Boyle Heights : The Wellness Center Case Study
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Transcript of 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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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19
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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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:
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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:
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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%)
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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:
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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,
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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).
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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:
DevelopingTheWellnessCenterTheCaliforniaEndowment
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50
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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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57
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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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58
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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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59
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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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60
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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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foroverayear.Thesechallengesmimickedthoseaddressedintheliterature,suggesting
thatwithmoretime,TWC’suniquemodelhasthepotentialtoflourishnotonlyintheBoyle
Heights,buttoinspirecommunityengagementandresidentactivisminotherunderserved
low‐incomeminoritycommunities.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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62
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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.
DevelopingTheWellnessCenterTheCaliforniaEndowment
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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.