When Americans experience a disparity in their access to healthcare, many utilize the support of community health centers. These nonprofit organizations offer high-quality medical care to patients who may not otherwise be able to afford or access care, such as primary medical care, pharmacies, dental and mental health services, and specialty clinics.

According to the National Association of Community Health Centers (Bethesda, Md.), one in 11 Americans is a health center patient. Of those patients, 59 percent are publicly insured, 90 percent are low income, 65 percent are members of racial/ethnic minority groups, and 42 percent live in rural communities.

The same study showed that health centers provide care for 1.3 million unhoused people, 8.6 million children, 400,000 veterans, and 3.3 million elderly patients.

Even with this breadth of services and patient populations, the extent to which a community utilizes a community health center and its services is dependent upon how visible and approachable the clinic is to the people it serves.

Role of community health centers

For decades, community health centers have been on the front lines of addressing the country’s most prevalent health concerns. For example, these facilities take care of emergent medical needs during natural disasters and support people impacted by the opioid and HIV epidemics, and, most recently, the COVID-19 pandemic.

Data from the National Association of Community Health Centers found that community health centers across the country have administered 22.2 million COVID-19 vaccines and 20 million tests and distributed 7.2 million N95 masks to patients who may not have otherwise had access to these life-saving necessities.

That role of supporting underserved populations continues to grow, too. In 2021, the use of community health centers rose to the highest number of patients ever recorded in a calendar year, representing a 1.2 percent increase from pre-pandemic visits, according to the Kaiser Family Foundation.

Much of this growth, the Foundation notes, can be attributed to the nationwide increase in the need for behavioral health and substance abuse treatment services.

As a result of this increase in need, many community health centers require facility upgrades that allow for expanded services such as behavioral health rooms, dental equipment, specialty clinics, or additional primary care exam rooms.

Upgrading a community health center requires a careful look at what services or needs patients and communities have and adapting the building in a way that best suits these needs, including through renovations, expansions, or new building projects.

Expanding care services in underserved areas

Community health centers face a unique set of challenges, such as the need to assimilate deeply into the communities they serve to provide customized care.

For example, in 2021, The Neenan Company (Fort Collins, Colo.) collaborated with the El Dorado Community Health Center in Placerville, Calif., to design a new facility from the ground up that would allow for an expanded scope of services in one convenient location. This project doubled the health center’s capacity by combining clinics previously hosted in two other locations and adding services.

Upon learning that many patients at this clinic utilized telehealth appointments but didn’t have access to Wi-Fi or privacy at home, the project team incorporated a designated telehealth space at the new clinic where patients can go to conduct virtual visits.

Project teams also should understand the prevalent health crises facing a region as well as services lacking in the area so they can plan a comprehensive approach to programming and facility layouts. For instance, community health centers serve a large percentage of people in rural communities, who often have limited access to medical services.

The American College of Obstetricians and Gynecologists states that less than 50 percent of women in rural communities live within a 30-minute drive to a hospital offering perinatal services and proportionately fewer women in rural areas have preventative screening for breast and cervical cancer.

During a project with Yakima Valley Farm Workers Clinic—West Valley Family Health & OB/GYN in Yakima, Wash., the project team sought to improve health outcomes of rural women and their babies.

The new facility , which opened in fall 2022, incorporates family primary care, specialized OB-GYN care, an ultrasound suite, and other services, allowing the community health center to offer a “whole family” approach to medicine.

Welcoming clinic design

In addition to delivering comprehensive care, it’s important for community health centers to provide an atmosphere that promotes comfort and healing through welcoming aesthetics and respite spaces for patients and staff.

The West Valley clinic, for example, offers an outdoor patio, garden overlooking an orchard, and a yoga lounge, which help transform the space from a clinic to a healing space.

Considerations for family members accompanying patients during an appointment are also important. Ideas can include waiting rooms with soothing lighting and color schemes and comfortable seating as well as kid-friendly diversions, such as a “bubble wall” display that has moving bubbles and changing colors to relax and entertain children while they wait.

Cultural considerations for community health clinic design

For someone who speaks English as a second language, engaging in medical care can be overwhelming. The Colorado Health Institute (Denver), a nonprofit research and consulting group advancing equity and well-being, revealed that people who speak a language other than English are less likely to have accessed healthcare in the past year in comparison with English speakers.

By increasing bilingual services through translations wherever possible, community health centers can expand their reach and support more patients. Design strategies to address this include bilingual signage and ensuring the flow of the building is logical to navigate in case the patient does not speak the language used on the signage.

Similarly, some health centers serve a large population of refugees and require a profound understanding of their patients’ cultural background to best address patients’ needs. Something as simple as color schemes can completely alter a patient’s experience, as certain colors in some cultures are unwelcoming.

For instance, many medical spaces include extensive uses of the color white to represent cleanliness and simplicity in Western cultures. In other cultures, however, the color white represents death and mourning.

Architects can also assist in limiting barriers patients may face in getting to their appointments by improving access to parking or public transportation.

For example, for the Yakima Valley Farm Workers Clinic in Kennewick, Wash., Neenan worked with city officials to install a bus station at the clinic, which has been a significant aid for patients to get medical care.

Cost-effective design strategies

Recognizing that community health centers operate as nonprofit organizations, it’s important for project teams to deliver cost-effective design solutions that meet the specific needs of this facility type. The biggest factor in delivering quality spaces within a budget is collaboration with the client, project team, and funding source.

The first question to ask a client is simply, “what specifically do you need?” Some health centers may be looking for more points of care, while others may seek a more appealing design to attract more employees. Once a firm understands the client’s needs, they can keep these goals at the forefront of project decisions.

Understanding funding sources is also key. Oftentimes, community health center clients utilize government funding programs or grants, which have specific requirements. Architecture firms should work closely with the client and the funding agent to understand these guidelines and make sure they’re being met throughout the project.

By working together and understanding community needs, project teams can support community health clinics in providing quality healthcare to underserved patients.

Dulcye Rodriguez is vice president of business development at The Neenan Company (Fort Collins, Colo.) and can be reached at dulcye.rodriguez@neenan.com.