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Siouxland Community Health Center

Resource Manual

Gabriela Valdovinos

Social Work Practice III

Sister Shirley Fineran

May 2, 2014

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Introduction

Siouxland Community Health Center (SCHC), a Federally Qualified Health Center

(FQHC) in Sioux City, Iowa has provided quality low cost health care services to the community

for over 20 years (Appendix 1).“The mission of Siouxland Community Health Center is to

provide primary health care that eliminates access barriers and improves the health of the

Siouxland community” (Appendix 2). In order to meet a wide range of needs, the health center

provided the following services under one roof: financial counseling and sliding scale fee

payments, primary medical care for adults and children, laboratory and radiology services,

chronic disease management and case management services, pharmacy with medication

counseling and medication financing assistance, behavioral health screening, evaluation,

treatment, as well as care coordination through behavioral health and social services, substance

abuse screening through the Screening, Brief Intervention and Referral to Treatment (SBIRT)

program, infectious disease prevention and care coordination services, language interpretation

services that includes Spanish, Vietnamese, French, Somali, Oromo, and Amharic. Siouxland

community Health Center has had the opportunity to provide a dental home for both adults and

children (Appendix 3).

Siouxland Community Health Center has gone through many changes over the years in

order to accommodate the expanding needs of the Siouxland community (Appendix 4). The

health center moved to a larger building in 2009 and continued to expand to meet the high

demand of health care services in the surrounding counties. To improve the delivery of the

services offered in the community, collaborative agencies also underwent changes. New services

were created, services had been removed, and other services were expanded, which made it

difficult for members of the community to stay updated.

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Gabriela Valdovinos was a senior social work major at Briar Cliff University in Sioux

City, Iowa. She began her internship in the social services department at Siouxland Community

Health Center on January 27, 2014. Her role in the department as a future social worker was to

be “the change agent.” As a change agent Miss Valdovinos was able to recognize the needs of

the community and plan for change. Miss Valdovinos recognized that change was always

happening and periodical updates needed to be made.

The Need for Change and Preparation for Change

At Siouxland Community Health Center, departments worked collaboratively to ensure

that patients received the appropriate services. If needed services could not be provided in the

health center, the social services department had a responsibility to refer patients to the adequate

agency. With the ongoing growth of services at the clinic, the behavioral health and social

services staff had an increasing number of tasks. However, the department had already been

short-staffed for several months which made it more difficult to meet with every patient that

would benefit from their assistance. In addition to assisting patients during their medical

appointments, the behavioral health counselors were responsible for administering Test’s of

Variables for Attention (TOVA) in order to provide Attention Deficit/Hyperactivity Disorder

evaluations (Appendix 5). They also completed psychiatric diagnostic evaluations; as well as,

provided psychotherapy for the patients who are patients of the medical clinic.

Leslie McDonald-Gonzalez, LISW, was a previous student of Briar Cliff University and

took the role as her internship supervisor. Gabriela Valdovinos had the opportunity to shadow

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her throughout her internship. During one of her encounters with a patient, her initial task was to

provide the patient with information on adult day care services in order to assist with her health

care and social needs. For the requested information, she searched the current resource manual

which included a list of services provided by agencies in the surrounding counties, and contact

information.

Miss Valdovinos soon realized that her task involved researching the information because

it had not been provided in the manual. She found information about adult day care agencies

around Siouxland, through the internet, that helped initiate her work. She quickly learned that the

agency had discontinued their services. As she continued her research, she discovered that

multiple agencies have changed their contact information, created new programs, discontinued

services, changed physical address, and even changed their agency name. For example, a major

resource for seniors is Connections Area Agency on Aging (Appendix 6), which was previously

known as Siouxland Aging (Appendix 7).

Gabriela Valdovinos recognized that change is always happening and updates to the

resource manual would need to be made. She discussed revising the current resource manual as a

change opportunity with her supervisor and the other member of the department, Shelly

Backhaus, LISW. As a team, they decided that reviewing local resources, identifying changes,

and updating the resource manual would be an essential task in order to continue to provide

accurate information to the medical providers while meeting the needs of the patients. Her

change process was to revise the Siouxland Community Health Center social service resource

manual. Before the change agent arrived, the social service department had been aware of the

need for updating and revising information in the manual. The Siouxland Community Health

Center was kept extremely busy during the day due to the high numbers of patients seen on a

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daily basis. For this reason other staff were not able to take on the project due to lack of time.

Miss Valdovinos as part of the team was able to take on the project along with her other

responsibilities as an intern.

Phase I. Identifying the Change Opportunity

In the medical clinic, behavioral health and social services are offered to patients to

improve their mental health as well as their physical health. The social service department had

two behavioral health counselors that provided integrated health care services to the patients at

the request of the medical providers. An integrated healthcare facility’s definition indicated that

the facility provided mental health, substance abuse, and primary care services (Appendix 8).

Most patients came to the health center because they had physical symptoms of an illness or

disease. During the visit with the medical provider, patients were asked to fill out a Patient

Health Questionnaire PHQ-9 (Appendix 9), which is an initial screen for depression. If a patient

scored ten or more, the screen was considered positive and required further assessment by a

behavioral health counselor. After she gathered additional information, the behavioral health

counselor would review the resource manual in order to refer the patient to available services. It

was essential to have information on available services within reach to provide better patient

care.

Resource manual updates required many individuals to contribute their knowledge and

expertise. In this project, the Initiator System, defined by Fineran (2001; 2014) as “individuals or

groups who bring the situation or need to the attention of the change agent,” (p. 44) were Leslie

McDonald-Gonzales, LISW and Shelly Backhaus, LISW. As the change agent, Gabriela

Valdovinos brought the need of updating the manual to the attention of other staff.

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The Client system defined as “individuals, groups, organizations, communities who will

be the beneficiaries of the change process. There are primary beneficiaries who will benefit

directly. Secondary clients benefit indirectly. Client system may be an agency that has a work

agreement or contract, whether formal or informal, with the change agency,” (Fineran, p. 45).

The client system identifies agencies that benefit from the referrals made by the providers at

Siouxland Community Health Center. The primary beneficiaries are identified as the patients

who are referred to the agencies that provide the services required. The secondary clients are the

providers who benefit from being equipped with correct and updated information. ‘Target

Systems consists of “the people who are the targets of the change effort; the people who need to

be changed to accomplish the goals of the change strategy and produce the benefits for the client

system’ (Fineran, p. 45). In the case of this project the target system are the staff that will use the

manual. The sanctioning system defined as “The people with the formal authority and capacity

to approve and order the implementation of the proposed change strategy” (Fineran, p.45). For

this change process Leslie McDonald-Gonzales assumed the role of the supervisor and wrote the

sanctioning letter (Appendix 10). She supervised the change agent and also participated in

providing input for the project.

The supervisor accepted the change process, and the Change Agent System was selected.

The Change Agent System are “the people who will do work directly to produce the change,

including the change agent, the social worker, any social action organizations and groups, and

the people who belong to the social work agency or who employ the organization working to

produce the change” (Fineran, p. 45). The following individuals participated in the Change Agent

System, as well as, the Action System and the Planning Committee: Gabriela Valdovinos, the

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change agent, Leslie McDonald-Gonzales, LISW, Shelly Backhaus, LISW, Elizabeth Giles,

LBSW, Jason Byers, BSW, Jessica Maxwell, BA, Marcelina Cockburn, CADC, Michael Piplani,

MD, Stephen Pallone, MD, Natasha Ritchison, RN, and Alexandria Kohn, RN. These individuals

incorporated their knowledge and input to see the project completed.

The social service department members agreed that this project would be very beneficial

for Siouxland Community Center to use. As this was a very time consuming project, the change

agent needed to start working as soon as possible. Valdovinos was able to use the information

already provided on the manual to guide her through the project. She planned to use the internet,

phone and other individuals to gather her information. Valdovinos anticipated some boundaries

as she began her project. She knew that the clinic was a busy facility since day one. Her concern

was not being able to have the time to make calls during the morning in order to contact the

agencies. The reason for her concern was that some of the agencies were closed during the

weekends and some were only open at certain times, such as 8:00 am-5:00 pm. These were the

hours that she was at the Siouxland Community Health Center and conflicted with getting the

calls completed. Miss Valdovinos was not discouraged and continued her change process.

Phase II. Analyzing the Change Opportunity

Valdovinos was able to complete her research for the updated resource manual in

between meeting with patients in the medical clinic. She began by calling agencies identified on

the internet, and stated that she was working on updating a resource manual for Siouxland

Community Health Center. Agency employees confirmed changes to programs, verified

addresses and phone numbers; as well as, provided website information, and agency marketing

materials.

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The resource manual would be used by various departments and employees at clinic,

Miss Valdovinos was thoughtful about the organization of the materials. During this process, she

sought feedback to assure the manual would be accessible and that resources would be quickly

identified. She received strong support from the social service department, and felt that other

departments or teams lacked support due to the location of their offices. E-mail was the

identified form of communication but it was not as beneficial. This was due to not being able to

access Siouxland Community Health Center E-mail from home (Appendix 11).

During this phase, Miss Valdovinos also searched the internet for information on how

resource manuals were used at other facilities. The Institutional Effectiveness Resource Manual

was developed to guide and measure the effectiveness of the quality of teaching and learning at

Elizabeth City State University. This manual was used by the faculty to help them create an

appropriate an effective assessment plan. It was user friendly and listed steps of how to develop

an assessment plan. This was a current update of the previous manual Policies and Procedures

Manual for Institutional Effectiveness (Appendix 12). This manual served as an example that

changes and updates were highly important in order to improve the services for the community.

Phase III. Setting Goals and Outcomes

“The mission of Siouxland Community Health Center is to provide primary health care

that eliminates access barriers and improves the health of the Siouxland community” (Appendix

2). The mission statement was able to give the change agent an idea of how she could be able to

fulfill it with her change process. During the change agent's internship, she was able to come up

with goals, objectives and outcomes, along with her supervisor. This was in order for the team

to be able to stay on track with the change process. The following are the goals for the project.

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Goal One: To identify and analyze the need to update the social service community resource

manual.

Objective One: To review the resource manual and have a clear understanding of what needs to

be updated by January 31, 2014.

Objective Two: To create a list of agencies to research in order to verify contact information by

February 7, 2014.

Outcome One: Patients will benefit from accurate community resources.

Goal Two: To create a collaborate committee that includes participants from various

departments.

Objective One: Identify the departments that will be asked to be involved in the change process

by February 24, 2014.

Objective Two: Send an email to all participants informing them of the change process and to

invite them to be part of the committee by February 26, 2014.

Outcome Two: Patients will benefit from having employees from different departments

identify their needs in order to provide a comprehensive list of community resources.

Goal Three: To verify and make corrections to information provided in the current resource

manual.

Objective One: To research agencies on “Google” and compare the information provided in the

current resource manual and the information provided by Google by March 14, 2014.

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Objective Two: To use the information provided by “Google” and the current resource manual

and make phone calls to verify that all contact information is up to date by March 21, 2014.

Outcome Three: Patients benefit by being provided the correct information for resources.

Goal Four: To create a table of contents for the social service resource manual to be user

friendly.

Objective One: To discuss with the committee about the items that will be included in the

manual by March 28, 2014.

Objective Two: To print and organize the updated sheets of information for the manual by

April 23, 2014.

Outcome Four: Employees save time by having updated information readily available to

provide to patients. Patients benefit from waiting less time to be provided with resources they

need.

Goal Five: To create an evaluation survey for all provider teams to obtain insight on how

helpful the manual is for them.

Objective One: To create an evaluation survey of the use of the manual for provider teams by

May 1, 2014.

Objective Two: To handout the surveys to the provider teams and gather feedback by May 6,

2014.

Outcome Five: The patients will benefit by the clinic staff using an updated resource manual

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“Goals, objectives, and activities can be tracked on a Gantt Chart. The Gantt chart can

keep the change agent and the process on target. It provides the opportunity for the change agent

to plan when activities need to be accomplished, making sure that tasks get finished on time”

(Fineran, pg. 64). Valdovinos used the Gantt chart to keep track of her work and make sure that

her goals, objectives, and outcomes were completed by the set dates (Appendix 13).

Phase IV. Designing and Structuring the Change Effort

Miss Valdovinos had the overall responsibility during this project. She made sure that the

Change Agent System was involved and provided input while she worked on the manual. She

was responsible for sending out e-mails and communicating with committee members when she

encountered them in the building. It was also her responsibility to accept feedback and make

adjustments as needed. She was responsible for making the calls to verify community resource

information, update the information on the sheets, and organize it into a binder. She also ordered

information online from National Institute of Mental Health website that allowed her to provide

easy to read information on mental illnesses (Appendix 14). These pamphlets or booklets were

provided in a section of the manual. She also gathered ideas from additional providers, nurses,

and staff at the clinic who had not been members of the Change Agent System.

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Gabriela Valdovinos, Leslie McDonald-Gonzales, Shelly Backhaus, Elizabeth Giles,

Jason Byers, Jessica Maxwell, Marce Cockburn, Michael Piplani, Stephen Pallone, Natasha

Ritchison and Alexandria Kohn made up the committee. They were responsible for sending

information and communicating by word of mouth when encountering situations that needed

further research regarding available resources. The committee was also responsible for reviewing

the manual and making any suggestions on how it can improve.

Phase V. Determining Resources

‘The value of the change process and the support from the staff may be high but if the

change will incur money that has not been budgeted nor available for this fiscal year – and

maybe none in the near future – the idea will simply “go down the drain”’(Fineran, Pg. 74).

Luckily, revising the resource manual did not require much money.

Miss Valdovinos and her supervisor discussed the change process expense requirements.

They listed the supplies that were needed and create a budget that allowed them to see the

expenses of the change process. At Siouxland Community Health Center a budget was created

for each department within the clinic. The fiscal year started in February and prior to that a

budget was submitted to the clinic directors. After the clinic directors reviewed the budget, it was

submitted to the board of directors. The approved budget was then discussed with the department

manager. In the budget all the items necessary for the change process were included. This

included telephone, computers, internet, printing supplies, a binder, sheet protectors and

separators for the different sections of the manual. There was no additional cost for the change

process which was beneficial for the social service department. The following was the budget

created by the change agent for her change process.

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Community Resource Manual

Revenue SCHCProject

Client Fees$100,000.00 $0.00

Contracts$150,000.00 $0.00

Grants$500,000.00 $0.00

Total$750,000.00 $0.00

Expenses SCHCProject

Personnel$650,000.00 $0.00

Rent$82,500.00 $0.00

Supplies$5,000.00

$42.73

Telephone$4,000.00 $0.00

Copying and Printing$3,500.00 $8.29

Equipment$50,000.00 $0.00

Travel$5,000.00 $0.00

Total$750,000.00

$51.02

Phase VI. Implementing the Change Process

This phase described the process of the change that was implemented at Siouxland

Community Health Center. Gabriela Valdovinos started with the beginning stages of the process

as soon as her supervisor approved the change. This happened at the beginning of February

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2014. She reviewed the old manual and created the list that was used as a guide when she created

the table of contents. An email was sent to the committee members: Leslie McDonald-Gonzales,

Shelly Backhaus, Elizabeth Giles, Jason Byers, Jessica Maxwell, Marce Cockburn, Michael

Piplani, Stephen Pallone, Natasha Ritchison and Alexandria Kohn; to notify them of the change

process and how their assistance would be needed (Appendix 10) (Appendix 11). Their role was

to continuously assist the change agent by providing her with ideas on the items to be included

on the manual. There was resistance, change residue, and lack of support from some of the

committee members. When the email was sent only a few members replied to the message.

Gabriela Valdovinos used face to face communication in the hallways of the exam rooms to

communicate with some of the members that did not reply to email. She wanted all members to

participate in the process and she tried to make things run easy for everyone if they could not

make it to their email during the day. By walking around and asking the committee members to

give any updates on the encounters and needs of the patients, Gabriela Valdovinos was able to

manage this conflict.

The change was managed by Gabriela Valdovinos but with the help of the committee

members she was able to gather other ideas for services or agencies to be added to the manual.

All the sheets needed to be retyped into a word or excel document because there were no saved

documents from the previous information in the manual. Also the documents did not have page

numbers and the change agent wanted to make the manual user friendly. For this reason she

numbered the pages accordingly and separated them into sections.

Miss Valdovinos worked on the change process at the clinic but also outside clinic hours.

She called agencies to update information and also picked up brochures that have been updated.

Most of the work was done through calling and researching on the internet. She also consulted

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other social workers, Giles, Backhaus, and McDonald-Gonzales for feedback on the verification

of some of the services that they used frequently to provide to patients.

Every day a patient would come with an issue that gave the change agent or other social

workers ideas on adding items to the manual. This was something that the change agent was able

to recognize early in time. She notified the committee that a closing date was set for April 20,

2014 (Appendix 15). The reason was that this could be an ongoing change. Items can be added

every day, but the change agent wanted to be able to evaluate the change process for at least two

weeks. This would allow the change agent to have an evaluation sheet about how valuable the

change process was for the clinic patients.

When the change process began to be implemented providers were able to refer to the

manual. The manual was available to all clinic staff and their patients. All providers would be

able to take the evaluation survey after the two weeks that the manual was available to be used

(Appendix 16). The survey would be used to gather information on how valuable the change

process was for the providers to hand to their patients. It also would provide a space where they

could request for future additions.

The change agent was hired during her internship; she accepted the job and will be

returning after graduation. The change agent was able to hold the responsibility of this ongoing

project. Her responsibility was to ensure that the manual would stay up to date. She was also

responsible to keep in contact with nurses, providers, and other teams to assist with the

continuation of the updated resource manual. This responsibility was not included in her job

description but was discussed with Leslie McDonald-Gonzalez and Shelly Backhaus (Appendix

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17). As a team they decided that it would be beneficial for all since the change agent has all the

documents saved and has been working on the change process thus far.

Phase VII. Monitoring the Change Process

This time consuming change process needed to be monitored by the change agent

in order to be to be used by staff by the scheduled date. “Monitoring involves developing a

process ---and a simple tangible method ---to keep the change effort on course and to keep track

of implementation activities” (Fineran pg. 77). Gabriela Valdovinos recognized that that this was

a very important part of the change process to be able to finish the project. Miss Valdovinos used

all the handouts that were provided by the old manual. The sheets on the manual are different but

the change agent was able to create a list of agencies to research and call to verify contact and

program information (Appendix 18). She went down the list and in the process was able to also

add the agencies that were provided by the committee.

The change agent also used a Gantt chart to be able to monitor her change progress and

the goals of this project. Gabriela Valdovinos had a goal of completing the manual at least two

weeks before she finished her internship. The Gantt chart allowed her to see the progress

throughout time. She was able to keep her goals as planned, although there were some

unexpected situations. Since she was having a hard time communicating with the committee, she

needed to make time walk around during the day and talk to providers and nurses. Gabriela

Valdovinos was also busy consulting with patients and documenting about their visit. This made

it more difficult for her to have extra time to walk around and consult with the committee. She

was able to handle the situation by continuing to email members and making time during clinic

hours to have a brief conversation. The change was able to proceed as planned and be able to be

completed according to her goal.

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As change continued to happen throughout time, Miss Valdovinos acknowledged that the

resource manual would need to be kept updated. Her plan was to revise the manual every year

but also when visiting a patient she will be able to assist the patient calling the agency. This will

allow her to see that the agency has not changed and continues to provide the services specified.

Although, the change process was completed by April, Gabriela Valdovinos will be able to

continue to add and modify the manual.

Phase VIII. Evaluating the Change Process

“Evaluation is making a value judgment about the worth of the change” (Fineran Pg. 81).

During this stage Gabriela Valdovinos developed a survey that allowed her to see how

valuable her change process was considered (Appendix 16). She will be able to hand the surveys

to the providers, nurses, and committee members that used the resource manual. Now that the

change was completed she will be able to receive feedback from the individuals that will take the

survey. She will also have an opportunity to make any appropriate changes to the manual as

suggested by the staff.

Phase IX Reassessing and Stabilizing the Change

According to Fineran (2001; 2014), “Most change agents either leave the agency after a

major change episode or move to a different position in the agency” (p. 86). Fineran described

reassessing and stabilizing as a time to transfer responsibility. Fortunately Gabriela Valdovinos

received an opportunity to continue working at Siouxland Community Health Center. She will

remain with the agency and after graduation she will be taking the Behavioral Health Care

Coordinator position. The change process was part of the agency and one of her responsibilities

will be to continue to update any outdated information that patients or staff members encounter.

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Valdovinos will need to make all staff aware that she will continue to work as needed, on the

resource manual after her return to the clinic. Shelly Backhaus and Leslie McDonald-Gonzales

were both involved in the change process and were involved in the decision of having Gabriela

Valdovinos as the responsible individual for the community resource manual and its proper

maintenance. Miss Valdovinos will also use the evaluation surveys filled out by the staff to

consider any changes recommended. The support of the committee and other staff members

allowed for the change to be completed.

The new Social Service Manual allowed the clinic to be able to provide contact

information, informational handouts, program information and other community resources that

are frequently used by the patients. “The mission of Siouxland Community Health Center is to

provide primary health care that eliminates access barriers and improves the health of the

Siouxland community” (Appendix 1). With the completion of the project, the cooperation of the

staff and the services provided by the health center; Siouxland Community Health Center was

able to live by its mission.

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References

Fineran, S. (2001; 2014). Macro social work change process handbook. Sioux City, IA, Briar

Cliff University.

Office of Institutional Effectiveness, Research, and Assessment (2012) Institutional

Effectiveness Resource Manual. Retrieved on April 2, 2014, from

http://www.ecsu.edu/iera/docs/InstitutionalEffectivenessResourceManual.pdf