Healthy by Design – Wellness Center Design
Tags: Affordable Care Act, Haley Peterson, school based health center, Venice Family Clinic, wellness center design
Categories: Adolescent health care, Wellness Centers
July 28, 2015 — By Haley Petersen
“If you build it they will come.” Though the oft-quoted phrase has a heroic ring to it, public service agents and policy makers know that those proverbial words do not always ring true. There are a variety of reasons why patients may choose not to visit a medical clinic; not the least of these is the stigma associated with the services offered or with the clinic itself. Confronting and changing negative social stigma is an incredibly difficult undertaking that, like most attitudinal shifts, is generational and can move at a glacially slow pace. However, the Venice Family Clinic has found what appears to be a relatively quick fix in the short term – change the design.
The Venice Family Clinic is part of a network of free clinics that provide services to low-income children and families. Where most medical center redesigns focus on improving equipment and creating a space that is more efficient for doctors, the Venice Family Clinic approached their renovation from a place of aesthetics. The problem was not the services or the equipment. The problem was the way that patients felt while they were in the facilities.
As an intern with The L.A. Trust, I have visited a number of Wellness Center sites throughout Los Angeles. One key takeaway that arises each time we debrief about a site visit is that clinics do not feel hospitable or welcoming. In the interest of discouraging vandalism and for patient safety reasons, many of the clinics are barricaded by heavy, metal gates and security cameras. A patient must be buzzed in the gate before entering. Once inside, the walls are stark. The staff is friendly. The equipment is up-to-date. The décor is practical and sterile (both in the hygienic and aesthetic sense). There is nothing wrong with this kind of Wellness Center. They are functional. However, it does little to advance efforts intended to make students and families want to call the Wellness Centers their medical homes.
In contrast, the Venice Family Clinic is a place where patients say they want to be. A recent article in the Los Angeles Times describes the clinic as an imaginative, family-friendly facility. The article notes that the clinic replaced its waiting room chairs with couches, transformed exam rooms into galactic, oceanic, and forest themes, and supplied both the waiting rooms and the exam rooms with toys for the children to play with and books that the children can take home with them after their visits. Soumya Karlamangla, a journalist with the Los Angeles Times and the author of the previously referenced piece, noted that “with the health insurance expansion under the Affordable Care act, newly insured patients have options for the first time beyond free clinics.”
The redesign is a win for both clinic administrators, who need a steady stream of patients, and for the patients themselves. The most obvious and most talked about stigma associated with Wellness Centers is the connotation that accompanies reproductive health and mental health services. However, there is also the less-discussed stigma of poverty. Our students already go to schools with metal detectors. The campus facilities are locked and gated. The communities are highly policed. Bare walls in the waiting room can lead students to further internalize poverty as a part of their identities. It reinforces the message that they are not going to the clinics by choice but rather because they cannot afford or access more welcoming options.
Minimalist designs may also miss the mark in providing valuable, adolescent-centered learning opportunities. A school-based health center that we recently visited had brightly colored posters that displayed health-related facts and myths. There were catchy, graphically appealing brochures and magazines in the magazine racks and on the side tables. There was a bulletin board with photos and small bios for each of the doctors that students may see for their visits. These relational details are small, but they go a long way in making a student feel comfortable, valued, and understood.
Can a can of paint overhaul stigmatizations that have been deeply embedded in our social landscape for centuries? No. But it might be a good place to start.
Haley Petersen is a Leadership for Educational Equity Policy and Advocacy Fellow. She was a former middle school teacher (6th grade science) in Charlotte, North Carolina before moving to Los Angeles. This fall, she will begin a graduate program at USC in public policy with a concentration in urban and social policy. This summer, Haley is examining the intersection between wellness policies and education policy for The L.A. Trust.