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A Word from Our Owners – Damien Center

Alan Witchey is president and CEO of the Damien Center, Indiana’s oldest and largest HIV/AIDS service organization. Alan began working with the Damien Center as a volunteer in the 1990s and later became a full-time employee. He has more than 15 years of experience in nonprofit management, previously serving as executive director of the Coalition for Homelessness Intervention and Prevention (CHIP).

 

 

Some Owners come to us as they are still developing the vision for their space. They need an outside perspective on what is working currently and what isn’t—should they make renovations, add on, find a new space, or build from scratch?

Damien Center, Indiana’s oldest and largest HIV/AIDS service organization, serves more than 4,000 individuals affected by HIV/AIDS every year. They’ve seen an increased demand for their wraparound services, as well as shifting demographics. They knew their existing space wasn’t working perfectly anymore, but they needed guidance. Schmidt Associates conducted a building and space needs assessment to help them determine their next steps.

Why are the services the Damien Center provides so critical?

People with HIV are more likely to have other sexually transmitted diseases, higher rates of homelessness, and mental health and addiction issues. It’s very common for our clients to come in and have a host of other issues that need to be addressed, including food insecurity, legal issues, or counseling needs. We can address all of those issues collectively under one roof. We’re a one-stop-shop.

The sooner they get into care, the more likely they are to be adherent to their medication regimen and eventually become virally suppressed. That means they are living a healthy, normal life, and they cannot pass on the virus to others.

Have you seen trends in the demand for your services that affect your facility needs?

When we are considering future spaces, we really have to look at who is accessing services here. One of the key things we continue to see is a growth in young people that need support and services. Many of the new infections are among young people ages 18 to 29. That means services and outreach efforts and education all have to be tailored to meet their needs and appeal to them. We also see a lot of patients who are racial or ethnic minorities—that’s the majority of our clientele. So how do we make sure that everything we’re doing is culturally competent? We also serve the LGBTQ+ population, who are often marginalized and not accepted in many areas of their lives.

Many of our clients don’t feel comfortable going to a large medical institution. Parking in a giant parking garage, getting inside the building, getting around when things aren’t labeled well. The institutionalized feel of those buildings doesn’t make people feel comfortable and safe.

As we serve those key populations, they need to feel this is a second home for them. We want them to feel welcomed, accepted, and seen as valuable. We often hear that patients don’t feel welcome in their own home, but they feel welcome here.

Why did you do a building/space needs assessment?

One key issue we struggle with is space. It’s hard when you’re not in [the architecture business] to know how to translate the need into actual square footage. I know we need more space for certain departments, but I don’t know what that means. We wanted to assess our current space — How are we using it? Are there other ways we can use it more effectively? Can we build on to gain enough space, or do we need to find another location, or would we need to build from the ground up?

What did you learn?

The surprise was that we need more space than we thought. We found we were using the space as well as we could and using all available spaces—we were cramming into closets and hallways, which makes it complicated to provide services.

We’re also in an old building, so we are not always ADA compliant. We are grandfathered in right now with this building, but in a new space, we have to learn and follow these regulations. That’s hard to figure out on your own.

What challenges do you face in pursuing a new space?

We have a strong vision of what we’re trying to create, but we have to understand the space we need. We have to think about not just where we are today, but how we make sure a new space is not immediately outdated and will accommodate us five or 10 years in the future. In our industry in particular, there are a lot of changes and evolutions in care. Where we will be in five years will be radically different than where we are today.

We know how to save people, improve people’s lives. But we don’t know how to build buildings. It is really important for us to have someone like Schmidt Associates to give us the knowledge and expertise so we can make educated decisions.

What opportunities do you see for your program in the future?

There’s been a growth in health disparities in our community and our country, and I think Damien Center is really committed to being at the forefront to address those issues. Our key goal is to improve the health of our community as a whole, and in order to do that, we need to improve the health of our clients and patients.

It would be amazing if we could have a brand new building on a new piece of property that is very celebratory of the past, as well as recognizing our future—something that culturally makes a lot of sense and helps us meet our patients where they are.

Designing Facilities for Wraparound Health Services

Wraparound healthcare services are exactly what they sound like—they encompass medical and non-medical services and resources that wrap around a person or family to best support their individual needs and improve their well-being in multiple areas of their life.

Wraparound healthcare programs are based on the idea of treating the whole person. There are many complex determinants of health and someone’s ability to seek or follow through with treatment, particularly for vulnerable populations. This can include financial, emotional, logistical, and other concerns. Wraparound services also account for the impact someone’s illness has on his or her mental health, family, or other chronic conditions.

For example, if your doctor prescribes a specific medication, do you have the ability to get to the pharmacy, pay for the prescription, understand and take it as prescribed, and return for a follow-up appointment to determine if the medication is working? Wraparound care aims to alleviate obstacles in the diagnosis and treatment process—like eliminating a trip to the pharmacy by including one right in the clinic—and providing multiple service and medical providers in one location. Comprehensive care like this has been shown to reduce ER visits and hospital readmissions and improve health outcomes.

One organization providing these types of services in Indianapolis is the Indiana University Student Outreach Clinic (IUSOC). The clinic is a partnership between several educational institutions and community organizations and operates out of the Neighborhood Fellowship Church on East 10th Street in Indianapolis. The clinic provides primary care-based services free of charge. IU School of Medicine, University of Indianapolis, and IUPUI students and other partners provide this care under the supervision of physicians and licensed providers. This includes medical, pharmacy, physical and occupational therapy, dental, social work, and legal services.

Clinic Renderings

Plan for Reception Area & Nurses’ Station at IUSOC

We worked with IUSOC to design a new space to better serve patients. Three primary principles guided our process:

1. Understand What Drives the Mission

Designing spaces that provide wraparound services is a unique challenge. Before you dive into the details of design, you must first understand the organization’s mission and vision. Why do they do this work?

The IUSOC, for example, “strives to close the healthcare gap in the community by coordinating a medical presence to address a wide variety of conditions.” Its focus is the uninsured and underserved, who historically are less likely to seek medical care for a host of reasons, including previous negative experiences with the healthcare system.

This mission drives how the clinic’s volunteers serve patients and the values the clinic space should embody. The team makes a concerted effort to create a welcoming environment where those who are nervous or skeptical to see a doctor feel comfortable. They also have an increased focus on education, helping patients understand their conditions, treatments, and how to navigate the healthcare system. This serves to empower patients to better manage their health.

2. Design for Full-Service Care

The idea of wraparound healthcare is to provide, essentially, a one-stop-shop for patients, making it more convenient and efficient for them to receive the different types of care they need.

To achieve this for IUSOC, we designed what we call “full-service” exam rooms. These rooms are large enough to accommodate a variety of medical equipment so that patients can get everything from an eye exam to a gynecological exam all in one place. If a patient comes in for one problem, and the practitioner finds another problem at the same time, this allows both to be addressed without the hassle of making a separate appointment or moving to a different wing of the clinic.

We were also cognizant of tangential services patients may require to achieve positive health outcomes, such as meeting with a social worker or getting legal support. These services are co-located in the clinic, allowing patients to address root causes and make long-term healthy lifestyle changes.

3. Focus on Access

Having a streamlined, efficient, full-service facility is fantastic. But if that facility isn’t easy to get to or isn’t welcoming to its patrons, it won’t be successful.

For IUSOC, we recommended a new space in Clifford Corners, a mixed-use building containing affordable house and retail we completed for another client, across the street from the church where it currently resides.

Clifford Corners

Clifford Corners

This location was a natural and convenient choice. It is right next to the existing clinic and in a neighborhood where many patients live. In addition, 10th Street is a major thoroughfare to and from downtown Indianapolis, with direct access to public transportation routes.

Overall, the space promises enhanced outcomes for the community—growing the foundational education of our young providers, creating community, and helping to build and maintain individuals and families—regardless of ability to pay.

 

The IUSOC is currently seeking funding to secure its new space and enhance its ability to care for patients. Learn how you can support this mission.