Design Considerations for Pediatric Behavioral Health Environments
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Table of Contents
Statistics & Patient Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Thoughtful Choices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Challenges & Attributes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Unit Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Room Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Toolkit: Functional Risk Assessment Matrix . . . . . . . . . . . . . . . . . 10 Evidence-Based Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
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Statistics
>15%
5%
of US children and adolescents meet the diagnostic criteria for a mental health disorder
of US children are taking medication for behavioral or developmental disorders
>$2B/yr
10%
is spent on childhood mental/ behavioral disorders
of hospitalizations in children >3YO are for primary mental health diagnoses
Suicide is one of the top five leading causes of death among adolescents/teens.
Patient Disorder Types 1.
Acute Psychosis
8.
Eating Disorder
2.
Anxiety Disorder
9.
Generalized Anxiety Disorder
3.
Attention Deficit Hyperactivity Disorder
10. Obsessive Compulsive Disorder
4.
Autism Spectrum Disorders
5.
Bipolar Disorder
6.
Borderline Personality Disorder
7.
Depression
11. Panic Disorder 12. Post-Traumatic Stress Disorder 13. Schizophrenia 14. Social Phobia 15. Suicide Ideation
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Thoughtful Choices Environmental features shaping the experience
Monolithic Ceilings Contraband control Tuneable Lighting Circadian / color temp control Impact Resistant Surfaces Limit repair disruption Monolithic / No-Wax Flooring Reduce noise, chemical odors
As pediatric behavioral health patient admissions rise, and fluctuate by age, gender, diagnosis and acuity, the interior environment must be safe, flexible, durable and have a broad appeal for children, adolescents and teens—and, inspire parent confidence.
Engagement is a primary goal in a patient and familycentered care environment. A welcoming atmosphere for families and high visibility foster those connections.
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BEHAVIORAL HEALTH DESIGN CHALLENGES • Variation
• Census fluctuation
– age
• Normalization
– gender
• Integrated care
– risk – acuity
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DESIGN ATTRIBUTES • Welcoming • Whimsical • Nature-inspired • Safe/comfortable
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UNIT ENVIRONMENT
CORRIDOR FEATURES • Restricted access • Clear sight lines
ENGAGEMENT ZONES
• Shock absorbing floor
Flexible, quiet, and noisy activity autonomy, learning, socialization Organized, clutter-free spaces a and help reduce aggression.
• Impact resistant surfaces • Freedom of movement • Elopement buffers
HALLMARKS OF SUCCESSFUL BEHAVIORAL HEALTH ENVIRONMENTS INCLUDE: • Strong first impression and connections at admission / intake • Disney model for on- and off-stage circulation, intake and food & supply delivery • Flexible • Compact neighborhood / pod configuration • Discreet control points • Daylight exposure / circadian or tuneable lighting • Art integrated into architecture • Anti-barricade doors; passive surveillance • Wayfinding clarity and cues 8
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spaces foster n and play. are non-threatening
EMERGENCY DEPARTMENT INTAKE A significant percentage of Pediatric BH admissions occur via the Emergency Department. On average, one in eight ED visits is due to a behavioral or mental health issue. Swing exam spaces which include mechanisms such as rolling shutters to conceal med gas services, safe furniture and tamper-resistant fittings allow staff to Triage/Room the patient, reducing risk to patient and staff.
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ROOM ENVIRONMENT
WINDOW / VIEWS • Maximize window extent • Secure / impact-resistant glazing • Integral window treatment • Light & temperature control
ROOM FEATURES • Sturdy, built-in furniture reduces the risk of injury • Personalization • No hidden corners • Technology integration (education and play)
TOILET ROOM CHARACTERISTICS • Impervious surfaces • Plumbing shutoffs • GFI / tamperproof outlets • Anti-ligature hardware and fittings • Shatterproof mirror and lighting • Vision panel for occupancy cue • Curbless shower • Monolithic sink, counter and bowl
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COLOR / SHAPE STRATEGIES Soft shapes and playful juxtaposition of colors create a canvas for artful, environmental nature-themed graphics. Complementary warm wood tones create familiarity and natural context.
BED COMPLEMENT Single bed rooms offer privacy and dignity and have been shown to reduce aggression and increase self‑coping. Patients experience fewer moves to accommodate appropriate gender and age cohorting. In the room pictured left, personal storage for belongings, warm wood tones and lighting control play pivotal roles in creating a safe, nonthreatening environment. 11
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TOOLKIT: Functional Risk Assessment Matrix Common Program Elements
Risk Considerations (Y/N) Harm to Self
Harm to Staff
Harm to Other Patients
Tamper Resistant
AntiLigature
AntiBarricade/ No Hiding
Escape/ Retreat
Intake Corridors On-Stage Off-Stage Team Station Patient Room - 1 Bed Patient Room - 2 Bed Patient Toilet Outboard Inboard Nested Seclusion Group Therapy Consultation Quiet Activity Noisy Activity Multi-Sensory Room Patient "Porches" Exam Room Nourishment Room Team Station Team Respite Multipurpose Staff Room Medication Room Clean Supply Clean Linen Soiled Workroom Storage, Equipment Service Core Staff Lounge 12
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Safety Features (Scale of 1—5) Switched Plumbing
Electric Protection
Environmental Controls
Monolithic Surfaces
No Weaponization Low Contraband of Furniture or Maintenance/ Control Finishes Durability
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Evidence-Based Design Improving outcomes through the built environment
Applying benchmark data and best practices to behavioral health design: • Reduced LOS • Diffuse perception of hierarchy • Increased safety • Biophilic strategies • Access to nature / light • Empowerment / choice • Power of art & positive distractions
DIGNITY NORMALCY NON-THREATENING
BENEFITS /ADVANTAGES • Better outcomes • Reduced LOS • Individualized, humanized care • Reduced pain perception, agitation, violence
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Array’s Behavioral Health Thought Leader Pat Malick CHID, EDAC, NCIDQ, Lean Green Belt Practice Leader Interior Design “Every project is a fresh opportunity to promote psychological wellness in an environment which supports respect, empathy and compassion for every patient.”
Learn more at array-architects.com.
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