In recent years, there has been a growing awareness of what has been widely referred to as student wellness, a more holistic view of the well-being of K-12 students that goes beyond traditional and more simplistic notions of student health. Today, there is an understanding that wellness is a multi-faceted concept comprised of physical health, mental wellbeing, nutrition, and the more abstract concept of ensuring young people have a sense of belonging.
CALLING IT A CRISIS OF WELLNESS IS NOT AN OVERSTATEMENT
The focus on wellness has been prompted by what has been widely called a crisis among American youth (1) —isolation, a host of mental health conditions (2), and steep increases in suicide. The pandemic and associated isolation have been cited as one of many causes, including the inherent difficulties of adolescence itself. Add to this the increasing lack of access to medical care and adequate food sources in a society where poverty and homelessness are at crisis levels.
Schools prioritizing wellness and healthcare do so based on a fundamental truth: a strong, proven connection exists between well-being and achieving desired outcomes. Healthcare and wellness are directly connected to what we consider success in school: good attendance, academic performance, behavioral health, being socially well-adjusted, getting along with peers, and the promise of long-term connectedness, the ability to become a happy and productive adult. In plain terms, when your brain power is not consumed with stress and negativity, there’s room to focus on retaining information, taking tests, and following your passion.
School-based health centers empower students to prioritize their well-being by providing immediate, confidential care on campus, ensuring they never have to choose between their health and education.
WELLNESS WITHOUT BORDERS AT LAUSD
Los Angeles Unified School District (LAUSD) is committed to student wellness. Serving over 430,000 students, this is the largest school district in California and the second largest in the nation. LAUSD currently hosts nineteen wellness centers on school campuses, which are built by the district and operated by third-party providers (Federally Qualified Health Centers, FQHC) or Student Medical Services. LAUSD wellness centers offer services to both students and members of the community. Although the service mix varies from site to site, those typically provided include medical, mental health, vision, and dental services, focusing on prevention, education, early intervention, and screening.
HMC Architects is designing wellness centers on four campuses within the district, including a 6,000 SF center at Los Angeles High School (LAHS). Founded in 1873, LAHS is Southern California’s oldest public high school. Prominent in the campus history is an architecturally significant Romanesque tower feature that dates to the early twentieth century.
Today, LAHS serves approximately 2,000 students in grades 9–12, with 95 percent of its population comprising minority groups. The school is in the vibrant and diverse Mid-City neighborhood, where 78 percent of residents belong to non-white ethnic groups. The area faces socioeconomic challenges—48 percent of households earn less than $75,000 annually, with a median household income of $84,750. Access to healthcare is a pressing issue for the community, as the nearest major public accessible healthcare is miles away. This clinic will be crucial to the well-being of students and their families, underscoring the significant need for school-based health services.
This single-story building features a large sloping roofline that acts as a shroud, blending the campus’s traditional style with a more contemporary aesthetic. Inside are exam rooms, dental rooms, counseling rooms, and the associated support spaces necessary to operate a clinic offering medical, dental, and mental health services. We worked within an LAUSD specifications document to ensure district-wide consistency among clinics. The project is in the final design phases, with completion targeted for August 2028.
THE INTERSECTION OF EDUCATIONAL AND HEALTHCARE DESIGN
The clinic will be shared between the school population and the neighborhood community at large. To accommodate shared use, many design problems had to be solved. The center was located on the West Boulevard edge of the 20-acre campus to be more accessible to the residential side of the neighborhood.
To ensure student privacy and be efficient in space planning, there are separate entrances and lobby/waiting rooms, while both patient flows access a shared but separate reception desk. This strategic placement allows students to approach the health center to maintain privacy from others on campus while being visible to campus staff. Additionally, the design ensures easy access for the community, offering a seamless transition from the parking lot and a thoughtfully designed nature pathway leading from the sidewalk to the entry.
The exam rooms are strategically placed on both sides of the building, as the medical department is expected to be the most frequently used service and will remain open on weekends for easy accessibility during those times. The medical support spaces are centrally located within the building to ensure seamless access to all mental health, medical, and dental services throughout the day. This layout also establishes a visual barrier, separating community and student circulation within the floor plan.
The mental health department is positioned adjacent to the student entry to minimize the distance students must walk to meet with their therapists while reducing visibility to community members, thus preserving their privacy. The dental rooms are located near the south side of the building for added convenience.
Key recommendations from our HMC healthcare practice have greatly assisted our ability to navigate many of the complexities of the clinic design for LAUSD. Healthcare design is highly regulated and, for good reason, falls under the jurisdiction of the California Department of Healthcare Access and Information (CA HCAI). There are special requirements for accessibility, seismic, infection control, room size and layout, and technology integration, among many others. This was a great collaboration across HMC practices.
By addressing physical and emotional needs, wellness centers cultivate a healthier, more focused student body, enabling them to thrive academically and become impactful, contributing members of society.
CREATING SAFE, NURTURING SPACES— THE POWER OF NATURE
One of the things we adults need to remind ourselves of is just how difficult and stressful growing up can be. In the design process at LAHS, we considered a student coming to the health clinic about a sensitive issue—contraception, pregnancy testing, a host of other situations—and how terrifying that can be. We asked how to make that experience better and more manageable.
In addition to essential privacy and confidentiality that we addressed in the space planning, our interior design team and our LAUSD partners shared a vision of creating humanized spaces in often highstress healthcare environments. Research shows that softening healthcare spaces and incorporating natural elements can significantly reduce stress and pain while improving emotional well-being and outcomes.
One of the core concepts is called biophilia— the innate human connection to nature. Biophilic design stems from recognizing that the human mind and body develop within a sensory-rich world, which is essential for intellectual, emotional, and spiritual health. Humans have evolved by adapting to natural conditions and stimuli, such as sunlight, plants, animals, water, and landscapes. These concepts are directly translated into the natural wood material palette and large environmental graphics, featuring softer and brighter color schemes and the inclusion of natural light sources whenever possible. The colors and textures selected were also drawn from the indigenous Tongva tribe native to the Los Angeles area.
SCHOOLS AS CRITICAL ASSETS FOR COMMUNITIES IN NEED
Today, there are an estimated 3,900 School-Based Health Centers (SBHCs) in districts across the country, up from less than 2,600 in 2017, according to the SchoolBased Health Alliance, a national nonprofit organization. A U.S. National Institutes of Health (NIH) study confirms that SBHCs reduce barriers to mental health access to care and improve educational outcomes for young people.
As more centers come online, we look forward to seeing data that tracks positive results. From conversations with staff and educators, we know that when healthcare services are available, students are far more likely to seek them out. Early diagnosis and treatment of basic infections can prevent more severe complications.
Stepping back from the work at LAHS, you see a more significant crisis in the nation. Millions of people lack access to basic healthcare, including preventative screenings and services many take for granted. For these families, conditions routinely go untreated or undiagnosed. In urban Los Angeles, these challenges are especially significant.
The State of California has launched several large initiatives in recent years to address the wellness crisis (3) . LAUSD continues to prioritize wellness centers across its vast number of school sites. As parents and community members, we are personally invested in improving wellness and the more significant idea of people caring for each other. As architects, we are grateful to be part of addressing these complex problems, with the hope that the infrastructure we design will make a real difference.
For Further Reading:
School Health Centers https://www.schoolhealthcenters.org/ school-based-health/why-sbhcs/ LAUSD Student Medical Services Branch https://www.lausd.org/Page/18488
1. U.S. Surgeon General; Centers for Disease Control and Prevention (CDC); American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association (CHA)
2. From a California School Boards Association presentation: Mental health issues are now the leading cause of hospitalization for children under 18 in California (U.S. Centers for Disease Control and Prevention); the rate of suicide among Black youth in California doubled between 2014 and 2020 (The Children’s Partnership); one in three California 7th and 9th graders, and nearly half of 11th graders experienced chronic sadness (State of CA data).
3. Children and Youth Behavioral Health Initiative (CYBHI), $4.4B; Master Plan for Kids’ Mental Health, $4.7B; Community Schools Strategy, $4.1B; MediCal CalAIM Initiative; Healthcare Workforce Expansion, $1.4B; SchoolBased Behavioral Health Workforce
