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The Integration of Mobile Psychosocial Care into Disaster Response Through the Re-Creation of a Sense of Place Krista Williams

Submitted in Partial Fulfillment of the Requirements

For the Degree of Master of Fine Arts in Interior Design at The Savannah College of Art and Design

Š May 2012, Krista Leigh Williams

This author hereby grants SCAD permission to reproduce and to distribute publicly paper and electronic thesis copies of document in whole or in part in any medium now known or hereafter created.

Signature of Author and Date_________________________________________________________________________________

_________________________________________________________________/____/_______ Helena Moussatche, Ph.D. Professor, Interior Design Department Committee Chair

_________________________________________________________________/____/_______ Crystal Weaver, Ph.D. Professor, Interior Design Department Committee Member

_________________________________________________________________/____/_______ Michael Brooks, Ph.D. Dean of the College of Arts and Sciences, South University Committee Member


The Integration of Mobile Psychosocial Care into Disaster Response Through the Re-Creation of a Sense of Place

A Thesis Submitted to the Faculty of the School of Building Arts in Partial Fulfillment of the Requirements for the Degree of Master of Fine Arts in Interior Design Savannah College of Art and Design

By

Krista Leigh Williams Savannah, GA May 2012


THE INTEGRATION OF MOBILE PSYCHOSOCIAL CARE

Acknowledgments

I would like to thank my family and my parents, who have always supported me and encouraged me to further my education. There have been many days where they have inspired me, reassured me, and given me the confidence to accomplish great things and finish strong. Thank you Mom, for teaching me the importance of education and supporting my leap of faith into graduate school. Your excitement and enthusiasm has been an inspiration to me. Thank you Dad, for being a constant encourager - no matter what. Thank you for being strong; you have taught me how to have strength and to finish all of my endeavors with strength. Brett, thank you for helping me dream about my future. Your support and pride in my accomplishments are irreplaceable.

To my professors and mentors, Helena, Crystal, Deborah & Michael, Kathy, and Ruth, thank you for constantly listening and hearing my ideas, answering questions, and being available. You have challenged me and pushed me to think in ways that I thought were beyond my capabilities. Thank you for always being an inspiration to me. I know that you have and will change many students’ lives as you have changed mine.

Finally, Joey, thank you for always helping me and always making me see the brighter side of things during all the stressful times. Thank you for your daily support and encouragement as I pursued my degree and a brighter future for my career. The “You can do its” never went unnoticed.


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Table of Contents List of Figures………….……………………………………………………………………...….1 Abstract…………………………………………………………………………….……………..3 Introduction……………………………………………………………………............................4 Thesis Statement Significance and Purpose Relevancy to the Field of Interior Design Part 1 - Review of Literature and Theory…………………………………………...………..9 Review of Literature Sense of Place Theory Disaster Relief Culture Mental Healthcare Codes/Guidelines for Mental Healthcare and Mental Healthcare Products Mobile Health Facilities Shelters Part 2 - Research….…………………………………………….…………………………........21 Methodology Assumptions/Liabilities Methods of Data Collection Methods of Analysis Findings Discussion Part 3 – The Prototype: Feasibility and Logistics…………………......................................36 A mobile/modular shelter with clinical support for children affected by natural disasters Availability of Big Box Stores for Design Implementation Location of Big Box Stores within areas prone to natural disasters


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DIRTT Environmental Solutions Availability of Power, Data, Water Site Analysis - 3 Prototypical Locations within 3 regions of the United States The Relevance of the Regions of the United States - Flat Pack Designs per region Part 4 – The Design Response………………………………………………………………….53 Design Drivers Concept Statement Design Concept General Programming Prototype for the clinical module Prototype for the shelter module Design Solution General Floor Plan Layout Waiting Area Patient Units Multi-purpose Rooms Conclusion....................................................................................................................................68 References.....................................................................................................................................69 List of Visuals...............................................................................................................................75 Appendices....................................................................................................................................76 Appendix A1 - History of Mental Healthcare Appendix A2 - History of Disaster Relief Shelters Appendix A3 - Code Guidelines for Mental Healthcare Appendix A4 - Product Analysis of DIRTT Environmental Solutions Appendix A5 - Case Study - Mental Treatment Center for Children in Savannah, GA Appendix A6 - ‘Place-Making’ Game Results Visuals.........................................................................................................................................112


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List of Figures

Figure 1 - A message board to help reunite families.....................................................................28 Figure 2 - The need for appropriate volunteer/worker rooms........................................................28 Figure 3 - The need for appropriate play areas for children..........................................................29 Figure 4 - The need for emotional/mental support for disaster victims.........................................29 Figure 5 - Children feeding a horse - element of play...................................................................34 Figure 6 - Major Big Box Closings, 2006-2010............................................................................37 Figure 7 - Number of Empty Wal-marts........................................................................................38 Figure 8 - Cities Prone to Disaster.................................................................................................38 Figure 9 - Prototypical Design Locations......................................................................................39 Figure 10 - Comparison of stores to big box stores.......................................................................41 Figure 11 - Corpus Christi, TX Site Location................................................................................44 Figure 12 - The Culture and Environment of Corpus Christi, TX.................................................45 Figure 13 - Sacramento, CA Site Location....................................................................................47 Figure 14 - The Culture and Environment of Sacramento, CA.....................................................48 Figure 15 - Creston, IA Site Location............................................................................................50 Figure 16 - The Culture and Environment of Creston, IA.............................................................51 Figure 17 - Materiality with a pattern that emphasizes attach and detach.....................................55 Figure 18 - A design element that emphasizes a visual attachment and detachment that is located in various parts of the design.........................................................................................................55 Figure 19 - A design element that physically attaches and detaches - modular furniture piece that is located in waiting room..............................................................................................................56 Figure 20 - A design element that is transformable - modular couch/bed that is located in the patient unit.....................................................................................................................................56


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Figure 21 - A design element that emphasizes modularity - moveable cabinet located in the multi-purpose room........................................................................................................................57 Figure 22 - Programming Requirements........................................................................................58


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The Integration of Mobile Psychosocial Care into Disaster Response Through the Re-creation of a Sense of Place

Krista Williams May, 2012

Children are the most affected group of people during natural disasters and are prone to develop mental disorders due to their experience. By providing a mobile mental health facility that focuses on redeveloping a sense of place through disaster relief efforts, children’s symptoms of mental disorders can be reduced. This interior design thesis defines a mobile prototype for an effective and quickly assembled mental health facility and shelter, supported by previous disaster relief examples of healthcare and housing, the sense of place theory and its relationship to mental health, and research on typical behaviors and symptoms of children who suffer from mental disorders, such as trauma, bereavement, grief, depression, anxiety, and post-traumatic stress disorder. These topics inform the design by uncovering the important elements about disaster relief and how it relates to healthcare, different ways to implement the sense of place theory through a child’s perspective, the unique relationship between a mobile facility and the perception of a sense of place, and the behavior of mental health patients who suffer from disaster-related symptoms. Research and design focuses on children who are ages four to seventeen and mentally suffering from the recent occurrence of a natural disaster. The design focus addresses children who have symptoms of mental disorders, but not serious mental illnesses. Information gathered includes: a photo analysis, demographic and geographic studies, interviews, site visits, observations, case studies, and a review of disaster relief and mental healthcare literature. The information gathered will be cross-referenced and translated into evidence-based design solutions that should provide a renewed sense of place for the occupants of a mobile mental healthcare facility during disaster relief efforts.


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Introduction The first decade of the twenty-first century began with a devastating earthquake and tsunami in 2004, located in the Indian Ocean. It was claimed as the most powerful earthquake in forty years, with a death toll close to two-hundred thousand people, followed by other deadly natural disasters such as Hurricane Katrina and Rita that hit the southeastern part of the United States in 2005. Indonesia experienced a severe earthquake in 2006, with a death toll close to five thousand people. In 2008, China experienced a deadly earthquake that claimed over ten thousand lives, and Myanmar was hit by a cyclone that claimed over twenty-two thousand lives. In 2009, Indonesia suffered from several earthquakes that severely affected numerous communities. Within the past few years, the world has experienced natural disasters such as major earthquakes and catastrophic tsunamis in Haiti and Chile in 2010, and New Zealand and Japan in 2011. Also in 2011, the Southeast region of the United States experienced a barrage of deadly storms that killed over three hundred people. Most recently in the United States, a tornado outbreak occurred in 2012 across several states causing severe destruction and devastation to communities. According to these examples, there is enough evidence indicating that the frequency of natural disasters and the problems caused by them is quite significant. Despite these devastating events, there remains a lack of preparedness for disaster relief regarding mental healthcare. Ruzek, Young, Cordova, and Flynn (2004) found the following: facilities do not implement mental healthcare as part of their medical treatment during disaster relief, causing people to suffer from mental disorders and forms of anxiety (p. 47). According to Belfer (2006), “Children, who most often are alone and separated from their families, become the most affected and most prone population during and after natural disasters� (p. 523). Children are forced to experience the destruction of their own communities, leaving them


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confused in their own environment. After a natural disaster occurs, most aspects of a familiar environment are destroyed or missing, causing anomie, which can be defined by Newman (2006) as a sense of disorientation that disrupts social norms (p. 508). Because of these environmental conditions, often, when children experience natural disasters, they are prone to develop symptoms of mental disorders (p. 523). However, according to Kopec (2006), symptoms of mental disorders can significantly decrease through the recreation of a sense of place within a mental healthcare facility (p. 62). For children, a sense of place can be created through objects and environments that relate their personal emotions to a familiar place. Manzo and Perkins (2008) stated: “The existing mental healthcare facilities do not significantly consider a patient’s place attachment and a patient’s need for a sense of place, causing a feeling of loss and alienation” (p. 337-338). The sense of place theory can be defined in several ways. A general definition of sense of place, according to Najafi and Shariff (2011), can be “a collection of symbolic meanings, attachment, and satisfaction with a spatial setting held by a group or individual” (p. 189). According to Long and Perkins (2007), place attachment is similar to sense of place and can be defined as affective ties to an environment or fondness for a place (p. 566). Through connection with specific objects and environments related to familiar places, such as home, school, and play, children can achieve a sense of place and place attachment when displaced. As the mental health facility is implemented into different locations, specific elements of the proposed prototypes can be adjusted according to the location of the disaster, type of disaster, and needs of the area. This study proposes two specific components to the design of this type of facility: a clinical module and a shelter module. The clinical module would support medical


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needs of the children, while the shelter module would incorporate the temporary residential component of the project with patient rooms, staff rooms, and areas for recreational activites. The faciliy itself should help overcome anomie and produce a child’s sense of place, place attachment, and sense of community through the appropriate balance of semi-private and public spaces. The main outcomes of this project will hopefully enable the improvement of patients’ mental health and wellness follwing a natural disaster.


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Thesis Statement Preparation for disaster relief must address mental disorder symptoms caused by natural disasters. A quick-assembled, effective, and mobile mental health facility can provide a sense of place for children in a disaster relief effort as a means to decrease symptoms of mental health disorders. Significance and Purpose Convissor (2010) reminded us of Herman Miller’s famous design director, George Nelson, who stated: “Design is a response to social change” (para. 1). How can design take a step further in response to social change? Design can be more than just ‘good design.’ How can design positively affect and decrease the world’s problems, such as poverty, lack of clean water, and hunger? According to a book published by Architecture for Humanity (n.d.), “Design is important to every aspect of our lives. It informs the places in which we live, work, learn, heal, and gather” (para. 4). This idea suggests that it is possible to change the world through design. However, there is a significant problem. According to Pable (2010), “Architects and interior designers currently provide services for less than 10% of the world’s population” (p. 8). She reflects further by saying: “We, as designers, have limited our potential by seeing most major human concerns as unrelated to our work” (p. 9). The services that interior designers and architects offer are not providing for all people, and especially not for those who need it the most. Through the implementation of socially beneficial design, these problems can be addressed by the services provided by designers. Pable (2010) claimed that this type of design “embodies how a problem and need are defined, how a solution is developed, and how that


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solution is implemented” (p. 9). Therefore, socially beneficial design requires empathetic thinking and prioritization, rather than just focusing on user-centric thinking that currently drives most design programming and projects. Although there are many ways to implement socially beneficial design, the researcher chose to explore the possibilities of applying design skills and knowledge to disaster mitigation and recovery by designing a mental healthcare facility for communities who are prone to natural disasters. The purpose of this exploration is to make a small difference in the world by improving the environments of children who need mental healthcare after a natural disaster. Relevance to the Field of Interior Design According to Pable (2010), “It is time to set aside the superficial benefits of design and embrace a culture where design’s true worth is measured by the problems it solves....and the lives and activities it enhances” (p. 10). A current world issue is being overlooked by a great number of architects and interior designers: disaster mitigation and recovery. Designers must begin to address these issues more often through design solutions that respond to the major existing problems in the world. This study is meant to facilitate a unique design idea that focuses on the people who are mentally affected by natural disasters, specifically children. Due to the ever-changing data that supports evidence-based design, the design of healthcare facilities is constantly changing too. Nussbaumer (2009) defined evidence-based design as an informed approach to design where designers intentionally base their decisions on qualitative and quantitative research (p. 4). Innovative ideas for healthcare are being considered and created, such as mobile health facilities, so that all patients have more opportunities for healthcare. Although many mobile health facilities have been previously developed, Aquilino


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(2011) states that most attempts do not consider a patient’s need for sense of place or place attachment, even though the importance and significance of the sense of place theory has been supported by research (p. 193). Therefore, this theory must be effectively and successfully incorporated within the design, when providing mental healthcare to all patients who are in need.

Part 1 - Review of Literature and Theory The literature review includes an analysis of published material related to disaster relief, the history of mental healthcare, important aspects of mental healthcare, aspects of culture and its importance in a community, a history of shelters used for disaster relief, the sense of place theory (including place attachment and sense of community), the sense of place theory relating to children, mobile health facilities, implication of design on mental health, and codes/guidelines for mental healthcare. Information has been gathered, sorted, analyzed, combined, and crossreferenced with findings from evidence-based design research to create an effective framework for a design solution. Sense of Place Theory Sense of place theory is defined in different ways by various scholars. Often, sense of place is associated with elements of nature, home, and personalization, but scholars also suggest that sense of place is similar to other theories such as place attachment, spirit of place, and sense of community. According to Billig (2006), people become linked to their environment through three aspects: attachment, familiarity, and identity (p. 250). However, Cross (2001) explained that some social scientists define sense of place as “the particular experience of a person in a particular setting” (p. 1). Other scholars used general definitions of sense of place to form specific meanings of ‘sense of place.’


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According to Najafi and Shariff (2011), sense of place can be described as “a collection of symbolic meanings, attachment, and satisfaction with a spatial setting held by a group or individual” (p. 189). These authors expanded Cross’ (2001) classification by proposing an evolving process that categorizes sense of place into seven levels: knowledge of being located in a place, belonging to a place, attachment to a place, identifying with the place goals, involvement in a place, and sacrifice for a place (p. 189). In this case, sense of place can be seen as interpretive and emotional aspects of an environmental experience, suggesting that a place can be psychological, interactional, and physical. Under this theoretical framework, the factors affecting sense of place can be divided into two groups: the cognitive factors and the characteristics of a physical setting (p. 189). Cognitive factors refer to concepts and meanings that can be understood by people in a place, where an individual can attach himself/herself to concepts and meanings that are attributed to a place. Additionally, sense of place becomes an emotional bonding between people and place after cognition occurs. The physical setting of place can contribute to a sense of place through “the size of setting, scale, proportion, diversity, distance, texture, ornaments, color, smell, temperature, and visual variety” (p. 190). In this sense, elements of design can also contribute to the creation of a sense of place. Read (2007) concluded that additional research supports the creation of a sense of place within a building by integrating critical design elements (p. 388). These studies suggest the use of natural materials that are appropriate for the site, forms and shapes that relate to or contrast with the surroundings, a pronounced threshold between the exterior and interior, incorporation of vegetation, spatial variety, and sunlight (p. 388).


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Other theories, such as the place attachment theory, have similar characteristics, providing additional information on a user’s relationship and connection with an environment. Cross (2001) explained: Place attachment is the symbolic relationship formed by people giving culturally shared emotional/affective meanings to a particular space o[r] piece of land that provides the basis for the individual’s and group’s understanding of and relation to the environment....Thus, place attachment is more than an emotional and cognitive experience, and includes cultural beliefs and practices that link people to place. (p. 1) Long and Perkins (2007) considered place attachment as “affective ties with the material environment.....[including] fondness for a place because it evokes pride, and an individual’s commitment to their neighborhood and neighbors” (p. 566). Billig (2006) states that place attachment can become so strong that people may risk their lives for their home, their community, and their experiences in special places (p. 262). The author continued to explain that elements attribute place attachment to psychological factors including emotions, cognitions, and experiences that cause a person or group of persons to feel attached to a certain place. It can be conceptualized as “a series of emotions and behaviors that modulate distance from and hence maintain contact with the object of attachment, which is a source of protection and satisfaction” (p. 250). However, Najafi and Shariff (2011) believed that place attachment is affected by other factors: socio-demographic characteristics, environmental experiences including people’s type of involvement with place, people’s degree of familiarity with place, people’s expertise or knowledge about place, the culture of a place, place satisfaction, preference of place, attachment to place, activity in a place, and the physical setting of the place itself (p. 191).


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The presence of place attachment can change due to devastating conditions, such as natural disasters. Natural disasters disrupt place attachments and disturb communities, causing a feeling of loss and alienation. Manzo and Perkins (2008) propose that in order for a community to rebuild, they must recognize these negative feelings and reactions to the disruption of place and community, while addressing the emotional problems caused by natural disasters (p. 337338). Nevertheless, according to Eshelman and Evans (2002), place attachment can provide feelings of happiness, embedded emotions, feelings of security, sense of self, self identity, and self-esteem (p. 2). Without the presence of these feelings, people can become upset, worried, angry, or mentally unstable. These reactive feelings are typical for disaster victims, specifically children, and must be treated at a disaster relief facility for mental healthcare. Often, disaster relief facilities incorporate mobility and transition into healthcare environments for patients. According to Dahl (2010), many studies have found negative connotations and relationships between the odds of moving and the forming of a sense of place, reinforcing the idea that social attachment grows with time (p. 637). However, Billig (2006) claims: “A different relationship has developed between place attachment and mobility” (p. 250). The author further explains: “Today, mobility of people is often regarded as an ideal....Mobility may signify freedom, opportunity, and new experiences” (p. 250). There are many different ways to explain the sense of place theory and place attachment based on the behaviors of adults. However, the most significant research found in the literature is the one showing that children interpret a sense of place and place attachment in different ways. According to Hutchison (2007), “A small but growing number of social studies teachers have recently begun to pay attention to the ways in which children value, find meaning in, and make sense of their immediate environments, particularly their home, school, and play spaces” (p. 1-2).


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Not surprisingly, children value places based on their relation to home, play spaces, ‘secret’ places, the natural world, and pathways and routes between places (p. 2). For instance, Vickers and Matthews (2002) found that nature is seen as an important element to the experiential world of childhood and child habitats (p. 16). Furthermore, they demonstrate that aspects of play and activities can also cultivate a sense of place within children (p. 17). While children play, they create relationships with other children through socializing, imagining, building, creating, and expressing themselves. Specific spaces must be designed in order for elements of play, nature, and home to become relevant to children, helping them to create a sense of place. The sense of place theory and the place attachment theory, then, are relevant to inform the elements of interior design. According to Rubinstein’s taxonomy theory, Eshelman and Evans (2002) believed that place attachment can be interpreted through elements of interior design, such as personalization, privacy, and the provision of continuity with the past (p. 2). The authors continued to explain that a designer’s ability to enrich settings, make them aesthetically meaningful, and detail them with features that support personalization is of significant, measurable value in enabling place attachment and elevating self-esteem” (p. 2-3). Therefore, the design and design elements of a mental healthcare environment are important and can support a patient’s ability to overcome symptoms of their mental disorders. Disaster Relief Aquilino (2011) believed “that earthquakes and tsunamis will always happen, but disaster is no longer inevitable” (p. 182). Due to the increase in natural disasters, a quick and effective response of disaster relief is increasingly important and can help to decrease the possibility of devastating conditions for disaster victims. During the response to natural disasters, victims are


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likely to respond with horror, shock, numbness, grief, and re-experiencing of the disaster. The response of helpers during this phase will include basic care and stabilization of life. According to Fernando (2005), treatments conducted during this phase can effectively utilize basic interventions, such as active listening (p. 267). Victims who are in need of treatment may range from small children to senior adults, according to the type of disaster situation. Belfer (2006) believed that “children represent a high percentage of the population in many of the countries most recently affected by natural disasters” (p. 523). The author claimed that children, with their natural dependency, are particularly at risk as a result of being orphaned, parental stresses, and being disrupted from significant parts of their lives, such as, school and association with peers” (p. 523). In order to restore normalcy, family reunification, the rebuilding of schools, and the reestablishment of normal routines must be reestablished during post-disaster relief. Lindgaard, Iglebaek, and Jensen (2009) discovered: ...as the world is continuing to experience natural disasters, it is important to understand more of the effects such events may have on families as a whole. Understanding more of what changes family members’ experiences in the aftermath of trauma, and what mechanisms may lead to better coping, can help in planning interventions (p. 103). Post-disaster, families change their values by developing feelings of solidarity and feelings of gratefulness, and as well as valuing their time and possessions differently. The authors add that because of children’s reactions after the tsunami, changes in families’ daily routines needed to be made. Some children were afraid of being separated from their parents, or were afraid to sleep alone and had to sleep in their parents’ bed. Some children had difficulty concentrating at school or with their homework (p. 109). The situation is even more difficult for children who might


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have been separated from their parents. As Belfer (2006) explained, “It is known that children derive security from maintaining routines and staying connected to their family and institutions” (p. 523). Neuner, Schauer, Catani, Ruf, and Elbert (2006) claimed that children are also more vulnerable to psychological impairment after disasters, and recovery rates are limited for children with PTSD and similar mental disorders, proving that there is a significant need for adequate mental health assistance (p. 340). Culture According to Athey and Moody-Williams (2003), culture is defined as national origin, customs and traditions, length of residency in a place, language, age, generation, gender, religious beliefs, sexual orientation, perceptions of family and community, physical ability or limitations, socioeconomic status, geographic location, and family/household composition (p. 15). Aquilino (2011) explained it further: Cultural heritage is constituted not just by monuments and objects, but also historic cities, vernacular housing, and ecological systems, such as waterways and natural features. Traditional skills, practices, and languages are an important part of our cultural past as well, encompassing the skillful use of local resources and the living dimensions of heritage that come about, particularly in urban environments, as a result of the vibrant interaction of people with each other and their surroundings. (p. 167) Although an adult’s interpretation of culture can be easily understood through basic traditions, resources, and objects of the past, children are still experiencing and learning about their own culture, requiring additional support and education concerning culture. A child’s unique sense of


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environment can been thoroughly explained through the significance of culture and its role in disaster relief. Belfer (2006) stated: An understanding of culture is crucial to the development of appropriate programs for children and adolescents. Programs that do not fit with the local culture can be stigmatizing, rejected by those who are targeted or placing young people in conflict with their community environments. (p. 525) Not only does culture need to be referenced within the children’s physical environment in order for children to experience and learn about its significance, but culture must be appropriately explained in a context that children can understand. Hutchison’s (2007) previously mentioned research indicates that “children have their own kind of geographical understanding, one that is based on uniquely developmental and formative relationship with familiar and valued places” (p. 1). Moreover, he continues, “[n]ot surprisingly, young children often situate the place-based contexts they value in relation to home” (p. 1). Following this line of thought, Nebelong (2008) suggests that interior elements, which could include cultural elements, can provide play spots along a hallway to encourage children to pause and play for a while before continuing to the next location (p. 21). In conclusion, cultural competency must be part of disaster relief organizations and the facilities that provide disaster relief resources to provide healing during times of tragedy. Athey and Moody-Williams (2003) explained that disaster mental health services are most effective when survivors receive assistance that is in accord with their cultural beliefs and consistent with their needs (p. 20).


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Mental Healthcare Carrico (2011) researched the history of mental healthcare in the United States. History shows that mental health treatment in the United States shifted from institutionalization to deinstitutionalization beginning in the seventeenth century through the nineteenth century (p.10).The author suggested that those who had mental disabilities suffered from “societal stigmatization and the inhuman treatment they received within federal institutions” (p. 10). The author described a mental healthcare facility as an environment that caused patients to be deprived of their freedom and dignity while being confined by mental abuse, physical restraints, and straightjackets (p. 10). For a detailed explanation of the history of mental healthcare see Appendix A1. The history of mental healthcare provides a background according to the types of facilities that were available for mental healthcare, examples of the different stigmas of mental healthcare within society, and the history of various treatments for mental disorders. This research provided a significant understanding of mental healthcare’s past to be able to consider and design for mental healthcare facility in the future.

Codes/Guidelines for Mental Healthcare and Mental Healthcare Products According to The American Institute of Architects (AIA) standards, behavioral health care facilities must have 100 (net) usable square feet per private patient room and 80 (net) usable square feet per patient in a semi-private room (Sine & Hunt, 2007, p. 9). Similar requirements and additional considerations regarding space planning, safety issues, construction, and materials can be located in Appendix A4.


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Mobile Health Facilities Disaster relief utilizes prefabricated buildings as resources for providing services. Aquilino (2011) explained that prefabrication has a bad reputation, especially in disaster relief, where prefabricated buildings are ‘site-less,’ made with provisional structures that are constructed out of cheap materials and hastily put together (p. 240). There are some additional disadvantages to prefabrication, specifically with the mobile medical approach. Krol, Redlener, Shaprio, and Wainberg (2007) reported that the availability of gas, a limited supply and storage of necessary items, knowledge of mechanics for vehicular repairs, and possible disruptions to roadways, according to the disaster, are just a few disadvantages to a mobile medical unit (p. 338). However, there are mobile clinics that are constructed properly, have access to the appropriate resources, and are extremely successful in providing healthcare to a community. Many mobile clinics consider the culture of the people through a secondary use of the facility, acknowledging the need for serving patients who do not have access to healthcare. For instance, Architecture for Humanity (2006) discussed a mobile health clinic that was designed for the AIDS population in sub-Saharan Africa, incorporating elements of a clinic and a local marketplace for vendors and artisans to sell their products (p. 236). This particular design consists of two components: a permanent component and a mobile component. The permanent component is built by the community before the arrival of the clinic, which is the mobile component. The permanent space will leave behind a local contact person and a pharmaceutical resource once the clinic is functional. During the day, the space serves as a clinic. At night, the space serves as a community center and marketplace where events can be held (p. 236). This facility is an example of an efficient and effective mobile clinic that serves the general healthcare needs of the community.


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Another example of a mobile health clinic, which was part of post-Katrina disaster relief and a mobile medical program called Operation Assist, was implemented into various areas of Mississippi to provide access to healthcare. Krol, Redlener, Shapiro, and Wainberg (2007) believed that this program allowed for community outreach to identify people in need of healthcare who might have suffered from adverse health consequences, bringing care to their doorstep (p. 338). The facility also allowed for the ability to search for patient populations who may have become isolated from the community following the disaster and may not have had typical access to medical services. The clinic provided a wide range of medical services and supplies, including medications and vaccinations, to underserved populations of people. This mobile medical unit became a substitute for permanent clinics until they were able to be up and running again (p. 338). Mobile medical units or clinics can be a temporary solution to the lack of healthcare or medical resources in a community. However, the disadvantages should be considered before implementing a mobile healthcare facility for disaster relief situations or underserved communities. Shelters Shelter is a significant aspect of disaster relief. People who have lost their homes, their communities, and their belongings must live in temporary shelters that may have no consideration for privacy or personal space. Often, these shelters are overcrowded with people who have a lack of resources to healthcare, food, and sanitation. During these situations, it is important to consider the community and the culture of the people who will be living in temporary housing or shelters. An example of a temporary post-disaster housing project can be


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found in Tamil Nadu, India. This housing project was approached by the government after the Indian Ocean tsunami that occurred in 2004. This particular project had a strong emphasis on community, its people, and their way of life, fishing. For this community, fishing was not seen as a job, but as a lifestyle that emphasizes the environment of the coast: a warm climate, fresh mangos, coconut trees, and a leisurely way of life. The traditional Hindu system was applied to the construction of the design, enhancing the well-being of residents. However, the culture of the local people was not considered during the construction of the government’s post-disaster settlements. According to Aquilino (2011), “A lack of appreciation for local housing culture has characterized India since its colonial period; present building codes, urban plans, and housing policies evolved not out of Indian culture and experience, but as a result of Western traditions” (p. 188). For this specific example, the trees of the area were very important to the culture of the people. Due to construction, the trees were removed, along with the areas of congregation for people and opportunities for shade. The author stated: “The eradication of trees has dismantled livelihoods and social life, and has led to poor health. Many people believe that the absence of trees is responsible for increased rates of alcoholism, domestic violence, depression, and suicide in their communities” (p.193). Additionally, Aquilino continued to explain: “In the absence of shade trees, people are forced to stay inside. They spend much less time together, as meeting friends is traditionally not associated with home visits, and their new houses are too small and not designed for entertaining” (p. 193). The lack of trees not only affected the communities and the adults of the community, but also specifically affected the children. The author clarified: “The absence of trees and open common space also limited the children’s way of life. Without shade trees, children no longer played together outside. Parents fear that keeping their children


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inside is bad for their health and development, and encourages them to do nothing but watch television and become lazy� (p. 193). This temporary housing project did not consider the importance of the local culture, leaving the people with a housing development that was ineffective for their community. During temporary situations and post-disaster relief, it is very important for the community to feel comfortable within housing and shelter environments. Generally speaking, a history of shelter and facilities for disaster relief include structures like tents, modular shelters, a canvas prototype, housing made from shipping pallets, housing made from shipping containers, balloon systems, prefabricated shelters, and mobile housing. See Appendix A2 for unique and typical examples of shelter construction and facilities for disaster relief.

Part 2 - Research

Methodologies The objective of this study is to define a new prototype for quick, effective, mobile, and flexible mental healthcare units for children to be implemented into existing structures after a natural disaster. This prototype had to be designed in response to two problems identified in the current literature: a lack of mental healthcare attention during first response disaster relief according to Ruzek, Young, Cordova, and Flynn (2004) - and the patient’s need for a familiar sense of place within a mental healthcare facility, according to Kopec (2006). In order to design in response to these problems, research beyond a literature review was required. The overall research strategy used was a multi-method qualitative study combining


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findings from the literature review with data collected empirically to inform design thinking and design decisions. Data was collected through a case study that included observations and interviews as well as internet searches for photographs. Content analysis and visual analysis were conducted to sort out the relevant information that informed the design solution. Methods of Data Collection As previously stated, data was obtained through various methods and strategies that included a review of literature, site observations, interviews, and a questionnaire regarding mental healthcare and its relationship to the sense of place theory. Case studies and precedent studies were identified in the literature review and were specific to mobile healthcare, mental healthcare as part of disaster relief, and children’s healthcare. They helped to define the specific needs of children and their environments within a healthcare facility. The data collected also included a selection of disaster relief imagery, expert responses to interviews, findings of a site observation of a facility with a similar purpose, and responses to a place-making activity game given to patients of a mental health treatment center. Disaster relief imagery was collected through FEMA’s photograph database and the selection was based on the living conditions of shelters, emotional conditions of victims, a child’s physical and emotional response to the natural disaster, and anything that would indicate design opportunities and could be found within the environment of temporary shelters. According to Kopec, Sinclair, and Matthes (2011), an image incorporates factual data, symbolic messages, and emotional reactions (p. 154). Interviews with experts were strategically focused around the possible behaviors of potential patients who experience mental disorder symptoms related to anxiety, depression, and


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trauma in order to thoroughly understand the necessary design considerations for the proposed facility. Those interviews were conducted with a counselor/student accommodation specialist of student counseling services at the Savannah College of Art and Design. This specialist has previously worked in mental hospitals and is very familiar with the behavior of patients who are suffering from trauma, PTSD, depression, bereavement, and loss. Questions were intended to identify a level of expected behaviors of patients who suffer from these particular mental disorders. An additional goal of this interview was to understand medical staff requirements and medical equipment requirements for this type of mental healthcare. The strategy for collecting information in a site observation was to physically experience an existing mental healthcare environment for children in order to better inform programming requirements. This site visit and observation was conducted on a local mental treatment center for children in Savannah, GA (See Appendix A6). The data collection method used, in this case, was a direct observation of a staff member’s activities of the physical settings during a guided tour of the treatment center. The tour included a walk-through of a highly-functional patient unit. Although this treatment center is in a location different than the proposed mobile facility locations, the patients of this treatment center have similar mental disorders as the intended users of this design. The purpose of this phase of the study was to identify positive and negative design and behavioral issues in types of environments that are utilized for healing and wellness of children who are resident patients at a typical mental treatment center. The ‘place-making’ game was a data collection strategy employed to understand how patients, who have similar mental disorder symptoms, feel and react to specific design elements and the overall environment of their mental treatment facility. This game was originally made by Project for Public Spaces (PPS), a nonprofit organization dedicated to sustaining public places


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that build communities. The game is based upon their specific definition of what makes a great place: sociability, uses and activities, access and linkages, and comfort and image. Because various parts of the game were not applicable to children or to design aspects of mental healthcare facilities, some questions were modified to better direct the children towards defining a sense of place within a design perspective. The format of the game includes a section where the child must rate certain aspects of the facility as poor or good. The second part of the game involves specific directions, incorporating open-ended questions, direct questions, and questions that involve the completion of a drawing activity as response. This game identifies a patient’s perspective of someone who is currently in treatment for trauma/PTSD related mental disorders. The relationship of feeling and place is the main focus of the questions. What symbolizes a feeling of place for children? Can this symbology be represented in the design in order to achieve an increase in comfort? Can further research derived from the survey results justify the implementation of certain recreational activities or an increase in opportunity for personalization in spaces? The patients’ perspective on the theory of sense of place is of the highest value to the proposed design solution. Since the children who are receiving therapy at this mental treatment center have similarities with the intended users of the proposed design, these findings were expected to help to identify and achieve a significant relationship of a children’s perspective of feelings and place within a healing environment in a mental healthcare facility. See appendix A6 for the game format as it was applied. Methods of Analysis Through intensive sorting of hundreds of photos on FEMA’s website, a collection of forty-eight images was identified and analyzed. Because there was limited access to a scene of a natural disaster during the course of this study, a photo analysis was a beneficial alternative to


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thoroughly understand the situation of a natural disaster. Through this method, the purpose of the photo, the context of the images within the photo, and the framing of objects within the photo were analyzed. The images were classified by thematic analysis based on depicted emotional expressions, situation descriptions, and behavioral representations related to design. Once these general categories were established and the photographs were organized by themes, the imagery was re-evaluated according to their content and its possible correlation to design theory. Once the contents of the images were identified and categorized, and relationships with design theory were established, the new data was synthesized into general findings. These findings were triangulated with other gathered data to obtain and validate the overall research findings that informed the design process. The content analysis of the information gathered during the site visit and observation of the mental treatment center was based on the emphasis placed by staff members on certain design elements. A previous literature review indicated specific issues to focus on during observations as well as probing questions that were prepared ahead of time. During the direct observation of a staff member, the program of the treatment center, the organization of the patient units, educational and recreational components, and different types of therapy were discussed. These aspects were observed with the possible components of the proposed facility in mind, and they were triangulated with information and recommendations found in the review of literature. Through triangulation, clarity was achieved regarding several design issues, and insights on possible design responses were made possible. The findings from expert interviews were significant because the interviewee is familiar with the behaviors of patients with these types of disorders, and works as a counselor, assisting with a patient’s success overcoming their mental disorder symptoms. Content analysis of the


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answers during the interview provided data that was cross-referenced with similar information found in the review of literature for validation. During cross-referencing, insights to possible design solutions occurred. The ‘place-making’ game involved open-ended questions and qualitative data, resulting from a scaled rating system modified from Project for Public Spaces’s original place-making game. The analysis of the data collected from this activity was formulated based on previously published research findings that indicated a children’s sense of place existed through specific elements of design. The game’s symbolic survey, aiming to identify children’s connections of feelings and emotions with place, allowed for a more in-depth evaluation of a child’s sense of place. The game was facilitated by a staff director of the mental treatment center and the information was compiled into a table, indicating the average ratings for each category of ‘Rate the Place’ as well as the answers that were given in relationship to the quest Limitations -The data collected from the photo analysis contains images that can only be found through FEMA’s database. -The ‘place-making’ game was administered by staff instead of the researcher, resulting in a breach of all patients’ privacy according to the HIPPA law that protects against the sharing of a patient’s personal information. Due to the mistake, staff collected the patient’s surveys, drawings, and questionnaires and presented the results to the researcher. Results, such as the patient’s drawings, were not fully reported to the researcher. -The expert interviewee, who is a counselor and previous psychologist, has not had experience with children who suffer from mental disorder symptoms due to natural disasters.


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-The case study of the local children’s mental treatment center includes therapy and treatment for a larger variety and more severe mental disorder symptoms, making the facility similar, but also very different in comparison to the proposed facility. Findings Within the disaster imagery, people are prone to post written announcements and messages following a natural disaster, emphasizing the importance of vertical surfaces as a means to communicate with lost family members and friends (See Figure 6). Other images showed a large number of volunteers that lacked proper sheltering accommodations, emphasizing the significant need for appropriate volunteer/worker bedrooms and leisure spaces (See Figure 7). Additional images revealed that children tend to play on the floor with scattered objects left or found while being supervised by volunteers (See Figure 8). A variety of images emphasize the need for emotional and mental support of disaster victims. Displaced people are emotionally distressed and depend on each other for emotional support. These interactions occur in improvised sheltering settings that do not offer privacy. Within medical aspects of disaster relief, a need for therapy areas, appropriate patient units with privacy, and a need for a functional nurse’s station were identified. Within mobile medical healthcare, the logistics and presence of Red Cross’ mobile medical unit was discovered, the need for mobile bathrooms and mobile power was emphasized. Within the consideration of children during disaster relief, a need for resources, education, and a ‘sense of place’ was identified through multiple images.


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Figure 1 - A message board to help reunite families (FEMA, n.d.).

Figure 2 - The need for appropriate volunteer/worker room (FEMA, n.d.).

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Figure 3 - The need for appropriate children’s play areas (FEMA, n.d.).

Figure 4 - The need for emotional/mental support for disaster victims (FEMA, n.d.).

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During the visit of the mental treatment center, the patient’s individual responsibilities became clear, emphasizing the concept of a typical regimented ‘home-like’ environment implemented through a reward/penalty system. Patients, who are old enough to be able to do chores, are responsible for cleaning their own rooms, cleaning common areas, their own personal hygiene, and their laundry (specifically their clothes). The patients also have a point system that awards them for good behavior, such as permission to have longer phone conversations with their family, a later bedtime, additional unique privileges, and additional outings and activities. If they do not have ‘good behavior,’ they are penalized from recreational activities and additional outings. Although the responsibility of having ‘good behavior’ does not ensure the re-creation of a ‘home-like environment’ for patients, it encourages a positive environment and individual responsibilities for each patient that is essential to most nurturing ‘home-like’ atmospheres. The results of the interview with the expert helped to clarify the significance of a patient’s behavior for informed design decisions. Children who suffer from PTSD, trauma, bereavement, depression, and grief can have suicidal and aggressive behaviors, which were not being considered initially, and indicated that the facility must be designed with this situation in mind for everyone’s safety. Specific standards must be considered when designing for these behaviors. Additionally, a patient’s behavior may reflect a feeling of emotional numbness, a tendency to withdraw from social activities and communication with people, and a sense of loss while other patients may show behaviors that result from significant suffering, like severe depression and grief, with possible suicidal and aggressive behaviors. The expert recommended including a variety of staff members, such as a physician (specifically a psychiatrist and a psychologist), a nutritional consultant, and two different types


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of nurses: a nurse practitioner and a psychiatric nurse that has been specifically trained for children patients. For medical equipment, recommendations included first aid kits, equipment and a lab for blood work, and a secure area for medications and antibiotics. If any medical issues occur, a nurse practitioner must be able to take care of these patients as well as perform blood work and physicals on patients. The expert also explained that initial screenings must be effective and as detailed as possible. If the patients openly speak about their suicidal and aggressive behaviors, the patient is not fit for a temporary facility. If patients have symptoms that indicate they have a serious mental disorder, they should be referred to a mental hospital for more appropriate care. Before the patient is accepted into a temporary relief program, they should undergo a physical completed by a nurse practitioner, ensuring that they have no additional physical health issues. If the patient suffers from a physical disease or condition, that issue must be treated before the patient receives mental healthcare. Since the expert has not worked specifically with mental health during disaster relief, estimates of patient behavior and knowledge of the relationship of mental health and disaster relief were somewhat limited. However, the results of this interview have significantly informed program requirements and suggested design elements that address the mentioned behaviors expected of patients. Findings related to the place-making game were obtained from a specific unit of children who are currently receiving treatment and therapy for various mental health issues. The findings indicate specific feelings that relate to a sense of place, according to certain areas of the facility


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that may trigger specific emotions. The patients rated their facility based on comfort and image, uses and activities, and sociability, resulting in a medium average for most categories. Categories, such as ‘feeling safe’, rated somewhat low on the scale as well as the comfort of a place to sleep, and the overall attractiveness of the facility. The comfort of therapy rooms had the highest rating, and the incorporation of activities that support learning and growing had the second highest rating for the activity. To see the specific ratings and answers that were gathered through the place-making game and survey see Appendix A6. The overall findings, however, are still inconclusive, but they provided insightful information that could become more meaningful through further research. Discussion The photo analysis further supported the previous theories of a child’s sense of place, which indicated that it can be created through elements of school, home, and play. For example, disaster relief following Hurricane Katrina brought in horses for children to interact with, while they were staying at a shelter. This could be considered an element of play and it is an attribute that could help to re-create a sense of place in certain areas of the country, where horse farms are common (See Figure 5). Also, within the disaster imagery, there is a clear need for vertical surfaces as a means to communicate and express one’s self, a need for appropriate volunteer/worker bedrooms and leisure spaces, proper areas for children to play, and spaces for the community of patients, volunteers, and staff to interact with one another privately and publicly. While observing the mental health treatment center during the tour of the patient unit, the layout of the ‘living room’ area and the patients’ rooms clearly replicated a sense of home.


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Although patients were limited in their incorporation of personal belongings in their bedrooms, a few options for personal items were allowed, giving them a sense of belonging and ownership. Their living area had big and comfortable club chairs and couches, with a television set, just for hanging out. These elements represent a ‘home-like’ environment for them, which is one of the most important aspects of a sense of place theory, to be applied while designing a facility for children’s mental healthcare. While touring the facility, the program requirements became clearer. Although the observed facility is somewhat different than the proposed facility, some features of the tour of the treatment center suggested new user needs to be addressed in the proposed design solution. For example, as stated before, suicidal behavior needs to be taken into consideration when designing any type of mental healthcare facility. Contraband items, which are objects that may be harmful or unsafe to patients but tend to be brought in, must be sorted out from appropriate items in order for this facility to be successful in the healing of its patients. This indicates the need for a triage area, as well as careful sequencing of activity areas at the approach zone. ‘Time-out rooms’ and other appropriate spaces might be necessary to insure the discipline of these patients. These are aspects of significant importance for healing and for reassurance of a safe environment for all users in this facility.


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Figure 5 - Children feeding horses-element of play (FEMA, n.d.) Finally, a tour through a patient unit gave access to real patients who have mental illnesses and need therapy. At times, it was overwhelming to experience the patient’s behavior and interact with them in their own environment. However, this was a necessary experience for a designer in order to fully understand how this type of facility needs to function. In this facility, each unit houses children who have been clustered according to age, gender, and levels of mental capability. While visiting the unit, insights on appropriate selection criteria for furniture, materiality, and hardware became very evident. For this proposed treatment center, the design must consider possible dangerous behaviors that may or may not occur. Although a level of extremity will not be necessary for children who only suffer from trauma/depression symptoms, an appropriate level of suicidal precaution must be considered in the design order to insure the safety, healing, and wellness of these patients and the staff caring for them daily. This case study also indicated the need for staff to have their own space, where they can decompress from the stress built-up when working with their patients, dealing with their behavioral issues, and from handling the precarious conditions that they will have to experience daily.


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Speaking with staff members, it became clear that family presence is a very important part of the healing process for these patients. In comparison, at a disaster relief facility family may or may not be present. Although interaction with family is a positive thing for children patients, family participation should be handled with care and understanding, since not all children will have access to family members as a component of healing. Segregated areas for family interaction, then, might be necessary to avoid conflicting situations. The expert interview has also informed program requirements, standards that are very important to many elements of design in behavioral healthcare facilities, and provided significant information concerning the appropriate medical staffing for the facility and the required medical equipment. Most importantly, the project became better informed on how to design for the types of behaviors that these patients may have. This information is invaluable and not found in the reviewed literature, and it is fundamental to ensure that the facility is designed with appropriate strategies to support behavioral treatment methods as well as to prevent potential safety issues by keeping possible reactions in mind during the design process. Unfortunately, due to the limited access to patients, the results of the place-making game were inconclusive, requiring more research to confirm or reject a hypothesis. However, the results of a few ratings were significant and include the most important elements of a mental health facility, which are the patients’ feeling of safety and comfort. With the proper incorporation of design elements that can foster safety and comfort in a mental health facility, an increase could occur in the rates of patients’ healing and wellness. areas for children to play, and spaces for the community of patients, volunteers, and staff to interact with one another.


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Part 3: Feasibility and Logistics Feasibility When a mobile/modular shelter is designed for children affected by natural disasters, it involves logistical thinking skills and feasibility studies. The feasibility of this project involves many different aspects: including the availability of existing and empty “big-box” stores, the transportation and implementation of a universal and flat-pack system of mobile and transformable design elements, and the transfer of patients from organizations such as ‘The Red Cross’ to a mental healthcare facility once initial disaster relief has responded. Based on previously designed disaster relief facilities, the main issue with today’s designs for disaster relief revolve around the lack of consideration for feasibility and logistics. Since this idea is based upon the availability of an empty or non-utilized ‘big-box’ store within the area of all natural disasters, it will be possible that such a store will not be available for use when needed. In this case, a prefabricated system might be considered as an alternative.This idea, however, even though it is a modular prototype, does have the potential to grow and should be able to handle significant natural disasters, even though it is not equipped for extremely devastating circumstances. However, due to prepackaged availability, these flat-pack systems are ready for implementation at any time, no matter when a disaster strikes. When the system is transported and arrives at an appropriate site, the product installation will take a few hours and can be executed while patients are beginning their initial screening process. For more information regarding the customizable, modular interior elements and its installation see Appendix A4. A specific flat-pack size should be specified according to the size of the available “bigbox” store. A “big-box” store facility is made up of mass-oriented retailers such as Wal-mart,


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Home Depot, and Target. The facilities have significant square footage amounts and are constructed based on standardized structural bay sizes, making it possible to create and design a standardized flat pack system. Since empty “big-box” stores have been increasing since 2006 (See Figure 6), research shows the availability of these stores within certain areas of the United States.

Figure 6 - Major ‘Big-Box’ Closings, 2006-2010 (Colliers International, 2010).

According to Figure 7, there are many empty Wal-mart stores as well as other “big-box” stores all across the United States. Figure 8 explains which cities are prone to disaster that have existing empty “big-box” store locations. Due to the time frame of this study, three prototypical locations were chosen for the implementation of the design: Sacramento, CA, Corpus Christi, TX, and Creston, IA (See Figure 9). Each location represents an area prone to a specific type of natural disaster. Sacramento, CA is prone to earthquakes. Corpus, Christi, TX is prone to hurricanes. Creston, IA is prone to tornadoes. The design for each prototype must respond to each geographic location, type of disaster, and type of users’ need.


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Figure 7 - Number of Empty Wal-mart Stores, (Institute for Self Reliance, 2007).

Figure 8 - Cities Prone to Disaster, (Walmart, n.d.).

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Figure 9 - 3 Prototypical Locations, (Walmart, n.d.).

Each prototypical location has a unique culture, geographic location, demographic, and population characteristics, which means that each location would define a sense of place in a different way. Logistics In case of a natural disaster, the location of the “big-box� stores will have to be determined before the mobile unit is delivered. Through technology such as BIMStorm technology, CrisisMapper.net, Open StreetMap, Sahana, and Ushahidi, appropriate buildings can be located as quickly as twenty-four hours after a disaster has occurred. These websites help humanitarian organizations better understand how the disaster affected specific areas, what areas have the most need, the current location of first response units and which area of people they are


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assisting or have already assisted. These tools give organizations significant resources that help with crowd-sourcing and assessing an accurate depiction of the situation, helping in preparation for responsibilities as a disaster relief volunteer or a disaster relief organization. These websites also provide tools for building capabilities during initial design brainstorming and effective warnings for information concerning the after effects of natural disasters, providing the general public with important information such as threats of aftershocks. Sahana, a program created specifically for healthcare, focuses on hospital triage management through assistance in family reunification, photo capture and electronic notification of patients, and management of intake records (Sahana Foundation, n.d.). The chosen building type uses a standardized and sturdy construction system that is specifically designed for “big-box” stores. These buildings can occupy a range of space from 25,000 square feet to 250,000 square feet, incorporating open floor plans, high ceilings of around twenty to thirty feet, and large surface parking lots. Figure 10 shows a comparison of different ‘big-box’ store sizes with other retail store sizes. According to Woodcock (2008), the interior of a “big-box” store is regulated by a grid of basic steel columns and defined by single CMU exterior walls with ethylene propylene diene terpolymer (EPDM) roof construction (p. 20). There are very few architectural details in these buildings except for a standard grid of columns and trusses, a few signage components, and occasionally, some skylights. Because this construction is standardized and spaces are adaptable, it allows for unique and innovative design opportunities. A standard bay size of thirty feet by thirty feet was identified through an analysis of existing buildings on Wal-mart’s (n.d.) real estate website. During this building analysis, three standard sizes were considered: a small, a medium, and a large “big-box” store. A small store


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consists of 70,000 square feet or below. A medium store was considered as having 70,000 square feet to 100,000 square feet. A large store is one with 100,000 square feet or more. Once three categories of building types were established, a comparison between examples of the three revealed that the bay sizes remained constant even when the square footage increased or decreased. Therefore, a large, medium, and small building have thirty foot bays, supporting the idea that the thirty feet by thirty feet measurements can be considered the typical bay sizes for “big-box” stores of all sizes. Although these sizes will vary according to each “big-box” store, this design proposal was based on the typical bay and the minimum square footage needed for the program established. The adaptable nature of the design allows for an increase in square footage, if necessary.

Figure 10 - Comparison of stores to ‘big-box’ stores (Colliers International, 2010).

The proposed design solution was designed to handle and overcome some of the possible existing conditions of the “big-box” building. It is possible that the existing building would not have direct access to power or water. If the building is without power, the use of Sky Built’s


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Renewable Mobile Power Solutions (MPS) will be recommended, providing “off the grid” solar power that can generate power for the entire facility. The MPS systems can be shipped to the appropriate location, involving a quick setup to operation with little to no maintenance, fuel, or logistics (Sky Built, n.d.). This MPS system is also compatible with construction technology of the specified building products, allowing for electrical and power flexibility within the building. Water is also a resource that requires availability for the success of this facility. For this particular solution, water may or may not be available to supply the needs of the facility. If water is not available, it could be supplied through water trucks as part of typical disaster relief protocol. A rainwater collection system is also a beneficial option, depending on the environment and the availability of water resources. Toilets and showers will be provided through an appropriate amount of portable facilities that will be located in a designated area of the design.

Three Prototypical Locations within Three Regions of the United States Three prototypical locations have been identified as Corpus Christi, TX, Sacramento, CA, and Creston, IA. These locations were selected based on being prone to natural disasters, the varying sizes of the cities and varying sizes of building types, and the actual existence of an empty and available ‘big-box’ store in these locations. These locations are also part of different regions of the United States: the Southwest, the West, and the Midwest. Each region incorporates a unique environment through existing culture which is represented in historical elements, types of food, music, dancing, art, and natural resources. Corpus Christi is a coastal city that is located in the southern region of Texas and is specifically prone to hurricanes as well as tornadoes. This location represents the second largest


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in general population and the second largest population of children in comparison to the other two prototype locations. The location of the existing ‘big-box’ store can be seen on Figure 24. This store is approximately 57, 000 square feet, making it the example of a small ‘big-box’ store. The store is located in a shopping center and has been renovated in 2008. The culture and environment of Corpus Christi, TX is visually represented in Figure 25. Corpus Christi is a city located near the coast with a prominent beach culture with access to water sports, a marina, coastal wildlife, and ranch style houses. These images are examples of what could be included in the design and color palette of the Southwest-inspired flat pack.


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Figure 11 - Corpus Christi, TX Site Location with specific site information and general information about Corpus Christi (Walmart, n.d.), (USA.com, n.d.).

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Figure 12 - The Culture and Environment of Corpus Christi, TX - information that indicates the color palette and design elements of the Southwest region of the United States (Google Images).


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Sacramento is the capital city of California and is located in the northern area of the state that is close in proximity to Central Valley. The city is specifically prone to earthquakes with the largest population of people and the largest population of children in comparison to the other two prototype locations. This ‘big-box’ location is also the largest in comparison to the other two ‘big-box’ stores with approximately 150,000 square feet. The location of the existing ‘big-box’ store is also in a shopping center. It was built in 2001, and its location can be seen in Figure 26. The culture and environment of Sacramento, CA is visually represented in Figure 27. The region has a large agricultural influence, and these images are an example of what would be included in the West imagery database, representing the West region of the United States in the design and color palette of the West-inspired flat pack.


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Figure 13 - Sacramento, CA Site Location with specific site information and general information about Sacramento (Walmart, n.d.), (USA.com, n.d.).


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Figure 14 - The Culture and Environment of Sacramento, CA - information that informs the color palette and design elements of the West region of the United States (Google Images).

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Creston is a small town located in the southern region of Iowa and is specifically prone to tornadoes and occasional earthquakes. This location represents the smallest population of people considered and the second largest existing ‘big-box’ store, in comparison to the other two prototype locations. The location of the existing ‘big-box’ store can be seen in Figure 28. This store is approximately 65,000 square feet, is a freestanding building, and was constructed in 2001. The culture and environment of Creston, IA is visually represented in Figure 29. Creston is a town that has a large emphasis on agriculture, local production of crops, and farming. These images are an example of what could be included in the design and color palette of the Midwestinspired flat pack.


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Figure 15 - Creston, IA Site Location with specific site information and general information about Creston (Walmart, n.d.), (USA.com, n.d.).

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Figure 16 - The Culture and Environment of Creston, IA - information that informs the color palette and design elements of the Midwest region of the United States (Google Images).

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The Relevance of the Regions of the United States The variety in culture and the color palette of the natural environment within the five regions of the United States indicated the need for five different color palettes within the design of the flat packs in order to ensure a sense of place. Materiality and color for the design of each region was inspired by the history, natural elements of the environment, and the culture of the people. Three color palettes were defined to reflect the regions chosen for prototypical locations (the Southwest, the West, and the Midwest regions). The Midwest region is known for its low, flat, and rolling plains. This area is rich with agriculture, emphasizing the importance of using a natural color palette. Generally speaking, this region is typically prone to tornadoes, but can also experience other natural disasters such as earthquakes. The wheat and sunflower fields, and the rolling plains were an inspiration for an analogous color palette, implementing golds, bieges, greens, and blues. The West region is the most geographically diverse area, consisting of fertile valleys, mountains, beaches, and grassland. Typically, this area is prone to earthquakes with a possibility of occasional tornadoes.The majestic mountains, fertile valleys, and colorful sunsets inspired a complementary color palette, composed of blues, purples, and hints of yellow. The Southwest is known for its historical connection to the Native American and Hispanic culture, a unique natural environment that is extremely hot, dry, and arid. This area can experience tornadoes and earthquakes. The canyons, desert sunsets, plateaus, arches, and Native American culture were the main inspiration for a complementary color palette, consisting of blues, blue-greens, reds, and oranges.


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Part 4 – The Design Response Design Drivers The design drivers for this thesis project are as follows: -an efficient and effective assembly/disassembly construction -transformable and modular design elements -flexible spaces that allow for attachment of personal items and objects -color and materiality that represent the natural environment of each region of the United States -safe and secure environment for patients, staff, and volunteers Concept Statement When patients arrive at the proposed facility, they must adapt and emotionally attach to their environment to ‘feel’ a sense of place. Through this sense of place, symptoms of mental disorders should, at least, decrease. Once the patient has finished his/her stay in the facility, a natural detachment must occur as easy as possible. Specific elements of the design must facilitate both attachment and detachment. The attach/detach concept can guide decisions related to materiality, functionality, and aesthetics, as well as be inspiring for the layout and space planning of the facility.


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Exploring the Design Concept Attach/Detach There is a specific behavioral and emotional pattern that occurs during disaster relief efforts: attaching and detaching. Due to the role that a sense of place plays in the healing process of mental disorder symptoms, patients must emotionally attach to a new environment to heal and overcome their symptoms. Once the patients have healed and are healthy, they must also be able to detach themselves from the environment. In addition, staff must also attach to patients, who are in constant need of their help, assistance, advice, and constant supervision. The reoccurring needs of patients may become stressful and overwhelming to staff, so they must systematically detach from their working environment, problems related with their patients, and the disturbing reality of their surroundings. Elements of emotional attachment to place could be seen as a direct connection to the built and natural environments that encourage the patient’s healing and wellness. Without a patient’s proper place attachment, a decrease in their symptoms may not be able to occur. A creation of a sense of place, which is a form of attachment, must occur through the presence of objects and spaces that are most important to children; those are design elements that resemble or reference home, school, nature, and play. Elements of place detachment on the other hand, can be seen as an opportunity to encourage independence, while learning and growing. Once place detachment has occurred, a patient can leave the facility, ready to start a new life due to successfully overcoming the symptoms of their mental disorders. The design concept can be identified through the implementation of agile architectural solutions as well as a variety of design elements: patterns found in materiality (See Figure 12),


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furniture that visually connects and disconnects (See Figure 13), furniture that can attach and detach (See Figure 14), furniture that is transformable (See Figure 15), and modular furniture (See Figure 16).

Figure 17 - materiality with a pattern that emphasizes attach and detach (Designtex, n.d.).

Figure 18 - a design element that emphasizes a visual attachment and detachment that is located in various parts of the design (Steelcase, n.d.).


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Figure 19 - a design element that physically attaches and detaches - modular furniture piece that is located in the waiting room (Gaen Kho, n.d.)

Figure 20 - a design element that is transformable-modular couch/bed that is located in the patient units (Hey Team, 2010).


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Figure 21 - a design element that emphasizes modularity-moveable cabinet located in the multi-purpose room (Steelcase, n.d.)

General Programming The general program of the facility will comprise two basic modules: the shelter module and the clinical module (See Figure 17). Each module type can be chosen and specified according to each disaster and the specific needs of the community. The shelter module will contain residential patient units and residential staff units, a food preparation and eating area, ‘time-out’ rooms, a laundry area, and an accessible area of bathrooms and showers. The clinical module will provide for the healthcare needs of patients, focusing on individual and group therapy rooms, an ‘attach’ multi-purpose room, a ‘detach’ multi-purpose room, a waiting area with a visitor’s lounge, an intake area with a nurse’s station, a business area with flexible office space for staff, ‘time-out’ rooms, and access to bathrooms.


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Figure 22 - Programming Requirements Prototype for the clinical module The clinical module will function similarly to a typical health clinic, including a waiting area, reception area, and access to bathrooms for those who are waiting. Before the patient can undergo therapy sessions, they must participate in a health screening, so that the staff can better understand the patient and the patients’ needs. Once the patient has been called into the screening or intake area, the staff will perform all precautionary methods to ensure there are existing symptoms of mental disorders that are appropriate to the facility. After a patient has passed screening, he or she will be accepted and integrated in the program, beginning with group therapy sessions, allowing staff to begin evaluation and observations of patients. Group therapy sessions usually incorporates various types of play based


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therapy as well as specific therapeutic activities, such as art, drama, and music. Individual therapy sessions are more appropriate for patients who have more severe symptoms or behaviors of mental disorders. These sessions tend to include other types of play therapy and various activities that support the healing and wellness of the patient. An ‘attach’ multi-purpose room is being proposed to encourage patients to develop a sense of place through specific design elements within the facility’s environment. Similarly, a ‘detach’ multi-purpose room should allow patients to properly detach from the facility through specific activities that express their journey in healing. The clinical module will also incorporate small play areas within hallways called “kid’s corners” that serve as simple discoveries of play opportunities to draw a child’s attention, and serve as landmarks for way-finding. This aspect of the design should provide children with additional opportunities to heal, grow, and overcome their symptoms of mental disorders. A few ‘time-out’ rooms are implemented into the program/layout to be used in case patients have behavioral outbreaks. If this occurs, the patient must quickly be removed from the situation and from interaction with other patients to ensure everyone’s safety. This type of room should be able to withstand damage from tampering or tantrums that could possibly occur. The clinical module will also incorporate a business area that includes an open, private office area for doctors and nurses to casually meet, discuss, and solve problems pertaining to patients. This area will also include a small meeting space, open offices, and a break room for staff to decompress during the day. Separate storage for medication and medical files concerning patients will be securely located within this space.


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Prototype for the Shelter Module The shelter module will only be available to children who are receiving treatment and are displaced from their homes, whether this is a temporary or permanent situation. Patient rooms will be divided into units, specifying four patients who have symptoms and behavior that will be accommodating to one another per unit. Units will be organized according to their functioning levels, age, and gender of the patients to avoid disturbing behavioral problems, inappropriate situations, or disagreements. For instance, a specific disaster may require the implementation of a unit of patients who are severely depressed. These patients may need a certain amount of separation from other patients that are presenting behaviors that may irritate their existing symptoms. Each unit will provide separate areas for individual patients, including a bed, desk, open shelving, a small closet space with a semi-private curtain that is tamper-resistant, and an opportunity for appropriate personalization. The organization of these units should give each patient a feeling of having their own space, while being part of a small community of patients. Staff rooms will be organized in a similar way to the patients’ units, with direct access to the lounge area that allows staff and volunteers to decompress and detach from the activities and challenges of the day. This space is especially important to protect the health of the staff and volunteers, so they can continue to assist patients and be an asset to the facility and disaster relief efforts. A portable bathroom facility is provided for residential patients, staff, and visitors and will be appropriately placed. A laundry area will also be available to both patients and staff. The provision of this component is important to restore a sense of normalcy while also giving patient’s responsibility to do their own laundry with supervision.


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Design Solution General Floor Plan Layout A floor plan layout was designed as a prototype and guide for appropriate space adjacencies and recommended square footage, integrating the clincal and residential modules. According to the specific needs of the disaster, the size of these spaces might change; however, a basic layout that shows the interaction of modules and different spaces was established to fully understand the functionality of the proposed facility. Generally speaking, the clinical module is located towards the left of the layout image and the residential module is located towards the right. The spaces that are located in the middle are considered important to both modules, therefore affording easy access and use of these spaces for all modules. A grid organization was established for circulation in order to enable effective wayfinding for users. The circulation is dimensioned as 10’ wide corridors for ample room for human traffic, casual conversations between staff, and opportunities for small play areas to maintain the attention of patients when traveling to other areas of the facility. The spaces have a variety of 8’-10’ ceilings consisting of lay-in, translucent 2’ x 2’ ceiling tiles with 2’ x 2’ LED flat panel light fixtures for general lighting. The ceiling will also incorporate 2’ x 2’ air vents that can be used for general venilation of the space or a possible connection to the existing HVAC system. The design of the wall panels for each area are specified according to DIRTT combination wall tiles, and they are standardized to incorporate three different material selections: A variation of frosted tempered glass and clear tempered glass is located on the top, back-painted, tempered glass is applied to the middle, and chromacoats water-resistant paint is applied to the bottom of the panel protected by a 6” metal wall base.


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Waiting Area Upon entering the big-box store’s main entrance/exit, there will be a large, multi-faceted waiting and reception area. The waiting area is a very important space that allows an appropriate introduction of an environment that responds to a child’s need for a sense of place. This particular area incorporates 10’ ceilings as well as existing walls into the design due to the existing ‘back of house’ areas that are always located at the entrances of ‘big-box’ stores. Flooring for this area will be a 2 x 2 striped carpet tile, allowing for easy mobility and cleanability. Accessories that are implemented into this area include eight picture hooks, four marker trays, and five coat hooks. The prototypical design for the waiting area in Corpus Christi, TX is in the Southwest region of the United States. The color, finishes, and materiality for this iteration is inspired by images of the Southwest’s natural environment. The color palette consists of golds, oranges, blues, and blue-greens. Immediately to the right, there is a supervised play area for incoming patients of all ages, which provides various interactive activities, games, and toys that encourage place attachment. A variety of colors and patterns were chosen for the play area, incorporating a sense of play into the furniture, materials, the pattern in the carpet, the color of the wall panels, and the color of the ceiling. The backpainted glass on the wall panels is covered in a deep goldenrod that is similar to the colors seen in the desert environment of the Southwest, which brings a reference to the natural environment into the space. Glass on the top of the wall panels surrounding the space, allow ample amounts of daylight to flood through the waiting area. Modular, child-sized furniture with nearby displays of children’s art bring a sense of scale to the space, encouraging all patients to feel comfortable and at home in this environment. Unique activities and transformable furniture make this space exciting with endless opportunities for


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play. Through interactive stations, such as ‘What shape do you see?’ station, ‘Make your own sculpture’ station and ‘Familiar’ stations, the incoming patients will begin to engage themselves with the new ‘home’ environment and experience artistic expression. The ‘Make your own sculpture’ station suggests to patients that they can combine found objects and debris collected following natural disasters to create art on a magentic board, which is intended to help patients identify with the existing condition of their current environment. The ‘What shape do you see?’ station will include a clear markerboard with changeable images and will be used for general artistic expression. ‘Familiar’ stations will have an image that relates to familiar places in the region’s surroundings and will encourage the patients to draw a self-portrait into the image to foster re-identification with their previously familiar environment. A ‘fun facts’ graphic will remind the patients that their familiar environment is special and unique in fun ways, providing information about local and regional animals, plants, and weather, allowing an opportunity for the patients to learn more about their surrounding environment. A general lounge space is located near the entrance/exit for visiting family members and guests as well as NGOs or other responsible parties. This space is separated from the main waiting area for several reasons including visiting families or guests that may prefer not to share a waiting space with incoming patients and their responsible parties. Also, this lounge is designed to be more intimate, considering visiting parties may want a moment to reunite with their child. The lounge incorporates comfortable furniture in a simple layout, similar to a living area of a home. The design of this space will includes the continuation of imagery and graphics also related to the environment of the region, but this will be considered a space for adults. Adjacent to the lounge area is the main waiting area, which is located in front of the reception area. This space accomodates older incoming patients, visiting families and guests.


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Because of possible high anxiety levels in patients and visitors, the design for this space consists of a simple and comfortable color palette and a relaxing furniture layout that includes large club chairs, couches, ottomans, and end tables. A young adults area is also part of the main waiting area, incorporating the use of computers with headphones to avoid disrupting the quiet and comfortable atmosphere promoted in the main waiting area. Patient Units The patient units provide bedrooms for displaced patients and for patients who have severe, but manageable mental disorder symptoms, such as depression or anxiety. The design allows patients to personalize specific areas of their unit and provides privacy for changing and self-grooming, a small closet space, and a work area to give patients a ‘home-like’ environment during their temporary stay in the facility. This area accommodates four patients per unit with 8’ ceilings. The design of the wall panels follow the standardized design, however, there are four areas within the back-painted glass section of the wall panel that vary, by changing into film and cork to create two markerboards and two corkboards. One corkboard and marker board combination is located above the small work area and the other is located on an outside panel wall, to be used for posting fun facts and identification to each residing patient. Flooring for this area will be a 2’ x 2’ non-directional carpet tile. Accessories and additional furniture components included within the design are as follows: five shelves (1’-6” x 4’), one shelf (1’-6” x 1’), a bench (1’-6” x 4’), a desktop (1’-6” x 2’), two coat hooks, three picture hangers, a tamperresistant curtain rod with privacy curtain, and a closet shelf with clothes hangers.


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The prototypical location of the patient units is Creston, Iowa, in the Midwest region of the United States. The color, finishes, and materiality of the waiting area is inspired by images of the Midwest’s natural environment. The Midwest region color palette consists of golds, beiges, blues, and greens (See Visual 9). While entering a patient unit, a small work area is located on the right and consists of a desk made out of white Corian and a stool with a vivid red top and a colorful patterned bottom, while a small closet space with a white Corian bench, shelving, and a privacy drapery is located on the left. A modular bed with playful patterns of yellows, bieges, and gold can transform into a couch with two end tables or into a table with chairs and is located in the corner of the room next to a bed-side shelf. The backpainted glass on the wall panels are covered in an aqua color that is similar to colors found in clothing and jewelery of the Native American culture, bringing a sense of the existing regional culture into the space. Multi-purpose Rooms Near the patient units, there are two multi-purpose rooms: one that supports activities that help patients emotionally ‘attach’ to the facility and another that supports activities for patients ready to emotionally ‘detach’ from the facility. The layout of both spaces are very similar, providing an easy transition from one room to the other; however, the activities taking place within these areas are very different. Since the treatment program of this facility is decided by its staff and users, these multi-purpose areas are flexible, allowing for all ages of patients to inhabit the space at one time or for a few patients to participate in certain activities of interest when prescribed. The colorful design of the wall panels was inspired by the design concept - the emotional ‘attaching’ and ‘detaching’ of patients and staff. These panels incorporate a combination of squares and rectangles that connect, but are also visually detached from one another. The atmosphere of these rooms is playful, exciting, and energizing due to the activities


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that occur in the rooms and the incorporation of playful design elements. Flooring for this area will also be a 2’ x 2’ striped carpet tile, allowing for easy mobility and cleanability. Accessories for this area include twenty picture hooks for various displays of patient’s work, six 4’ x 1’-6” shelves, and six 1’ x 1’-6” shelves per activity area. The prototypical location of the multi-purpose rooms is Sacramento, CA, in the West region of the United States. The color, finishes, and materiality of these rooms is then inspired by images of the West’s natural environment, defining the West region color palette, which consists of purples, blues, and golds. The attach and detach multi-purpose rooms include a small play area to the right with a large light oak storage cabinet for toy storage and a brightly-colored blue modular couch. Throughout the center of the room, there will be eight square cafe tables with four stools per table for drawing and other activities. The left wall is designed to display children’s artwork while the back wall serves as a background for small activity areas, including music/dance, art, and theater/drama. Each of these activity areas will have a large light oak cabinet on casters, and two small white moveable cabinets to store supplies as well as the incorporation of shelving and corkboard above the storage cabinets. The shelving and picture hooks for each activity area allows for a variety of display options, depending on the room being an ‘attach’ or a ‘detach’ multi-purpose room. The ‘detach’ multi-purpose room will display other patient’s success stories that could be in any form, such as drawings, paintings, art, play scripts, verses of a rap, or pages of a book. The ‘attach’ multi-purpose room will display artwork or objects created from an activity and will also function as storage for necessary supplies per activity area. Patients can play with the supplies in that activity area or move the cabinets into the middle of the room to include everyone in an activity. For both the ‘attach’ and ‘detach’ multipurpose rooms, each activity area will incorporate familiar elements of the surrounding


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environment. For example, the theater/drama activity space for the West region of the United States could provide play scripts, costumes, that may include a surfer on the beach, a farmer in a valley, or a cowboy on a mountain, with props that convey the different natural environments that exist within the region. The music/dance activity space could include appropriate folk or pop dancing and music that is typical or popular in the West, as well as specific mediums and local types of art. The subject of the art can also include components of the region’s natural environment and various people’s cultures. The right back wall is designed to accomodate the needs of young adults, providing desks and taller stools for a computer area and a small lounge area for video games and for simply hanging out. Colorful, modular furniture, such as two transformable couches, two end tables, four ottomans, and a light oak t.v. stand, make the space customizable. The backpainted glass on the wall panels are covered in a playful purple and a deep goldenrod, creating a unique rhythmn and excitement through pattern and color.


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Conclusion The design conceived for the children’s mental healthcare facility addresses the significant need for the integration of a sense of place, which has not been previously considered in mental healthcare design. The proposed design encompasses the three components that define a child’s perception of a sense of place to help patients overcome a tragic situation that often occurs after natural disasters, the development of severe mental disorder symptoms. In areas that incorporate elements of play, school, and a ‘home-like’ environment, patients can experience a sense of place through personalization of spaces, ‘attach’ and ‘detach’ activities, and gain familiarity through materiality and color palettes that are culturally sensitive to the regional environments of the United States. The design creates a place where patients can feel safe and secure in environments that encourage a sense of community with other children who have similar struggles. The playful environment encourages healing through unique educational techniques and interactive activities that stimulate learning and growing. Educational components assist patients in personal re-identification with the familiar natural environment, as known before the natural disaster, and with their current environment, as after the natural disaster, helping the patient subconsciously reconcile with their changed situation. Such design for mental healthcare facilities should provide healing, wellness, and a sense of belonging for children who suffer from symptoms of mental disorders due to the devastation created by natural disasters.


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References

Aquilino, M. (2011). Beyond Shelter: Architecture and Human Dignity. New York, NY: Metropolis Books. Architecture for Humanity. (n.d.) Retrieved from http://architectureforhumanity.org/about. Architecture for Humanity. (2006). Design Like You Give a Damn: Architectural Responses to Humanitarian Crises. New York, NY: Metropolis Books. Athey, J. & Moody-Williams, J. (2003). Competence in Disaster Mental Health Programs: Guiding Principles and Recommendations. U.S. Department of Health and Human Service: Substance Abuse and Mental Health Services Administration Center for Mental Health Services. Belfer, M. (2006). Caring for children and adolescents in the aftermath of natural disasters. International Review of Psychiatry, 18, 523-528. Bell, B., Wakeford, K. (Eds.). (2008). Expanding Architecture: Design as Activism. New York, NY: Metropolis Books. Billig, M. (2006). Is my home my castle? Place attachment, risk perception, and religious faith. Environment and Behavior, 38, 248-265. Cabot, S. (n.d.) Disaster field hospitals: triage and treatment in times of crisis. Homeland Security, Retrieved from http://www.blu-med.com/pdf/sandra_cabot.pdf. Carrico, K. (2011). Blurring the Boundaries: redefining the mental health paradigm through permeable space. Retrieved from Savannah College of Art and Design-ThesesDepartment of Interior Design.


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Chatterjee, P. (2005). Mental health care for India’s tsunami survivors. The Lancet, 365, 833834. Colliers International. (2010). The Big Box Dilemma: Part 1: Second Generation Big Box Retail. Retrieved from http://colliers.com/research. Cross, J. (2001). What is Sense of Place? Department of Sociology: Colorado State University, 1-14. Dahl, M., Sorenson, O. (2010). The Social Attachment to Place. Social Forces, 89(2), 633-658. DIRTT Environmental Solutions (n.d.) Retrieved from http://www.dirtt.net/walls/. Eshelman, P., Evans, G. (2002). Home Again: Environmental predictors of place attachment and self-esteem for new retirement community residents. Journal of Interior Design, 28(1), 1-9. Fernando, G. (2005). Interventions for Survivors of the Tsunami Disaster: Report from Sri Lanka. Journal of Traumatic Stress, 18, 267-268. Ham, T., Guerin, D., & Scott, S. (2004). A cross-cultural comparison of preference for visual attributes in interior environments: America and china. Journal of Interior Design, 30(2), 37-50. Hutchison, D. (2007). Drawing on children's "sense of place"-the starting point for teaching social studies and geography. The Literacy and Numeracy Secretariat, 1-4. Kopec, D. (2006). Environmental Psychology for Design. New York, NY: Fairchild Publications. Krol, D., Redlener, M., Shapiro, M., Wajnberg, A. (2007). A Mobile Medical Care Approach Targeting Underserved Populations in post-Hurricane Katrina Mississippi. Journal of Health Care for the Poor and Underserved, 18, 331-340.


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Lindgaard, C., Iglebaek, T., Jensen, T. (2009). Changes in Family Functioning in the Aftermath of a Natural Disaster: the 2004 Tsunami in Southeast Asia. Journal of Loss and Trauma, 14,101-116. Long, D., Perkins, D. (2007). Community Social and Place Predictors of Sense of Community: A multilevel and longitudinal analysis. Journal of Community Psychology, 35(5), 563581. Manzo, L., Perkins, D. (2008). Finding Common Ground: The Importance of Place Attachment to Community Participation and Planning. Journal of Planning Literature, 20, 335-350. Najafi, M., Shariff, M. (2011). The Concept of Place and Sense of Place in Architectural Studies. International Journal of Human and Social Sciences, 6, 187-193. Nebelong, H. (2008). A sense of place: Improving children's quality of life through design. Green Places, 45, 20-24. Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in sri lanka. Journal of Traumatic Stress, 19(3), 339-347. Newman, D. (2006). Sociology: Exploring the architecture of everyday life. Thousand Oaks, CA: Sage Publications. Pable, J. (2010) Socially Beneficial Design: What can interior designers do? In Martin, C. & Guerin, D. (Eds.). The State of the Interior Design Profession (p. 8 -16). New York, NY: FairChild Books. Read, M. (2007). Sense of Place in Child Care Environments. Early Childhood Education Journal, 34(6), 387-392.


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Figures Colliers International. (2010). [big-box closings table]. The Big Box Dilemma: Part 1: Second Generation Big Box Retail. Retrieved from http://colliers.com/research. Designtex. (n.d.). [uptown upholstery]. Retrieved from http://www.designtex.comProductSearchResults.aspx?f=35536&pg=1&nm=UPTOWN. FEMA. (n.d.). [photos from natural disasters in the United States]. Retrieved from http://www.fema.gov/photolibrary/. GaenKho. (n.d.). [modular puzzle piece furniture ]. Retrieved from http://www.behance.net/gallery/Seating-Furniture-TAT-Tris/525699. Hey Team. (2010). [modular bed]. Retrieved from http://www.heyteam.it/. Institute for Self Reliance. (2007). [comparison of big-box stores and their sizes]. Retrieved from http:// newrules.org/retail. Steelcase. (n.d.). [large storage cabinet]. Retrieved from http://www.steelcase.com/en/products/ category/storage/cabinets/denizen/pages/overview.aspx. Steelcase. (n.d.). [mobile storage cabinet]. Retrieved from http://www.steelcase.com/en/products/ category/storage/cabinets/campfire/pages/overview.aspx. USA. (n.d.). [information regarding Sacramento, California]. Retrieved from http://www.usa.com/west-sacramento-ca-income-and-careers.htm. USA. (n.d.). [information regarding the city of Corpus Christi, Texas]. Retrieved from http:// www.usa.com/corpus-christi-tx-income-and-careers.htm USA. (n.d.). [information regarding the city of Creston, Iowa]. Retrieved from http://www.usa.com/creston-ia.htm.


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Walmart. (n.d.). [empty big-box store information for existing sites and locations]. Retrieved from http://walmartrealty.com.

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List of Visuals Visual 1 - Design Concept Diagram Visual 2 - Region Diagram - The Midwest Visual 2.1 - Region Diagram - The Southwest Visual 2.2 - Region Diagram - The West Visual 3 - Zoned Floorplan Layout Visual 4 - Entrance to play room in waiting area Visual 5 - Interactive Stations in the play room of the waiting area Visual 6 - Interactive Stations in the play room of the waiting area Visual 7 - Floorplan of Waiting Room and Southwest-inspired color palette Visual 8 - Closet area and bed of patient unit Visual 9 - Small work area and bed in patient unit Visual 10 - Floorplan of patient unit and Midwest-inspired color palette Visual 11 - Floorplan of multi-purpose room and West-inspired color palette Visual 12 - Multi-purpose room perspective of cafe tables and young adults lounge Visual 13 - Multi-purpose room with activity areas

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Appendices Appendix A1 - History of Mental Healthcare A history of mental healthcare was thoroughly explained by Carrico (2011). Beginning in 1773, the first hospital, in Williamsburg, Virginia, was created for the treatment of the mentally disabled (p. 10). Because the traditional treatments of restraint, strong drugs, plunge bath, bleeding and blistering salves did not work, recreation and exercise activities were implemented in 1790 (p. 11-12). The implementation of a new system in 1836 caused mental health to shift towards self-control, moral management, and kindness, versus restraint (p. 12). Patient rooms began to resemble apartment living with libraries, vocational training, and gathering areas that created a sense of community (p. 12). During the nineteenth century, doctors believed that these mental disorders were curable, but these cures could only be achieved through an appropriate facility, emphasizing the need for a mental health facility (p. 12). Carrico reports that mental health reform occurred at the turn of the twentieth century due to an autobiography written by Clifford Beers (p. 13-14). During this reform, available services for those with mental disorders were enhanced, there was a significant improvement of society’s perception toward mental disabilities, a support and promotion of mental healthcare, and research that promoted the prevention of mental disabilities (p. 14). Mental healthcare then made many leaps ahead through significant funding for mental health services became successful, the number of patients occupying mental hospitals decreased, and the stigma toward those who suffer from mental illnesses have also decreased (p. 14). Deinstitutionalization, which is the shift of treatment from mental institutions into community-based and family-based environments, began to grow during the middle of the twentieth century (p. 15). Shorter outpatient care became more evident in mental healthcare


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rather than longer inpatient care. During the 1960’s, Paul Rudolph created the ‘Architecture of Insanity,’ a mental health facility that was designed to reflect the relationship between a building and the psyche of the mentally ill (p. 15). This concept was an experimentation of mental health environments, but was not a successful design. Because of tax cuts in the 1980s, the quality of mental health treatment decreased and consecutive research was not able to be fully conducted due to a lack of funding (p. 15). Within the 21st century, mental health courts have already been created to address mentally disable defendants and support a positive transformation of the mental health system (p. 19-20). The additional presence of mental health care organizations, advocates, health care providers, researchers, and educators have helped to improve overall mental health in America (p. 20). “Psychosocial care can be just as valuable as material assistance in disaster situations and there is growing evidence to show that early diagnosis and timely interventions can make a significant difference to the recovery process, but few people who have experienced natural disasters view themselves as in need of mental healthcare, and are therefore unlikely to seek help” (Chatterjee, 2005, p833). Chatterjee defends the idea that traditional methods should be avoided as well as uses of mental health labels, and replaced with an active outreach approach. Counseling sessions are generally approached to be entertaining and interactive with many games and opportunities to express ones creativity and concern (p. 833). “Biologically, traumatic stress in childhood negatively affects the development of neural networks and the neuroendocrine systems that regulate them, which for many results in enduring brain dysfunction” (Wahlstrom, Michelsen, Schulman, & Backheden, 2010, p. 245). Therefore,


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children are significantly affected by the stress that is associated with natural disasters. Wahlstrom, Michelsen, Schulman, & Backheden state: The toll of disasters on psychological health is substantial. Although most individuals experience only transient distress after the immediate reactions have subsided, a significant portion of survivors do go on to develop psychological symptoms. Posttraumatic stress disorder is the most studied outcome, but depression, anxiety, various stress-related somatic symptoms, problematic alcohol consumption or the exacerbation of existing psychiatric disorders are other known consequences (p. 245).


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Appendix A2 - History of Disaster Relief Shelters

‘Architecture for Humanity’ (2006) is a book that reports the latest development in shelter designs for disaster relief. According to the book, an emergency tent is an idea that has existed for a long period of time and is still considered a usable resource for all types of disaster relief. Previous designs have either been too permanent, too difficult to install, or too costly to replicate (p. 60). In 2002, there was a growing sense that the design of tents should be overhauled. The idea of a synthetic, lightweight emergency tent was proposed, which provides a solution that will not deteriorate quickly, giving a smaller volume and weight which saves on shipping costs and increases an easier handling (p. 62). The design of the tent itself and how it separates space, thoroughly considers a need for privacy through the implementation of private spaces, semi-private spaces, and open spaces (p. 62). Modular shelters that fold, made from corrugated laminate, began their prototypical development in 1995 (p. 74). Because of materiality, this design has a limited shelf life as well as concerns for cost and logistics associated with shipping. However, the designer believes that the sturdiness of the shelter’s construction makes up for the additional expense of producing such a design. A concrete canvas prototype was invented by engineers at the Royal College of Art to act as a ‘building in a bag.’ According to the design, the bag inflates and twelve hours later a structure is ready for use (p. 98). The canvas fabric is impregnated with cement and filled with water. “The size of the sack controls the water-to-cement ratio, eliminating the need for measurement.” (p. 98). After leaving the bag for fifteen minutes so that the concrete becomes completely hydrated, a cloth-like fiber matrix and water-absorbent bonding agents draw water,


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creating a chemical reaction that mixes with the cement. The next step is to unfold the structure, which begins the inflation process, causing a release of gases. Once the structure is inflated, it should be left to harden and then the openings must be cut for doors and ventilation. A design for a shelter can also be made from shipping pallets, which was an original idea that was created in 1999 for ‘Architecture for Humanity’s Transitional Housing Competition’ for a refugee community (p. 114). Because of the ever-present influx of aid during disaster relief, shipping pallets are constantly available. According to the environment of implementation, the pallet shelter could be left open for air ventilation or it could be properly insulated for colder conditions. This design is seen as sturdier, compared to typical emergency tent designs. A balloon system is another example of disaster relief housing. Sometimes these designs seem too high-tech and unfeasible. This particular balloon system offers a low-tech solution through the implementation of hemp as its materiality. Hemp is considered a strong, long-lasting, inexpensive, and abundant natural resource (p. 118). Although this idea is somewhat unusual as a structure, it represents innovative thinking. The idea is to sew used hemp sacks together to form a dome-shaped structure with a construction that is separated into prefabricate elements that can be assembled off-site or a local industry near the site (p. 118). The sewn hemp skins are connected to plastic ties and attached to specific elements of the structure. The hemp structure must be stuffed with inflated airbags or balloons, then a thin layer of concrete must be created to develop an exterior shell. After the concrete has dried, the excess hemp is cut from the openings and deflate the airbags, which can be reused (p. 118). All these ideas, although promising, fail to acknowledge the fact that there might be a number of existing buildings that, if properly retrofitted, could be used as shelters.


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Appendix A3 - Code Guidelines for Mental Healthcare

According to AIA standards, behavioral health care facilities must have 100 net usable square feet per private patient room and 80 net usable square feet per patient in a semi-private room (Sine & Hunt, p. 9). Space Planning Considerations If possible, have all outlets in each patient room on a separate circuit and be able to locate breakers for these circuits so they are readily available to staff without having to enter the patient rooms (Sine, & Hunt, 2007, p. 9). Locate serviceable parts of patient room HVAC systems where they can be serviced without entering the patient rooms (Sine, & Hunt, 2007 p. 9). Blind spots in corridors where patients cannot be observed by the nurse’s station must be avoided whenever possible (Sine & Hunt, 2007, p. 12). Safety Issues - Levels 1 through 5 - Level 5 being the highest level of concern -”Level 1 - Staff and service areas where patients are not allowed.” -”Level 2 - Corridors, counseling rooms, interview rooms and smoking rooms where patients are highly supervised and not left alone for periods of time.” -”Level 3 - Lounges and Activity Rooms - where patients may spend time with minimal supervision.”


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-”Level 4 - Patient Rooms (semi-private and private) and patient toilets - where patients spend a great deal of time alone with minimal or no supervision.” -”Level 5 - Admission rooms, examination rooms and seclusion rooms - where staff interact with newly admitted patients that present potential unknown risks and/or where patients may be in a highly agitated condition.” (Sine& Hunt, 2007, p. 9-10). Construction and Materials Considerations The following construction and materials considerations are according to Sine & Hunt (2007). “Floors should avoid patterns and color combinations that may appear to animate into objects that could contribute to visual misperception by patients” (p. 12). Ceilings should be carefully considered if lay-in acoustical tile is being installed. Clips could be a good solution to keep patients from tampering with the ceiling tiles (p. 12). Glass should be tempered, if applicable. However, for mirrors and cabinet windows, a polycarbonate material should be substituted for glass (p. 12). Hardware should be chosen carefully in behavioral health facilities, considering what could be a risk for the patient. For instance, the design of hinges, arm pulls, push/pull latches, knobs and levers, and fire safety equipment should be thoroughly considered before specified. Some hardware, such as locks, could be tampered with and could put patients at risk. Other types of hardware, such as levers, knobs, and rods, could be used for suicidal purposes (p. 13-14).


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Light fixtures should be installed at an appropriate height or location that is not necessarily accessible to patients. If they are near a patient’s reach, tamper-resistant hardware and shatter-proof bulbs must be specified (p. 15). Window treatments should not have cords or chains and must be flush mounted tight to the ceiling (p. 15). All kitchen appliances, including garbage disposals, should have key operated lock-out switches that disable the appliance, providing a child-resistance feature and promoting safety for the patients (p. 17). Furniture should not provide opportunities for hiding contraband and must resist being disassembled by patients. It should also be very sturdy and easily cleanable (p. 19-20). “Non-adjustable beds without wire springs or storage drawers are preferred” (p. 20). The use of restraints should be considered when selecting beds, if necessary (p. 20). Door swings should swing into the corridor to prevent patients from barricading themselves into their room (p. 21). Security for entrance doors should be strongly considered, providing an intercom and/or pushbutton type lock to ensure safety of all patients (p. 14). Exit doors must be locked at all times, specifically with magnetic locks in case of an emergency (p. 14). Seamless flooring should be strongly considered for clean-ability (p. 23). The shower curtain material should be made of cloth that is treated with waterproofing. Plastic shower curtains should not be installed due to a risk to the patients (p. 25).


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All lavatory waste and supply piping must be enclosed and should not be accessible to patients (p. 25). All artwork and wall installations should have polycarbonate type glazing and the frames should be screwed to the walls with tamper-resistant screws (p. 16). Appendix A4 -Product analysis: DIRTT Environmental Solutions The flat-pack systems will be designed with DIRTT wall products, a company that creates pre-engineered and pre-manufactured walls that are completely moveable and customizable (DIRTT, n.d.). These products have been thoroughly evaluated through a showroom visit that had settings implementing DIRTT products, several DIRTT factory observations, a tour of the manufacturing process, an interview with a DIRTT public-relations employee for information regarding product manufacturing, product durability, and product implementation, and a phone interview with a DIRTT healthcare specialist, regarding healthcare concerns with clean-ability, applications of healthcare codes, appropriate sources for power, data, plumbing and electrical implementation, and ensuring a successful integration of DIRTT products for disaster relief use. A product evaluation was necessary to compile information from all of these interviews and observations The DIRTT Product line features customizable doors, walls, floors, and accessories. This unique and innovative lines of products is completely customizable because of its preengineered, pre-manufactured construction. According to their philosophy, “The environment must be fully responsive to both aesthetic and functional needs, at point of creation and over time, without concern for compatibility� (DIRTT Environmental Solutions, n.d.). Because of this way of thinking, anything in the design is possible with DIRTT products.


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The line of DIRTT walls comes in a few customizable types: ‘breathe’ living wall, face mounted tiles, center mounted tiles, combination, and bespoke. The ‘breath’ living wall is a simple system that incorporate plants into the DIRTT wall system. This particular system can be retrofitted onto any existing DIRTT wall and mounted to any vertical surface such as gypsum, concrete, stone, etc. It is easily expandable from one panel to the next, creating a monolithic wall of plant life. Face mounted tiles support any manufacturer’s new or legacy furniture, storage, appliances, and technology. These walls support data, power, security devices, medical gasses, and plumbing. Each side of this wall can function independently as an aesthetic, but it can also function independently. Center mounted tiles offers all kinds of design opportunities including curves, vistas of glass, muntins or mullions, side-lites, clerestories or transoms, or even specification of local materials. The combination walls specify the all DIRTT walls can be combined to create a unique design full of function, privacy, glass, wood, and paint. Bespoke combines unique sizes, combinations, curves, angles, dimensions, and shapes. Anything is possible with Bespoke line of walls.


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Breathe’ Living Walls

Face mounted wall tiles

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Center mounted wall tiles

Combination Wall

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‘Bespoke’ wall DIRTT doors are unique because they allow for height adjustments and easy on site installations. There are three different door types: sliding doors, pivot doors, and butt hinged doors. Sliding doors bring further freedom than typical sliding doors, by being non-handed for reconfigurations with optional locking versions and elegant styles. Pivot doors have optional automatic closers, frameless giant glass styles, veneer wrapping, and unique pivot styles such as a center-pivot door. Butt hinge doors are typical doors, but DIRTT gives this option so that customers can only order hardware from DIRTT and order the door locally. DIRTT floors provide a low-profile access floor that is suitable for power, data, and building management technologies. This flooring system allows for quick power infrastructure changes, easy access, a quiet foot-fall, cable management, and a fast installation.


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DIRTT accessories include a variety of items, such as different brackets for hanging pictures, trays, coat hooks, shelves, furniture, or even office supplies.

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Product analysis: DIRTT Factory and showroom

The DIRTT factory in Savannah, GA

The DIRTT factory in Savannah, GA

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DIRTT Markerboard

DIRTT data/technology components

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DIRTT accessories - paper holder

Markerboard and markerboard tray

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accessories - magazine holder

accessories - flower holder

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Coat hook

Installation of a ‘Breathe’ living wall

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Shelving

Center-mount wall tiles

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Combination wall example

Brackets

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Brackets

Brackets

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Door hardware

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Appendix A5 - Case Study - Mental Treatment Center for Children in Savannah, GA Mental Treatment Center: Savannah, GA -specializes in acute care (5-7 day program) and residential treatment programs (range from 3 months to 1 year program) for children, ages 4-17, with a 1:5 ratio- children to staff -treats children who have behavioral issues, psychiatric disorders, verbal/physical aggression, suicidal/self injurious behaviors, effects of PTSD/trauma, school learning problems and familial dysfunction -has a specialized program to provide care and treatment for residents with developmental delays/mental retardation -has a specialized treatment program to provide for sexually aggressive and sexually reactive behaviors resulting from sexual trauma Programming A “home-like environment� -they are responsible for cleaning their rooms, working together to clean common areas, personal hygiene and laundry -they have a point system that awards them for good behavior by giving them more longer phone conversations at night, a later bedtime, unique privileges like movies, cds, makeup, earrings, watches, outings to the movies, etc and penalizes them for bad behavior How can a mental facility create a home-like environment while also incorporating and considering safety?


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Daily Recreation -they are equipped with licensed recreational therapists who plan activities such as dances, basketball games, art and craft projects and cooking classes - to support these activities there is an indoor gymnasium as well as an art room (with a kitchenette) -these activities are decided on according to the mental disorders of the children as well as age and scoring on leisure assessments and skills -all activities help children improve on their social skills, trust-building skills, and promoting a healthy lifestyle -An outside recreation area is available for activities to only children who are considered at a certain level -The outside area, which is surrounded by high fencing and video cameras, is divided up into 5 units, allowing 5 different groups of children to play outside at the same time, while still being separated. This facility has a pool (with lifeguards), a basketball court, and open fields for festivals and cook-outs in the summer -During free time, children gave play with cards, dominoes, puzzles, and the indoor gym. They cannot play with board games or other items that may cause harm to the children -There are co-ed activities and outings on the weekends depending on the children’s behavior during the week Units - as of recent there are operating 8 residential units and 2 acute units -Children are divided into units, based on age, gender, and levels of mental capability -Most children have roommates and must share a room and bathroom with other children while they sleep


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-Each unit is equipped with its own nurses’ station, play area, individual and group therapy rooms, as well as laundry facilities and a time out room -Each unit is staffed by a psychiatrist, program director, therapist, senior counselor, mental health assistants, nurses, and other special expertise according to need. -Units have a meeting every morning with all staff and children, focusing on their individual goals for the day as well as how they are feeling or what problems are arising within individuals and within the unit as a group Family Interaction -Family interaction is very important to this facility, allowing children to see their families 4 times a year with accommodations provided by the treatment center or state funding. -Visiting areas allow guests and family members to interact with the children through games and various entertainment; If families are visiting, they are allowed to take their children on an “outing” through the city if they desired. -Children are encouraged to bring items that remind them of their family and of home; however there are EXTREME restrictions to what the child may or may not have in the facility because of suicidal behavior and aggressive behavior -Children are also encourage to speak with their parents on a daily basis through phone calls that are given as a privilege at night Pharmacy and Medication -All medication is in contract with a company and is delivered daily to the unit nurses in bubble packages for specific dosage times


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Patient Rooms -Children have open shelving, bunk beds that are bolted to the floor, daylighting with blinds that are permanently closed, and bathroom with a mirror (made out of plexi-glass), sink, toilet, and shower (the shower curtain is permanently pulled back to avoid suicidal issues) -They are allowed to decorate their rooms once they have proven good behavior and have reached a certain amount of points Therapy -play therapy - for younger children - involves sand boxes, drawing, stuffed animals, role play -older children - creating a book that describes what happened, or role playing and creating an easy environment for them to talk about their issues or what happened without forcing them to talk through their problems -Therapists specialized in specific types of therapy and behavior and rotate children every 6 weeks, allowing a variety of treatment types and experiences for the children School -There is an integrated Chatham County/Georgia Accredited Public School System within the treatment center, allowing students to continue classes while receiving credit during their times of therapy and treatment -Students, who have been permanently removed from the public school system, can also earn their GED’s through the education program -The school schedule is not the same as typical public schools, allowing for group therapy and individual therapy sessions to occur during the day


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Appendix A6 - ‘Place-Making’ Game Results

Rate The Place

Comfort and Image Overall Attractiveness Feeling of Safety Comfort of a Place to Sleep Comfort of Therapy Rooms

Uses and Activities Frequency of events/activities Variety of activities

Average rating

2.57 2.45 2.26 2.37 3.20

2.64 2.64 2.46

Overall excitement of activities and play time

2.58

Activities that support learning and growing

2.86

Sociability

2.46

Frequency of social events

2.24

Number of friendships that have developed

2.61

Play and learn well with others

2.53

1. What do you like best about this place? The outside pool The fact that I can let my emotions out in a positive way Some of the staff A place to sleep It’s ok but it’s not home The help I’m getting

The privileges Gives you a second chance in life Outings x3 Food outings The dances! I can call home every day The girls x2


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Coed activities x3 Coed classroom The therapy—learning how to control myself I am on student council and that is supportive for me The food x3 Outings, field trips, friends, some of the groups

The Recreation Therapy staff because they help me get in shape Going outside and social events The staff who really like their jobs My relationship with staff We bow when we pray The therapists x3 The teachers The people I can get along with Staff is like family to me 2. List things that you would do to improve this place that could be done right away and that wouldn’t cost a lot: Get us some video games Coed activities daily A new washer and dryer (one unit’s is Take down some of the fences Allow iPods broken right now!) Have more to do on 2nd shift (after 3pm) Game systems for each unit Go to the park and have lunch twice Bean bags and couches in the day every week if we have good behavior rooms New more comfortable chairs Paint the walls brighter colors x2 More freedom Being able to socialize with other units in Get independent living information and the cafeteria study it to be successful More social events, more outside time Blinds (our blinds don’t open—they are More groups, more time-consuming inside two panes of the window) activities TVs in our rooms Take us to the mall New food and see the girls more A bigger pool and more outings to the Bigger doors park More events For kids to stop fighting Take the blinds out of the inside of the Better mattresses and pillows x2 windows and put up sunblock/tint on the Put clothes in the point store outside Paint pictures in the time out rooms More recreation and coed activities 3. What changes would you make to therapy rooms and how could it benefit your therapy sessions? More time and comfortable chairs Make them more fun Have longer passes The therapy rooms are the nicest place in the building already Make sessions shorter Make sessions longer Sensory benefits Nothing because it’s all good More games, like legos, Knex, Barbies Make them bigger x3 (to act out things) Have a more comfortable child-like Computers for patients Candy atmosphere with hands on activities Good toys Make the rooms a different bright color Add a fishtank x4 Inspirational paintings on the wall, more Make them look bigger with windows comfortable sitting areas and mirrors


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Make them darker, because the dark calms me and lets my mind think openly More books Make them bright to keep us happy in therapy Do sessions outside more

Bright colors on the wall, it would make my sessions more bright and not depressing Put a mailbox on their doors Sandboxes

4. We did not survey question #4‌our kids answer more honest when they don’t work together! 5. Draw how you could make some of these changes: most drawings were unavailable, but there are a few examples below.


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Appendix A7 - Visuals

Visual 1 - Design Concept Diagram

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Visual 2 - Region Diagram - the Midwest

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Visual 2.1 - Region Diagram - the Southwest

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Visual 2.3 - Region Diagram - the West

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Visual 3 - Zoned Floorplan Layout

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Visual 4 - Entrance to Play Room in Waiting Area

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Visual 5 - Interactive station in the play room of the waiting area

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Visual 6 - Interactive stations in the play room of the waiting area

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Visual 7 - Floorplan of waiting room and Southwest-inspired color palette

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Visual 8 - Closet area and bed of patient unit

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Visual 9 - Small work area and bed in patient unit

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Visual 10 - Floorplan of patient unit and Midwest-inspired color palette

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Visual 11 - Floorplan of multi-purpose room and West-inspired color palette

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Visual 12 - Multi-purpose area with cafe tables and young adults lounge

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Visual 13 - Multi-purpose room with activity areas

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The Integration of Mobile Psychosocial Care into Disaster Response  

an interior design thesis project based on a mobile prototype for an effective and quickly assembled mental health facility for disaster rel...

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