Boyle Heights: The Wellness Center Case Study

Developing
The Wellness Center

At The Historic General Hospital:
A Case Study
Prepared by:
Contributors

Jorja Leap, Ph.D.
Laura Rivas, M.S.W./M.P.P.
Louisa Lau

The Wellness Center represents the dedication and efforts of many individuals. It is,
however, critical to note that without the vision, leadership and investment of Supervisor
Gloria Molina, The California Endowment and the Boyle Heights community, The Wellness
Center at The Historic General Hospital would not be a reality today.
This case study was possible thanks to the commitment and hard work of many individuals
and organizations that generously shared their time, reflections and ideas. We appreciate
the staff from many different agencies that are committed to the overall wellness of the
Boyle Heights community and beyond.

October 2014

TABLE OF CONTENTS

Introduction

Literature Review

CommunityBased Programming and Accessibility

Client Empowerment and Advocacy

Cultural Sensitivity

Focus on Preventive Care and Health Promotion

Historic General Hospital: An Overview

Opening The Wellness Center

Mission and Vision

TWC Physical Space

Funding, Staffing, and Administration

Service Provision

Place Matters: Boyle Heights

The Wellness Center Case Study

Methodology

Interviewee Demographics

First Month of Operations

Key Successes

Key Challenges

TWC Model: Missing Pieces, Future, and Replicability

Replicating TWC: MLK Jr. Community Hospital

History of the MLK Hospital

2015: The New MLK Hospital

Incorporating TWC Model

Conclusion

Works Cited

Appendix A: Interview Protocol

Appendix B: MLK General Hospital Extended Case Study Materials

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66
INTRODUCTION

Three years ago, recognizing the future need to promote wellness and provide
preventive health care in the communities she served, Supervisor Gloria Molina envisioned
the creation of an allencompassing health resource center. In a remarkable example of
repurposing, it was further envisioned that this center be housed in an East Los Angeles
community landmark The Historic General Hospital. After an arduous planning and
implementation process that involved community members, stakeholders and involved
local and national organizations, The Wellness Center opened its doors to the residents of
Boyle Heights in March 2014.
This case study carefully examines the relationship between The Wellness Center
(TWC) and the community it is designated to serve, using a researchbased narrative to
chart its development alongside the potential growth of resident engagement within Boyle
Heights. Through interviews and ethnographic observation, the case study research
explores the role of residents, stakeholders, and local officials in the visioning process, the
thoughts and activities that accompanied the creation of the center, and how TWC is
positioned to respond to the ongoing needs of this vibrant but marginalized and under
resourced community. In addition, the case study offers an instructive example of how
TWC contributes to overall individual and community wellbeing while advancing The
California Endowment (TCE) mission of building healthy communities and transforming
the way in which communities and the healthcare system think about and approach
wellness. Interviews with TWC stakeholders and community residents, uncovered The
Wellness Center response to community needs as well as the sensitivity of its service
Developing The Wellness Center

The California Endowment
October 2014

providers to the unique cultural concerns of Boyle Heights residents. The research process
focused on:
1)
2)
3)
4)
How TWC is structured to respond to community needs.

How TWC advances health care access and overall wellbeing of residents.
Community engagement in supporting and enlarging TWC functioning.
Community perceptions and beliefs regarding the role of TWC in facilitating
community wellness.
5) Role of community engagement and participation in visioning, executing, and
sustaining TWC.

The research was strongly guided by the mission and vision of TWC and the
operating model of TCE, which together posit that individual health and community well
being are based on many factors including healthy life styles, family diet, positive
behaviors, and the availability of community resources to help with both prevention and
early disease detection and treatment. With its collaborative approach to combating the
epidemic levels of obesity, hypertension, cancer, and other chronic diseases affecting
marginalized populations, the case study worked to capture how TWC is uniquely
positioned to empower residents and patients to take control of their own health, fostering
its ability to improve overall health outcomes for the community through the expansion of
preventive and responsive care services.

TWC represents the first communitybased wellness center in East Los Angeles, a
reimagining of a historic hospital setting, anchored in the community. Most importantly, it

stands as an undertaking that has actively engaged officials, nonprofit organizations, and
community members in its design, construction, and functioning. This case study will
portray how TWC is an example of both communitybased health care and resident
engagement.


October 2014

LITERATURE REVIEW

Wellness is defined by multidimensional considerations including social,
occupational, spiritual, physical, intellectual, and emotional.1 These dimensions are
interrelated, interactive, and integrated within an individual or community system of
functioning.2 Traditional wellness centers provide a diverse range of services, that may
include fitness, nutrition and diet, relaxation/ meditation, mental health, and education
with services designed to improve and promote individual and community health. An
analysis of the literature revealed several dominant themes in the operation and
effectiveness of wellness centers, including communitybased programming, preventive
health care, client empowerment, and cultural sensitivity.
CommunityBased Programming and Accessibility
Any wellness center programming must be accessible and relevant to community
residents in order for them to seek services. The centers with the greatest impact are
located within the community where those in need of services live. This allows residents
optimal access to resources, as well as increased opportunities for selfefficacy and
empowerment. Due to their intentional and direct integration into the communities they
serve coupled with service provision that meets specific needs of the population they are
serving, communitybased programs prove to be an effective model for outreach.
Client Empowerment and Advocacy
Nyknen and Seppl (2012) describe how patient empowerment is integral to the
citizencentered health care model and community wellness. Due to the fragmentation of

1 Suresh, Ravichandran, & Ganesan (2011) pg. 17.
2 Berrylin (2008). Pg. 19.


October 2014

health care today, patients must be proactive in both integrating and tracking the
completeness of their care; they can no longer exist as passive consumers of services.3
Increased patient empowerment can ultimately lead to improved quality of care
management through wiser and healthier lifestyle choices, healthier behaviors, better
disease management, improved care coordination, and improved care recommendations.
Empowerment is also viewed as helping to reduce health care costs, as clients assume
more responsibility for their health, their commitment to wellness and disease prevention
cuts down costs such as unnecessary or repeated hospital visits.4
It is also clear that the presence and use of wellness centers leads to both policy and
environmental change even while enhancing individual and community wellness and
health. The role of advocacy in wellness centers focused on prevention differs from
traditional medical care settings. Wellness centers differ markedly from traditional
facilities that often pose barriers for lowincome populations of color, who are often weary
and distrustful of traditional care systems. In these communitybased centers, clients gain
a sense of empowerment and control over their own health and wellbeing and are inspired
to act on behalf of their families. Client advocacy is enhanced through the involvement of
community leaders, neighborhood social networks, mass communication campaigns in
their native language, and grassroots education tactics. 5 A focus on assets rather than
deficits empowers clients to act on their own behalf and to move more confidently through
the healthcare system.

3 Nyknen & Seppl (2012) pg. 118.

5 Merzel & DAffitti (2003) pg. 558.

October 2014

Cultural Sensitivity
According to Anderson (2005), efforts to create models for health services must
take into account how people view their own general health, as well as how they
experience symptoms of pain and illness and whether or not they judge their problems to
be of sufficient importance to seek professional help. In fact, perceived need is never
devoid of social context; perceived need is a largely social phenomenon and can be
explained by culture, social structures and health beliefs.6 Merzel and DAffitti (2003) cite
the failure of programs to impact health behaviors in various communities because these
programs focused mainly on individuals, and were not sufficiently tailored to reach
population subgroups. Largescale health education often does not make more than a
modest impact, primarily due to the lack of specific cultural considerations.7 In contrast to
traditional health care settings, wellness centers consider cultural sensitivity to be
fundamental and services are geared toward the needs of the specific target population.
Focus on Preventive Care and Health Promotion
Research on the effectiveness of wellness centers also portrays the effectiveness of
their focus on preventive services and health promotion and education as opposed to
providing direct health services. Promoting healthy eating, active living and an overall
healthy lifestyle, with an emphasis on disease prevention, cuts down on healthcare costs by
eliminating the need for unnecessary hospitalizations and emergency room visits.
Nyknen and Seppl (2012) contend that the citizencentered health care paradigm rests
on preventive care, proactive services, and early detection/diagnosis to ensure patients

6 Anderson (2005), pg. 3.
7 Merzel & DAffitti (2003), pg. 569.

October 2014

wellness makes up a strategy that is more beneficial and cost effective than the
management of symptoms, illness and chronic disease.8

HISTORIC GENERAL HOSPITAL: AN OVERVIEW

What is now known as the Historic General Hospital was first opened in 1878, when
Los Angeles County (LAC) established a 100bedroom hospital on Mission Road to serve
the regions needy population.9 Seven years later, in 1885, the General Hospital affiliated
itself with the fiveyear old University of Southern California (USC) Medical School, creating
a long and prosperous academic partnership. 10 At that time, the Hospital consisted of
100 beds and 47 patients. This small structure soon proved inadequate to serving its
target population. As a result, after construction beginning in 1928, in 1930, actress Mary
Pickford dedicated the 8ton cornerstone of a new LAC General Hospital on State Street. In
1933, the modern Los Angeles County Hospital, affectionately referred to as The Rock,
finally opened. The new hospital fulfilled what then Supervisor Shaw deemed to be Los
Angeles Countys Duty to the Needy.11 This one million square foot facility would serve as
a beacon of hope, setting an exemplary standard for high quality healthcare that was
provided to the community for the next 75 years.
9 Supervisor Gloria Molina, First District. The Wellness Center at the Historic General Hospital.
10 Ibid.
11 Ibid.

October 2014

After its construction, the Loma Linda University Medical School, as well as the
California College of Medicine became involved with the hospital but later withdrew. By
1968 USC remained the only medical school affiliated with Los Angeles County Hospital.12
That year, the LA County Board of Supervisors voted to change the name of the hospital to
Los Angeles County University of Southern California (LACUSC) Medical Center to
reflect the academic partnership that was held between the two.13 However, while the
partnership endured, the hospital began to deteriorate, ultimately failing to meet
earthquake and fire codes implemented after the 1994 Northridge Earthquake. As a result,
there was an unplanned and immediate need for a renovated space to handle the patients
in the aftermath of the disaster.14
In November 2008, a 600bed stateoftheart facility operating as the replacement
hospital opened to the public. The new edifice consisted of three towers a clinic tower,
diagnostic and treatment tower, and inpatient tower. Today, the LAC+USC Medical Center

13 Health Services Los Angeles County. LAC+USC Medical Center About Us.

October 2014

serves as a LevelOne trauma center as well as a hub in the Los Angeles Countybased
healthcare system. In total, the LAC+USC Medical Center serves over 10 million residents
and community members.15 It is one of most recognizable buildings on the East Los
Angeles County skyline, still representing health care and hope. As a beacon and holding
historic landmark status, this historic building is now home to the recently opened
Wellness Center.
OPENING THE WELLNESS CENTER

TWC is the product of a publicprivate and community partnership between The
California Endowment, the Office of the First District County Supervisor Gloria Molina, the
Los Angeles County Departments of Health Services, Public Health, and Mental Health, and
a number of healthminded nonprofit tenant organizations. With all of the entities
involved, the LACUSC Medical Center, an independent 501(c)(3) nonprofit organization,
continues to serve as a predominant, lead partner in the establishment of The Wellness
Center.
The former General Hospital was chosen as the site for TWC in response to the
desire of County leaders to honor and continue the legacy of healing that would promote
health, prevention, and collaboration as its main goals.16 Based on stakeholder interviews
and document review, it was clear that this effort was driven by Supervisor Molinas vision
of creating an allencompassing resource service to be housed in the previously
underutilized General Hospital, transforming a previously recognizable monument in Boyle
Heights to a beacon of health and opportunity.

15 Health Services Los Angeles County. LAC+USC Medical Center About Us.
16 Ybarra, Jennifer. (April 30, 2012). Memorandum: Boyle Heights Wellness Center at the Historic General
Hospital. Pg. 1

October 2014

From the time the new LACUSC Medical Center was opened in 2008, the 77,000
square foot area on the first floor of the old hospital building comprised vacant space
owned by Los Angeles County. The building included offices, meeting rooms, educational
space, an auditorium, a cafeteria, and a kitchen. After convening a stakeholder meetings
and garnering input from community members, project partners decided that the first floor
of the building provided the most appropriate setting to achieve TWC goals, offering a
common space that would be ideal for facilitating collaboration between nonprofit
partners. Invested parties, with the help of TCE leadership, conducted an informal needs
assessment of the surrounding communities. According to one interviewee, The process
was not as iterative as it should have beenthere was a general sense of the areas of highest
impact, and service providers would need to meet these identified service gaps.
As TWC was designed, these partners would be working together to perform a
broad range of functions. As they organized in different configurations and collaborations,
aided by their offices in the same structure and the common space, the resident partners
could easily work to develop programming, share knowledge and advantageous practices,
and combat high levels of diseases (such as obesity, stroke, heart disease, cancer) within
the East Los Angeles community.17 With this vision, TWC would serve as a colocated and
collaborative model: agencies are not only located in under one roof but are required to
collaborate on programming.

Hospital. Pg. 1.

October 2014

TWC was initially planned as a project that would be developed in several phases
spanning five years. However, early on, based on responses from partners and community
members, it was clear that this multiphase, multiyear plan was not going to work.
Instead, planning activities composed an initial phase of preparation in the spring 2011,
with the building completion and opening slated for late fall 2012.18 As a part of this initial
planning phase, startup activities included a request for proposals (RFP) process for
Wellness Center partners. These partners would operate under the auspices of TWC and
would expand their services to the Boyle Heights community.19 Based on community input,
and to ensure that all partner organizations were aligned with the previously noted needs
assessment conducted by TWC planning committee, the RFP required that all applicants
demonstrate the capacity to provide culturally competent and linguistically appropriate
programs. Additionally, agencies had to show a commitment to reducing medical costs
18 In our document review, this initial phase was referred to as Phase I. For our purposes, we have removed
this language because subsequent phases were not clearly delineated.
19 TWC Case Statement. (November 2013). Pg 3.

October 2014

10
through preventionbased service provision. The RFP required all applicants to provide
services in the following areas:20
Chronic Disease Management
Wellness and Prevention
Supportive Services
Community Building Activities

The RFP process attracted 46 applicants, and ultimately led to the selection of 14 nonprofit
partners.
The planning phase also focused on aspects of building production including
financing, construction, and internal structure. In an attempt to begin process and
preliminary outcome evaluation efforts, The Nonprofit Network conducted a capacity
assessment from fall 2012 thru 2013. The Network was hired to summarize and articulate
capacity issues experienced by the TWC project as well as offer recommendations for
moving forward, including ideas about how to implement its strategic plan over the next
three years.21 22 The Capacity Plan memo that The Network submitted noted that their
team completed surveys and interviews at a moment in time before tenants had full
knowledge of the leasing termsbefore the tenants had started meaningful work
together.23 Informal interviews revealed that many individuals felt this kept the process
stuck in planning. However, there were key operational considerations and
20 Request for Proposal. RentFree Space: First Floor at the Los Angeles County Wellness Center at the
Historic General Hospital. (2011).
21 The Nonprofit Centers Network. (March 7, 2013). Memo: Wellness Center Business Plan: Part I, Capacity
Plan. Pg. 1.
22 TWC Case Statement. (November 2013). Pg. 4.
23 The Nonprofit Centers Network. (March 7, 2013). Memo: Wellness Center Business Plan: Part I, Capacity
Plan. Pg. 1

October 2014

11
recommendations reported in both a final memo and Business Plan PowerPoint. These
included:24 25
Need for Medical Director to interface with the Hospital to establish client
flow and educate the staff.
Facilitation of client referrals is crucial for driving visitors.
Design a data collection strategy.
Employing information technology solutions employed by other
nonprofits.
Enhance outreach/community relations role, marketing, and promotion
efforts.
Ensure usage of TWC by addressing transportation and access issues.
Collaboration among the tenants should be TWCs primary focus and
should be facilitated by the Executive Director with clear expectations and
trust.
Consider longrange planning goals and financial sustainability.

Collaborating with The Network to ensure that TWC was properly positioned to meet the
needs of the community and ensuring appropriate service provision was an important step.
Development was in a constant state of flux as leadership learned that building
rehabilitation would take one year, ultimately; this process took 2 years. The opening of
The Wellness Center had tentatively been scheduled for December 2012, but accounts
indicated that it was pushed back as many as four times. After being repeatedly and
consistently delayed, many organizations had put the notion of TWC aside to focus on core
programming. Fearing that the process had become too much about the building and not
enough about TWC programming, the leadership team held luncheons, meetings, and
presentations to keep the tenant organizations invested in the project. This delayed
timeline proved most frustrating for smaller organizations that were dependent on
securing grant funding prior to opening their Wellness Center offices for programming.

24 Ibid. Pg. 23.
25 The Nonprofit Centers Network. (March 8, 2013). PPT Presentation Business Plan: Part I Capacity Plan.

October 2014

12
Tenants were provided with little knowledge about the facilities timeline, and when it was
finally announced that it was time to movein, tenants were illprepared. Due to lost
funding as a result of the delays, many tenants had not finalized new programmatic
deliverables or scopes or work. Without a cohort of fulltime Center staff, tenants were left
confused they had more questions than answers. Despite these challenges, the move to
TWC proceeded.

After two to three years of construction, building and administrative delays, tenants
moved in over the span of several weeks and once they were settled in they had a grand
opening celebration on March 15, 2014. Despite tenants feeling a bit unsettled, the grand
opening was truly a time of great joy and celebration. Illustrating that spirit, the
photographs above depict TWC supporters at the front entrance of The Historic General
Hospital and Supervisor Molina watching a cooking demonstration in the buildings shared
demonstration kitchen facilities. Throughout the day, community members had a chance
meet with and hear from local officials and Hospital staff, attend healthy cooking
demonstrations, and watch local musicians and cultural dancers. They were also entered

October 2014

13
in various drawings to win prizes and receive giveaways. The event truly embodied
Molinas commitment to health and wellness in the Boyle Heights community. Most
significantly, community members in attendance saw first hand the investments made on
behalf of city officials, LAC+USC healthcare personnel, and local and national nonprofit
organizations. Alongside appreciating the publicprivate investments, community members
were truly engaged with the mission of TCE and its BHC initiatives, the community, actively
talking and learning about healthy eating and active living and how critical these behaviors
are to ensuring health and wellness. Residents were empowered to take advantage of the
culturally and linguistically appropriate health care services and to advocate for the needs
of their families.
Mission and Vision
The grand opening symbolized the many individuals that were involved in creating
the mission and vision of TWC. From the onset, input from community members, local
officials, and Wellness Center tenants and staff helped to shape TWC mission: to inspire
and empower residents and patients to take control of their own health and wellbeing by
providing culturally sensitive wellness and prevention services and resources that enable
prevention, address the root cause of disease and improve health outcomes.26 According to
several Center publications, the vision is very broad and inclusive, consisting of a
commitment to the values listed below:27

26 TWC. (2014) About the Wellness Center.
27 TWC Partners List and Fact Sheet. (December 2013). Pg 2.

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14
Provide culturally sensitive programming to the residents of the area in

order to address the root causes of disease prevalent in the community.
Enable residents/patients to empower themselves and to exercise
autonomy over their health and lives.
Support the Affordable Care Act by promoting preventive practices in order
to reduce health care costs and preventing unnecessary hospital
readmissions.
Improve health outcomes for the patients and community by expanding
preventive care services.
Encourage collaboration among nonprofit organizations to provide
programming and services and events to community residents.
Attract community development and investment in a predominantly
indigent population.
Become a key component of an East Los Angeles regional integrated health
care delivery system.

TWC Physical Space
The Center is characterized by an expansive and interesting layout, which is
depicted in Figure 1 below, including the display of the proposed outdoor space. In
viewing the floor plan it is important to note the demonstration kitchen, the dance studio,
and the tenant offices along with shared space.28 Eventually, the entire Wellness Center
space will incorporate several sustainable and culturally relevant features including but
not limited to: native plants, low impact development, public art, and LED lighting. After
the grand opening, the entrance to TWC was moved from the front of the building to the
side. Although this may not be as architecturally consonant with the structure, it was
important to move the entrance in order to meet accessibility standards as outlined by the
Americans with Disabilities Act. The yellow arrows in the graphic below indicate these

28 TWC Presentation. (March 2014). Slide 8.

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15
two locations. Parking for TWC is in a nearby structure and is not displayed on the map
below.

1 Playground 5
2 Demo. Garden 6
3 Seating Area 7
4
Splash Pad
Performance
Space
Gazebo
Fitness Trail
9
10
11
Healing Garden
12
Restroom/Prgm
Office
Parking
Bike Racks
Native Plant
Habitat
13
14
15
16
Meditation Area
Tot Area
ADA Ramp
Mayan/Aztec
Elements
Figure 1: The Wellness Center Floor Plan

Funding, Staffing, and Administration

In support of the publicprivate partnership providing preventive services to a
community in need, local and national organizations pledged funding for the model early in
the process. Startup funding for facilities, amenities, and building transformation were

October 2014

16
estimated at $14.4 million and the table below outlines funding secured as of 2012.29
These corporate and philanthropic funds would cover WiFi access, staff salaries, software
development, as well as renovations and repurposing. Additional funds from The
California Endowment, First District Office and Proposition A grants were received later
and are not documented below. As portrayed in Table 1, a broad range of funders with
specific programmatic aims invested in TWC.30 31
Funders
Purpose
CDC Community
Transformation Grant
(administered by LAC DPH)
Executive Director Salary

(75% excluding benefits)
Amount
$475,00
$500,000
over 5 years
$90,000
$95,000
over 1 year
Startup funds
LA Health Care Plan
Development of Wellness Center

capacity assessment, business
plan, and strategic plan
$150,000
over 1 year
The California Wellness

Foundation
Information technology
assessment
$100,000
over 6
months
Design/build play area for

children 05 years on the side of
the State lot
Street entrance to the building
Rehabilitate/repurpose outdoor
areas surrounding General
Hospital
First 5 LA
California State Parks

First District and County CEOs
Office
LAC (transferred to Amigos de
los Rios Spring 2012)
$280,000
for 1 year
$1.839
million
Rentfree office space to tenants
$5.8 million
Outdoor rehabilitation
$250,000
29 Numbers in the Table below reflect the amount of funding available from each entity according to 2012
1013 reports. Be advised that across publications, these numbers varied slightly.
30 TWC Funds (2012 Overview), pg. 12.
31 TWC Case Statement. (November 2013). pg. 25.

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17
LAC (transferred to the

Foundation in Spring 2012)
Foundation Fall 2012)
Foundation in December 2012)
Construction (Architecture)
$250,000
Construction (Project Manager)
$150,000
Construction (Demolition and

Rehabilitation)
$5.144
million
Table 1: TWC Funders

With this significant investment, it is clear that the administrative and
accountability structure of TWC is critical to its effectiveness and functioning. In the day
today administration of TWC, the Executive Director, currently Ms. Nancy Mullenax, is
accountable to the LACUSC Medical Center Foundation Board of Directors. It is the
executive directors responsibility to oversee the leadership, planning, fundraising, and
comprehensive management of the Center.32 Additionally, the Executive Director is also in
charge of the development of an operating and sustainability planas well as a common
evaluation system that measures Wellness Center client outcomes. This process is
explored in detail as part of the analysis below. The administrative structure appears to be
a work in progress. During interviews that will be discussed in detail later in the report
several individuals expressed their concern that many of these responsibilities have not
been implemented or shared with TWC tenants. Individuals also pointed out that the roles
and responsibilities of TWC staff and tenants have neither been agreed upon nor clearly
articulated. Figures 2 and 3 below portray the contrast between the current TWC staffing
structure as of early 2014 (developed by Leap and Associates) and the proposed structure
by The Network, respectively.33 34

32 TWC Case Statement. (November 2013).

33 TWC Directory. Pgs. 14.

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18

Figure 2: Current TWC Staff (as of early 2014)

Staffing
Medical
Proposed
Foundation

President/CEO

Wellness Center
Medical Director

Director

Communications

& Fundraising
Program
Manager

(Staff or
Consultant)

Information
Promotoras

Technology

Administrative

Support

Figure 3: Nonprofit Center Proposed Staffing Model

32
2013 The NonprofitCenters Network & Tides

34 The Nonprofit Centers Network. (March 8, 2013). PPT Presentation Business Plan: Part I Capacity Plan.


October 2014

19
The administrative structure of TWC continues to be ongoing challenge. From the

projects inception, there have been several instances of turnover and staffing changes. In
order to provide comprehensive services and conduct community outreach, the Center
continues to grapple with the need for more fulltime staff with clear roles and
responsibilities. In an effort to fill in some of these employment gaps and address vital
needs, TWC tenant workgroups lead the programmatic discussions before permanent
personnel were hired. According to interviewees, the tenants originally created and
staffed four workgroups:
1. Data
2. Program Collaboration
3. Promotoras
4. Operations
After suggestions from key personnel, a fifth group, Outreach, was developed.
These workgroups met for several months prior to the grand opening and continue to
evolve, focused on defining their roles and responsibilities within the larger TWC
framework. During the planning phase and under the direction of the Interim Executive
Director, Joanne Pineda, workgroups flourished. Ms. Pineda, who originally worked as a
consultant on the project prior to her appointment as interim director, did not have the
assistance of fulltime staff. For the length of her 5month tenure from November 2012
March 2013, she facilitated monthly program partner meetings. To ensure that there were
no duplicative services, all of the partners were surveyed to determine their capacity and
primary service area. It is critical to note that prior to November 2012, much of the work

October 2014

20
on TWC had been focused on facilities and construction concerns. However, with the
introduction of fulltime Wellness Center staff including the permanent director Ms.
Mullenax, in the second half of 2013, workgroups were no longer considered the driving
force behind the project. Amid pressures to begin outreach and programming, tenant staff
did not feel encouraged to participate in the workgroups, nor did they feel that their
opinions were respected or valued. Several individuals who were interviewed discussed
how their workgroup had labored intensively and proposed several structural changes
regarding roles and responsibilities that were repeatedly dismissed. Even now, the role of
the workgroups continues to be in flux and part of the developing identity of TWC, a
dynamic process that is moving towards a more positive resolution.
Probably the most significant example of how the workgroups and tenant partners
are struggling to define themselves within the current structure involves the promotoras.
Promotoras, or patient navigators, were initially hired to engage in outreach with
community residents and to refer them to resources. The promotoras assist individuals in
maneuvering through the current healthcare system and its various complexities. As part
of their efforts, promotoras were responsible for building relationships with clients,
assisting residents in signing up for health insurance, and ensuring that prevention
screening and follow up treatments are available to those in need. However, now their role
within the Center is unclear and some tenants feel that they are acting as glorified
secretaries. Current tenants expressed concern that promotoras have not been given
proper training or tools to oversee the Centers common messaging, distribution of
marketing materials, or community outreach efforts.

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21
The tenant organizations are listed in Table 2 below. These organizations are
housed, rentfree, on the first floor of TWC.35 The agencies are expected to meet the
previously outlined RFP requirements and to collaborate on health and wellnessbased
programming efforts. Despite difficulties, this is a unique and important model, with an
exciting design for service provision.
Alma Family Services
East LA YMCA
Maternal and Child Health

Access
American Diabetes
Association
Jovenes, Inc.
Mexican American
Opportunity Foundation
American Heart
Association
Arthritis Foundation
Building Healthy
Communities Boyle
Heights

LA Care Health Plan
Family Resource Center

LAC Department of
Health Service
National Multiple Sclerosis

Society
LAC Department of
Mental Health
Neighborhood Legal
Services of LA County
Proyecto Jardin
LAC Department of
Worker Education and
Public Health
Resource Center
Table 2: Wellness Center Tenant Organizations/Program Partners

East LA Women's Center
Service Provision
As an integrated model, TWC was created and designed to provide a comprehensive
range of services such as health education, support programs, healthy eating and active
living behaviors for the community via the nonprofit organizations within TWC.36 The
tenant organizations located within the Wellness Center are working zealously to provide
services for predominantly Boyle Heights based clients, with an emphasis on improving

35 TWC Case Statement. (November 2013). Pg. 4

36 TWC Case Statement. (November 2013). Pg. 34.

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22
health outcomes for the community, encouraging residents to take charge of their own
wellness and to live healthier lives. As part of TWC mission, they are all focused on
educating the public to avoid and understand the root causes of disease within the
community while providing a safe opportunity for residents to be able to exercise and
participate in community events.
TWC was consistently defined by individuals interviewed, participants at the
opening and involved community members as a onestop shop of health and social services
resources for the underserved community of Boyle Heights. Once the center is running at
full capacity, and in more purposeful collaboration with the Hospital and referring
physicians, TWC tenant organization staff hope to provide a new pathway toward
coordinated and managed health care.
TWC connects to patients at the LACUSC Medical Center through a referral process.
In order to ensure that clients are aware of the comprehensive preventive services offered
at TWC, LAC+USC physicians issue referral, termed Wellness and Park Prescriptions to
their patients.37 These referrals will facilitate engagement, helping community members
take ownership of their own health and wellbeing. Based on the clients needs, referrals
will be made to the appropriate Wellness Center agencies. A wide range of services is
provided by the tenant agencies through selfrun and collaborative programs. Such
services include, but are not limited to what is portrayed in Table 3 below.38

Hospital. Pg. 1.
38 TWC Summary of Services. (February 10, 2014). Pgs. 111.

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23
Service Areas
Mental Health
Services/Support
Groups
Examples of Services Provided

Alma Family Services: Grief and loss groups as well as individual, family, and group
counseling.
Senior Services
Mexican American Opportunity Foundation: Senior Hispanic Information Assistance

Program (SHIAS) connects nonEnglish speaking seniors to state and community based
services that increase and aid in building selfsufficiency and improved quality of life
including medical counseling, caregiver support, coping with disease, and exercises classes.
Disability Services
Arthritis Foundation: Walk with Ease includes stretching, health education, strengthening
exercise, and motivational strategies for individuals with arthritis. This program is designed
to decrease pain and depression, increase increasing physical activity and walking distance.
American Diabetes Association: DiabetesRelated Information and Education is for
Diabetes Prevention and

individuals who would like to know how to prevent diabetes, and will assist those living with
Management
diabetes with daily selfmanagement for the prevention of complications related to diabetes.
Heart Health Services
American Heart Association: Alcanza Tu Meta is a fourmonth program that focuses on

blood pressure management. Participants learn how to control their blood pressure by
adopting healthier behaviors and following medication.
Advice from Nurses
LA County Department of Public Health: Ask A Nurse Sessions are scheduled with Public
Health nurses to answer any healthrelated questions and discuss concerns
Services for Sexually

Transmitted Infections
East LA Womens Center: Women and Families Living with HIV provides comprehensive and
culturally sensitive, individualized services to women and their families who are affected by
HIV/AIDS. Aims to provide resources and access to health services, improve overall quality
of life for women and their families, strengthen family relationships, improve physical,
emotional, and mental wellbeing, and improve natural support networks.
Emergency
Preparedness
L.A. Care Health Plan Family Resource Center: Red Cross First Aid, CPR
(cardiopulmonary resuscitation) and AED (automated external defibrillator) training and
certification to meet the needs of workplace responders, professional rescuers, school staffs,
professional responders and healthcare providers, and the general public
Disease Prevention
LA County Department of Public Health: Disease Prevention Classes about sexually

transmitted infections/safe sex, Food Borne Illnesses, Children and Adult Immunizations, Flu
Prevention, Tuberculosis, Pertussis, and other public health disease prevention topics.
Legal/Immigration/
Housing Rights
Neighborhood Legal Services of LA County: MedicalLegal Community Partnership (MLCP)

allows patients to receive oneonone support and legal counsel from an advocate on site.
Information for housing and immigration rights also provided.
Health Advocacy
Maternal and Child Health Access: Provides outreach to uninsured/underinsured

individuals and families to increase enrollment into free and low cost health coverage
programs. Provides assistance for individuals enrolling in CalFresh.
Healthcare Benefits/
Insurance Services
L.A. Care Health Plan Family Resource Center: Provide education and assistance to
families about free and lowcost health insurance options, including Covered CA.

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Community
Organizing/Advocacy
Building Healthy Communities Boyle Heights: Provide support to 14 Building Healthy

Communities with the goal of improving employment opportunities, education, housing,
neighborhood safety, unhealthy environmental conditions, and access to healthy foods.
Violence Prevention
East LA Womens Center: All My Relationships Program is a violence prevention program

for teenagers, including a 12week youth leadership development program and peertopeer
training.
Nutrition/Healthy
Eating
American Diabetes Association: Food preparation classes for diabetics and individuals at
risk of diabetes, teach participants how to prepare foods in healthier ways, portion size, and
healthy choices outside the home.
Physical Therapy
National Multiple Sclerosis Society: Provides physical/ occupational therapy programs

with group exercise classes.
Computer Literacy
Fitness/Physical Activity
Maternal/Child Health
Work Training/
Vocational
Rehabilitation
Promotoras
Meditation/Relaxation
Gardening
East LA Weingart YMCA: Youth Institute offers programs for career and college readiness,
learning graphic design, digital media, web design, and movie making.
Maternal and Child Health Access: Best Babies Collaborative/Prenatal Outreach offers a
walking club.
Maternal and Child Health Access: Best Babies Collaborative provides 2year care
management, home visits, extra food, walking club, and breastfeeding support.
Worker Education & Resource Center: Healthcare career counseling for careers such as
medical assistant, home health aide, diagnostic technicians, etc. Also offers computer literacy
classes to prepare for such careers.
East Los Angeles Womens Center: Trainings for promotoras concentrating on domestic
violence, sexual violence, and HIV.
Arthritis Foundation: Tai Chi classes to help with relaxation.
Proyecto Jardn: Offers food preparation demonstrations and guided tours of the garden.
Literacy
L.A. Care Health Plan Family Resource Center: Lap Read is an early education program for
children 05 years old. Children have fun reading, singing, and do arts and crafts together.
Public Education
Campaigns
LA County Department of Public Health: Public education campaign topics include

reducing injuries, violence prevention, reducing tobacco use and exposure, active living, and
healthy eating.
Table 3: Service Areas and Service Provision

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PLACE MATTERS: BOYLE HEIGHTS

To gain a full understanding of the impact of The Wellness Center on the health and
wellbeing of community residents, it is crucial to take a closer look at the Boyle Heights
community. This vibrant and diverse neighborhood is located in the heart of the Los
Angeles Basin, directly east of downtown Los Angeles. Its geographic area, as well as the
location of TWC, is depicted in the map provided below in Figure 4.
Figure 4: Map of Boyle Heights (with TWC Inset)
Boyle Heights is an old, historically significant neighborhood in East Los Angeles

populated with approximately 90,000 residents; it is characterized by a strong community
and cultural identity. 39 For over 40 years, Boyle Heights has been the home of one of the
largest Chicano/Mexican populations in the United States.40 Many Boyle Heights residents
speak Spanish as well as English, including the newer Spanishspeaking immigrants

39 BHC Connect: Building Health Communities: Boyle Heights Community.

40 The Wellness Center. Website.

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26
arriving from Central America. The community continues to grapple with persistently
elevated numbers of high school dropouts, the presence and impact of gangs, violence, and
teen pregnancy. Despite the persistence of these challenges, the community also possesses
multiple assets and strengths. The California Healthy Interview Survey details other
critical demographic information for Boyle Heights is portrayed below:41 42
98% Latino (vs. 51% in LA County)
1% White (vs. 24% in LA County)
1% African American (vs. 8% in LA County)
68.8% of the population have less than a high school diploma
32.8% live below the poverty line
62% lowincome households (vs. 44% in LA County)
62% limited English proficiency (vs. 67% in LA County)
15% Unemployed (vs. 13% in LA County)

Boyle Heights has continued to encounter challenges in terms of economic growth,
education, public safety, and public health. These challenges have persisted throughout its
history as a community. As outlined previously, TWC was formed largely in an effort to
help Boyle Heights and its inhabitants grow into a healthier community. Through the
patientcentered medical home model, TWC relies on preventive care as the primary
medium by which services are administered.43 These emphases are vital: Boyle Heights is
the site of epidemic levels of obesity, hypertension, stroke, cancer, and various other long
term chronic diseases within the East Los Angeles area.44 Based on statistics from the
California Health Interview Survey, more than 33% of Boyle Heights residents are

41 The California Endowment. Making Health Happen by Building Healthy Communities. Boyle Heights.
42 UCLA Center for Health Policy Research. Building Healthy Communities: Boyle Heights Health Profile.
Hospital. Pg. 2.
44 TWC Case Statement 2013, pg. 1.

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27
overweight and 23% are obese. These rates correlate with chronic diseases and an overall
poor quality of life. Furthermore, in comparison to most cities in Los Angeles, Boyle
Heights also experiences a profound lack of open green space. With low levels of
educational attainment, the widespread lack of health literacy as well as deficits in health
outcomes is to be expected but not accepted.
Boyle Heights represented an optimal location for TWC due to its rich community
characteristics and challenges. They are the same factors that drove its selection as one of
TCEs Building Healthy Communities (BHC) Initiative 14 target sites across California.
Clearly, Boyle Heights is an exemplary model of a community ready for change and The
Wellness Center is positioned to serve as a catalyst for positive community change and
individual wellbeing, while reducing healthcare costs to residents through preventive
health care services. The need for such services is vital in the lowincome underprivileged
community of Boyle Heights.45 Additionally, through the BHC initiative, TCE is working to
promote healthy homes in the BHC sites and is prioritizing partnerships with public
hospitals and linkages to services that promote health, wellness, and prevention.46 To
further reinforce this relationship, today, BHC Boyle Heights is a supportive tenant/partner
of TWC, as they are leading the way in collaboration with other local and national tenants
to provide education to residents. Partnership with the BHC has allowed for the burgeoning
of local leaders, youth advocacy efforts, and a culture of active communitybased
organizations. Clearly, BHC and TWC perfectly align in their joint efforts to: increase
45 TWC Case Statement 2013, pg. 1.
Hospital. Pg. 2.

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28
access to health and social services for youth and adult residents, create safe spaces for
youth programming, and advance projects that utilize community building strategies.47

THE WELLNESS CENTER CASE STUDY

Methodology

The case study research methodology represents an effective and useful approach to
understanding community and systems change while offering a guide to future

interventions and initiatives. Employing rigorous case study methodology, qualitative and
quantitative data (where applicable) was collected, coded, and analyzed for this
comprehensive final report. The case study specifically sought to document the creation of
TWC, examining how stakeholders are involved in and helping advance its work.

The case study began with a period of informal ethnographic observation,
information interviews, and document review. From these efforts, an interview

questionnaire (see Appendix A) was constructed, integrating topics and issues that arose
frequently and repeatedly during this period of preliminary research. The protocol was
pilot tested in three initial interviews to ensure that questionnaire was capturing
meaningful information, helping to paint an accurate picture of the development, successes,
and challenges faced by TWC staff, community, and organizations.

Case studies provide a holistic understanding of a broader issue through a detailed
contextual analysis of reallife scenarios. Jack and Baxter (2008) explain the use of case
studies when they state:

Qualitative case study is an approach to research that facilitates

47 Ibid.

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29

exploration of a phenomenon within its context using a variety

of data sources. This ensures that the issue is not explored through

one lens, but rather a variety of lenses, which allows for multiple

facets of the phenomenon to be revealed and understood[Case

studies] ensure that the topic of interest is well explored48

This quotation highlights the primary motivation for using the case study approach; case
studies allow us to collect information in the depth needed to understand organizations
and communities including the processes and changes that comprise their structure and
functioning. In particular, The Wellness Center case study truly required this sort of
informational depth to ultimately produce the most useful and valid findings that
emerged from multiple interviews, observation and document analysis. Drawing upon this,
the case study represents an effort to create a fundamental understanding of what took
place during the development of TWC, what occurred during its initial months of service,
and the outline of its future prospects. Additionally, the material from this case study will
be used to inform other organizations about the innovative and remarkable work
happening on the first floor of Historic General Hospital. In particular, this work can be
used a starting point to guide further research into the potential for, and efficacy of,
wellness centers in other TCE sponsored Building Healthy Community sites. As such, this
case study can serve as a guide for other sites working on improve the health and wellness
of their communities.

As part of this, the research assessed many facets of community engagement as well
as the level to which the ideals and practices of a healthier community were being
promoted. Drawing upon multiple approaches, researchers utilized depth interviews,
ethnographic observation, and detailed analysis of available documents. Both the research

48 Baxter, P. and Jack, S. (December 2008). Pg. 544.

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30
approach and interview protocols broadly engaged government representatives,

stakeholders, and community residents, allowing them to present each of their viewpoints
and experiences. The interview process was both participatory and intentional and
involved facetoface interviews were conducted with individuals from each the following
groups:

Local and national nonprofit tenants of TWC

LAC+USC Medical Center
Office of First District Supervisor Gloria Molina
Boyle Heights Community members
BHCBH members

To identify and recruit participants for the case study, the research team relied on a
purposive sampling method, working closely with The California Endowment to identify
key stakeholders. From there, each individual interviewed was asked for the names and
contact information for other key participants and people they believed would be valuable
to interview. Participation in the case study was completely voluntary and participants
were not compensated for completing the interview. While most individuals were
extremely helpful and cooperative when approached for an interview, there were others
who did not respond. This is an understandable reaction to requests of this nature
particularly as peoples schedules and concerns are multiple and demanding.

With permission from interview subjects, the evaluation team recorded all
interviews. These recorded interviews were then transcribed and the transcripts were
analyzed using an open coding process. To develop preliminary themes, members of the


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31
evaluation team listened to a random sampling of three interviews and created a

comprehensive list of over 30 line items. To ensure that the list of themes was all
encompassing, all interviews were then played back twice and coded based on this
complete list. Using codes developed from the open coding process, the second coding
process created more highly refined key themes. The most prominent themes are
discussed below; these were themes present in at least 25% of interviews, with some
mentioned in as much as 83% of the interviews. This coding process provided the research
team with the qualitative context for the table presented below. This data triangulation
helped to ensure internal validity. As demonstrated in the following section, interviews
illuminated the ways in which the establishment of The Wellness Center continues to meet
community needs and in effect, enlarges upon TCEBHC drivers of change: collaboration,
resident and youth leadership, and policy and systems change. These formal interviews
were augmented with informal interviews and lengthy discussion with community
members. While these were not part of the coding process, the additional qualitative data
gathering was used to augment the formal interview material.
Interviewee Demographics

The research team completed 12 formal interviews over the course of several
months with a variety of stakeholders who reported wideranging levels of involvement

with the project since its inception. The graph portrayed in Figure 5 below depicts the
breakdown of respondent categories: one interview was conducted with two staff
members from the 1st District office. The majority of interviewees were center tenants,
which included seven local organizations and two national organizations. In the interest of

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32
candor and in sensitivity to respondent requests, the specific individuals and their agencies
are being kept confidential.

Respondent Breakdown
1
1
Ist District Office
2
Tenants: National Organizations

LACUSC
1
Tenants: Local Organizations

TWC Staff
Figure 5: Respondent Breakdown

First Month of Operations

According to one of our interviewees, in her efforts as executive director, Ms.
Mullenax requested that the 16 tenants provide progress reports documenting the first
month of service. The case study team asked tenants that were interviewed if they would
provide their reports for review. Of the nine tenants interviewed, six provided their
reports as requested. In order to paint a picture of the daytoday operations at TWC, while
not revealing the identity of the interviewees, the case study will highlight some of their
work. All of the reports reviewed indicated that within the first month after opening, offices
were full operational; this included the installation of phone lines, computers, other related
media, and office furnishings. Office infrastructure was developed, staff was hired, and


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33
policies and procedures were finalized. After these initial steps, agencies began with the
promotion and delivery of quality services. Perhaps most importantly, interagency
collaborations and referrals were initiated. One of the first steps in service provision was
ensuring that the office was equipped with appropriate Wellness Center materials so that
staff could begin building clientele. All of tenants described how they worked to establish
relationships with the LAC+USC campus. As one individual explained, We wanted to
ensure open lines of communication, partnerships, and development of collaborative
activities. This was important to us from the very beginning.

These efforts quickly paid off. One of the local tenant organizations reported that
they had served 27 clients through 1on1 appointments that were both scheduled or
occurred on a walkin basis and advocacy clinics during their first month of operation. We
just reached out to folks informally, a staff member explained, And people started to come
in. Several of the individuals from agencies interviewed indicated that from the moment
they moved in, they began to collaborate on trainings to help community members
understand the Affordable Care Act and other health coverage options. In a report, one
tenant documented their work with 60 families that needed assistance with health care
enrollment as well as efforts at troubleshooting with an additional 12 families seen for
information and issues surrounding CalFresh. Another tenant, a national organization,
reported serving eight clients through econsult with LAC+USC and has hosted exercise
classes. Additionally, this agency has reached out to several LAC+USC departments
included Rehabilitation Services, Wellness Committee, and Rheumatology. A third local
tenant agency described their efforts at creating and offering trainings around Census Data

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34
and Social Media as well as hosting tours of the Wellness Center, reporting, We have all
sorts of agencies coming here like Teach for America. They want to learn about what we are
doing its a great model. This enthusiasm was echoed in the words of the director of a
fourth local agency, who reported:
We are able to help each other we can benefit from having

immediate access to experts in all sorts of field were all in

spaces close to each other. There is enhanced communication
and all of us have strengthened the dialog that was already in
existence. Colocation is a great idea, the proximity to various
experts in our field will foster collaborations.

This tenant proceeded to chronicle how their agency is hosting advisory council meetings
at TWC and had 17 representatives from ten various Boyle Heights community based
organizations participating. Additionally, they have provided direct service that included
support groups, counseling, and case management to five clients.

From a review and analysis of the reports as well as informal exchanges with agency
personnel, it is clear that the first month activities were largely administrative and
operational. However, as their comments and reports reveal, agencies did not limit these
efforts strictly to these efforts. Instead, workshops, information sessions, and client
meetings were held and even in their early months of operation, TWC tenants managed to
make an initial but important positive contribution to the health and wellbeing of their
clients. Individuals sought and received vital information regarding health care access,
support groups, and exercise. Informal interviews with community members and
discussions upheld these accounts. This is not to say that the early months of operation
passed without challenges, which will examined. However, responses show how
community needs were being met.


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35
Key Successes

Despite the concerns of the individuals interviewed and the challenges they
highlighted throughout the interviews, there was tremendously positive response to The
Wellness Center. What was apparent is that even in its earliest months of operation, the
tenant enthusiasm was matched by community response and engagement. The chart
below illustrates the most prominent successes experienced by TWC and those involved
with it that emerged from the interviews conducted. Through coding and metaanalysis,
the research team identified five key successes that occurred with the greatest frequency.
These are depicted in Figure 6 below.
Key Successes
12
10
8
7
6
5
4
2
0
Collaboration
(58%)
Moving In/Grand
Opening (42%)
Organizational
Growth (50%)
Community Access
(33%)
Unique Model
(25%)
Figure 6: Key Successes

Theme One: From the beginning, individuals viewed the greatest success of The
Wellness Center as providing the opportunity for collaboration. Among the majority
of the respondents, there was consistent enthusiasm over the prospects for building


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working relationships and effective partnerships. Of the individuals interviewed, 58% of

respondents agreed that fostering collaboration represented a key victory for TWC. The
significance of this theme was reinforced by content from interviews with TWC Staff and
staff from the First District office. All of these interviews highlighted the high value of
collaboration in the Wellness Center model. Several individuals also focused on the idea
that TWC is not merely about colocation. These were ideas that also emerged from the
literature review. One individual observed:
The partners, generally speaking, learned to work together well.

There was a bonding experience. And from the beginning, the
partners all endured struggles and frustrations. Instead of letting
things get us down or upset us, we all bonded over the experience
of creating this together.

Another individual offered his thoughts about what was developing within TWC, saying,
There are definitely collaborations happening within the building. We are supporting one
another through this process. These connections would not have occurred if we were not
under one roof.

Theme Two: Alongside the significance of collaboration, another key success noted
was the opportunity for organizational growth. Half of the respondents believed that
this was both a strength as well as a success for TWC. Interview analysis revealed that
organizational growth occurred in two ways: organizations expanded their presence in the
community and organizations expanded the services they delivered. One individual
developed this theme during her interview:


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37
We are more involved with the Boyle Heights community, with

other agencies and with the medical community. We have been
able to build our connections to the community in a way we never
could have accomplished on our own. Its a tremendous
opportunity and a real success for communitybased prevention
efforts.

Another individual observed that, Several agencies are expanding. Agencies are providing
new services and a wider range of services. These developments were positive
achievements for both the organizations that experienced them and for the community that
benefited from them. Community members weighed in during informal discussions,
talking about the organizations they did not know provided services that they could access
and use in their everyday lives.

Theme Three: Although the movein was not troublefree, hosting the grand opening
and finally occupying the facility was viewed as a key success. The celebratory event
that marked the creation of The Wellness Center was a source of both joy and pride with
many individuals remarking how meaningful it was to share this with the Boyle Heights
Community. While 42% of the individuals entered remarked upon the effectiveness of the
event, among community members, the support for the event was even stronger. In an
informal discussion group held after a BHC gathering, one woman recalled, It was a
wonderful day a great party and a great event. And now were here. Her experience was
matched by that of one tenant who recalled, smiling, Despite complicated pseudoCounty
processes and all the bureaucracy, we got it donenicely. The grand opening served as a
kind of healing event, enabling the tenant agencies to move past their frustration. Another
individual interviewed detailed the process:


October 2014

38

Lets be honest the projected movein was delayed once or
twice, I stopped counting after a certain point. But through it
all, the agencies who were tenants developed a kind of
camaraderie. We worked through everything and trusted the
process together. The celebration was great and now we can
look at each other and were thinking, we did it, were in!

Overall, there was a tremendous sense of accomplishment that after much planning, The
Wellness Center was finally a reality. Some of the individuals interviewed focused on the
difficulties of the moving in process but eventually even the most critical voiced their
satisfaction that they were finally settled and working to partner with one another and
with the community.

Theme Four: Although the response was not as strong as with other key successes,
one third of those interviewed, stated that increased community access represented
a major victory. One individual described the intrinsic value of community access,
commenting:
Its so important and empowering that we have secured this
facility, this space has been reenvisioned as a space of healing
this is for the community. We help to staff it, we are here to

serve, but in some very real way this is owned by the
community. It is their center.

Another respondent expressed their belief that TWC can thrive as a community center we
all see a vision of success. The need for the Boyle Heights community to both possess and
use a communitybased wellness center was viewed as integral to family and neighborhood
health. During interviews, several respondents expressed similar opinions that this center
fulfilled a longstanding need in this marginalized community. I dont know why it took so


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long, one interviewee offered, But I think we are all glad the center is finally here. This was
a tone that persisted throughout all of the interviews: whatever the critique, there was
consistent acknowledgement that the establishment of TWC represented an important
accomplishment that would serve Boyle Heights in the year to come.

Theme Five: The final key success was a sentiment expressed by respondents who
felt it was important to be part of and play a role in the development of a unique
model. Throughout all of the interviews, there was a general sentiment that this was an
innovative endeavor, and a vast improvement on previous efforts. One out of four
individuals interviewed expressed their commitment to the development of a new model of
community based preventive health care. It feels good to be part of something that is new
and innovative, one individual exclaimed. Another interviewee offered a succinct
summary of the unusual character of TWC, saying:
There are places that are colocated but not places that
underscore the importance of collaboration across partners
to this level. There are also collaboratives that are not
colocated and while they engage with partner, there is no
sense of being able to walk across the hall to another office.
For these reasons, The Wellness Center is unique.

These words were reinforced by the observations of another interviewee who maintained
that The Wellness Center presented an important opportunity because the model is a great
one, we looked at other venues, but nothing of this scope is out there. It doesnt make sense,
there should be more places like The Wellness Center these multipurpose/ multidisciplinary
centers are crucial to good health. Cultural sensitivity is a critical aspect of this unique
model of wellness and effective health promotion, and is one of the areas where TWC in


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Boyle Heights thrives. While TWC is looking to incorporate additional programming for
other communities, notably for the disabled and for LGBTidentified folks, the RFP
process ensured that their tenants were providing culturally relevant and linguistically
appropriate services for the predominantly Latino population.

Key Challenges

Throughout interviews, individuals raised and discussed several structural and
administrative challenges that The Wellness Center faces. The chart below, portrayed in
Figure 7, depicts the major challenges described by interviewees. As with the successes
highlighted above, a wide range of challenges was described. As part of a metaanalysis of
qualitative data, the case study team combined ideas to create overarching thematic areas.
Again relying on the coding process, six key challenges and three additional challenges
themes have been identified. These were the ideas that were coded with the greatest
frequency, with key challenges present in at least 58% of interviews. The three additional
themes (TWC Staffing, Lack of Clear Roles/Responsibilities, and Sustainability Concerns)
were coded with slightly less frequency and were present in at least 41% of interviews.

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41
Key Challenges
12
Lack of Accessibility (58%)

10
10
TWC Staffing
Funding (58%)
Delayed MoveIn (67%)
7
6
Logistics/Infrastructure (75%)
Lack of Commmunication/Cohesion (75%)
Sustainability Concerns
No Clear Understanding of Roles/
Responsibilities
Marketing Outreach and Promotion (83%)
Figure 7: Key Challenges

Theme One: In defining key challenges, Outreach and Promotion emerged as the
most prominent theme, with 83% of respondents specifically citing problems with
marketing. First and foremost for TWC to be successful, there must be a common
understanding of what TWC is and what it represents for Boyle Heights. There was
extensive concern about mission and messaging. Several individuals felt that an overall
outreach strategy was missing and truly needed. One tenant captured this belief,
observing, There is a lack of consensus about what TWC truly is what it represents this is
crucial. We need to decide just what we are and get the message out there. Interviewees
agreed that the Center and its administrative structure needs to make a more thoughtful
and intentional effort at creating marketing materials that accurately represent all facets of
the Center. Another tenant offered their opinion that, We need an outreach plan we need


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materials and we need bodies to do the outreach. There was great concern that not
everyone in the Boyle Heights community was aware of TWC and the services it offered.
There are people we need to reach, who dont know about us and many of them have the
greatest health needs, one individual explained. It is clear that there is a desire for
effective leadership in this arena. These interviews aligned with one of the key
recommendations raised early on by The Network the need for a unified and
comprehensive marketing/outreach plan. Tenants raised concern that many of these
recommendations continue to fall by the wayside. Raising the question as to why the
evaluation was conducted in the first place and whether the recommendations made were
taken seriously by TWC administration.

Theme Two: Another key challenge that emerged focused on problems with
communication and cohesion with the vast majority of individuals describing
problems in this area. This challenge was very strongly connected with the marketing
concerns previously identified. The interwoven uneasiness characterized 75% of the
individuals interviewed their thoughts and feelings were repeated in multiple interviews.
Tenants expressed strong feelings about the lack of clear and concise communication
between TWC Staff and the tenants. For many, their concerns were best captured in the
words of one individual who noted, There are just no realistic goals and clear expectations
about what is needed from the tenants. Several noted that their capacity has changed since
drafting their original proposal but despite this, the Center staff has not been willing to
engage in conversations or updates. One individual discussed his concerns:

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43
There is a serious need for a strategic plan. Right now I

dont think there is one and thats not a good thing this all
fosters anxiety and a negative reaction from folks. We need
to feel like we are all in this together and that we all have
a road map for change.

This theme also tied in closely with individual concerns about roles and responsibilities.
One individual reinforced the need for a strategic plan and alignment saying, There are a
lot of hands in the pot, we need to come together intentionally and strategically our realities
need to align. What clearly emerged from the themes identified through interview
analysis was the need for The Wellness Center to create and present a united, integrated
front to both Boyle Heights residents and to the medical community. TWC staff must
recognize that not all tenants are service providers, not all have the same levels of capacity,
and finally, not all tenants have enough funding to meet TWC demands without being
allotted the time and space to secure additional funding.

Theme Three: The majority of individuals interviewed expressed concerns about the
TWC structure, particularly logistics and infrastructure, with problems surrounding
their lack of voice in any planning or structure. This challenge was consistently cited by
75% of the individuals interviewed and represents an area warranting future attention.
One individual was very direct, noting Partners do not have enough say in the process.
Again, this theme overlaps with other challenges, particularly the lack of communication
and the inability to define roles and responsibilities. From interview accounts, it appears
that the needs of tenants were consistently overlooked in the planning process. Given the
multiple agendas operating throughout the planning process, this is not surprising, but the

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44
interviewees were insistent that this now had to be addressed. A related concern was well
summarized by one individual who described how the intake process is really
complicatedits unnecessarily invasive and repetitive. This belief represents serious
concerns on the part of tenants who are required to ensure confidentiality and respect
HIPPA. Interviewees raised related concerns surrounding specific leadership and
bureaucratic concerns. Many respondents believe that there are key structural pieces
missing from TWC model, namely, communication, transparency, and accountability. This
issue is exacerbated by the lack of a clear relationship between funding entities, LAC, TWC
administration, and tenants. Overall, TCW tenants concerns clustered the belief expressed
by one interviewee who seemed to express what many were feeling:
The Center is wonderful and its important to the community
but it needs to live up to its promise. Right now we all are
feeling that the center is lacking a sense of organizational
effectiveness time, planning, and cooperation are all missing
and this is key. All of the agencies here are dedicated to what
we are doing but we need good, strong infrastructure and
communicated. For some reason, this isnt happening.

Theme Four: Challenges that resulted from the delayed move represented a key
theme for twothirds of the individuals interviewed. Along with this strong emphasis
on postmovein problems, over half of the interviewees described now facing
funding problems that resulted from the late movein. One individual embodied the
reaction of many interviewees as they explained the problems that faced their agency:
We were forced to develop our infrastructure all at once.
The building was not functional before movein, which
impacted programmatic deliverables, timelines, and scope
of work it caused confusion. We expected to move into a
stable environment we knew there would be problems,


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45
but nothing approached what we found when we tried to

move in. Nothing was ready.

There was confusion, lack of preparation, and no sign of infrastructure. Several tenants
discussed their inability to secure funding as a direct result of the continually delayed
movein; this was a problem most notably for the smaller, local agencies. One individual
who was interviewed recalled,
We expected to hit the ground running, and it was a rude
awakening when we had to stop in our tracks and take care
of things like getting the phone hooked up that should have
been taken care of for us. Only now that we are actually in the
facility can we begin fundraising. This has been a serious
problem for us.

Many of the interviewees revealed their feelings of surprise that the infrastructure of TWC
was not as well organized as they had anticipated. There was recognition that problems
were anticipated, but not the type or extent that was experienced. Attending to all of these
problems diverted their attention and energies from fundraising and maintaining
relationships with ongoing and sustaining funders. We thought we wouldnt have to deal
with any of this, one individual recalled, thats why we joined the Center. But we wound up
experiencing double the problems. Funding loomed large as an ongoing challenge,
exacerbated by the delayed move. Again aligning with The Network recommendations, this
ongoing concern regarding funding adds to the anxiety about the sustainability of TWC
model. Related to sustainability, several tenants expressed the need for outcome
development in order to measure and validate the Centers success. When coupled with
the concern about building a solid clientele, many of the interviewees feel that the Centers
future is troubled and uncertain.

October 2014

46

Theme Five: Lack of accessibility presented a major challenge facing The Wellness
Center, a perception shared by tenants and community members. This is the one
challenge that arose in both formal interviews and informal discussion with community
members. For the most part, tenants and district office staff agreed on challenges and
problems, while community members were simply thrilled to have The Wellness Center
operating. However, with this challenge, everyone was in agreement. In addition, there
was a strong sense of urgency accompanying the remarks of those who discussed
accessibility. As one individual insisted,
This is far more important than any of the administrative,
structural, and marketing concerns and needs to be solved
immediately. I am embarrassed to try giving directions to clients.
I keep thinking of how someone might try to walk to the Wellness
Center from the parking lot if they try to come up that staircase,
they could slip and fall. And weve got clients who are already
uncertain about the health care system. Its difficult enough to
navigate online now its difficult to navigate from the parking lot.

Another individual described how, The complex landscape of the LACUSC campus and
parking lot is enough to keep them from setting foot at TWC. There was a significant
amount of concern expressed about the safety of consumers coming to TWC." One tenant
raised their concern that, there is not enough signage we have to give extensive directions,
which exacerbates the pressure to get people here. Four community members were quite
vocal in their concerns noting, The Center is great but I cant park and walk there theyre
crazy if they think its easy to get to, while another older woman asked, What are we
going to do when it rains? The following photographs and instructions depicted in Figure

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47
8 and 9 are two sections of a handout created by TWC tenants to provide understandable
directions to clients.49

Figure 8: Parking Directions

For those who cannot or choose not to make the 710 minute walk up the steep
staircase, TWC has implemented a free shuttle service. Still, for the tenants interviewed,
this was not enough. The shuttle, they suggested, should run through the nearby
communities and work to coordinate schedules with the metro lines for those who not
have reliable transportation. Below is a map depicting the shuttle schedule and route. The
shuttle is expected to stop at four convenient locations at 15minute intervals. For those
dependent on the shuttle service, they must leave ample time for parking and transport
when calculating the time needed to arrive on time for their appointments. Community
members claimed that this was an unrealistic and unwelcoming plan; one suggested that

49 TWC Parking. (2014).

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48
there be a town hall meeting to discuss how to create better access to The Wellness Center.
I dont want to wind up with a broken leg, one remarked while another laughingly added,
I want to go to The Wellness Center for preventive medicine not rehabilitation.
Figure 9: The Wellness Center Shuttle

TWC Model: Missing Pieces, Future, and Replicability

Nearly all of the individuals interviewed expressed their belief that if TWC were
operating at full capacity, the Center would be representative of and responsive to the
needs of the Boyle Heights community. At this time, however, and as a result of the
challenges listed above, interviewees agreed that the Center has not yet reached full
capacity. Moving forward, respondents identified several services that they felt could be
enhanced:


October 2014

49
Disability Services/Accessibility
Immigration Services
Direct Health Services (ex: Dental)
Substance Abuse Services
Cancer Services (National Organization)
Support Group Services
Culturally and linguistically appropriate programming
Youth programming (Arts and Sports)

Respondents agreed that this first year represented a critical time for TWC. As part of this,
tenants expressed hope that the Center will develop both internal and external (third
party) evaluation models so that they can more thoroughly measure their successes and
desired outcomes. There was careful thought about the future and the vision that would
best guide TWC. The individuals interviewed were very clear about what was both needed
and desired in the months ahead:
See a steady flow of traffic and expanded services.
Become a nationally recognized model funded by the Federal government.
Build stronger relationships with the medical and nonprofit sectors
Develop trust amongst members of the East Los Angeles community.
Gain a better understanding of the role of all stakeholders
Set specific benchmarks/outcomes identified that are achievable and
transformational
Provide programming worth coming back for.

During interviews, the issue of replicability was discussed at length. It is key to
note that the discussions of the prospects for replicability of a model refers to The Wellness
Center model as a whole most notably, a colocated multitenant model with collaborative
programming. There were varying degrees of enthusiasm about this model, as portrayed
in Figure 10, with 91% of respondents voicing their belief that the comprehensive and
holistic model of providing health care services, education, and prevention methods is
replicable. However, once the interviewer drilled down into perceptions and nuances, one


October 2014

50
out of four individuals voiced some hesitation. Individuals explained that to truly
determine if the model was replicable, the Center must first have the time and opportunity
to operate at full capacity and with full effectiveness. One respondent indicated that the
model is not yet replicable explaining that the internal structure, lack of transparency and
accountability, and poor definition of roles and responsibilities remain as key areas of
concern.

Is TWC Model Replicable?

1
Yes (Absolutely)
Yes (With Hesitation)
8
No
Figure 10: Is TWC Model Replicable?

Building on this discussion, and based on the research at other community based
wellness centers, multitenant nonprofit organizations offering health and wellness
services to residents are characterized by both the capacity to grow and the ability to be

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51
replicated. What is clear from these external studies and from the research conducted at
TCW, is that the following components must in place:50
Beginning with a shared vision of health concerns
Using selfhelp support circles as a tool for enhancing personal/collective
empowerment
Developing health education and promotion workshops that actively involve
participants, enabling them to share experiences in support circles while in
the program
Housing the program in an accessible and welcoming space in the community
Providing onsite exercise classes and equipment
Establishing and maintaining supportive and collaborative community
partnerships.

Alongside replicability, the issue of scalability was also raised. Many respondents
voiced their belief that while the model itself is too complicated for replication, elements of
the model could be incorporated into existing health care campuses on a smaller scale.
Tenants believed that this would be a much more seamless process. The lessons learned
from the establishment of TWC could be used to inform the process of creating another
wellness center at a BHC site in California. While some interviewees believed it was
essential to build other centers in historical buildings, the majority of individuals expressed
their concern about how effective it would be to avoid using a historical structure
ultimately ensuring a quicker construction or renovation process. Certainly, in southern
California there is another community that would warrant this innovative and exciting
approach to engaging residents and building community health. South Los Angeles shares
many of the same strengths and challenges as Boyle Heights and represents fertile ground
for future innovation.

50 Elliot Brown, Jemmott, Mitchell, & Walton (1998), pg. 151152.

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52
REPLICATING THE WELLNESS CENTER:

MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL

History of the Martin Luther King, Jr. Community Hospital

In South Los Angeles, Martin Luther King, Jr. County Hospital first opened its doors
in 1972. It was constructed after the Watts Riots and traces its origins directly to the local
as well as national belief that the absence of health services contributed to civil unrest.51 At
the time, the community of South Los Angeles lacked and desperately needed a general
hospital. Individuals were actually forced to travel to Los Angeles County Hospital in Boyle
Heights to receive services. Addressing From these challenges as part of Los Angeles
Countys commitment to change, the original Martin Luther King, Jr. General Hospital came
into existence. The Hospital began as a 461bed general acute hospital one of the few
facilities that catered to the poorest and most underserved residents of the community.52
Its existence represented hope to people who had never experienced good care in their
own community.

51 Martin Luther King, Jr. Community Hospital. Our Story.

52 Ibid.

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53
Sadly, over time, the promise and hope gave way to problems and ultimately crisis in terms
of medical care and service delivery. In August 2007, after a long history of well
documented operational difficulties, the hospital lost its accreditation and was forced to
close. District Two Supervisor Mark RidleyThomas and Los Angeles County leadership
remained committed to providing health care and critical emergency services to South LA.
But the question remained: How?

In October 2007, the South Los Angeles Medical Services Preservation Fund was
signed into law, guaranteeing that Los Angeles County would provide funding to build a
new, stateoftheart hospital that would replace MLK and provide the highest quality
health care. The old hospital has continued to provide outpatient services through the
Martin Luther King, Jr. Multi Service Ambulatory Care Center (MACC), which still functions
today.

There was ongoing concern about funding and capacity. As a result, in 2008, LAC
approached the UC Regents and Governor Schwarzenegger to ask for additional assistance
in building a new hospital. The following year, the UC agreed, transforming the hospital
into an independent, 501(c)(3) nonprofit organization. In 2010, the partnership sponsored
Assembly Bill 2599 to provide financial stability to the new hospital, which was signed into
law by September. RidleyThomas and LAC leadership held a series of community
meetings to discuss plans for establishing and staffing the new hospital and to obtain input
from civic leaders, business owners, health care advocates, and local residents.53

Based upon the publicprivate partnership established by LAC and the University of
California to address the health needs of the community, the collaboration created an

53 Martin Luther King, Jr. Community Hospital. Our Story.

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54
independent nonprofit organization, the Martin Luther King, Jr.Los Angeles Healthcare
Corporation, which was charged with overseeing the administration of the Hospital. In
2011, the Corporations board of directors created the Martin Luther King, Jr. Community
Health Foundation to support the work of the new Hospital. The Foundation will meet the
needs of the public by increasing access to resources concerning health and wellness,
creating initiatives that ensure better service to the community, conducting outreach, and
obtaining funds. All of this is important to note in understanding that a substantial
infrastructure for this health care facility.
2015: The New Martin Luther King, Jr. Community Hospital

The new Martin Luther King, Jr. (MLK) Community Hospital represents a priority
project for Supervisor Mark RidleyThomas and is an integral piece of his 2013 Master
Plan.54
The Hospital will have 131 inpatient beds and is set to open in early 2015. Envisioned as a
central hub in an integrated system of care, the Hospital will be providing the highest
quality of medical services and offering health education and community outreach
programs both on the site and with regional community partners, ultimately creating a
comprehensive system of wellness services.55 Designed to effectively serve the 1.2 million
residents of South Los Angeles, including Compton, Inglewood, Watts, and Lynwood, MLK
will offer inpatient primary care, basic emergency services, as well as health education and
outreach services for the community.56 Outpatient services will be located nearby and will

54
Ibid. About the Hospital.

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

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55
be offered through the Martin Luther King, Jr. Center for Public Health, which will focus on
preventive care, and the Augustus Hawkins Mental Health Center.
According to the Los Angeles County Department of Public Health, South Los
Angeles is home to some of LAs most vulnerable populations with several health
concerns.57 The following table portrays South LAs population distribution and the
problems they encounter.
74% Hispanic and 23% African American
35% of community is under 18 years
30% of South LA adults report their health to be fair or poor
38% uninsured
29% have no regular health care
45% of adults have difficulty accessing medical care

Accessibility has proven to be a crucial problem for these vulnerable populations
and for the community. After the original Hospital was shuttered and services were shut
down, many residents lost crucial access to healthcare and resources including
emergency services, surgical care, and general medical care. Although patients from the
former Hospital were absorbed into other local hospitals around the area, most of the

57 Ibid. Statistics from the 2013 LA County Department of Public Health survey.

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56
hospitals were not as accessible. Public transportation was an ongoing problem as was the
lack of outreach and followup. For this reason, the establishment of a modern hospital to
provide optimal services and communitybased care to the indigent and marginalized
residents of South LA is of utmost importance.
Incorporating TWC Model

Considering the Hospitals rich history and its new position as a hub for South Los
Angeles health and wellness needs, the MLK model mirrors that of the TWC at The Historic
General Hospital. With its commitment to including community voices, elements of TWC
Model would be important as well as invaluable to the development of community based
wellness efforts in South Los Angeles. Integrating this model within the existing
Foundation initiatives would be ideal, fitting together matching strategies. There several
local community organizations emphasizing health and wellness in South LA that could
play a critical role as thought and leadership partners, providing significant, community
based resources and services that are integral to the wellness of South Los Angeles
residents. These local organizations are listed below in Table 4:58
Type of Service
Family/Community Social
Service Centers
Community Health Clinics

Organizations Providing Services

Al Wooten Jr. Heritage Center
El Nido Family CenterManchester
Para Los Nios
Watts Labor Community Action Committee
Bradley/Milken Youth and Family Center
Watts Health Center
South Central Family Health Center
St. Johns Well Child and Family Center
Crenshaw Community Health Center

58 Martin Luther King Community Health Foundation. (2014). Community Resources.

October 2014

57

Food Banks

APLA Health and Wellness Center
Hubert Humphrey Comprehensive Health Center
Mental Wellness/
Didi Hirsch Community Mental Health Center
Counseling
House of Uhuru Counseling Center
YMCA
Fitness/Exercise
Challengers Boys and Girls Club
Higher Goals, Inc.
Shelters/Temp Housing
Homeless Outreach Program & Integrated Care System
San Miguel Church
Spiritual Wellness
West Angeles Church of God in Christ
Urban League Worksource Center
Workforce Development/
Jordan Downs Portal
Employment
SoutheastLACrenshaw Center
Compton CareerLink
Table 4: South LABased Service Providers
CONCLUSION

This case study explored and identified the creation of The Wellness Center
alongside its relationship to the Boyle Heights community. Today, TWC has been operating
for roughly eight months and despite structural and administrative complications it has
and will continue to positively impact individual and community wellbeing. Significantly,
the model aligns with the mission and vision of The California Endowments Building
Healthy Communities initiative. TWC is an embodiment of two key tenets of the Health
Happens Here mantra Health Happens with Prevention and Health Happens in
Neighborhoods. In its efforts throughout California in general and in Boyle Heights in
particular, TCE has moved the discussion of health and wellness beyond the traditional
doctors office walls to the areas where we live, learn, and play. TWC is an important
asset for a community like Boyle Heights rich in culture and activism yet lacking the
knowledge and resources to achieve healthy eating and active living on its own.


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With the implementation of significant policy changes under the Affordable Care
Act, the current political and economic environment provides a unique opportunity for
TWC to thrive. With these emerging transformations in the health care system, TWC is
positioned to ensure that lowincome minority communities are afforded access to health
coverage, insurance and resources. Most importantly, TWC encourages its clients to begin
their wellness journey by addressing the root causes of illnesses. Community engagement
is a central component of this model and is integral to providing appropriate education and
services to meet the needs of Boyle Heights residents. As a result, residents are now taking
charge of their healthcare and becoming advocates for healthy eating and active living in
their underserved community.
In alignment with the research on wellness centers nationwide, TWC stakeholders
identified several key successes: collaboration among tenant organizations, improved
communitybased programming, and increased access to culturally and linguistically
appropriate services. The Wellness Center model has proven to be unique: it is colocated
and collaborative. Research suggests that different agencies clustered under one roof
raises awareness of various partners particular service areas and ultimately attracts
greater public support and engagement.59 In the same vein, colocation is critical to
enhancing resident participation and increasing access to services. Research demonstrates
that colocated nonprofit centers not only have the capacity to grow and expand but to be
replicated throughout the country. In fact, colocated nonprofit centers have been on the
rise for years, and are favorably viewed because of lower tenant costs, emphasis on
organizational development, efficiency, and effectiveness, and better coordination of client

59 VinokurKaplan & McBeath (2014), pg. 79.

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59
services.60 TWC tenants believe that sharing the same physical space provides the
opportunity for a diverse set of organizations to interact in ways not previously possible,
allowing for the creation of a onestopshop, and helping to broad their programming to
better reflect community needs.61 Collaboration among healthcare providers has also
proven to be an important factor in the provision of comprehensive services. In many
examples of these communitybased programming efforts, the patient is placed at the
center of the model which is crucial to ensuring continued engagement.

In light of the increased awareness of these colocated and collaborative wellness
center models, this case study offered an example of South LAs Martin Luther King, Jr.
Hospital as a communitybased medical facility that could potentially benefit from
implementing elements of TWC model. As a part of its foundation initiatives, MLK could
amplify nontraditional health and wellness services and place an emphasis on prevention.
As in Boyle Heights, the research team identified several healthminded nonprofit
organizations in that could collaborate to provide these resources.

To effectively meet emerging challenges, TWC tenants voiced a need for more
effective communication among all stakeholders tenants, funders, and staff. There needs
to be a clearer understanding of roles and responsibilities and increased accountability and
transparency among TWC staff. In order to ensure continued reliance on Wellness Center
services, staff is working on implementing a more comprehensive marketing program
combined with intentional outreach and referral to and from the LAC+USC Hospital. Issues
concerning funding/sustainability can be better addressed after TWC has been operating

60 Ibid.
61 Ibid.

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for over a year. These challenges mimicked those addressed in the literature, suggesting
that with more time, TWCs unique model has the potential to flourish not only in the Boyle
Heights, but to inspire community engagement and resident activism in other underserved
lowincome minority communities.

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61
Works Cited62

Andersen, R. M. (1995). Revisiting the Behavioral Model and Access to Medical Care: Does
It Matter. Journal of Health and Social Behavior, 36(1), 110.

Bates, T. W. (2011). Community and Collaboration: New Shared Workplaces for Evolving
Community Practices (Master's thesis, Massachusetts Institute of Technology).

Baxter, P. and Jack, S. (December 2008). Qualitative Case Study Methodology: Study Design

and Implementation for Novice Researchers in The Qualitative Report, 13(4). 544

559. http://www.nova.edu/ssss/QR/QR134/baxter.pdf.

BHC Connect: Building Healthy Communities. Boyle Heights Community.

http://www.bhcconnect.org/healthhappenshere/boyleheights/ourcommunity.

The California Endowment. Making Health Happen by Building Healthy Communities.
Boyle Heights. http://www.calendow.org/communities/buildinghealthy
communities/.

California Health Interview Survey (CHIS). (20032005). Healthy City: Information + Action
for Social Change. Zip Codes: 90033, 90063: Quick Stats. www.healthycity.org.

Elliot Brown, K. A., Jemmott, F. E., Mitchell, H. J., & Walton, M. L. (1998). The Well: A
NeighborhoodBased Health Promotion Model for Black Women. Health & Social
Work, 23(2), 146152.

Health Services Los Angeles County. LAC+USC Medical Center: About Us.

http://dhs.lacounty.gov/wps/portal/dhs/lacusc/.

Martin Luther King Community Health Foundation. (2014). Our Community.

http://mlkchf.org/about/.

Martin Luther King, Jr. Community Hospital. http://www.mlkcommunityhospital.org/.

Merzel, C. & D'Afflitti, J. (2003). Reconsidering CommunityBased Health Promotion:
Promise, Performance, and Potential. American Journal of Public Health, 93(4), 557
574. DOI: 10.2105/AJPH.93.4.557.

The Nonprofit Centers Network. (March 7, 2013). Memo: Wellness Center Business Plan:
Part I, Capacity Plan.

62 Wellness Center Staff and TCE personnel provided many of the documents referenced herein. Documents
are referenced by their titles and dates (when available). Complete citations provided where applicable.

October 2014

62

The Nonprofit Centers Network. (March 8, 2013). PPT Presentation Business Plan: Part I,

Capacity Plan.

Nyknen, P. & Seppl, A. (2012). Collaborative Approach for Sustainable CitizenCentered
Health Care. In Critical issues for the development of sustainable ehealth
solutions (pp. 115134). DOI: 10.1007/9781461415367_8.

Request for Proposal. RentFree Space: First Floor at the Los Angeles County Wellness
Center at the Historic General Hospital. (2011).

Rosenberg, A. (November 19, 2009). UC to help reopen South L.A.'s MLK hospital.

http://newsroom.ucla.edu/stories/uctohelpreopensouthlas112842.

Suresh, S., Ravichandran, S. & P. G.. (2011) Understanding Wellness Center Loyalty
Through Lifestyle Analysis, Health Marketing Quarterly, 28:1, 1637.
http://dx.doi.org/10.1080/07359683.2011.545307.

Steinhauer, J. (November 22, 2009). Deal Will Turn a Los Angeles Hospital Private. The New

York Times. http://www.nytimes.com/2009/11/23/us/23hospital.html?_r=0.

Supervisor Gloria Molina, First District. The Wellness Center at the Historic General
Hospital. Retrieved from:

http://gloriamolina.org/thewellnesscenteratthehistoricgeneral%20hospital/.

Thompson, C. W., Monsen, K. A., Wanamaker, K., Augustyniak, K., & Thompson, S. L. (2012)
Using the Omaha System as a Framework to Demonstrate the Value of Nurse
Managed Wellness Center Services for Vulnerable Populations. Journal of
Community Health Nursing, 29:1, 111, DOI: 10.1080/07370016.2012.645721.

The Wellness Center. (2014). Homepage. http://www.thewellnesscenterla.org/.

TWC Case Statement. (November 2013). Pages 1 5.

TWC Funds. (2012 Overview).

TWC Parking. (2014).

TWC Partners List and Fact Sheet. (December 2013). Pages 13.

TWC PowerPoint Presentation. (March 2014).

TWC Summary of Services. (February 10, 2014). Pages 1 11.


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63
UCLA Center for Health Policy Research. Building Healthy Communities: Boyle Heights

HealthProfile.http://www.calendow.org/uploadedFiles/Health_Happends_Here/
Communities/Our Places/BHC%20Fact_Sheet_Boyle%20Heights.pdf.

VinokurKaplan, D. & McBeath, B. (2014), Colocated Nonprofit Centers. Nonprofit
Management and Leadership, 25: 7791. DOI: 10.1002/nml.21110

Ybarra, Jennifer. (April 30, 2012). Memorandum: Boyle Heights Wellness Center at the

Historic General Hospital.


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APPENDIX A: INTERVIEW PROTOCOL

1. Please tell me how the TWC came into being how did the process begin? What took
place over time? In other words please discuss the story of TWC.

2. Are there things you would change about the process of creating TWC?
3. What were the biggest challenges in that journey? Biggest successes?
4. Where did the best support come from?
5. What is the future of TWC? Where do you envision TWC being 5 years from now?

6. Is this a model that that is replicable what is your sense of that? What are the key
elements?

7. How were the agencies chosen to participate in TWC?
8. What pieces do you think need to be added to TWC?
9. Anything else you want to discuss or add to the case study?
10. Who are some additional key stakeholders I should reach out to?


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APPENDIX B:
MARTIN LUTHER KING, JR. GENERAL HOSPITAL EXTENDED CASE MATERIAL
Mission and Vision

Martin Luther King, Jr. Hospitals mission is to provide high quality health care,
comprised of a compassionate, integrated, coordinated, and collaborative approach

towards its community to improve overall health among its children and families. To
achieve this goal, the hospital leadership will collaborate with other healthcare facilities
and providers within the community to make services not available in the hospital readily
accessible to the public. 63
Funding Partners

Fundraising to construct and establish the new Martin Luther King, Jr. Hospital has
received generous, widespread support from both public and private community partners.
In considering how TWC can inform the creation of a wellness center in South Los Angeles,
it is critical to note that several of these partners are also supporters of TWC. In particular,
The California Endowment and LA Care are noted as providing valuable startup support.
Funders
Purpose
Amount
LA County
Startup funds for expenses/operating

costs
$50 million64
LA County
Care for uninsured patients
$13.3 million a
year65
LA County
Capital project commitment
$353.8 million66
63 Martin Luther King, Jr. Community Hospital. About the Hospital.
64 Steinhauer, J. (2009, November 22). Deal Will Turn a Los Angeles Hospital Private. The New York Times.
65 Ibid
66 Rosenberg, A. (2009, November 19). UC to help reopen South L.A.'s MLK hospital.


October 2014

66
LA County
Annual operating funds
$63 million67
(major lending
institution)
Operating funds for first 6yrs
$100 million
(credit letter)68
Kaiser Permanente
Labor/Delivery Department
$2 million
Weingart Foundation
Healthy Babies,
Healthy Beginnings Initiative
The Ralph M. Parsons

Foundation
Healthy Babies,
LA County
The Ahmanson
Foundation
The David and Lucille

Packard Foundation
Healthy Beginnings Initiative

Siemenss Symphony MRI
NA
$750,000
$500,000
Expansion of obstetric services and

maternity programs
_________________________________
$800,000
Healthy Babies, Healthy Beginnings

Initiative
Good Hope Medical

Foundation with UCLA
Health System and David
Geffen School of Medicine
Planning and pilot programs to

establish The Learning Center
$100,000
The Annenberg
Foundation
Planning and pilot work related to The

Learning Center
$151,880
The Walt Disney

Company
Art Fund Initiative to establish a healing

art program at the hospital
NA
Table 5: MLK Funders

Service Provision

67 Ibid
68 Ibid

October 2014

67
In addition to high quality and comprehensive medical care and mental health care
services, the MLK Foundation will be overseeing communitybased initiatives.69 These

efforts will be both innovative and accountable for meeting community needs and interests.
For example, the Art Fund will ensure that the traditionally sterile hospital environment
will be adorned with art to foster a restorative, calming, and peaceful ambiance. The
Healthy Babies, Healthy Beginnings effort is designed to ensure that mothers in South LA
have accessible and compassionate care irrespective of their economic standing. In
another facet of comprehensive care, the Learning Center will serve as the connection
between the Hospital and community residents, providers, and organizers. The Center will
provide education for residents as they navigate the complex healthcare system while
collaborating with other local and national organizations to ensure completeness of care.
The provision of outpatient treatment is essential to a comprehensive health care model
and will be offered through the Hospitals Transitional Care Program. In partnership with
David Geffen School of Medicine at UCLA, this Program will strengthen the safety net
through the utilization of care teams with the goal of improved health outcomes and
enhanced experience for recently discharged patients who may need additional help
managing their care. This program is intended to shift care delivery from hospital to
community.70 Finally, the Hospital is relying on health care innovations such as
telemedicine to connect to other facilities and ensure proper diagnoses and treatments as
69 Martin Luther King Community Health Foundation. (2014). Initiatives.

70 Martin Luther King Community Health Foundation. (2014). Initiatives.

October 2014

68
well as smart beds and advanced nurse call systems to ensure effective communication.
On the following page, Table 6 provides a basic overview of the Hospital services.71
Facility/Organization
Services Provided
Martin Luther King, Jr.

Hospital
Anesthesiology
Cardiology (medical and diagnostic)
Emergency medicine
Endocrinology
Gastroenterology
General Medicine
Gynecology
General Surgery
Neurology
Obstetrics
Oncology
Ophthalmology
Orthopedics (including spine)
Otolaryngology
Pathology
Radiology
Reconstructive Surgery
Pulmonary Medicine
Urology
MLK Jr. Multi Service
Urgent care
Ambulatory Care Center
Additional services including: general medicine,
(MACC)
cardiology, dermatology, dentistry, geriatrics,
HIV/AIDS, neurology, orthopedics, and physical
therapy
Augustus Hawkins Mental Outpatient and inpatient psychiatric care and mental
Health Center
health services
MLK Foundation
Community Based Initiatives
Art Fund
Healthy Babies, Healthy Beginnings
The Learning Center
Strengthening the Safety Net
Health Care Innovation
Table 6: Services Provided by MLK Community Hospital

71 Martin Luther King Community Hospital. Medical Services.

October 2014

69
For services not provided at the Hospital (ex: Cardiology, Chemical Dependency,
Transplant, and Trauma), there will be agreements and MOUs in place with other nearby
hospitals to ensure that patients receive the most comprehensive care available.


October 2014

70

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Developing

The Wellness Center

Developing The Wellness Center

How TWC is structured to respond to community needs.

reimagining of a historic hospital setting, anchored in the community. Most importantly, it

Developing The Wellness Center

Developing The Wellness Center

3 Nyknen & Seppl (2012) pg. 118.

4 Nyknen & Seppl (2012) pg. 118.

Developing The Wellness Center

7 Merzel & DAffitti (2003), pg. 569.

Developing The Wellness Center

HISTORIC GENERAL HOSPITAL: AN OVERVIEW

8 Nyknen & Seppl (2012) pg. 117.

Developing The Wellness Center

Developing The Wellness Center

OPENING THE WELLNESS CENTER

Developing The Wellness Center

Developing The Wellness Center

this language because subsequent phases were not clearly delineated.

19 TWC Case Statement. (November 2013). Pg 3.

Developing The Wellness Center

Historic General Hospital. (2011).

22 TWC Case Statement. (November 2013). Pg. 4.

Developing The Wellness Center

Developing The Wellness Center

Developing The Wellness Center

26 TWC. (2014) About the Wellness Center.

27 TWC Partners List and Fact Sheet. (December 2013). Pg 2.

Developing The Wellness Center

Provide culturally sensitive programming to the residents of the area in

28 TWC Presentation. (March 2014). Slide 8.

Developing The Wellness Center

Figure 1: The Wellness Center Floor Plan

In support of the publicprivate partnership providing preventive services to a

Developing The Wellness Center

Executive Director Salary

The California Endowment

LA Health Care Plan

Development of Wellness Center

The California Wellness

Design/build play area for

California State Parks

Rentfree office space to tenants

Developing The Wellness Center

LAC (transferred to the

Construction (Project Manager)

Construction (Demolition and

Table 1: TWC Funders

32 TWC Case Statement. (November 2013).

Developing The Wellness Center

2013 The NonprofitCenters Network & Tides

Developing The Wellness Center

The administrative structure of TWC continues to be ongoing challenge. From the

Developing The Wellness Center

Developing The Wellness Center

Maternal and Child Health

National Multiple Sclerosis

35 TWC Case Statement. (November 2013). Pg. 4

Developing The Wellness Center

Developing The Wellness Center

Examples of Services Provided

Mexican American Opportunity Foundation: Senior Hispanic Information Assistance