounty)x 62%limitedEnglishproficiency(vs.67%inLACounty)x 15%Unemployed(vs.13%inLACounty)

BoyleHeightshascontinuedtoencounterchallengesintermsofeconomicgrowth,

education,publicsafety,andpublichealth.Thesechallengeshavepersistedthroughoutits

historyasacommunity.Asoutlinedpreviously,TWCwasformedlargelyinaneffortto

helpBoyleHeightsanditsinhabitantsgrowintoahealthiercommunity.Through“the

patient‐centeredmedicalhome”model,TWCreliesonpreventivecareastheprimary

mediumbywhichservicesareadministered.43Theseemphasesarevital:BoyleHeightsis

thesiteofepidemiclevelsofobesity,hypertension,stroke,cancer,andvariousotherlong‐

termchronicdiseaseswithintheEastLosAngelesarea.44Basedonstatisticsfromthe

CaliforniaHealthInterviewSurvey,morethan33%ofBoyleHeightsresidentsare

41TheCaliforniaEndowment.MakingHealthHappenbyBuildingHealthyCommunities.BoyleHeights.42UCLACenterforHealthPolicyResearch.BuildingHealthyCommunities:BoyleHeights‐HealthProfile.43Ybarra,Jennifer.(April30,2012).Memorandum:BoyleHeightsWellnessCenterattheHistoricGeneralHospital.Pg.2.44TWCCaseStatement2013,pg.1.


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overweightand23%areobese.Theseratescorrelatewithchronicdiseasesandanoverall

poorqualityoflife.Furthermore,incomparisontomostcitiesinLosAngeles,Boyle

Heightsalsoexperiencesaprofoundlackofopengreenspace.Withlowlevelsof

educationalattainment,thewidespreadlackofhealthliteracyaswellasdeficitsinhealth

outcomesistobeexpectedbutnotaccepted.

BoyleHeightsrepresentedanoptimallocationforTWCduetoitsrichcommunity

characteristicsandchallenges.Theyarethesamefactorsthatdroveitsselectionasoneof

TCE’sBuildingHealthyCommunities(BHC)Initiative14targetsitesacrossCalifornia.

Clearly,BoyleHeightsisanexemplarymodelofacommunityreadyforchangeandThe

WellnessCenterispositionedtoserveasacatalystforpositivecommunitychangeand

individualwell‐being,whilereducinghealthcarecoststoresidentsthroughpreventive

healthcareservices.Theneedforsuchservicesisvitalinthelow‐incomeunderprivileged

communityofBoyleHeights.45Additionally,throughtheBHCinitiative,TCEisworkingto

promote“healthyhomes”intheBHCsitesandisprioritizingpartnershipswithpublic

hospitalsandlinkagestoservicesthatpromotehealth,wellness,andprevention.46To

furtherreinforcethisrelationship,today,BHCBoyleHeightsisasupportivetenant/partner

ofTWC,astheyareleadingthewayincollaborationwithotherlocalandnationaltenants

toprovideeducationtoresidents.PartnershipwiththeBHChasallowedfortheburgeoning

oflocalleaders,youthadvocacyefforts,andacultureofactivecommunity‐based

organizations.Clearly,BHCandTWCperfectlyalignintheirjointeffortsto:“increase

45TWCCaseStatement2013,pg.1.46Ybarra,Jennifer.(April30,2012).Memorandum:BoyleHeightsWellnessCenterattheHistoricGeneralHospital.Pg.2.


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accesstohealthandsocialservicesforyouthandadultresidents,createsafespacesfor

youthprogramming,andadvanceprojectsthatutilizecommunitybuildingstrategies.”47

THEWELLNESSCENTERCASESTUDY

Methodology

Thecasestudyresearchmethodologyrepresentsaneffectiveandusefulapproachto

understandingcommunityandsystemschangewhileofferingaguidetofuture

interventionsandinitiatives.Employingrigorouscasestudymethodology,qualitativeand

quantitativedata(whereapplicable)wascollected,coded,andanalyzedforthis

comprehensivefinalreport.Thecasestudyspecificallysoughttodocumentthecreationof

TWC,examininghowstakeholdersareinvolvedinandhelpingadvanceitswork.

Thecasestudybeganwithaperiodofinformalethnographicobservation,

informationinterviews,anddocumentreview.Fromtheseefforts,aninterview

questionnaire(seeAppendixA)wasconstructed,integratingtopicsandissuesthatarose

frequentlyandrepeatedlyduringthisperiodofpreliminaryresearch.Theprotocolwas

pilottestedinthreeinitialinterviewstoensurethatquestionnairewascapturing

meaningfulinformation,helpingtopaintanaccuratepictureofthedevelopment,successes,

andchallengesfacedbyTWCstaff,community,andorganizations.

Casestudiesprovideaholisticunderstandingofabroaderissuethroughadetailed

contextualanalysisofreal‐lifescenarios.JackandBaxter(2008)explaintheuseofcase

studieswhentheystate:

“Qualitativecasestudyisanapproachtoresearchthatfacilitates47Ibid.


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explorationofaphenomenonwithinitscontextusingavariety ofdatasources.Thisensuresthattheissueisnotexploredthrough onelens,butratheravarietyoflenses,whichallowsformultiple facetsofthephenomenontoberevealedandunderstood…[Case studies]ensurethatthetopicofinterestiswellexplored…”48

Thisquotationhighlightstheprimarymotivationforusingthecasestudyapproach;case

studiesallowustocollectinformationinthedepthneededtounderstandorganizations

andcommunitiesincludingtheprocessesandchangesthatcomprisetheirstructureand

functioning.Inparticular,TheWellnessCentercasestudytrulyrequiredthissortof

“informationaldepth”toultimatelyproducethemostusefulandvalidfindingsthat

emergedfrommultipleinterviews,observationanddocumentanalysis.Drawinguponthis,

thecasestudyrepresentsanefforttocreateafundamentalunderstandingofwhattook

placeduringthedevelopmentofTWC,whatoccurredduringitsinitialmonthsofservice,

andtheoutlineofitsfutureprospects.Additionally,thematerialfromthiscasestudywill

beusedtoinformotherorganizationsabouttheinnovativeandremarkablework

happeningonthefirstfloorofHistoricGeneralHospital.Inparticular,thisworkcanbe

usedastartingpointtoguidefurtherresearchintothepotentialfor,andefficacyof,

wellnesscentersinotherTCEsponsoredBuildingHealthyCommunitysites.Assuch,this

casestudycanserveasaguideforothersitesworkingonimprovethehealthandwellness

oftheircommunities.

Aspartofthis,theresearchassessedmanyfacetsofcommunityengagementaswell

astheleveltowhichtheidealsandpracticesofahealthiercommunitywerebeing

promoted.Drawinguponmultipleapproaches,researchersutilizeddepthinterviews,

ethnographicobservation,anddetailedanalysisofavailabledocuments.Boththeresearch48Baxter,P.andJack,S.(December2008).Pg.544.


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approachandinterviewprotocolsbroadlyengagedgovernmentrepresentatives,

stakeholders,andcommunityresidents,allowingthemtopresenteachoftheirviewpoints

andexperiences.Theinterviewprocesswasbothparticipatoryandintentionaland

involvedface‐to‐faceinterviewswereconductedwithindividualsfromeachthefollowing

groups:

x LocalandnationalnonprofittenantsofTWCx LAC+USCMedicalCenterx OfficeofFirstDistrictSupervisorGloriaMolinax TheCaliforniaEndowmentx BoyleHeightsCommunitymembersx BHC‐BHmembers

Toidentifyandrecruitparticipantsforthecasestudy,theresearchteamreliedona

purposivesamplingmethod,workingcloselywithTheCaliforniaEndowmenttoidentify

keystakeholders.Fromthere,eachindividualinterviewedwasaskedforthenamesand

contactinformationforotherkeyparticipantsandpeopletheybelievedwouldbevaluable

tointerview.Participationinthecasestudywascompletelyvoluntaryandparticipants

werenotcompensatedforcompletingtheinterview.Whilemostindividualswere

extremelyhelpfulandcooperativewhenapproachedforaninterview,therewereothers

whodidnotrespond.Thisisanunderstandablereactiontorequestsofthisnature–

particularlyaspeople’sschedulesandconcernsaremultipleanddemanding.

Withpermissionfrominterviewsubjects,theevaluationteamrecordedall

interviews.Theserecordedinterviewswerethentranscribedandthetranscriptswere

analyzedusinganopencodingprocess.Todeveloppreliminarythemes,membersofthe


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evaluationteamlistenedtoarandomsamplingofthreeinterviewsandcreateda

comprehensivelistofover30lineitems.Toensurethatthelistofthemeswasall‐

encompassing,allinterviewswerethenplayedbacktwiceandcodedbasedonthis

completelist.Usingcodesdevelopedfromtheopencodingprocess,thesecondcoding

processcreatedmorehighlyrefinedkeythemes.Themostprominentthemesare

discussedbelow;thesewerethemespresentinatleast25%ofinterviews,withsome

mentionedinasmuchas83%oftheinterviews.Thiscodingprocessprovidedtheresearch

teamwiththequalitativecontextforthetablepresentedbelow.Thisdatatriangulation

helpedtoensureinternalvalidity.Asdemonstratedinthefollowingsection,interviews

illuminatedthewaysinwhichtheestablishmentofTheWellnessCentercontinuestomeet

communityneedsandineffect,enlargesuponTCE‐BHCdriversofchange:collaboration,

residentandyouthleadership,andpolicyandsystemschange.Theseformalinterviews

wereaugmentedwithinformalinterviewsandlengthydiscussionwithcommunity

members.Whilethesewerenotpartofthecodingprocess,theadditionalqualitativedata

gatheringwasusedtoaugmenttheformalinterviewmaterial.

IntervieweeDemographics

Theresearchteamcompleted12formalinterviewsoverthecourseofseveral

monthswithavarietyofstakeholderswhoreportedwide‐ranginglevelsofinvolvement

withtheprojectsinceitsinception.ThegraphportrayedinFigure5belowdepictsthe

breakdownofrespondentcategories:oneinterviewwasconductedwithtwostaff

membersfromthe1stDistrictoffice.Themajorityofintervieweeswerecentertenants,

whichincludedsevenlocalorganizationsandtwonationalorganizations.Intheinterestof


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candorandinsensitivitytorespondentrequests,thespecificindividualsandtheiragencies

arebeingkeptconfidential.

Figure5:RespondentBreakdown

FirstMonthofOperations

Accordingtooneofourinterviewees,inhereffortsasexecutivedirector,Ms.

Mullenaxrequestedthatthe16tenantsprovideprogressreportsdocumentingthefirst

monthofservice.Thecasestudyteamaskedtenantsthatwereinterviewediftheywould

providetheirreportsforreview.Oftheninetenantsinterviewed,sixprovidedtheir

reportsasrequested.Inordertopaintapictureoftheday‐to‐dayoperationsatTWC,while

notrevealingtheidentityoftheinterviewees,thecasestudywillhighlightsomeoftheir

work.Allofthereportsreviewedindicatedthatwithinthefirstmonthafteropening,offices

werefulloperational;thisincludedtheinstallationofphonelines,computers,otherrelated

media,andofficefurnishings.Officeinfrastructurewasdeveloped,staffwashired,and

1

2

1

7

1

RespondentBreakdown

IstDistrictOffice

Tenants:NationalOrganizations

LAC‐USC

Tenants:LocalOrganizations

TWCStaff


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policiesandprocedureswerefinalized.Aftertheseinitialsteps,agenciesbeganwiththe

“promotionanddeliveryofqualityservices.”Perhapsmostimportantly,inter‐agency

collaborationsandreferralswereinitiated.Oneofthefirststepsinserviceprovisionwas

ensuringthattheofficewasequippedwithappropriateWellnessCentermaterialssothat

staffcouldbeginbuildingclientele.Alloftenantsdescribedhowtheyworkedtoestablish

relationshipswiththeLAC+USCcampus.Asoneindividualexplained,“Wewantedto

ensureopenlinesofcommunication,partnerships,anddevelopmentofcollaborative

activities.Thiswasimportanttousfromtheverybeginning.”

Theseeffortsquicklypaidoff.Oneofthelocaltenantorganizationsreportedthat

theyhadserved27clientsthrough1‐on‐1appointmentsthatwerebothscheduledor

occurredonawalk‐inbasisandadvocacyclinicsduringtheirfirstmonthofoperation.“We

justreachedouttofolksinformally,”astaffmemberexplained,“Andpeoplestartedtocome

in.”Severaloftheindividualsfromagenciesinterviewedindicatedthatfromthemoment

theymovedin,theybegantocollaborateontrainingstohelpcommunitymembers

understandtheAffordableCareActandotherhealthcoverageoptions.Inareport,one

tenantdocumentedtheirworkwith60familiesthatneededassistancewithhealthcare

enrollmentaswellaseffortsattroubleshootingwithanadditional12familiesseenfor

informationandissuessurroundingCalFresh.Anothertenant,anationalorganization,

reportedservingeightclientsthroughe‐consultwithLAC+USCandhashostedexercise

classes.Additionally,thisagencyhasreachedouttoseveralLAC+USCdepartments

includedRehabilitationServices,WellnessCommittee,andRheumatology.Athirdlocal

tenantagencydescribedtheireffortsatcreatingandofferingtrainingsaroundCensusData


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andSocialMediaaswellashostingtoursoftheWellnessCenter,reporting,“Wehaveall

sortsofagenciescomingherelikeTeachforAmerica.Theywanttolearnaboutwhatweare

doing–it’sagreatmodel.”Thisenthusiasmwasechoedinthewordsofthedirectorofa

fourthlocalagency,whoreported:

“Weareabletohelpeachother–wecanbenefitfromhaving immediateaccesstoexpertsinallsortsoffield–we’reallin spacesclosetoeachother.Thereisenhancedcommunicationandallofushavestrengthenedthedialogthatwasalreadyinexistence.Co‐locationisagreatidea,theproximitytovariousexpertsinourfieldwillfostercollaborations.”

Thistenantproceededtochroniclehowtheiragencyishostingadvisorycouncilmeetings

atTWCandhad17representativesfromtenvariousBoyleHeightscommunitybased

organizationsparticipating.Additionally,theyhaveprovideddirectservicethatincluded

supportgroups,counseling,andcasemanagementtofiveclients.

Fromareviewandanalysisofthereportsaswellasinformalexchangeswithagency

personnel,itisclearthatthefirstmonthactivitieswerelargelyadministrativeand

operational.However,astheircommentsandreportsreveal,agenciesdidnotlimitthese

effortsstrictlytotheseefforts.Instead,workshops,informationsessions,andclient

meetingswereheldandevenintheirearlymonthsofoperation,TWCtenantsmanagedto

makeaninitialbutimportantpositivecontributiontothehealthandwell‐beingoftheir

clients.Individualssoughtandreceivedvitalinformationregardinghealthcareaccess,

supportgroups,andexercise.Informalinterviewswithcommunitymembersand

discussionsupheldtheseaccounts.Thisisnottosaythattheearlymonthsofoperation

passedwithoutchallenges,whichwillexamined.However,responsesshowhow

communityneedswerebeingmet.


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KeySuccesses

Despitetheconcernsoftheindividualsinterviewedandthechallengesthey

highlightedthroughouttheinterviews,therewastremendouslypositiveresponsetoThe

WellnessCenter.Whatwasapparentisthateveninitsearliestmonthsofoperation,the

tenantenthusiasmwasmatchedbycommunityresponseandengagement.Thechart

belowillustratesthemostprominentsuccessesexperiencedbyTWCandthoseinvolved

withitthatemergedfromtheinterviewsconducted.Throughcodingandmeta‐analysis,

theresearchteamidentifiedfivekeysuccessesthatoccurredwiththegreatestfrequency.

ThesearedepictedinFigure6below.

Figure6:KeySuccesses

ThemeOne:Fromthebeginning,individualsviewedthegreatestsuccessofThe

WellnessCenterasprovidingtheopportunityforcollaboration.Amongthemajority

oftherespondents,therewasconsistententhusiasmovertheprospectsforbuilding

7

56

43

0

2

4

6

8

10

12

Collaboration(58%)

MovingIn/GrandOpening(42%)

OrganizationalGrowth(50%)

CommunityAccess(33%)

UniqueModel(25%)

KeySuccesses


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workingrelationshipsandeffectivepartnerships.Oftheindividualsinterviewed,58%of

respondentsagreedthatfosteringcollaborationrepresentedakeyvictoryforTWC.The

significanceofthisthemewasreinforcedbycontentfrominterviewswithTWCStaffand

stafffromtheFirstDistrictoffice.Alloftheseinterviewshighlightedthehighvalueof

collaborationintheWellnessCentermodel.Severalindividualsalsofocusedontheidea

thatTWCisnotmerelyaboutco‐location.Thesewereideasthatalsoemergedfromthe

literaturereview.Oneindividualobserved:

“Thepartners,generallyspeaking,learnedtoworktogetherwell. Therewasabondingexperience.Andfromthebeginning,thepartnersallenduredstrugglesandfrustrations.Insteadoflettingthingsgetusdownorupsetus,weallbondedovertheexperienceofcreatingthistogether.”

AnotherindividualofferedhisthoughtsaboutwhatwasdevelopingwithinTWC,saying,

“Therearedefinitelycollaborationshappeningwithinthebuilding.Wearesupportingone

anotherthroughthisprocess.Theseconnectionswouldnothaveoccurredifwewerenot

underoneroof.”

ThemeTwo:Alongsidethesignificanceofcollaboration,anotherkeysuccessnoted

wastheopportunityfororganizationalgrowth.Halfoftherespondentsbelievedthat

thiswasbothastrengthaswellasasuccessforTWC.Interviewanalysisrevealedthat

organizationalgrowthoccurredintwoways:organizationsexpandedtheirpresenceinthe

communityandorganizationsexpandedtheservicestheydelivered.Oneindividual

developedthisthemeduringherinterview:


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“WearemoreinvolvedwiththeBoyleHeightscommunity,withotheragenciesandwiththemedicalcommunity.Wehavebeenabletobuildourconnectionstothecommunityinawaywenevercouldhaveaccomplishedonourown.It’satremendousopportunityandarealsuccessforcommunity‐basedpreventionefforts.”

Anotherindividualobservedthat,“Severalagenciesareexpanding.Agenciesareproviding

newservicesandawiderrangeofservices.”Thesedevelopmentswerepositive

achievementsforboththeorganizationsthatexperiencedthemandforthecommunitythat

benefitedfromthem.Communitymembersweighedinduringinformaldiscussions,

talkingabouttheorganizationstheydidnotknowprovidedservicesthattheycouldaccess

anduseintheireverydaylives.

ThemeThree:Althoughthemove‐inwasnottrouble‐free,hostingthegrandopening

andfinallyoccupyingthefacilitywasviewedasakeysuccess.Thecelebratoryevent

thatmarkedthecreationofTheWellnessCenterwasasourceofbothjoyandpride–with

manyindividualsremarkinghowmeaningfulitwastosharethiswiththeBoyleHeights

Community.While42%oftheindividualsenteredremarkedupontheeffectivenessofthe

event,amongcommunitymembers,thesupportfortheeventwasevenstronger.Inan

informaldiscussiongroupheldafteraBHCgathering,onewomanrecalled,“Itwasa

wonderfulday–agreatpartyandagreatevent.Andnowwe’rehere.”Herexperiencewas

matchedbythatofonetenantwhorecalled,smiling,“Despitecomplicatedpseudo‐County

processesandallthebureaucracy,wegotitdone…nicely.”Thegrandopeningservedasa

kindofhealingevent,enablingthetenantagenciestomovepasttheirfrustration.Another

individualintervieweddetailedtheprocess:


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“Let’sbehonest–theprojectedmove‐inwasdelayedonceortwice,Istoppedcountingafteracertainpoint.Butthroughitall,theagencieswhoweretenantsdevelopedakindofcamaraderie.Weworkedthrougheverythingandtrustedtheprocesstogether.Thecelebrationwasgreatandnowwecanlookateachotherandwe’rethinking,wedidit,we’rein!”

Overall,therewasatremendoussenseofaccomplishmentthataftermuchplanning,The

WellnessCenterwasfinallyareality.Someoftheindividualsinterviewedfocusedonthe

difficultiesofthemovinginprocessbuteventuallyeventhemostcriticalvoicedtheir

satisfactionthattheywerefinallysettledandworkingtopartnerwithoneanotherand

withthecommunity.

ThemeFour:Althoughtheresponsewasnotasstrongaswithotherkeysuccesses,

onethirdofthoseinterviewed,statedthatincreasedcommunityaccessrepresented

amajorvictory.Oneindividualdescribedtheintrinsicvalueofcommunityaccess,

commenting:

“It’ssoimportantandempoweringthatwehavesecuredthisfacility,thisspacehasbeenre‐envisionedasaspaceofhealing–thisisforthecommunity.Wehelptostaffit,wearehereto serve,butinsomeveryrealwaythisis“owned”bythecommunity.Itistheircenter.”

AnotherrespondentexpressedtheirbeliefthatTWC“canthriveasacommunitycenter–we

allseeavisionofsuccess.”TheneedfortheBoyleHeightscommunitytobothpossessand

useacommunity‐basedwellnesscenterwasviewedasintegraltofamilyandneighborhood

health.Duringinterviews,severalrespondentsexpressedsimilaropinionsthatthiscenter

fulfilledalong‐standingneedinthismarginalizedcommunity.“Idon’tknowwhyittookso


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long,”oneintervieweeoffered,“ButIthinkweareallgladthecenterisfinallyhere.”Thiswas

atonethatpersistedthroughoutalloftheinterviews:whateverthecritique,therewas

consistentacknowledgementthattheestablishmentofTWCrepresentedanimportant

accomplishmentthatwouldserveBoyleHeightsintheyeartocome.

ThemeFive:Thefinalkeysuccesswasasentimentexpressedbyrespondentswho

feltitwasimportanttobepartofandplayaroleinthedevelopmentofaunique

model.Throughoutalloftheinterviews,therewasageneralsentimentthatthiswasan

innovativeendeavor,andavastimprovementonpreviousefforts.Oneoutoffour

individualsinterviewedexpressedtheircommitmenttothedevelopmentofanewmodelof

communitybasedpreventivehealthcare.“Itfeelsgoodtobepartofsomethingthatisnew

andinnovative,”oneindividualexclaimed.Anotherintervieweeofferedasuccinct

summaryoftheunusualcharacterofTWC,saying:

“Thereareplacesthatareco‐locatedbutnotplacesthatunderscoretheimportanceofcollaborationacrosspartnerstothislevel.Therearealsocollaborativesthatarenotco‐located–andwhiletheyengagewithpartner,thereisnosenseofbeingabletowalkacrossthehalltoanotheroffice.Forthesereasons,TheWellnessCenterisunique.”

Thesewordswerereinforcedbytheobservationsofanotherintervieweewhomaintained

thatTheWellnessCenterpresentedanimportantopportunitybecause“themodelisagreat

one,welookedatothervenues,butnothingofthisscopeisoutthere.Itdoesn’tmakesense,

thereshouldbemoreplaceslikeTheWellnessCenter–thesemultipurpose/multidisciplinary

centersarecrucialtogoodhealth.”Culturalsensitivityisacriticalaspectofthisunique

modelofwellnessandeffectivehealthpromotion,andisoneoftheareaswhereTWCin


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BoyleHeightsthrives.WhileTWCislookingtoincorporateadditionalprogrammingfor

other“communities”,notablyforthedisabledandforLGBT‐identifiedfolks,theRFP

processensuredthattheirtenantswereprovidingculturallyrelevantandlinguistically

appropriateservicesforthepredominantlyLatinopopulation.

KeyChallenges

Throughoutinterviews,individualsraisedanddiscussedseveralstructuraland

administrativechallengesthatTheWellnessCenterfaces.Thechartbelow,portrayedin

Figure7,depictsthemajorchallengesdescribedbyinterviewees.Aswiththesuccesses

highlightedabove,awiderangeofchallengeswasdescribed.Aspartofameta‐analysisof

qualitativedata,thecasestudyteamcombinedideastocreateoverarchingthematicareas.

Againrelyingonthecodingprocess,sixkeychallengesandthree“additionalchallenges”

themeshavebeenidentified.Theseweretheideasthatwerecodedwiththegreatest

frequency,withkeychallengespresentinatleast58%ofinterviews.Thethreeadditional

themes(TWCStaffing,LackofClearRoles/Responsibilities,andSustainabilityConcerns)

werecodedwithslightlylessfrequencyandwerepresentinatleast41%ofinterviews.


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Figure7:KeyChallenges

ThemeOne:Indefiningkeychallenges,OutreachandPromotionemergedasthe

mostprominenttheme,with83%ofrespondentsspecificallycitingproblemswith

marketing.FirstandforemostforTWCtobesuccessful,theremustbeacommon

understandingofwhatTWCisandwhatitrepresentsforBoyleHeights.Therewas

extensiveconcernaboutmissionandmessaging.Severalindividualsfeltthatanoverall

outreachstrategywasmissing–andtrulyneeded.Onetenantcapturedthisbelief,

observing,“ThereisalackofconsensusaboutwhatTWCtrulyis–whatitrepresents–thisis

crucial.Weneedtodecidejustwhatweareandgetthemessageoutthere.”Interviewees

agreedthattheCenteranditsadministrativestructureneedstomakeamorethoughtful

andintentionaleffortatcreatingmarketingmaterialsthataccuratelyrepresentallfacetsof

theCenter.Anothertenantofferedtheiropinionthat,“Weneedanoutreachplan–weneed

7

5

78

9 9

56

10

0

2

4

6

8

10

12KeyChallenges

LackofAccessibility(58%)

TWCStaffing

Funding(58%)

DelayedMove‐In(67%)

Logistics/Infrastructure(75%)

LackofCommmunication/Cohesion(75%)

SustainabilityConcerns

NoClearUnderstandingofRoles/ResponsibilitiesMarketing‐OutreachandPromotion(83%)


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materialsandweneedbodiestodotheoutreach.”Therewasgreatconcernthatnot

everyoneintheBoyleHeightscommunitywasawareofTWCandtheservicesitoffered.

“Therearepeopleweneedtoreach,whodon’tknowaboutus–andmanyofthemhavethe

greatesthealthneeds,”oneindividualexplained.Itisclearthatthereisadesirefor

effectiveleadershipinthisarena.Theseinterviewsalignedwithoneofthekey

recommendationsraisedearlyonbyTheNetwork–theneedforaunifiedand

comprehensivemarketing/outreachplan.Tenantsraisedconcernthatmanyofthese

recommendationscontinuetofallbythewayside.Raisingthequestionastowhythe

evaluationwasconductedinthefirstplaceandwhethertherecommendationsmadewere

takenseriouslybyTWCadministration.

ThemeTwo:Anotherkeychallengethatemergedfocusedonproblemswith

communicationandcohesionwiththevastmajorityofindividualsdescribing

problemsinthisarea.Thischallengewasverystronglyconnectedwiththemarketing

concernspreviouslyidentified.Theinterwovenuneasinesscharacterized75%ofthe

individualsinterviewed–theirthoughtsandfeelingswererepeatedinmultipleinterviews.

Tenantsexpressedstrongfeelingsaboutthelackofclearandconcisecommunication

betweenTWCStaffandthetenants.Formany,theirconcernswerebestcapturedinthe

wordsofoneindividualwhonoted,“Therearejustnorealisticgoalsandclearexpectations”

aboutwhatisneededfromthetenants.Severalnotedthattheircapacityhaschangedsince

draftingtheiroriginalproposalbutdespitethis,theCenterstaffhasnotbeenwillingto

engageinconversationsorupdates.Oneindividualdiscussedhisconcerns:


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“Thereisaseriousneedforastrategicplan.RightnowIdon’tthinkthereisoneandthat’snotagoodthing–thisallfostersanxietyandanegativereactionfromfolks.Weneedtofeellikeweareallinthistogetherandthatweallhavearoadmapforchange.”

Thisthemealsotiedincloselywithindividualconcernsaboutrolesandresponsibilities.

Oneindividualreinforcedtheneedforastrategicplanandalignmentsaying,“Therearea

lotofhandsinthepot,weneedtocometogetherintentionallyandstrategically–ourrealities

needtoalign.”Whatclearlyemergedfromthethemesidentifiedthroughinterview

analysiswastheneedforTheWellnessCentertocreateandpresentaunited,integrated

fronttobothBoyleHeightsresidentsandtothemedicalcommunity.TWCstaffmust

recognizethatnotalltenantsareserviceproviders,notallhavethesamelevelsofcapacity,

andfinally,notalltenantshaveenoughfundingtomeetTWCdemandswithoutbeing

allottedthetimeandspacetosecureadditionalfunding.

ThemeThree:Themajorityofindividualsinterviewedexpressedconcernsaboutthe

TWCstructure,particularlylogisticsandinfrastructure,withproblemssurrounding

theirlackofvoiceinanyplanningorstructure.Thischallengewasconsistentlycitedby

75%oftheindividualsinterviewedandrepresentsanareawarrantingfutureattention.

Oneindividualwasverydirect,noting“Partnersdonothaveenoughsayintheprocess.”

Again,thisthemeoverlapswithotherchallenges,particularlythelackofcommunication

andtheinabilitytodefinerolesandresponsibilities.Frominterviewaccounts,itappears

thattheneedsoftenantswereconsistentlyoverlookedintheplanningprocess.Giventhe

multipleagendasoperatingthroughouttheplanningprocess,thisisnotsurprising,butthe


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intervieweeswereinsistentthatthisnowhadtobeaddressed.Arelatedconcernwaswell

summarizedbyoneindividualwhodescribedhow“theintakeprocessisreally

complicated…it’sunnecessarilyinvasiveandrepetitive.”Thisbeliefrepresentsserious

concernsonthepartoftenantswhoarerequiredtoensureconfidentialityandrespect

HIPPA.Intervieweesraisedrelatedconcernssurroundingspecificleadershipand

bureaucraticconcerns.Manyrespondentsbelievethattherearekeystructuralpieces

missingfromTWCmodel,namely,communication,transparency,andaccountability.This

issueisexacerbatedbythelackofaclearrelationshipbetweenfundingentities,LAC,TWC

administration,andtenants.Overall,TCWtenantsconcernsclusteredthebeliefexpressed

byoneintervieweewhoseemedtoexpresswhatmanywerefeeling:

“TheCenteriswonderfulandit’simportanttothecommunitybutitneedstoliveuptoitspromise.Rightnowweallarefeelingthatthecenterislackingasenseoforganizationaleffectiveness–time,planning,andcooperationareallmissing–andthisiskey.Alloftheagenciesherearededicatedtowhatwearedoingbutweneedgood,stronginfrastructureandcommunicated.Forsomereason,thisisn’thappening.”

ThemeFour:Challengesthatresultedfromthedelayedmoverepresentedakey

themefortwo‐thirdsoftheindividualsinterviewed.Alongwiththisstrongemphasis

onpost‐move‐inproblems,overhalfoftheintervieweesdescribednowfacing

fundingproblemsthatresultedfromthelatemove‐in.Oneindividualembodiedthe

reactionofmanyintervieweesastheyexplainedtheproblemsthatfacedtheiragency:

“Wewereforcedtodevelopourinfrastructureallatonce.Thebuildingwasnotfunctionalbeforemove‐in,whichimpactedprogrammaticdeliverables,timelines,andscopeofwork–itcausedconfusion.Weexpectedtomoveintoastableenvironment–weknewtherewouldbeproblems,


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46

butnothingapproachedwhatwefoundwhenwetriedtomovein.Nothingwasready.”

Therewasconfusion,lackofpreparation,andnosignofinfrastructure.Severaltenants

discussedtheirinabilitytosecurefundingasadirectresultofthecontinuallydelayed

move‐in;thiswasaproblemmostnotablyforthesmaller,localagencies.Oneindividual

whowasinterviewedrecalled,

“Weexpectedtohitthegroundrunning,anditwasarudeawakeningwhenwehadtostopinourtracksandtakecareofthings–likegettingthephonehookedup–thatshouldhavebeentakencareofforus.Onlynowthatweareactuallyinthefacilitycanwebeginfundraising.Thishasbeenaseriousproblemforus.”

ManyoftheintervieweesrevealedtheirfeelingsofsurprisethattheinfrastructureofTWC

wasnotaswellorganizedastheyhadanticipated.Therewasrecognitionthatproblems

wereanticipated,butnotthetypeorextentthatwasexperienced.Attendingtoallofthese

problemsdivertedtheirattentionandenergiesfromfundraisingandmaintaining

relationshipswithongoingandsustainingfunders.“Wethoughtwewouldn’thavetodeal

withanyofthis,”oneindividualrecalled,“that’swhywejoinedtheCenter.Butwewoundup

experiencingdoubletheproblems.”Fundingloomedlargeasanongoingchallenge,

exacerbatedbythedelayedmove.AgainaligningwithTheNetworkrecommendations,this

ongoingconcernregardingfundingaddstotheanxietyaboutthesustainabilityofTWC

model.Relatedtosustainability,severaltenantsexpressedtheneedforoutcome

developmentinordertomeasure–andvalidate–theCenter’ssuccess.Whencoupledwith

theconcernaboutbuildingasolidclientele,manyoftheintervieweesfeelthattheCenter’s

futureistroubledanduncertain.


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ThemeFive:LackofaccessibilitypresentedamajorchallengefacingTheWellness

Center,aperceptionsharedbytenantsandcommunitymembers.Thisistheone

challengethataroseinbothformalinterviewsandinformaldiscussionwithcommunity

members.Forthemostpart,tenantsanddistrictofficestaffagreedonchallengesand

problems,whilecommunitymembersweresimplythrilledtohaveTheWellnessCenter

operating.However,withthischallenge,everyonewasinagreement.Inaddition,there

wasastrongsenseofurgencyaccompanyingtheremarksofthosewhodiscussed

accessibility.Asoneindividualinsisted,

“Thisisfarmoreimportantthananyoftheadministrative,structural,andmarketingconcernsandneedstobesolvedimmediately.Iamembarrassedtotrygivingdirectionstoclients.IkeepthinkingofhowsomeonemighttrytowalktotheWellnessCenterfromtheparkinglot–iftheytrytocomeupthatstaircase,theycouldslipandfall.Andwe’vegotclientswhoarealreadyuncertainaboutthehealthcaresystem.It’sdifficultenoughtonavigateonline–nowit’sdifficulttonavigatefromtheparkinglot.”

Anotherindividualdescribedhow,“ThecomplexlandscapeoftheLAC‐USCcampusand

parkinglotisenoughtokeepthemfromsettingfootatTWC.”Therewasasignificant

amountofconcernexpressed“aboutthesafetyofconsumerscomingtoTWC."Onetenant

raisedtheirconcernthat,“thereisnotenoughsignage–wehavetogiveextensivedirections,

whichexacerbatesthepressuretogetpeoplehere.”Fourcommunitymemberswerequite

vocalintheirconcernsnoting,“TheCenterisgreatbutIcan’tparkandwalkthere–they’re

crazyiftheythinkit’seasytogetto,”whileanotherolderwomanasked,“Whatarewe

goingtodowhenitrains?”ThefollowingphotographsandinstructionsdepictedinFigure


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8and9aretwosectionsofahandoutcreatedbyTWCtenantstoprovideunderstandable

directionstoclients.49

Figure8:ParkingDirections

Forthosewhocannotorchoosenottomakethe7‐10minutewalkupthesteep

staircase,TWChasimplementedafreeshuttleservice.Still,forthetenantsinterviewed,

thiswasnotenough.Theshuttle,theysuggested,shouldrunthroughthenearby

communitiesandworktocoordinatescheduleswiththemetrolinesforthosewhonot

havereliabletransportation.Belowisamapdepictingtheshuttlescheduleandroute.The

shuttleisexpectedtostopatfour“convenient”locationsat15‐minuteintervals.Forthose

dependentontheshuttleservice,theymustleaveampletimeforparkingandtransport

whencalculatingthetimeneededtoarriveontimefortheirappointments.Community

membersclaimedthatthiswasanunrealisticand“un‐welcoming”plan;onesuggestedthat49TWCParking.(2014).


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therebeatownhallmeetingtodiscusshowtocreatebetteraccesstoTheWellnessCenter.

“Idon’twanttowindupwithabrokenleg,”oneremarkedwhileanotherlaughinglyadded,

“IwanttogotoTheWellnessCenterforpreventivemedicine–notrehabilitation.”

Figure9:TheWellnessCenterShuttle

TWCModel:MissingPieces,Future,andReplicability

NearlyalloftheindividualsinterviewedexpressedtheirbeliefthatifTWCwere

operatingatfullcapacity,theCenterwouldberepresentativeofandresponsivetothe

needsoftheBoyleHeightscommunity.Atthistime,however,andasaresultofthe

challengeslistedabove,intervieweesagreedthattheCenterhasnotyetreachedfull

capacity.Movingforward,respondentsidentifiedseveralservicesthattheyfeltcouldbe

enhanced:


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x DisabilityServices/Accessibilityx ImmigrationServicesx DirectHealthServices(ex:Dental)x SubstanceAbuseServicesx CancerServices(NationalOrganization)x SupportGroupServicesx Culturallyandlinguisticallyappropriateprogrammingx Youthprogramming(ArtsandSports)

RespondentsagreedthatthisfirstyearrepresentedacriticaltimeforTWC.Aspartofthis,

tenantsexpressedhopethattheCenterwilldevelopbothinternalandexternal(third‐

party)evaluationmodelssothattheycanmorethoroughlymeasuretheirsuccessesand

desiredoutcomes.Therewascarefulthoughtaboutthefutureandthevisionthatwould

bestguideTWC.Theindividualsinterviewedwereveryclearaboutwhatwasbothneeded

anddesiredinthemonthsahead:

x Seeasteadyflowoftrafficandexpandedservices.x BecomeanationallyrecognizedmodelfundedbytheFederalgovernment.x Buildstrongerrelationshipswiththemedicalandnonprofitsectorsx DeveloptrustamongstmembersoftheEastLosAngelescommunity.x Gainabetterunderstandingoftheroleofallstakeholdersx Setspecificbenchmarks/outcomesidentifiedthatareachievableand

transformationalx Provide“programmingworthcomingbackfor.”

Duringinterviews,theissueofreplicabilitywasdiscussedatlength.Itiskeyto

notethatthediscussionsoftheprospectsforreplicabilityofamodelreferstoTheWellness

Centermodelasawhole–mostnotably,aco‐locatedmulti‐tenantmodelwithcollaborative

programming.Therewerevaryingdegreesofenthusiasmaboutthismodel,asportrayed

inFigure10,with91%ofrespondentsvoicingtheirbeliefthatthecomprehensiveand

holisticmodelofprovidinghealthcareservices,education,andpreventionmethodsis

replicable.However,oncetheinterviewerdrilleddownintoperceptionsandnuances,one


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outoffourindividualsvoicedsomehesitation.Individualsexplainedthattotruly

determineifthemodelwasreplicable,theCentermustfirsthavethetimeandopportunity

tooperateatfullcapacityandwithfulleffectiveness.Onerespondentindicatedthatthe

modelisnotyetreplicableexplainingthattheinternalstructure,lackoftransparencyand

accountability,andpoordefinitionofrolesandresponsibilitiesremainaskeyareasof

concern.

Figure10:IsTWCModelReplicable?

Buildingonthisdiscussion,andbasedontheresearchatothercommunitybased

wellnesscenters,multi‐tenantnonprofitorganizationsofferinghealthandwellness

servicestoresidentsarecharacterizedbyboththecapacitytogrowandtheabilitytobe

8

3

1

IsTWCModelReplicable?

Yes(Absolutely)

Yes(WithHesitation)

No


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replicated.Whatisclearfromtheseexternalstudiesandfromtheresearchconductedat

TCW,isthatthefollowingcomponentsmustinplace:50

x Beginningwithasharedvisionofhealthconcernsx Usingself‐helpsupportcirclesasatoolforenhancingpersonal/collective

empowermentx Developinghealtheducationandpromotionworkshopsthatactivelyinvolve

participants,enablingthemtoshareexperiencesinsupportcircleswhileintheprogram

x Housingtheprograminanaccessibleandwelcomingspaceinthecommunityx Providingon‐siteexerciseclassesandequipmentx Establishingandmaintainingsupportiveandcollaborativecommunity

partnerships.

Alongsidereplicability,theissueofscalabilitywasalsoraised.Manyrespondents

voicedtheirbeliefthatwhilethemodelitselfistoocomplicatedforreplication,elementsof

themodelcouldbeincorporatedintoexistinghealthcarecampusesonasmallerscale.

Tenantsbelievedthatthiswouldbeamuchmoreseamlessprocess.Thelessonslearned

fromtheestablishmentofTWCcouldbeusedtoinformtheprocessofcreatinganother

wellnesscenterataBHCsiteinCalifornia.Whilesomeintervieweesbelieveditwas

essentialtobuildothercentersinhistoricalbuildings,themajorityofindividualsexpressed

theirconcernabouthoweffectiveitwouldbetoavoidusingahistoricalstructure

ultimatelyensuringaquickerconstructionorrenovationprocess.Certainly,insouthern

Californiathereisanothercommunitythatwouldwarrantthisinnovativeandexciting

approachtoengagingresidentsandbuildingcommunityhealth.SouthLosAngelesshares

manyofthesamestrengthsandchallengesasBoyleHeightsandrepresentsfertileground

forfutureinnovation.

50ElliotBrown,Jemmott,Mitchell,&Walton(1998),pg.151‐152.


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REPLICATINGTHEWELLNESSCENTER:MARTINLUTHERKING,JR.COMMUNITYHOSPITAL

HistoryoftheMartinLutherKing,Jr.CommunityHospital InSouthLosAngeles,MartinLutherKing,Jr.CountyHospitalfirstopeneditsdoors

in1972.ItwasconstructedaftertheWattsRiotsandtracesitsoriginsdirectlytothelocal

aswellasnationalbeliefthattheabsenceofhealthservicescontributedtocivilunrest.51At

thetime,thecommunityofSouthLosAngeleslacked‐‐anddesperatelyneeded‐‐ageneral

hospital.IndividualswereactuallyforcedtotraveltoLosAngelesCountyHospitalinBoyle

Heightstoreceiveservices.AddressingFromthesechallengesaspartofLosAngeles

County’scommitmenttochange,theoriginalMartinLutherKing,Jr.GeneralHospitalcame

intoexistence.TheHospitalbeganasa461‐bedgeneralacutehospital–oneofthefew

facilitiesthatcateredtothepoorestandmostunderservedresidentsofthecommunity.52

Itsexistencerepresentedhopetopeoplewhohadneverexperiencedgoodcareintheir

owncommunity.

51MartinLutherKing,Jr.CommunityHospital.OurStory.52Ibid.


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Sadly,overtime,thepromiseandhopegavewaytoproblemsandultimatelycrisisinterms

ofmedicalcareandservicedelivery.InAugust2007,afteralonghistoryofwell‐

documentedoperationaldifficulties,thehospitallostitsaccreditationandwasforcedto

close.DistrictTwoSupervisorMarkRidley‐ThomasandLosAngelesCountyleadership

remainedcommittedtoprovidinghealthcareandcriticalemergencyservicestoSouthLA.

Butthequestionremained:How?

InOctober2007,theSouthLosAngelesMedicalServicesPreservationFundwas

signedintolaw,guaranteeingthatLosAngelesCountywouldprovidefundingtobuilda

new,state‐of‐the‐arthospitalthatwouldreplaceMLKandprovidethehighestquality

healthcare.Theoldhospitalhascontinuedtoprovideoutpatientservicesthroughthe

MartinLutherKing,Jr.MultiServiceAmbulatoryCareCenter(MACC),whichstillfunctions

today.

Therewasongoingconcernaboutfundingandcapacity.Asaresult,in2008,LAC

approachedtheUCRegentsandGovernorSchwarzeneggertoaskforadditionalassistance

inbuildinganewhospital.Thefollowingyear,theUCagreed,transformingthehospital

intoanindependent,501(c)(3)nonprofitorganization.In2010,thepartnershipsponsored

AssemblyBill2599toprovidefinancialstabilitytothenewhospital,whichwassignedinto

lawbySeptember.Ridley‐ThomasandLACleadershipheldaseriesofcommunity

meetingstodiscussplansforestablishingandstaffingthenewhospitalandtoobtaininput

fromcivicleaders,businessowners,healthcareadvocates,andlocalresidents.53

Baseduponthepublic‐privatepartnershipestablishedbyLACandtheUniversityof

Californiatoaddressthehealthneedsofthecommunity,thecollaborationcreatedan53MartinLutherKing,Jr.CommunityHospital.OurStory.


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independentnonprofitorganization,theMartinLutherKing,Jr.‐LosAngelesHealthcare

Corporation,whichwaschargedwithoverseeingtheadministrationoftheHospital.In

2011,theCorporation’sboardofdirectorscreatedtheMartinLutherKing,Jr.Community

HealthFoundationtosupporttheworkofthenewHospital.TheFoundationwillmeetthe

needsofthepublicbyincreasingaccesstoresourcesconcerninghealthandwellness,

creatinginitiativesthatensurebetterservicetothecommunity,conductingoutreach,and

obtainingfunds.Allofthisisimportanttonoteinunderstandingthatasubstantial

infrastructureforthishealthcarefacility.

2015:TheNewMartinLutherKing,Jr.CommunityHospital

ThenewMartinLutherKing,Jr.(MLK)CommunityHospitalrepresentsa“priority

project”forSupervisorMarkRidley‐Thomasandisanintegralpieceofhis2013Master

Plan.54

TheHospitalwillhave131in‐patientbedsandissettoopeninearly2015.Envisionedasa

centralhubinanintegratedsystemofcare,theHospitalwillbeprovidingthehighest

qualityofmedicalservicesandofferinghealtheducationandcommunityoutreach

programsbothonthesiteandwithregionalcommunitypartners,ultimatelycreatinga

comprehensivesystemofwellnessservices.55Designedtoeffectivelyservethe1.2million

residentsofSouthLosAngeles,includingCompton,Inglewood,Watts,andLynwood,MLK

willofferinpatientprimarycare,basicemergencyservices,aswellashealtheducationand

outreachservicesforthecommunity.56Outpatientserviceswillbelocatednearbyandwill

54 Ibid. About the Hospital. 55 Martin Luther King Community Health Foundation. (2014). About. 56Ibid.


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beofferedthroughtheMartinLutherKing,Jr.CenterforPublicHealth,whichwillfocuson

preventivecare,andtheAugustusHawkinsMentalHealthCenter.

AccordingtotheLosAngelesCountyDepartmentofPublicHealth,SouthLos

AngelesishometosomeofLA’smostvulnerablepopulationswithseveralhealth

concerns.57ThefollowingtableportraysSouthLA’spopulationdistributionandthe

problemstheyencounter.

x 74%Hispanicand23%AfricanAmericanx 35%ofcommunityisunder18yearsx 30%ofSouthLAadultsreporttheirhealthtobefairorpoorx 38%uninsuredx 29%havenoregularhealthcarex 45%ofadultshavedifficultyaccessingmedicalcare

Accessibilityhasproventobeacrucialproblemforthesevulnerablepopulations

andforthecommunity.AftertheoriginalHospitalwasshutteredandserviceswereshut

down,manyresidentslostcrucialaccesstohealthcareandresources–including

emergencyservices,surgicalcare,andgeneralmedicalcare.Althoughpatientsfromthe

formerHospitalwereabsorbedintootherlocalhospitalsaroundthearea,mostofthe57Ibid.Statisticsfromthe2013LACountyDepartmentofPublicHealthsurvey.


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hospitalswerenotasaccessible.Publictransportationwasanongoingproblemaswasthe

lackofoutreachandfollow‐up.Forthisreason,theestablishmentofamodernhospitalto

provideoptimalservicesandcommunity‐basedcaretotheindigentandmarginalized

residentsofSouthLAisofutmostimportance.

IncorporatingTWCModel

ConsideringtheHospital’srichhistoryanditsnewpositionasa“hub”forSouthLos

Angeleshealthandwellnessneeds,theMLKmodelmirrorsthatoftheTWCatTheHistoric

GeneralHospital.Withitscommitmenttoincludingcommunityvoices,elementsof“TWC

Model”wouldbeimportantaswellasinvaluabletothedevelopmentofcommunitybased

wellnesseffortsinSouthLosAngeles.Integratingthismodelwithintheexisting

Foundationinitiativeswouldbeideal,fittingtogether“matching”strategies.Thereseveral

localcommunityorganizationsemphasizinghealthandwellnessinSouthLAthatcould

playacriticalroleasthoughtandleadershippartners,providingsignificant,community‐

basedresourcesandservicesthatareintegraltothewellnessofSouthLosAngeles

residents.TheselocalorganizationsarelistedbelowinTable4:58

TypeofService OrganizationsProvidingServices

Family/CommunitySocialServiceCenters

x AlWootenJr.HeritageCenterx ElNidoFamilyCenter‐Manchesterx ParaLosNiñosx WattsLaborCommunityActionCommitteex Bradley/MilkenYouthandFamilyCenter

CommunityHealthClinics

x WattsHealthCenterx SouthCentralFamilyHealthCenterx St.John’sWellChildandFamilyCenterx CrenshawCommunityHealthCenter

58MartinLutherKingCommunityHealthFoundation.(2014).CommunityResources.


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FoodBanks x APLAHealthandWellnessCenterMentalWellness/Counseling

x HubertHumphreyComprehensiveHealthCenterx DidiHirschCommunityMentalHealthCenterx HouseofUhuruCounselingCenter

Fitness/Exercise x YMCAx ChallengersBoysandGirlsClub

Shelters/TempHousing x HigherGoals,Inc.x HomelessOutreachProgram&IntegratedCareSystem

SpiritualWellness x SanMiguelChurchx WestAngelesChurchofGodinChrist

WorkforceDevelopment/Employment

x UrbanLeagueWorksourceCenterx JordanDownsPortalx Southeast‐LA–CrenshawCenterx ComptonCareerLink

Table4:SouthLA‐BasedServiceProviders

CONCLUSION

ThiscasestudyexploredandidentifiedthecreationofTheWellnessCenter

alongsideitsrelationshiptotheBoyleHeightscommunity.Today,TWChasbeenoperating

forroughlyeightmonthsanddespitestructuralandadministrativecomplications–ithas

andwillcontinuetopositivelyimpactindividualandcommunitywell‐being.Significantly,

themodelalignswiththemissionandvisionofTheCaliforniaEndowment’sBuilding

HealthyCommunitiesinitiative.TWCisanembodimentoftwokeytenetsofthe“Health

HappensHere”mantra–HealthHappenswithPreventionandHealthHappensin

Neighborhoods.InitseffortsthroughoutCaliforniaingeneralandinBoyleHeightsin

particular,TCEhasmovedthediscussionofhealthandwellnessbeyondthetraditional

doctor’sofficewallstotheareaswherewe“live,learn,andplay.”TWCisanimportant

assetforacommunitylikeBoyleHeights–richincultureandactivismyetlackingthe

knowledgeandresourcestoachievehealthyeatingandactivelivingonitsown.


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WiththeimplementationofsignificantpolicychangesundertheAffordableCare

Act,thecurrentpoliticalandeconomicenvironmentprovidesauniqueopportunityfor

TWCtothrive.Withtheseemergingtransformationsinthehealthcaresystem,TWCis

positionedtoensurethatlow‐incomeminoritycommunitiesareaffordedaccesstohealth

coverage,insuranceandresources.Mostimportantly,TWCencouragesitsclientstobegin

theirwellnessjourneybyaddressingtherootcausesofillnesses.Communityengagement

isacentralcomponentofthismodelandisintegraltoprovidingappropriateeducationand

servicestomeettheneedsofBoyleHeightsresidents.Asaresult,residentsarenowtaking

chargeoftheirhealthcareandbecomingadvocatesforhealthyeatingandactivelivingin

theirunderservedcommunity.

Inalignmentwiththeresearchonwellnesscentersnationwide,TWCstakeholders

identifiedseveralkeysuccesses:collaborationamongtenantorganizations,improved

community‐basedprogramming,andincreasedaccesstoculturallyandlinguistically

appropriateservices.TheWellnessCentermodelhasproventobeunique:itisco‐located

andcollaborative.Researchsuggeststhatdifferentagenciesclusteredunderoneroof

raisesawarenessofvariouspartners’particularserviceareasandultimatelyattracts

greaterpublicsupportandengagement.59Inthesamevein,co‐locationiscriticalto

enhancingresidentparticipationandincreasingaccesstoservices.Researchdemonstrates

thatco‐locatednonprofitcentersnotonlyhavethecapacitytogrowandexpandbuttobe

replicatedthroughoutthecountry.Infact,co‐locatednonprofitcentershavebeenonthe

riseforyears,andarefavorablyviewedbecauseoflowertenantcosts,emphasison

organizationaldevelopment,efficiency,andeffectiveness,andbettercoordinationofclient59Vinokur‐Kaplan&McBeath(2014),pg.79.


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services.60TWCtenantsbelievethatsharingthesamephysicalspaceprovidesthe

opportunityforadiversesetoforganizationstointeractinwaysnotpreviouslypossible,

allowingforthecreationofa“one‐stop‐shop,”andhelpingtobroadtheirprogrammingto

betterreflectcommunityneeds.61Collaborationamonghealthcareprovidershasalso

proventobeanimportantfactorintheprovisionofcomprehensiveservices.Inmany

examplesofthesecommunity‐basedprogrammingefforts,thepatientisplacedatthe

centerofthemodel–whichiscrucialtoensuringcontinuedengagement.

Inlightoftheincreasedawarenessoftheseco‐locatedandcollaborativewellness

centermodels,thiscasestudyofferedanexampleofSouthLA’sMartinLutherKing,Jr.

Hospitalasacommunity‐basedmedicalfacilitythatcouldpotentiallybenefitfrom

implementingelementsofTWCmodel.Asapartofitsfoundationinitiatives,MLKcould

amplifynontraditionalhealthandwellnessservicesandplaceanemphasisonprevention.

AsinBoyleHeights,theresearchteamidentifiedseveralhealth‐mindednonprofit

organizationsinthatcouldcollaboratetoprovidetheseresources.

Toeffectivelymeetemergingchallenges,TWCtenantsvoicedaneedformore

effectivecommunicationamongallstakeholders–tenants,funders,andstaff.Thereneeds

tobeaclearerunderstandingofrolesandresponsibilitiesandincreasedaccountabilityand

transparencyamongTWCstaff.InordertoensurecontinuedrelianceonWellnessCenter

services,staffisworkingonimplementingamorecomprehensivemarketingprogram

combinedwithintentionaloutreachandreferraltoandfromtheLAC+USCHospital.Issues

concerningfunding/sustainabilitycanbebetteraddressedafterTWChasbeenoperating

60Ibid.61Ibid.


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foroverayear.Thesechallengesmimickedthoseaddressedintheliterature,suggesting

thatwithmoretime,TWC’suniquemodelhasthepotentialtoflourishnotonlyintheBoyle

Heights,buttoinspirecommunityengagementandresidentactivisminotherunderserved

low‐incomeminoritycommunities.


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WorksCited62Andersen,R.M.(1995).RevisitingtheBehavioralModelandAccesstoMedicalCare:Does

ItMatter.JournalofHealthandSocialBehavior,36(1),1‐10.Bates,T.W.(2011).CommunityandCollaboration:NewSharedWorkplacesforEvolving

CommunityPractices(Master'sthesis,MassachusettsInstituteofTechnology).Baxter,P.andJack,S.(December2008).“QualitativeCaseStudyMethodology:StudyDesign andImplementationforNoviceResearchers”inTheQualitativeReport,13(4).544‐ 559.http://www.nova.edu/ssss/QR/QR13‐4/baxter.pdf.BHCConnect:BuildingHealthyCommunities.“BoyleHeightsCommunity”. http://www.bhcconnect.org/health‐happens‐here/boyle‐heights/our‐community.TheCaliforniaEndowment.MakingHealthHappenbyBuildingHealthyCommunities.

BoyleHeights.http://www.calendow.org/communities/building‐healthy‐communities/.

CaliforniaHealthInterviewSurvey(CHIS).(2003‐2005).HealthyCity:Information+Action

forSocialChange.“ZipCodes:90033,90063:QuickStats.”www.healthycity.org.

ElliotBrown,K.A.,Jemmott,F.E.,Mitchell,H.J.,&Walton,M.L.(1998).TheWell:ANeighborhood‐BasedHealthPromotionModelforBlackWomen.Health&SocialWork,23(2),146‐152.

HealthServices–LosAngelesCounty.LAC+USCMedicalCenter:AboutUs. http://dhs.lacounty.gov/wps/portal/dhs/lacusc/.MartinLutherKingCommunityHealthFoundation.(2014).OurCommunity. http://mlk‐chf.org/about/.MartinLutherKing,Jr.CommunityHospital.http://www.mlkcommunityhospital.org/.Merzel,C.&D'Afflitti,J.(2003).ReconsideringCommunity‐BasedHealthPromotion:

Promise,Performance,andPotential.AmericanJournalofPublicHealth,93(4),557‐574.DOI:10.2105/AJPH.93.4.557.

TheNonprofitCentersNetwork.(March7,2013).Memo:WellnessCenterBusinessPlan:

PartI,CapacityPlan.62WellnessCenterStaffandTCEpersonnelprovidedmanyofthedocumentsreferencedherein.Documentsarereferencedbytheirtitlesanddates(whenavailable).Completecitationsprovidedwhereapplicable.


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TheNonprofitCentersNetwork.(March8,2013).PPTPresentation–BusinessPlan:PartI, CapacityPlan.Nykänen,P.&Seppälä,A.(2012).CollaborativeApproachforSustainableCitizen‐Centered

HealthCare.InCriticalissuesforthedevelopmentofsustainablee‐healthsolutions(pp.115‐134).DOI:10.1007/978‐1‐4614‐1536‐7_8.

RequestforProposal.Rent‐FreeSpace:FirstFloorattheLosAngelesCountyWellness

CenterattheHistoricGeneralHospital.(2011).Rosenberg,A.(November19,2009).UCtohelpreopenSouthL.A.'sMLKhospital. http://newsroom.ucla.edu/stories/uc‐to‐help‐reopen‐south‐l‐a‐s‐112842.Suresh,S.,Ravichandran,S.&P.G..(2011)UnderstandingWellnessCenterLoyalty

ThroughLifestyleAnalysis,HealthMarketingQuarterly,28:1,16‐37.http://dx.doi.org/10.1080/07359683.2011.545307.

Steinhauer,J.(November22,2009).DealWillTurnaLosAngelesHospitalPrivate.TheNew YorkTimes.http://www.nytimes.com/2009/11/23/us/23hospital.html?_r=0.SupervisorGloriaMolina,FirstDistrict.TheWellnessCenterattheHistoricGeneral

Hospital.Retrievedfrom: http://gloriamolina.org/the‐wellness‐center‐at‐the‐historic‐general‐%20hospital/.Thompson,C.W.,Monsen,K.A.,Wanamaker,K.,Augustyniak,K.,&Thompson,S.L.(2012)

UsingtheOmahaSystemasaFrameworktoDemonstratetheValueofNurseManagedWellnessCenterServicesforVulnerablePopulations.JournalofCommunityHealthNursing,29:1,1‐11,DOI:10.1080/07370016.2012.645721.

TheWellnessCenter.(2014).Homepage.http://www.thewellnesscenterla.org/.TWCCaseStatement.(November2013).Pages1–5.TWCFunds.(2012Overview).TWCParking.(2014).TWCPartnersListandFactSheet.(December2013).Pages1‐3.TWCPowerPointPresentation.(March2014).TWCSummaryofServices.(February10,2014).Pages1–11.


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UCLACenterforHealthPolicyResearch.BuildingHealthyCommunities:BoyleHeights‐ HealthProfile.http://www.calendow.org/uploadedFiles/Health_Happends_Here/

Communities/OurPlaces/BHC%20Fact_Sheet_Boyle%20Heights.pdf.Vinokur‐Kaplan,D.&McBeath,B.(2014),Co‐locatedNonprofitCenters.Nonprofit

ManagementandLeadership,25:77–91.DOI:10.1002/nml.21110Ybarra,Jennifer.(April30,2012).Memorandum:BoyleHeightsWellnessCenteratthe HistoricGeneralHospital.


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APPENDIXA:INTERVIEWPROTOCOL

1. PleasetellmehowtheTWCcameintobeing–howdidtheprocessbegin?Whattookplaceovertime?Inotherwords–pleasediscussthestoryofTWC.

2. AretherethingsyouwouldchangeabouttheprocessofcreatingTWC?

3. Whatwerethebiggestchallengesinthatjourney?Biggestsuccesses?

4. Wheredidthebestsupportcomefrom?

5. WhatisthefutureofTWC?WheredoyouenvisionTWCbeing5yearsfromnow?

6. Isthisamodelthatthatisreplicable–whatisyoursenseofthat?Whatarethekeyelements?

7. HowweretheagencieschosentoparticipateinTWC?

8. WhatpiecesdoyouthinkneedtobeaddedtoTWC?

9. Anythingelseyouwanttodiscussoraddtothecasestudy?

10. WhoaresomeadditionalkeystakeholdersIshouldreachoutto?


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APPENDIXB:

MARTINLUTHERKING,JR.GENERALHOSPITALEXTENDEDCASEMATERIAL

MissionandVision

MartinLutherKing,Jr.Hospital’smissionistoprovidehighqualityhealthcare,

comprisedofacompassionate,integrated,coordinated,andcollaborativeapproach

towardsitscommunitytoimproveoverallhealthamongitschildrenandfamilies.To

achievethisgoal,thehospitalleadershipwillcollaboratewithotherhealthcarefacilities

andproviderswithinthecommunitytomakeservicesnotavailableinthehospitalreadily

accessibletothepublic.63

FundingPartners

FundraisingtoconstructandestablishthenewMartinLutherKing,Jr.Hospitalhas

receivedgenerous,widespreadsupportfrombothpublicandprivatecommunitypartners.

InconsideringhowTWCcaninformthecreationofawellnesscenterinSouthLosAngeles,

itiscriticaltonotethatseveralofthesepartnersarealsosupportersofTWC.Inparticular,

TheCaliforniaEndowmentandLACarearenotedasproviding“valuablestart‐upsupport.”

Funders Purpose Amount

LACounty Startupfundsforexpenses/operatingcosts $50million64

LACounty Careforuninsuredpatients $13.3millionayear65

LACounty Capitalprojectcommitment $353.8million66

63MartinLutherKing,Jr.CommunityHospital.AbouttheHospital.64Steinhauer,J.(2009,November22).DealWillTurnaLosAngelesHospitalPrivate.TheNewYorkTimes.65Ibid 66Rosenberg,A.(2009,November19).UCtohelpreopenSouthL.A.'sMLKhospital.


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LACounty Annualoperatingfunds $63million67

LACounty(majorlendinginstitution)

Operatingfundsforfirst6yrs $100million(creditletter)68

KaiserPermanente Labor/DeliveryDepartment $2million

WeingartFoundation

HealthyBabies,HealthyBeginningsInitiative NA

TheRalphM.ParsonsFoundation

HealthyBabies,HealthyBeginningsInitiative $750,000

TheAhmansonFoundation Siemens’sSymphonyMRI $500,000

TheDavidandLucillePackardFoundation

Expansionofobstetricservicesandmaternityprograms

_________________________________HealthyBabies,HealthyBeginnings

Initiative

$800,000

GoodHopeMedicalFoundationwithUCLAHealthSystemandDavidGeffenSchoolofMedicine

PlanningandpilotprogramstoestablishTheLearningCenter $100,000

TheAnnenbergFoundation

PlanningandpilotworkrelatedtoTheLearningCenter $151,880

TheWaltDisneyCompany

ArtFundInitiativetoestablishahealingartprogramatthehospital NA

Table5:MLKFunders

ServiceProvision

67Ibid68Ibid


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Inadditiontohighqualityandcomprehensivemedicalcareandmentalhealthcare

services,theMLKFoundationwillbeoverseeingcommunity‐basedinitiatives.69These

effortswillbebothinnovativeandaccountableformeetingcommunityneedsandinterests.

Forexample,theArtFundwillensurethatthetraditionallysterilehospitalenvironment

willbeadornedwitharttofosterarestorative,calming,andpeacefulambiance.The

HealthyBabies,HealthyBeginningseffortisdesignedtoensurethatmothersinSouthLA

haveaccessibleandcompassionatecareirrespectiveoftheireconomicstanding.In

anotherfacetofcomprehensivecare,theLearningCenterwillserveastheconnection

betweentheHospitalandcommunityresidents,providers,andorganizers.TheCenterwill

provideeducationforresidentsastheynavigatethecomplexhealthcaresystemwhile

collaboratingwithotherlocalandnationalorganizationstoensurecompletenessofcare.

Theprovisionofoutpatienttreatmentisessentialtoacomprehensivehealthcaremodel

andwillbeofferedthroughtheHospital’sTransitionalCareProgram.Inpartnershipwith

DavidGeffenSchoolofMedicineatUCLA,thisProgramwill“strengthenthesafetynet”

throughtheutilizationofcareteamswiththegoalofimprovedhealthoutcomesand

enhancedexperienceforrecentlydischargedpatientswhomayneedadditionalhelp

managingtheircare.Thisprogramisintendedto“shiftcaredeliveryfromhospitalto

community.”70Finally,theHospitalisrelyingonhealthcareinnovationssuchas

“telemedicine”toconnecttootherfacilitiesandensureproperdiagnosesandtreatmentsas

69MartinLutherKingCommunityHealthFoundation.(2014).Initiatives.70MartinLutherKingCommunityHealthFoundation.(2014).Initiatives.


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wellas“smartbeds”and“advancednursecallsystems”toensureeffectivecommunication.

Onthefollowingpage,Table6providesabasicoverviewoftheHospitalservices.71

Facility/Organization ServicesProvidedMartinLutherKing,Jr.Hospital

x Anesthesiologyx Cardiology(medicalanddiagnostic)x Emergencymedicinex Endocrinologyx Gastroenterologyx GeneralMedicinex Gynecologyx GeneralSurgeryx Neurologyx Obstetricsx Oncologyx Ophthalmologyx Orthopedics(includingspine)x Otolaryngologyx Pathologyx Radiologyx ReconstructiveSurgeryx PulmonaryMedicinex Urology

MLKJr.MultiServiceAmbulatoryCareCenter(MACC)

x Urgentcarex Additionalservicesincluding:generalmedicine,cardiology,dermatology,dentistry,geriatrics,HIV/AIDS,neurology,orthopedics,andphysicaltherapy

AugustusHawkinsMentalHealthCenter

Outpatientandinpatientpsychiatriccareandmentalhealthservices

MLKFoundation CommunityBasedInitiativesx ArtFundx HealthyBabies,HealthyBeginningsx TheLearningCenterx StrengtheningtheSafetyNetx HealthCareInnovation

Table6:ServicesProvidedbyMLKCommunityHospital

71MartinLutherKingCommunityHospital.MedicalServices.


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ForservicesnotprovidedattheHospital(ex:Cardiology,ChemicalDependency,

Transplant,andTrauma),therewillbeagreementsandMOUsinplacewithothernearby

hospitalstoensurethatpatientsreceivethemostcomprehensivecareavailable.