About 16% of US students aged 3–21 receive special education services, a number that has steadily increased—from 14% two decades ago and 8% two decades before that. Within this group is a much smaller subset of students with medical complexity—less than 1% of the national school-aged population. These students with medical complexity, or medical fragility, are a subpopulation of neurodiverse students with additional chronic life-threatening health needs requiring regular medical management. To support equal access to education, the built environment must address these complex needs.
Creating thoughtful environments centered on user needs requires extensive spatial research. At Stantec, we combine published findings with proprietary research to inform our work with evidence-based design strategies. When designing spaces for students with medical complexity, research is a foundational step to creating comfortable spaces for not only those students but also their teachers, caregivers, and guardians.
One example of this approach is the partnership between the Austin ISD Rosedale School and the Dell Children’s Comprehensive Care Clinic in Austin, Texas. This Stantec-designed space combines a public school with a healthcare facility. Since individuals with complex health conditions require frequent medical appointments, the creation of this dual typology responds to the students’ unique educational and medical challenges, allowing them to receive care within the same building. According to Dell Clinic staff, there is increased ease in medical visits with this co-located school and clinic, with Rosedale students taking only an elevator to the school-side entrance to receive care. For student-patients, the challenge of physical relocation is significantly reduced, with the close proximity allowing students to return to class more quickly, contributing to fewer disruptions and preserving instructional time. Parents and guardians have appreciated the reduced transportation demands, too, with Maureen Benschoter, a member of the school’s planning committee, sharing that it takes nearly an hour to load her son—George, who has spastic quadriplegia—into his wheelchair and their van. Now, with the clinic just an elevator ride away from his classroom, “it saves George the discomfort of the transport,” Benschoter reflects. This connection between the Rosedale School and the Dell Children’s Comprehensive Care Clinic allows students with complex needs to access medical support without disrupting their school day.
The Rosedale School-Dell Clinic is among public schools that feature a full-service school-based health clinic. After much research and numerous interviews with Rosedale teachers, nurses, and guardians, Stantec designed this healthcare partnership with all staff and students in mind. The carefully considered design decisions were made to serve not only Rosedale’s medically complex students but those found across Austin as well, as the clinic is open to those beyond the student body. The Dell Clinic offers a range of services provided in examination rooms, consultation spaces, a sensory room, a child life specialist playroom, and more—all spatially designed around the distinct needs of the users.
Designing a school-based health clinic like Rosedale requires prioritizing key characteristics: integration of educational and medical services, management of sensory triggers, physical accessibility, and support spaces for caregivers and nurses.
Seamless integration of educational and medical services
Educational and medical environments often have distinct foci and forms that are frequently at odds with each other. For instance, academic spaces tend to promote openness, flexibility, and social interaction for student development and a positive experience, while healthcare clinics prioritize privacy, cleanliness, and controlled circulation for patient safety and to prevent infections. To serve the medically complex student, Stantec went beyond the bounds of conventional, segregated spaces to create the integrated Rosedale-Dell environment.
Schools that are not specifically designed for medically complex students often result in unsanitary conditions for performing health-related procedures due to their general lack of privacy, insufficient access to hot water, and inadequate sanitation. Schools like Rosedale address these issues by providing dedicated spaces and systems to support health-related tasks while linked to educational facilities. This colocation reduces the need to perform medical procedures in nonsterile environments, helping support the health and well-being of students, teachers, and nurses.
" }Both clinic-only and Rosedale Students wait in a sensory-friendly lounge.
The colocation creates a direct connection between student-patients and the academic and medical facilities, lowering transportation requirements. For clinic-only patients, the Dell Clinic features a dedicated primary entrance and parking lot, supporting a more direct experience. Given that the majority of Dell Clinic users are not Rosedale students, this spatial separation is an important design consideration, especially as it limits disruption to student activities. By prioritizing both efficiency and user experience, the clinic is designed to be a welcoming and inclusive environment for all medically complex patients—students and non-students alike—their guardians, and staff. User feedback reflects positive experiences associated with these design strategies.
A focus on sensory triggers and physical accessibility
Healthcare facilities that focus on individuals with medical complexities have primarily been studied in terms of their impact on patients’ guardians and families, with little data on the effects on the patients themselves. Understanding the strain of attending constant medical appointments is important for all users; therefore, in addition to caregivers, the patients themselves were key considerations in the design of the Dell Clinic. To respond to potential anxiety for medically complex patients, the clinic's interior intentionally integrates positive distractions through engaging and calming activities.
Numerous studies have demonstrated the benefits of positive distractions for both adults and children undergoing procedures and treatments in healthcare settings. These distractions have been linked to reduced pain, anxiety, stress, fatigue, and distress. Elements like engaging visuals, soothing colors, and interactive features make the environment feel less clinical, contributing to an experience that differs from many recurring medical visits.
" }A sensory room featuring a long tube with bubbles changes color and disperses aromatherapy.
As the patients at the Dell Children’s Comprehensive Care Clinic are all individuals with neurodiversity and medical complexity, certain noises and lighting types are overwhelming; the Clinic’s design responds to these sensory triggers. The clinic includes a padded wall resembling a xylophone and plays soothing sounds adjacent to the waiting room. In the procedure room, a long cylinder with bubbles changes color and disperses aromatherapy.
For Rosedale student-patients who immediately return to class, this sensory-friendly strategy helps create consistency between academic and medical settings for the students, helping reduce variances and distractions. The hallways and rooms across the campus are wide enough to accommodate movement, with space for wheelchairs and multiple caregivers. Each classroom is also equipped with ceiling lifts to support students with diverse physical and mobility needs.
Practical support for nurses and caregivers
At the Rosedale School, health support extends beyond the clinical environment. While school nurses are crucial in all academic settings, they are especially in demand at Rosedale. They may administer scheduled medication; provide nutritional support for students with special dietary needs, like feeding through a G-tube; and respond to medical emergencies.
The clinical team appreciates the clinic’s colocation with the school as it affords interactions with their student-patients throughout the day. For instance, at the beginning of the day they can assess student well-being upon entry into school as the location of the nurses’ home base is adjacent to the school's primary student bus entrance. During the school day, the clinical team can see student-patients enjoying free time on the playground, outside of medical facilities.
To support needs in-classroom, Stantec conducted extensive discussions with care staff to understand their challenges and aspirations for the new facility. From the nurse’s office location to in-classroom support features and staff comfort elements, design strategies help support their essential role. Inside the classrooms, for instance, Rosedale includes a restroom and changing room equipped with an adjustable height changing table. This setup allows nurses to provide timely care within the classroom, aiding student privacy and minimizing the need for relocation. As private-duty nurses accompany many students, the classrooms are also designed to accommodate both the student body and their caregivers through the inclusion of individual lockers and storage spaces, allowing private nurses to store their belongings in separate and unobstructed areas.
" }A nurse and caregiver reading to a Rosedale student in a hallway cove.
In addition to supporting nurses’ roles as care providers, the design team integrated solutions to address their daily comfort needs. Softer floor treatments and ergonomic layouts take physical demands into account, as nurses estimate they walk nearly five miles a day within the facility and often remain on their feet throughout the school day. Furthermore, Rosedale School features a staff wellness room, providing a dedicated space of respite. This form of support space for caregivers is rarely included in schools, but with the physical and emotional load carried by these individuals, it was a small offering to include. The space was envisioned to be flexible in program, allowing for a range of uses, from moments of quiet reflection in solitude to yoga practice and light physical activities. The space also includes a restroom, shower, and changing area for staff to refresh during the day and for those who prefer to commute by bicycle.
Through surveys, interviews, analyses, and research, the built environment can be designed around users’ needs. The colocation of the Rosedale School and the Dell Children’s Comprehensive Care Clinic serves as a case study of this. The school-clinic typology emerged from a design process informed by research and stakeholder input. When the built environment is designed with empathy and inclusivity, it can accommodate a wider range of needs.
A version of this blog was originally published by Page, now Stantec.
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