Fifty years ago, Family Tree Clinic opened in response to community need.
Founded with the support of community involvement programs at Macalester College, the sexual and reproductive health clinic provided services that were hard for young people to access at the time, said Karla Ekdahl, Family Tree co-founder.
“Students said, ‘We want nonjudgmental health care, information about STI services, exams. We want it provided in a nonjudgmental way at a cost we can afford, which might mean free,’” Ekdahl recalled.
The clinic’s more open-minded approach was a welcome antidote to the more old-school health care providers that otherwise populated the neighborhood, said Nathalie Crowley, Family Tree’s director of people and culture. “It was what the community needed at that time.”
In the decades since its founding, as Family Tree’s patient population has changed and grown, the clinic has grown and changed, too. A significant acknowledgement of that growth happened Thanksgiving week 2021, when clinic staff packed up and moved across the river, to a brand-new, state-of-the-art building at 1919 Nicollet Avenue in Minneapolis.
For several years, Family Tree had struggled to serve its growing patient population, forcing clinic staff to create wait lists and provide services in tightly packed, outmoded treatment and meeting rooms. “We had really outgrown our space,” Ekdahl said. “It didn’t work for us anymore.”
The new facility, an architect-designed, community-influenced building with original murals and banks of windows, will allow Family Tree staff to reach 32,000 people a year through its medical clinic and education program, said Alissa Light, Family Tree executive director. “We’re so pumped to be there,” said Light. “It is a five-year project in the making.”
Expanded services, expanded space
In the years since its founding, Family Tree has never strayed from its mission of providing culturally responsive sexual and reproductive health care, Light said. What has shifted is the needs of its patients and community members.
“The world has changed so much since we opened in 1971,” she said, “including our broad thinking about what needs to happen to move the needle on health disparities. But what hasn’t changed is there are still folks who face profound barriers to health care. We still have a health care system that centers on people with a lot of access and privilege and fails to address people who are pushed to the margins. We want to be there to serve that population.”
One group that has faced serious health disparities is the LGBTQ community, Ekdahl said. Family Tree’s reputation as an open, nonjudgmental place made it appealing to people who felt mistreated, pushed aside or ignored by traditional health care providers, and the clinic slowly began attracting more and more LGBTQ patients, offering services including STI treatments, HIV testing and sexual education, and eventually hormone care for transgender patients. The clinic continues to provide reproductive health services, primary care and mental health care, though the demand for those services from college students has diminished.
“A lot of the area colleges have done a great job expanding their health services to better meet the reproductive and sexual health needs of students,” Light said. “That need isn’t as significant as it was in the beginning.”
Yet at its core, Family Tree is still the same place with the same intentions for care, Light said, and it is thriving because it is shifting with the culture. “Family Tree hasn’t really changed, because it always was designed to serve people who weren’t getting what they needed with traditional health care,” she said. “That group has changed. We still provide family planning and counseling and mental health services. The kind of services that we are providing are still focused on marginalized people.”
A destination clinic
Hormone care has become one of Family Tree’s most widely requested service offerings, Crowley said. When clinic staff began beefing up its care offerings for the LGBTQ community, requests for these kind of treatments began to grow.
“When we started our hormone care program, the response was amazing,” Crowley said. Now, people seeking hormone care “make up close to half of our visits. There is still a huge need out there.”
Some hormone-care patients travel hours to get to Family Tree, Crowley said. “We’ve even had patients coming from Canada. We have a patient who lives in Ireland who comes back here when they visit family. We know we’re doing something right.”
The new clinic has special, designated space for virtual meetings and consultations, Crowley added. “We can reach people all over the state and the region and share information with different providers so someone in Bemidji can get support, help and education on how to work with hormones and work with LGBTQ folks.” The clinic recently was awarded a $750,000, five-year Bush Foundation Community Innovation grant in support of trans and gender-nonconforming care.
Extra space means that Family Tree will be able to hire more staff to more effectively care for patients, said Jennifer Demma, Family Tree medical director. “We’ve added two new providers and we’ve been slowly, strategically adding more staff. The ideal would be for us to continue to grow.”
While the clinic has had a long history in St. Paul, the majority of its new client population lives in Minneapolis, or further afield. This realization gave planners and fundraisers free rein to search for a location closer to where patients live.
“While we were born out of a responsive neighborhood need, that same responsive need now has transformed us into a regional and local resource,” Light said. “We have people traveling to us from around the region and the nation. We’ve become a destination clinic. Recognizing that we weren’t as specifically needed in this neighborhood and that our facility was inadequate for what we need to do had us consider moving.”
The clinic’s new location, in Minneapolis’s Stevens Square and Loring Heights neighborhoods, is convenient to many of the clinic’s Twin Cities clients, Crowley said.
“Being in South Minneapolis, being where a lot of our patients are from, is important. We’re hearing that the new location is just right around the corner from them. They tell us they can walk to Family Tree now.”
To come up with the new clinic design, planners consulted with groups of stakeholders and community members to create a space that was trauma-informed and responsive to the unique needs of its patient population, many of whom have experienced negative interactions with medical professionals. The building was designed by the Minneapolis architecture firm of Perkins & Will.
“They listened to many people in designing this space,” Ekdahl said. “It is the happiest space you can imagine being in.”
In paying attention to the past traumatic experiences that many patients or staff may associate with health care, the building is designed with open spaces, clearly marked exits and art that reflects the population it serves. The architects, Demma said, “paid a lot of attention to wayfinding and signage, so you always know where you are in the building and how to get out. Natural light is a big issue. Even in the exam rooms, there is a little sliver window. The idea was that no one feels contained in the building.”
Furniture was selected and designed to respect the wide variety of sizes and shapes of the people who will be using it, she added. “We think about the common experience of body shame in people accessing health care and how often people carry the trauma of their bodies being judged when they are trying to access health care, so we are trying to do everything we can to make sure people have a chair to sit on or that we know as health care providers how to work with a fat body.” This approach extends to the exam rooms, as well: “We never require that somebody be weighed during a visit. It’s things like that that really make a difference.”
In the end, Family Tree staff hope that the people who use this new building will feel different visiting it than they have in any other clinic they’ve ever encountered.
“We’re hoping this new space will be an oasis,” Crowley said, “a place where people can be themselves and feel safe and cared for. That’s our goal, and I think we’ve been able to achieve that.”