Designs Delivered: Children's Hospital of the King's Daughters

designs delivered Children’s Hospital of the King’s Daughters Children’s Pavilion

table of contents

Project Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Community Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Exterior Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Planning & Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Integrating the Arts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Patient & Family Engagement . . . . . . . . . . . . . . . . . . . . . . . . 28 Keys to Project Success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Learn More . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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project overview Health, Healing and Hope for All Children Rising from the Norfolk skyline, Children’s Hospital of The King’s Daughters’ Children’s Pavilion stands out as a 14-story beacon of hope. The pavilion provides a continuum of mental health services underpinned by a program that destigmatizes care, engages families, and celebrates the area’s rich naval history.

Embracing creative expression as a vital aspect of care, the design integrates art from globally renowned artists and features a recording studio, rooftop recreation area, and horticultural therapy zone. The hospital is one of a select few nationally equipped with an infrastructure to facilitate parent participation in treatment.

AT A GLANCE • 591,180 SF – Medical tower: 366,700 SF – Structured parking: 224,480 SF / 425 spaces • 60 Pediatric inpatient behavioral health beds – Shell space for future beds • Day Treatment Hospital • Outpatient Behavioral Clinic • Outpatient Specialty Clinics: – General Academic Pediatrics – Sports Medicine – Radiology – Laboratory • Art Therapy/Music Therapy/Sound Studio • Gymnasium • Rooftop Recreation • Healing Garden • Terrace Dining

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community need The impetus for the hospital stems from clear community need. Experts estimate that at least 20 percent of children in the U.S. have a diagnosable mental health condition, and less than one fourth receive treatment. Early intervention is key to preventing debilitating mental illness or even death.

Despite that fact, many children wait for days for an inpatient psychiatric bed, or even travel far from home for treatment. With the opening of the Children’s Pavilion, CHKD is meeting this challenge head on.

>3,200

1 in 6

Children and adolescents will require

U. S. children aged 2—8 years, and 1

acute psychiatric care annually.

in 6 teens, had a diagnosed mental, behavioral, or developmental disorder.

1 in 6

2x

Children live in poverty in the

…poor children are almost

Hampton Roads region…

twice as likely to experience severe mental difficulties.

16%

+/-50%

of U.S. teens (ages 12 to 17)—more than

...of all lifetime mental

4 million adolescents—had at least one

health disorders start by

major depressive episode in 2022.

adolescence/mid-teens.

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exterior design Array’s design team worked in alignment of CHKD’s vision to create an iconic exterior design that would signal the importance of the facility to the region.

Collectively, the design goal celebrates rising to meet the dual challenge of expanded care access and destigmatizing mental healthcare.

The many roadways surrounding the building meant that all sides of the buildings would be observed, necessitating a consistency in the facades and the experiential elements of the building. We needed to create something unique that acknowledges the rich naval history of Norfolk, and we wanted to achieve a level of openness in the building while preserving privacy and the need for reflection and dignity in the healing process. With those tenets in mind, we turned to the drawing board.

As concepting began, we carefully studied the CHKD brand. Noting the barrelvaulted roofs in their iconography, we began to riff on that imagery. The resulting design features two opposing, gentle barrel vaults evoking movement and the water. The angled metal structure at the building fenestration evokes a sailboat’s jib or boat moving across the horizon, connecting with the notion of the patient’s journey to mental health. The striking exterior is shaped to stand out in the skyline as a beacon of hope and wellness, signaling mental healthcare is healthcare and welcoming all. The jib began to detail and separate functions of the building between private and public spaces of the building on the south side of the building.

On the north side of the building, where the main entry is, we were met with two different masses that we wanted to tie back to the main building, so we incorporated two wave-like elements at the top of the building to tie in different roof lines with the same jib. The effect when you are rotating around the building is a visual of multiple waves grounded by jibs, reinforcing the grand gesture of sailboats.

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AESTHETICALLY INTEGRATING THE PARKING GARAGE When designing the parking garage, we needed to fit an efficient footprint in limited space while aligning it aesthetically with the building, optimizing its location relative to solar control and energy performance, and maximizing views. The effect when you are rotating around the building is a visual of multiple waves grounded by jibs, reinforcing the grand gesture of sailboats.

The garage is connected to the main building, allowing visitors privacy as they proceed from it to an elevator that can take you directly to the lobby. Since the garage is a significant portion of the mass of the building, spanning seven decks tall, special care was required. The project team worked closely with the precast manufacturer to ensure the articulation for the precast spandrels featured textural elements and color. The articulation lends to a sense of movement gravitate visitors towards the front entry of the building, while blue-painted reveals in the spandrel panels adds a sense of playfulness and cohesion with the rest of the building. These reveals in the spandrels also feature angles in the front façade of the parking garage to reference back to the jibs on the building in the overarching massing of the garage.

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EXPERIENTIAL ELEMENTS, DYNAMIC MATERIALS Patient views from the facility benefit from an exceptional site. Located on two sides of the building, patient rooms face either the downtown Norfolk skyline, or the harbor where they can enjoy views of ships. Regardless of which side of the building the patient’s room is on, common spaces and activity spaces offer views in either direction.

The project team balanced the aesthetics of the design with the need for high performance, dynamic materials. The materials selected allow the feel of the building to change with the time of day and season. The exterior glass mitigates solar gain while featuring color tinting, while silver color metal panels offer a reflective effect that shifts as the day progresses. Some roofing elements as well as the diagonal jibs feature a blue color aligned with CHKD’s corporate branding. The movement and change that occurs as lighting and seasons progress heightens the visual interest of the building.

IN SUMMARY Where once mental health services were hidden away and kept distinct from other care facilities, the exterior design of CHKD’s Children’s Pavilion works to destigmatize mental healthcare while still affording privacy to families and patients. The concept of the exterior uplifts spirits as visitors and patients approach. Connecting the garage to the building allows for privacy proceeding from cars to care areas, while outdoor spaces for dining or exercising enable openness and a spirit of camaraderie. Visitor and patient privacy is also preserved by their choices of where to dine, spend time, and collaborate. Lastly, staff morale is boosted by their ability to enjoy beautiful outdoor healing gardens, inspirational art, uplifting public spaces, and biophilic elements connecting both the exterior and interior of the facility provide continuity for those experiencing the space.

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planning & design A NEW LEVEL OF CARE Children’s Pavilion is the centerpiece of CHKD’s Lighting the Way Campaign, a pursuit of a brighter future for children, adolescents and teens. As such, the colorful, sun-filled tower features a leading-practice patient, family, and staff-centric design to support behavioral health best practices, comfort, and safety.

Entering the facility, abundant natural light, colorful furnishings, and eye-catching installation art helps to welcome and engage guests in the atrium.

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SAFETY & SECURITY The guiding principles established by the project team for safety and security in Children’s Pavilion include: •

Patient de-escalation protocols

•

Maximizing sightlines

•

Sleep Room/Toilet Room configuration

•

Ideal unit size/geometry

•

Family engagement

•

Smaller engagement zones

The practice of designing to avoid seclusion helps patients feel safer, more respected, and more receptive to treatment within their environments. An environment which is normative, person-centered and therapeutic will set the stage for transformative mental health care. A healing environment will set the program for success and coupled with establishment of operational and observational protocols that allow staff to better anticipate escalation and deploy countermeasures which can diminish the frequency and severity of these occurrences, making need for seclusion rare.

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PLANNING CONSIDERATIONS Compartmentalization within a unit provides patients the space to self-regulate. A compartmentalized design allows staff to cordon off part of a unit and efficiently move patients out of that zone of risk when another patient begins to escalate. At Children’s Pavilion, 12-bed units are divided into four-room zones. These three zones each have cross-corridor doors, allowing staff to immediately observe if a patient is beginning to escalate within the zone. That visibility means that diffusing a situation is greatly simplified. As a patient begins exhibiting erratic behavior, staff can usher the other patients to a safe, adjacent zone and close the door behind them. This allows the patient experiencing dysregulation to interact with a durable environment as needed while staff work with the patient to self-calm.

Another key planning consideration for designing to avoid seclusion is access. Doors should be designed to allow for access control from the team station or directly at the door, allowing staff to lock /unlock and move patient through the door as needed.

INPATIENT ROOMS The 11th, 12th and 13th floors of Children’s Pavilion comprise a total of 60 inpatient rooms. Shell floors will accommodate future beds.

For children undergoing acute mental health treatment, anti-ligature hardware was specified throughout the care zone. Further mitigating risk of self-harm, blinds are situated behind glass, venting systems are weighted, and drywall and window glass are impact resistant. All movable furniture is weighted to resist lifting and movement.

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Inpatient rooms at the pavilion feature vibrant wall colors and full-height wall graphics to lift spirits. At night, patients can enjoy dimmable lighting, immerse themselves in color-changing light and self soothe with a tactile wall panel. A parent sleep area, desk, and open storage cubbies provide versatility and comfort in these private patient rooms. Locked storage secures special art and belongings from home.

Sidelight vision panels next to every room door allow for clear views into the room, and provide a redundant entrypoint that opens outward should staff need to gain immediate entry. Individual restrooms associated with each room have hallways entrypoints and an exterior light that signals to staff when they are in use. Shatterproof mirrors, breakaway curtains, rubberized ligature-resistant towel hooks, and key operated water and power shut-off switches are a few examples of the special safety features in patient bathrooms.

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EMPOWERMENT Calming elements and positive distractions also benefit CHKD’s care model. Sensory and tactile elements, color changing lighting, pleasing imagery and other elements of nature can help redirect negative energy. These elements empower patients with sensory interventions that help prevent negative behaviors, i.e. self-harm, by enabling them to access appeasing elements that are conducive to self-regulating behaviors. Acoustics also play an important role. Environments with hard surfaces required for durability tend to be noise reflective and have been shown to increase anxiety. At Children’s Hospital of the Kings Daughter’s, our team angled interior walls to decrease reverberation, and selected materials such as cushioned-back seamless flooring that were more absorptive, facilitating a calmer, quieter environment.

Inpatient floors were planned to allow caregivers optimal vantage points for observation into high-risk areas such as bathrooms. Communal spaces feature safe and durable furnishings, flooring placemaking cues, and TVs.

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Trauma-informed design principles encompass environmental features such as: imagery, art, furniture, color, spatial organization and lighting/daylighting. Spaces should be visually interesting but not too busy. Spaces need to be well organized and provide the opportunity for patients to inhabit the space on their terms, for example, some patients prefer to sit around the edges or observe the space fully before entering. Artwork and color play a significant role in impacting mood and behavior. Our design team chose a balance of energizing, saturated warm colors, complemented by blues and greens that are more calming; then offset all with an abundance of white—to create a therapeutic environment. Art inspired by nature can provide a great way to bring the outside in as well as to provide a connection to home that may be familiar or assist with wayfinding.

LEARN MORE about designing behavioral health environments to avoid seclusion.

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OUTPATIENT SERVICES Children’s Pavilion provides a setting that integrates mental health care with other routine medical services so that patients feel as comfortable seeking mental health treatment as they do during routine care visits. Children’s Pavilion’s partial hospitalization program provides intensive day treatment as a step down from acute hospitalization or step up from outpatient services. The welcome center on the 9th floor (below) offers choice and empowerment to patients and their family members with a variety of seating options, a child play zone for activity, and a farm table where parents can use a laptop.

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General Academic Pediatrics (GAP) is located on the 4th floor of the pavilion. GAP delivers primary care services, including routine care, well and sick visits, vaccinations and coordination of care for underserved families and patients with complex needs. The fifth floor of the facility hosts a sports medicine program for diagnosis, treatment and follow-up of sports injuries, concussion care, and more.

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RECREATION AREAS Exercise is proven to reduce stress, elevate mood, and contribute to a child’s sense of well-being.

To this end, Children’s Pavilion was designed to include a rooftop recreation area and indoor gym. The rooftop zone includes turf soccer field, horticultural therapy, a half basketball court, a foursquare court and a stepped lounge area.

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The indoor gym’s design features larger-than-life, nature-themed wall graphics, abundant natural light, and an adjoining exercise room. The halfcourt basketball area presents space to participate in many types of indoor activities that promote wellbeing. A therapist work zone allows for team careplanning and supervision of the space.

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integrating the arts A commitment to music, movement and creative expression in treatment zones evolved to an investment in art for all. The art collection communicates a clear and visible message to the community with two prominent exterior sculptures adjacent to the tower entry and flanking the healing garden, followed by kinetic mixed media and art glass in lobby, dining and conference center. The art program touches every area of the building and provided sponsorship opportunities for philanthropic partners.

ART THAT ELEVATES THE HUMAN SPIRIT Facility visitors begin to experience the art program before stepping through the front door.

Sculptor Lindy Lee’s One Bright Pearl graces the front of the building at the center of the circular drive. This large metal globe features concentric patterns on the sphere’s surface, allowing light to shine through. During the day, the piece reflects the pageantry of life; at night, it emanates light.

“Just as a pearl is created from an injury within an oyster, we have hope that every child who enters our facility experiencing pain, suffering, or trauma emerge as a bright pearl.”

- Children’s Hospital of the King’s Daughters

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Seattle Glass Artist Ann Gardner’s installation titled A New Day graces the lobby atrium of the pavilion. The piece is comprised of a series of multicolored glass shapes hanging from varying lengths of seven oval rings representing the days of the week. Two sections bursting with colors represent sunrise and moonrise. The piece reminds both patients and users of the facility that change and renewal are constant and every day starts anew.

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Entering the lobby, visitors are greeted by Venezuelan kinetic artist Manuel Mérida’s Cercles, three large monochromatic rotating disks. Comprised of sand, pigments, coal powder, wood and metal inside a circular case with glass, these pieces explore the countless forms and visions that can be created through the movement of media in a contained space.

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As visitors approach the Café, New York City-based sculptor Paul Villinski’s Celebration comes into view.

Composed of re-purposed vinyl LP records radiating from a wall-mounted record player, this installation evokes a moment of delight in its portrayal of birds soaring into flight. Record labels recognizable to families make up each bird’s unique plumage, evoking a joyous, musical migration made especially for CHKD.

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Brooklyn-based glass artist found inspiration in CHKD’s mission statement and combined with his concept of the twelve Jewels—knowledge, wisdom, understanding; freedom, justice, equality; food, clothing, shelter; and love, peace and happiness—things that everyone needs for a successful life.

Connecting the concepts in graffiti enamel and silver work can lead to joyful moments of discovery.

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Spanish sculptor David Rodríguez Caballero created Ori, a large exterior sculpture beautifully visible upon approach of the building and from the lobby. His piece, reminiscent of origami, reminds us that out of the ordinary can come something extraordinary. Whether you see a bird in flight or a plane about to glide, Caballero wants us to think of the journey that patients are on when they enter this facility.

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patient & family engagement The demand for patient and family-centered behavioral health spaces grows. Patients need safety, comfort, and calm in their environments. CHKD has gone the extra step to incorporate opportunities for creative expression to enhance the treatment journey throughout their programs.

An emerging trend is to engage family members in treatment modalities, participate in evening meals, and as appropriate, allow one parent to sleep in the child’s room during their inpatient stay. Children’s Pavilion is designed with this in mind, enabling family engagement and inclusion.

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ART THERAPY ROOM

MUSIC THERAPY ROOM

In the pavilion’s art therapy room, patients enjoy

A music therapy room inclusive of

drawing, painting and working with clay. Studies

a recording studio fosters creative

show that the creative process can help children

expression among patients.

and teens communicate, enhance self-esteem, and reduce anxiety and depression. In the room,

CALMING NOOKS

integral art, a multicolored honeycomb wall

Spread throughout the facility, cozy

graphic, and color blocked floor stripes encourage

nooks give children a quick spot to

creativity. A gallery located in the adjacent

self-calm or enjoy a moment of quiet

corridor displays patient artwork with pride.

amid the activity that surrounds them.

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FAMILY LOUNGE, AMENITIES A family lounge on each floor of the facility provides an area for parents to rest and recharge. Allowing parents to leave the unit and decompress, the lounge also provides the opportunity to get a snack or connect with other parents whose children face similar challenges.

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Families are integral to the recovery and healing process and as such, all single-patient sleep rooms are designed for one parent to stay overnight with their child.

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keys to project success The Children’s Pavilion as an architectural design project is a story of collaboration, ingenuity, and process excellence. From the discovery phase of the project, the team established optimal conditions for the success of construction and the client’s operations.

The project team and their roles consisted of:

ARCHITECTURE & INTERIOR DESIGN FIRM

CONSTRUCTION MANAGER & BUILDER

ENGINEERING

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LOCAL ASSOCIATE ARCHITECT

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BENCHMARKING & VISIONING Benchmarking is a valuable exercise at the start of any large project, but it took on a particular significance for CHKD since this new bed tower would be their first foray into Inpatient Mental Health Services. One of our first workshops during the discovery phase led the full stakeholder team through a seminar on trends and best practices in the design of mental health facilities.

The team analyzed various unit sizes and configurations, then narrowed them using a choosing-byadvantages matrix with weighted scoring. However, what really helped our client validate our path was touring and talking to peers at top tier institutions. The team traveled to Cincinnati and Columbus Ohio; Denver and Seattle. Tour participants included the design team, facility directors, psychologists and psychiatrists, therapists and nurses, as well as patient access and administrative leaders. Perhaps less expected, our CM joined as well to have greater cost certainty for the earliest pricing work.

We prepared score cards for all, then distilled all the feedback for another workshop when the tours were complete—the A3 format we use is a concise way to share information with those not on the tours.

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These peer-to peer connections around philosophies, care protocols, milieu and family engagement validated many assumptions but also served as a catalyst for the entire team to dream even bigger.

Visioning sessions helped CHKD define what it meant operationally to be authentically patient and family centered. The sessions also helped determine what opportunities were available to improve staff recruitment and retention and to design for flexibility— understanding that for a new service line, change is inevitable. These sessions led to the beginning of a roadmap for current and future state mapping.

Next, the team took on empathy and persona mapping to develop personas for children, their families, caregivers and community at large. This design thinking spurs our team to design every component of the building with intention. We challenge each participant to re-imagine what each constituent might hope, see, feel, think, hear and say in a variety of settings. The end result is a series of qualitative and quantitative characteristics which are embedded in the program AND the built environment.

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QUALITY DOCUMENTATION & COLLABORATION REDUCE RISK & DELIVER RESULTS The original contract for Children’s Pavilion was $185 million, with the change orders at completion of the project totalling only .2 percent of the contract. This is in stark contrast to the more typical change order of 4 percent. The project commenced on October 2019, and the final construction documents were completed April 2020.

PROJECT DELIVERY METHOD The responsibility to decide how the project was delivered was made by CHKD after a vigorous schematic design round. Selecting a CM-at-Risk delivery method, open collaboration with design partners was crucial to success. The design assist model worked well with W. M. Jordan Company bringing on a host of subcontractors early on. The team developed drawings in tight communication with curtainwall (JUBA), structure (SteelFab), parking garage pre-caster (Tindall), electrical (MC Dean), and mechanical (Southland) teams.

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A UNIFIED TEAM – PARTNER RELATIONSHIPS & STRENGTHS Array gathered a group of firms with superior reputations for quality work and team culture, allowing each team to play to their strengths. PF&A brought their experience with the client, while Array carries considerable experience with behavioral health design, healthcare planning, core and shell, life safety, coordination with large engineering teams, and large project design management. For mechanical engineering, PACE provided mechanical design, knowledge of CHKD standards, and field support; TLC provided electrical, fire protection and plumbing design. SSR provided technology and security design. As a whole, the team led a collaborative, friendly, problem-solving oriented approach that created success. WM Jordan’s expertise with large scale projects and relationship with the client allowed the team to predict needs and perform to meet or exceed expectations.

PHASING & TIMING OF CONSTRUCTABILITY The building was phased in two sections from drying in floors 1-7 prior to the upper floors. By creating a weather-tight structure at shaft penetrations and phasing exterior glazing delivery, it enabled electrical, mechanical, and framing trades to commence work on the lower floors much earlier.

LEVERAGING PREFABRICATION Prefabrication was used to increase speed-to-market, reduce the number of trades on site, and simplify construction. The project employed prefabricated racked plumbing and HVAC systems. These racks arrived in 12-16’ uni-strut sections, which were then staged on the building floor and hoisted in the place. This greatly simplified installation.

The rapid schedule drove an exterior design solution that facilitated drying in the building more quickly.

Working with our CM partner and their subcontractors in design assist roles, the team determined how to deploy prefabrication to unitize the curtainwall and metal panel systems to help speed erection. The pre-assembled window systems were installed floor by floor via an interior crane on the floor above.

All electrical rooms were prefabricated, then hoisted in place. These six-sides boxes were preassembled offsite. The panels were pre-installed, then shrink wrapped and shipped into place. This method allowed for simple installation that only required wiring once in place.

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learn more Continue your deep dive into Children’s Pavilion.

AIA WEBINAR Explore the planning and design challenges of the project and the unique solutions the team developed to overcome them.

Learn more.

BLOGS Exterior Design Feature: Children’s Hospital of the King’s Daughters Children’s Pavilion Explore the gleaming, angular, striking exterior design of Children’s Pavilion.

Designing Behavioral Health Environments to Avoid Seclusion Learn key design strategies to create behavioral health spaces that mitigate or eliminate the need for patient seclusion.

Planning your behavioral health project? Contact Array for your design, operational improvement or consulting needs: Sam Galvin Business Development Coordinator 202-795-3670 sgalvin@array-architects.com

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