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Running head: EXPANDING BRIDGERCARE’S OFFERINGS 1

Expanding Bridgercare’s Offerings to the Gallatin Valley

Esther Yoon Nickelson

Concordia University – Nebraska

December, 2014

Bridgercare

300 N Willson Avenue

Suite 2001

Bozeman, MT 59715

Executive Director: Mari Dominguez

Associate Director: Stephanie McDowell

Community Outreach Specialist: Hannah Wilson

EXPANDING BRIDGERCARE’S OFFERINGS 2

Abstract

A practicum takes the classroom education full of concepts and models and makes it a realistic

learning experience. With the goal to gain knowledge in the management and planning

departments of a clinic offering medical care and educational programs, I spent 75 hours at

Bridgercare in Bozeman, Montana. The timing felt right for what my practicum required and

what the clinic needed work on. With aspirations to relocate to a larger facility within the next

five years, Bridgercare has been starting the search for larger grants that would fund brick-and-

mortar requests, along with the promotion of more diverse programs. To help Bridgercare start

working on the next big steps, the majority of my time was spent on expanding education

programming and organizing potential funding sources, specifically for a new facility and

becoming more appealing to different types of people.


Expanding Bridgercare’s Offerings to the Gallatin Valley

When receiving more detailed information about the Master’s of Public Health practicum

experience required, I immediately knew who I would ask to complete this career related

learning experience. For nearly 20 years, Bridgercare has been an organization near and dear to

my heart. My mother began working there before I started kindergarten and since then, the staff

members have become my mentors through the years. Some are even considered as family. For

five years from the end of high school through college, I volunteered there as a clinical assistant.

During that time, I learned two things. First off, I learned how important the work of educating

and supporting the community in reproductive health is. Secondly, this is the type of work I

picture myself happily going to every day for many years. Being a non-profit organization, I

knew that Bridgercare would have work that was being piled up because of the small number of

personnel and time. I got in contact with the Executive Director, Mari Dominguez, to see if it

would be possible to complete my practicum hours and gain the service experience in public

health. Over the course of two months, I gained knowledge and experience within the

administrative department of this clinic, as well as skills public health organizations need to

survive.

Located in downtown Bozeman, Montana, Bridgercare, formerly known as Bridger

Clinic, is one of the largest non-profit family planning clinics in the state of Montana

(Bridgercare, 2014). The mission of Bridgercare is to provide, “excellent, affordable

reproductive and sexual healthcare and education in a safe, supportive, empowering atmosphere”

(Bridgercare, 2014). Like most other medical offices in the area, Bridgercare accepts private

insurance and Medicaid, but also uses a sliding fee scale to determine the amount due, despite

the actual cost of service after insurance (Bridgercare, 2014). Those in the lowest income bracket


are only asked to donate as much as they can. This brings in many people, especially students in

this college town. About 18% of their budget comes from federal grants and funding, which

leaves the remaining 82% expected from donations and visit fees (Bridgercare, 2014). The

population Bridgercare serves is mostly women (72%), followed by teenagers (17%), and then

men (16%). With the public relations changes they have started to make and more awareness for

men also having health check-ups, those numbers have started to fluctuate.

Serving these patients are six nurse practitioners, a mental health counselor, registered

nurses, clinical assistants, a community outreach specialist, and operational staff. The services

provided range from sexually transmitted infections testing and treatment, birth control options,

pregnancy counseling, and cancer screenings to minor therapy, menopause consultations, and

education programs in schools and private groups (Bridgercare, 2014). Because of its various

offerings, people of all ages are served at Bridgercare and their work is recognized in schools

and other local organizations. There is even a special time for teenagers every Monday afternoon

where they are allowed to walk in and have any services with full confidentiality. My efforts

were focused mainly on the fundraising and education realms during my practicum.

Health Issues Addressed

Like any non-profit, Bridgercare relies on funding and donations to serve the community.

Some patients are able to pay the full amount, while others are unable to pay even a dollar. With

the continuous growth of the community, it has become a priority at Bridgercare to expand

programs so a more diverse group of individuals are served. Their annual fundraiser, the Sweet

Tooth Ball, has grown year after year, but Bridgercare hopes to grow more in the near future,

structurally and internally. The current space has made it difficult to expand and service more

people, so it is Bridgercare’s goal to relocate within the next five years. Bozeman is known for


the high number of local non-profits, so competition for local funds is high. It has come to their

attention that they must search outside of local organizations to increase their funding base so

that the clinic can continue to grow and serve the Bozeman community.

One specific group Bridgercare is striving to become more educated in and be able to

service is the lesbians, gays, bisexuals, transgender, and queers (LGBTQ) community. Even in a

conservative Montana town, non-discriminatory laws have been passed and more people are

becoming more accepting of individuals that may be LGBTQ. To create a space that feels safe,

Bridgercare is hoping to make the necessary changes so their office is able to serve the LGBTQ

community. However, this is a relatively new field in health care, especially in Montana, so it

will take time and work to figure how to create a welcoming space with socially acceptable

language that suits LGBTQ and straight patients.

The new Community Outreach Specialist, Hannah Wilson, was hired in October of 2013

and has several ideas to better the education programs. The previous specialist held the position

for over ten years, so Hannah has made note of changes she would like to make after nearly a

year in the position. Currently, the curriculum is science-based, medically accurate, culturally

competent, and age-appropriate (Bridgercare, 2014). However, she really wants to reach out to

more of the community, not just through the school, but also through private groups and events.

Her time doing the educational session is part of her work day, but the new materials and

trainings will require more funding. Also, there are a couple programs local teenagers can

become involved in, such as the Teen Outreach Program (TOP) and Peer Educator, where high

school students teach their peers, families, and the community about human sexuality and

healthy decision making. Hannah hopes to provide more variety and learn more through

conferences within the next year.


Discussion

Having the opportunity to come back to Bridgercare meant serving in a new role at a non-

profit that has been an influential part of my life. There were many projects that needed some

attention and time. Most of my work was focused on the education and financial portions of the

administrative department. Spending my time with these two areas allowed me to apply what I

have learned in this MPH program and to real-life situations. By utilizing my time wisely and

having a basic understanding of Bridgercare prior to beginning my practicum, I was able to

achieve the goals that were set between my two supervisors and myself within the required 75

hours of service.

Role in Project

Working for Bridgercare during their slower season meant that I had several different

assignments within the administrative section of the clinic. When I was told that summer is more

for catching up, I did not realize how much work there was still to do. The first focus area was in

fundraising and grant work. I had the Associate Director, Stephanie, assigning me work. The

priority was to going through several folders of grants that have been printed out over the last

eight years. Because only 18% of Bridgercare’s budget comes from state and federal grants, the

board is looking to find other organizations to help start the expansion process at the clinic. The

spreadsheet included information about: the foundation offering the grant, contact information,

application due dates, the mission, category of what the grant would cover (healthcare, health

education, capacity building, infrastructure, brick and mortar, other), specific requirements,

limitations to applying, special parts to the application, past recipients, and other notes. Finding

details about some of the grants were difficult because they would change their criteria or were

no longer providing grants. All in all, I ended up with a spreadsheet with over 50 different grants


that could fund some part of the clinic in the near future. With the hopes to expand their services,

including moving to a large space, it has become a priority to search for as many applicable

grants as possible.

Outside of researching for potential grants, I had some other smaller jobs. Every winter,

the supporters of Bridgercare gather at the Sweet Tooth Ball for the annual fundraising event. It

is not the ticket sales that bring in the most money, but it is the silent auction items donated by

community members and organizations. As the biggest event, it is never too early to start

gathering items for the event. I was asked to contact a specific group of companies that always

auction well. Bozeman is known for its skiing. Every year, at least two of the largest ski resorts

donate packages that often include a free night or lessons, along with a full-day pass. I contacted

four different resorts to remind them of the event and had two state that they would put

something together, as they had for several years. After that, I was told that Bridgercare had

hopes to become more transparent with the community. To do that, administrators hoped to start

publishing annual reports to show where the budget was going and how it was being spent. My

job was to find sample annual reports and basic information on how to write them so that the

Executive Director and Associate Director could gather information to put together a simple

annual report available to the community. Prior to me completing my practicum, I was told that

Stephanie was working on designing the first annual report in many years. Lastly, the

Bridgercare Guidestar webpage was not up-to-date so I gathered the up-to-date information and

corrected the website. Guidestar is a website with information about non-profits. Some

organizations post their staff, services, events, and even financial information. Having some

variety allowed me to do something different every day.


The other major focus area was with the Community Outreach Specialist, Hannah, on

bettering the current education programming. The previous specialist had held the position for

many years, so Hannah saw great potential in updating the programs and bringing in more

current information. To take advantage of technology, I was asked to create a Prezi presentation

that included all the services the clinic offered as well as programs and events sponsored by

Bridgercare. The Prezi would be on continuous display at information fairs and other events.

Hannah also wanted to have something to follow-up with sites. (I have included it as another file

because I could not post it within this document in the appendices.) Because all her time and

work is free to any school, group, or organization, it seemed reasonable to send cards thanking

them for utilizing Bridgercare’s educational programs and asking them for any donations that

would go directly to the clinic (see Appendix A for actual letter). I put together a card design that

could be sent to anyone. Bridgercare began using the letter in August. Lastly, Bridgercare is one

of several local organization that provide free condoms. The condoms are included in the budget,

but there is always need for more, especially because they have several locations within different

organizations. I was assigned to looking for companies that provided free condoms to qualifying

organizations or discounted condoms in bulk. Initially, these seemed like simple tasks, but after

seeing the workload Hannah was taking on, it was rewarding to know that she was able to focus

on other important tasks.

Having assignments from both areas gave me insight on daily needs of the clinic and the

work done outside of the clinic through the different education programs. Outside of those two

focuses, I had some other tasks. Because Bridgercare is planning on expanding services and

work space, they were contemplating ways to create more staff in an affordable way. Because I

was an AmeriCorps Volunteer in Service to America (VISTA) during the 2013-2014 year, I


suggested the branch of AmeriCorps called Prevention Resource Center (PRC) VISTA. The goal

of PRC VISTA is to keep Montana children, communities, and families strong against any type

of risk (State of Montana, 2013). The risks a PRC VISTA would be working to prevent range

from lack of health care to poor education on reproductive health and mental health. The

information I gathered about how to become a PRC VISTA site will hopefully help them in

finding the necessary hands. Another task was to complete an outline so that the staff could write

an application for a grant through the Pride Foundation (see Appendix B for my notes for

Bridgercare). Based off of the requirements and information session provided by the Pride

Foundation, I was able to put together notes and deadlines so that a grant could be submitted this

round of application (see Appendix B and C). This assignment taught me a lot about the LGBTQ

community and how health care facilities are changing to become more accepting. A great

resource was the 7th edition of Standards of Care for the Health of Transsexual, Transgender, and

Gender-Nonconforming People published by the International Journal of Transgenderism. Their

goal was to provide some clinical guidance for providers so that they can provide the best

services (Coleman, 2011). Growing up in a conservative community, I took this chance to really

learn about the LGBTQ community and understand the policies locally and nationwide. The

variety of tasks allowed me to explore different areas within the administrative department while

also apply the knowledge I have gained from previous classes and experiences.

Barriers

My time felt incredibly successful and meaningful, but there were some barriers that

challenged me. The most time-consuming project was gathering grant information and

organizing it all into an Excel spreadsheet. Staff had printed or saved grant information that

dated as far back as eight years ago. I began by searching for more information about the grants


already found, but many of them had drastically changed who they target or did not exist any

longer. Before I could disregard that grant, I did several searches and even called some people to

make sure that they were no longer offering grants to organizations like Bridgercare. Sometimes

the grant would come up on searches, but no details could be found. I had to continue searching

to find out if it was still in existence or not. It took between five and thirty minutes to go through

one organization’s grant requirements. It was a long and tedious process, but necessary and

extremely rewarding to have organized all the papers that have been collected over the years into

a comprehensive spreadsheet.

Despite being familiar with the clinic, this area of work was something new to me. The

staff in this part of the clinic knew me because I had volunteered as a clinical assistant for years,

but our relationship was more like being acquaintances. On top of that, the Community Outreach

Specialist was new and had a lot of ideas she wanted to make a reality, but lacked the time and

resources. Therefore, I felt like the expectations were incredible high, but I did not receive as

much guidance as someone else who was unfamiliar with the clinic. There were times I had to

depend on the information I could find so I could stick to the timeline. This was especially the

case when both of my supervisors were on vacation, due to my practicum being in the summer

months. I believe that they gave me more freedom than they would some other person working

on their practicum, but sometimes, the freedom felt like lack of guidance. Because I did felt

comfortable with the staff, I was able to ask them for help and guidance as I found myself

struggling to find information. The challenge taught me more about the hardships in working for

a non-profit and small health clinic.

Personal Assessment


This organization and the work that they do has been a major influence in my desire to

work in the field of health care. Volunteering as a clinical assistant at Bridgercare showed me

first-hand the work done by the clinicians. Serving during my practicum hours showed me a new

side to the office and all the work that is required to keep the place running efficiently. The

administrative department keeps the clinic open. The time spent serving my practicum hours

provided a stronger understanding in the necessary management and leadership side of public

health. The course we took on management, programming, and organization became more than

concepts to me after my practicum. To better explain the knowledge that I have gained, I will use

the public health core competencies as topics. These were taken from the Council on Linkages

Between Academia and Public Health Practice (2014).

My main role built up my analytical and assessment skills as front line staff on tier one.

Much of my time required data collection, field work, and program planning. When organizing

the grants spreadsheet, it was important to select reliable data and be detail-oriented. It was a

long and tedious process, but I know that the effort I put into creating a useful document will

allow Bridgercare to find grants that match their needs and take less time figuring out if the

requirements are met. Another assignment was to assess areas of improvement to become more

appealing to the LGBTQ population. After researching how other organizations and clinics have

updated their protocol and methods, I put together an assessment of what is recommended and

how others have made the changes. Because I did not interpret the data nor make evidence-based

decisions, I would consider this work all in tier one.

Policy development and program planning skills were gained in tiers one and two. The

information I gathered for the LGBTQ improvements contributed to the development of the

strategic plan. These recommendations will help the organization decide on changes for the near


future. Also, the Associate Director had intentions on developing an annual report to be available

to the community. However, time and lack of experience creating one for a small, non-profit

clinic created a barrier. By gathering examples and useful guides on writing simple and

straightforward annual reports, I was able to provide her with simplified ideas so that an annual

report could be published within the next year. Planning and development, I have learned, is a

never ending process, especially if quality of service is important to an organization.

The skill set I did not anticipate experiencing was cultural competency. Bozeman is still

considered rural and a bit old-fashioned. However, Bridgercare has the desire to be vocal in its

stance for non-discrimination and be a known ally for the LGBTQ community. With the non-

discrimination ordinance passing in Bozeman the summer I worked at Bridgercare, the

administrators recognized the need to become more accepting and appealing to LGBTQ patients.

I would classify my work as tier one because I described the effects of current and potential

future policies, but would not say that I assessed the effects or ensured the diversity. The

information I gathered helped the staff collaborate on a Pride Foundation grant to fund the

changes they hope to make.

Grants help non-profits serve the community. However, grants are very time-consuming

and lack the funding to provide all organizations with monetary aid. My main role was to create

a document that specifies the qualifications and requirements for grants that Bridgercare could

apply for. These ranged from small local grants to national and government grants. My work was

tier one, because I provided information for potential funding sources and contributed to program

budget developments. If I was serving for a longer time, I would have been working in tier two

by preparing proposals for funding. The experience I gained from working on financial planning


assignments taught me how important planning is to keep public health programs moving

forward.

Conclusions & Recommendations

This opportunity to return to Bridgercare in a new role was a fantastic experience. It

made much of what I learned more realistic because I was able to see work in action. I have

always known that community health centers struggle to serve the people in all the ways they

want to, but the 75 hours I spent working for Bridgercare in this new capacity taught me how

much work and motivation it takes continue offering existing services. I was also able to

experience the beginnings of program expansion and have a feeling for the timeline. This

practicum also taught me about issues that have always interested me, but I had not had the time

to understand it well. After reading many articles and websites about LGBTQ issues, I see a lot

of work ahead for the staff when it comes to writing a strong grant to the Pride Foundation. The

clinic is far from being LGBTQ friendly, despite being an ally. Using the suggestions I found

that were provided by other organizations, Bridgercare should be able to submit a grant proving

the need and desire for change.

I have mentioned Bridgercare’s desire to expand the physical space. It will take an

incredible amount of work to find a new location in a growing community, especially after being

in the same location for over 30 years. I am glad they have started to take the necessary steps

early on. However, because they are a non-profit, it will be a financial challenge to find a new

place right for them. I hope to see them apply for more grants that will provide funding for the

brick and mortar work. Also, a stronger Sweet Tooth Ball fundraiser will show the community

the work that Bridgercare is doing and incorporate them in the effort to expand the clinic. Using


the information I gathered, I hope that there are worthy organizations providing grants to help

Bridgercare serve the community even better.

Along with the growth of the clinic physically, the internal programming has the

opportunity to develop and provide more educational services. With fresh ideas, Hannah hopes

to make more collaborations and strengthen relationships throughout the community. However,

all the work cannot be done by just one person. It will be important to somehow hire more staff

to head the education initiative with the current Community Outreach Specialist. The current

peer-educators and student volunteers make a difference, but they come and go regularly. An

AmeriCorps PRC VISTA position could be hired for up to three years for full-time at minimal

cost. This temporary position would be a great start to creating a long-term health education

position. To make the current list of education program ideas a soon reality, it will require more

work and more hands.


References

Bridgercare. (2014). The clinic. Retrieved from http://www.bridgercare.org/the-clinic/

Coleman, E., et al., (2011). Standards of care for the health of transsexual, transgender, and

gender-nonconforming people (ed. 7). International Journal of Transgenderism, 13:165-

232

Council on Linkages Between Academia and Public Health Practice. (2014, June 26). Core

competencies for public health professionals. Retrieved from

http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_P

rofessionals_2014June.pdf

State of Montana. (2013, September 20). About the PRC VISTA project. Retrieved from

http://prevention.mt.gov/vista/about/index.shtml

http://www.bridgercare.org/the-clinic/


Appendix A

Dear______,

Thank you for allowing us to come in and present to your classes!

Now in existence for over 40 years, Bridgercare continues to strive to expand its programs and

offerings to the community. Having experienced firsthand the pride we take in supporting our

cause, we hope that you and your organization could donate to Bridgercare in anyway.

Bridgercare relies on the generosity of individuals, like yourself, because as a non-profit, only

18% of our budget comes from federal grants and funding.

The program we provided would have cost $________ but we are able to provide you the service

for free.

A donor envelope is enclosed for your convenience. We hope that you will help support our

efforts.

If you have any questions or would like to schedule another program, please contact me at:


Appendix B

Notes for Pride Foundation Grant Application

● Changing intake forms and electronic template

o Open dialogue about gender identity and expression and sexual orientation makes

for more relevant and effective care.

o Because intake forms are the first impression of the office, wording should

change

▪ “Partner” replaced for “Spouse” and/or “husband/wife”

● Gender-neutral language = “partner,” “significant other”

▪ “Relationship Status” for “Marital Status”

▪ Add “transgender” option to “male/female” check boxes

▪ Allow for several options to be selected

● Some may not relate to just one sexual orientation label

● ex. a female that identifies as lesbian cannot be assumed to never

have had male sexual partners, has no children, or has never been

pregnant.

● Female, Male, Transgender (female to male/male to female/other),

other

● More on page 11-13

(http://www.glma.org/_data/n_0001/resources/live/Welcoming

%20Environment.pdf

▪ “Name I prefer to be called (if different)”

▪ “Preferred pronoun?” She or He


o Because LGBTQ people often have higher stress levels, they are more likely to

smoke and drink. Make sure to discuss their level of being “out”, mental health,

stress levels, and smoking/drinking.

o Explain why the information is needed

▪ “To properly assess your health risks, can you tell me about any history

you had had with hormone use?”

o Ask all patients violence screening questions in a neutral way

▪ “Have you ever been hurt by someone you are close to or involved with,

or by a stranger?”

▪ “Are you currently being hurt by someone you are close to or involved

it?”

▪ “Have you ever experienced violence or abuse?”

▪ “Have you ever been sexually assaulted/raped?”

● Staff training for best practices in the office and healthcare practices

o Continuing education

▪ Showing empathy, open-mindedness, and without judgment

▪ Appropriate language

▪ Basic familiarity with important LGBTQ health issues

● Marketing (We are Ally’s)

o Post rainbow flag/pink triangle in visible place in clinic

o support World AIDS Day, LGBT Pride Day, and National Transgender Day of

Remembrance

● What we can do better for the community


o Becoming a bigger part of Interchange, QSA of MSU, etc.

o Become more welcoming and easier to find specific for LGBTQ medical care (see

make clinic more friendly)

● Make clinic more LGBTQ friendly

o Change all bathroom signs to unisex, hang posters of racially and ethnically

diverse same-sex couples (available from LGBT and HIV/AIDS organizations)-->

“Restroom”

o List in the Gay and Lesbian Medical Association Provider Directory

▪ Free-to-the-public listing of LGBT-friendly practices in the US

o List clinic in glma.org, gayhealth.com, and local LGBTQ organizations

o Include handouts, magazines, and posters that include relevant information for

LGBT patients

▪ Brochures from American Cancer Society

▪ LGBT breast cancer, safe sex, hormone therapy, mental health, substance

use, STDs

▪ Out Magazine and Advocate Magazine subscriptions = 10 issues for $5

(per year)

▪ Curve Magazine = 8 issues for $39.95 (per year)

▪ Instinct Magazine = 6 issues for $9.95 (per year)

o Sign up for the Healthcare Equality Index by the Human Rights Campaign

▪ Shows how facility treats LGBT patients and employees

o Change the patient intake form to better fit the diversity of patients


Appendix C

Pride Foundation Grant Application Information

Application Opens July 1st 2014

Average grant amounts: $1,000 - $10,000

Full grant instructions and guidelines available after July 1st

Conference Calls

o Monday, July 7th 4PM

o Tuesday, July 8th 11AM

o Wednesday, July 9th 6PM

o RSVP to [email protected]

Invests in organizations, projects, programs, or strategies that:

o Reduce growing disparities in LGBTQ

o Promote structural institutional change to eliminate barriers to opportunities and

resources

o Expand level of engagement of LGBTQ and allies

o Create partnerships w/ diverse organizations

NO multi-year funding commitments

Will fund:

o General operating

o Capacity building

o Projects, programs, and/or strategies

o Collaborative efforts


DUE: Monday August 4th, 2014 by 6PM

Notified by November 3rd, 2014

[email protected]

Montana Development Organizer: Kim – (541)603-8626

Previous Grantees:

AIDS Outreach - Bozeman

Blue Mountain Clinic – Missoula

Bozeman GLBT Resource Center – Bozeman

*Funders for LGBTQ Issues

mailto:[email protected]


Evaluations