Behavioral Health for Children and Adolescents

Healthcare Behavioral Health for Children and Adolescents

Think What’s What’s Possible Possible Page is a powerfully powerfully imaginative imaginativeand andcollaborative collaborative architecture and architecture and engineering engineeringfirm: firm:one onethat’s that’sready readyfor for today and designed designed for for what whatcomes comesnext. next.We Wepair pairform form with function, function, reason reason with withemotion, emotion,and andideas ideaswith withexpert expert implementation. At implementation.

At Page, Page,the thepotential potentialofofwhat’s what’spossible possibleisis paired with the the practicality practicalityof ofhow howto tomake makeitithappen. happen.Our Our purpose is designing designing places placessmarter, smarter,while whileimproving improvingthe the experiences of of those those who whowork, work,live, live,and andlearn learnininthem. them.From From thought to finish, finish, Page Page experts—of experts—ofall alldisciplines—see disciplines—seethe thebig picture, big picture, figure figure the best the best way way forward, forward, and deliver and deliver solutions solutions in inventive in inventive and and amazing amazing ways. ways.

Imagine Imagine that. that.

Visit our website at pagethink.com

Visit our website at pagethink.com

Central State Hospital Adolescent Wing’s Sensory Room / Petersburg, Virginia (Rendering)

Hope, Trust, and Connection Supporting pediatric and adolescent health— caring for the whole child.

Page is invested in helping our clients integrate advanced therapeutic treatment, safe environments, children’s healthcare best design practices, good stewardship for the betterment of all, and quality of life into recovery-based behavioral health settings.

Design Considerations § Safety § Community Oriented § Patient-and FamilyCentered Care § Provide for Positive Distractions § Visual Security § Flexible Room Layout § Choice and Control of Environment § Access to Outdoor Spaces § Neighborhood Layout § Evidence Based Design

A good life requires a healthy start, and all children deserve support for their health, including their mental and behavioral health.

Page incorporates evidence-based design concepts and clinical treatment approaches to help children and their families heal and thrive. Our designs show how familyfirst facilities can incorporate nature and community into a safe place free from the stigma of mental healthcare.

The Commonwealth Center for Children & Adolescents was among nine Virginia Behavioral Health facilities for which Page recently provided therapeutic assessment survey and improved design recommendations.

We believe in creating warm, healing environments for growth and recovery with design that offers state-of-the-art treatment spaces in trauma-sensitive environments. Visual and physical access to nature and sunlight calm patients and comfort families and staff. Clear sight lines and subtly integrated security systems blend unobtrusively into safe, durable environments, secure exteriors; community connection; and hope / recovery for our most vulnerable population.

Art and environmental graphics reinforce the atmosphere of healing and enhances the patient and family experience. Vibrant, interactive environments enhance young patients’ journey to health and recovery by allowing them selfsoothing activities and a sense of control over their new environment.

2

Behavioral Health for Children and Adolescents

Case Studies Regional Institute for Children and Adolescents (RICA) Baltimore, Maryland The Behavioral Health Campus for Children & Adolescents includes three, 15-bed inpatient units, a patient courtyard, and a Day School for both inpatient and outpatient behavioral health patients.

The campus integrates “public” space for education and “private” space for three 15-bed living units. Public and private spaces orient around courtyards. An inpatient school-related treatment space serves as the “bridge” between the two zones.

Intermountain Primary Children’s Hospital at Lehi Lehi Valley, Utah Page designed the Pediatric Crisis Center and Inpatient Behavioral Unit to establish Intermountain’s new campus for children’s health. To be completed in December of 2023, the facility includes behavioral health space in the Emergency Department and outdoor activity terraces for inpatient use. An outpatient behavioral health clinic supports pediatric patients and their families in their continued healing journey.

“The Child First and Always.”

— Intermountain Health Primary Children’s Hospital

Curating Care: Design that Heals

Austin State Hospital / Austin, Texas

Fulton State Hospital / Fulton, Missouri

“This place makes me think I can get better; there is a chance I can get out.”

— Anonymous Patient at Fulton State Hospital

Page Southerland Page, Inc.

3

Design Considerations Age-Appropriate Positive Distraction Providing positive distractions for all age levels allows for a more uplifting hospital experience and appeals to the broad range of patients who visit on a day-to-day basis. These include multi-touch walls and playrooms for younger patients, and a high-tech media area for older adolescents.

Patient Family Support Spaces Support spaces for patient families are essential as they are a part of the treatment process and accompany patients often. Kitchen and dining spaces, laundry services, respite lounges, computer touchdown zones, and sleep rooms are just some of the various amenities that can be offered with patient families in mind.

Visual Security Maintaining a line of sight between staff and patients in their rooms is a necessary precaution, especially when considering that pediatric patients might not be able to identify for themselves when they need assistance. This visual security can be achieved through interior windows, glass doors, and strategically placed nurse stations.

Flexible Room Layout Pediatric patients are admitted with a multitude of different symptoms, creating the need for a variety of different equipment to be on hand. An acuity adaptable room design creates flexibility between patient needs and reduces disruptions caused by moving from one department to another. Additionally, having areas for patient families to sleep or engage together within the room is necessary for their involvement in the healing process.

Control of Environment Giving the patient control over their environment allows them to feel like they have a say over an aspect of their treatment process. Color changing lights and control over the temperature and television makes the space customizable to fit the patients interests and taste.

Outdoor Spaces In a hospital environment, patients may feel isolated from the outside world and lose the ability to exercise freely. Outdoor spaces, such as healing gardens, activity playgrounds, and patio areas, are key for allowing patients to exercise and have fun as children. When the patients need to stay indoors, outdoor views in the patient room still connect them to the outside.

Page Southerland Page, Inc.

5

Patient Support Spaces Patients being admitted long-term will have a disruption of their daily life, but there are ways to offer services to help ease the transition into the new normal. Classrooms and child life services allow for continuing education and guidance for patients as they pursue treatment alongside their regular schedule.

Safe Haven Designation When a patient is admitted, it is important for their overall experience to be as positive as possible. Designating the patient room as a safe haven that is separate from where procedures are performed is one way of creating a comfortable space where the patient can feel relaxed. Any life saving equipment that must stay in the room should be discreetly tucked away out of sight until it is necessary.

6

Communication Between Staff and Patient Families Communication between patient families and staff is critical for keeping the patient’s needs and progress in constant conversation. The integration of smart room technology, such as signage monitors outside the patient room and bedside charting connecting to the patient TV, keeps staff and patient families informed about the state of the patient. Additionally, patient TV’s can be used not only as a patient monitor, but also as an educational device, entertainment, on-demand meal request, and a tool for pain management.

Neighborhood Layout Providing inpatient units that resonate as a neighborhood design can offer privacy needs, social needs, and environmental stimulation for pediatric patients and their families. Thus, a ‘neighborhood’ organization that is a scaled down unit can ease the stress on patients. Each neighborhood can also be calibrated with their own identity and accessibility for easy of navigation through the unit.

Behavioral Health for Children and Adolescents

Page Southerland Page, Inc.

7

Primary Care/Bridging Clinic

Continuum of Care Outpatient Clinic

Primary Care is the first line of defense for mental and physical health and wellness care. Primary Care physicians can be the first point of entry into the care continuum. Bridging Clinics provide short-term Primary Care until a long term medical home is available.

Outpatient clinics offer many different mental and behavioral health programs that allow patients to receive specialized care part time while maintaining normal daily work and home life routines and responsibilities.

Intensive Outpatient Intensive outpatient services provide extended outpatient care often used as a step between inpatient and outpatient treatment. IOP programs allow for more structure and support while allowing patients to transition back to their home environment.

Residential Residential programs are 24/7 facilities that emulate the home environment with additional structure and support. These are for patients who may not have a stable home environment or who require more observation. These can be short or long term.

Crisis Stabilization Crisis Stabilization comes in many forms, but the purpose is for walk-in access to care for suicide prevention, behavioral health specific treatment and as a diversion to a higher level of care.

Psych Emergency Center PEC’s are essentially emergency services specifically for mental and behavioral health needs.

These provided more specialized care than a traditional medical emergency department.

Acute Inpatient Acute inpatient care allows for a short-term treatment option to provide stabilization, medication management and acute mental health care. These are usually 24/7 overnight stay secure units.

8

Behavioral Health for Children and Adolescents

Forensic Forensic facilities assess and treat individuals who have past or possible future criminal offenders. Often these offenders are suspected to have an underlying mental or behavioral health issue that may have affected their behavior or competency.

Supportive Housing Patients can go to live in a group of housing units with other similarly afflicted patients to better foster peer support and help re-integrate back into greater society.

VA The VA offers a wide variety of inpatient and outpatient services for mental health and substance abuse patients. They cater to members of the armed forces and provide treatment for that unique population group.

Research Mental, behavioral and brain health research is rapidly expanding, providing new insight to for the treatment and diagnosis.

Call Center If patients are unable to access in-person care, call centers are a useful resource in emergency and crisis situations. Social workers, clinicians and counselors are available 24/7 for counseling, suicide prevention and referral services.

Peer Support Peer Support programs incorporate care providers who have gone through similar programs as a patient. Support groups, supportive housing, and residential programs are just a few instances where peer support can be integrated.

Substance Abuse Substance abuse facilities provide detox, counseling and supportive therapy for drug and alcohol abuse.

Adolescent/Pediatric Adolescent and pediatric age groups require a different approach to treatment tailored to age and development.

Seniors

Adults

Mental heath facilities that treat seniors often have specialized care for memory along with accommodations for additional physical and mobility support.

Adult patient populations have many options regarding the type of mental health care they need, whether that be programs centered on the length of stay (i.e. inpatient, intensive outpatient, crisis stabilization, etc.) or the treatment of a specific illness (i.e. substance abuse).

Page Southerland Page, Inc.

9

The first priority is to create supportive environments that resist re-traumatization.

People experiencing trauma can be hyper aware and / or hyper sensitive to their surroundings.

Trauma-Informed Spaces Context / History Exposure to abuse, neglect, discrimination, violence, and other adverse experiences increase a person’s lifelong potential for serious health problems and engaging in health-risky behaviors, as documented by the landmark Adverse Childhood Experiences (ACE) Study.

A trauma-informed approach acknowledges the need to understand an individual’s life experiences in order to deliver effective services and has the potential to improve engagement, treatment / program adherence, health outcomes, and staff wellness.

Guiding Principles A set of guidelines is emerging around the following categories: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment & choice, as well as cultural, historical and gender issues. Page has been developing a set of best practices, based on available research and project experience. Each guiding principle is comprised of a set of considerations or recommendations with the ultimate goal of providing a supportive physical environment in which all individuals can thrive. Each of these principles is described in the graphic to the right.

However, it is important to acknowledge that best practices are not a substitute for empathy. There isn’t a single “magic bullet” solution that will work for all - designing for the average is designing for no one.

This is why Page will work closely with you to develop appropriate design solutions in support of your mission, your staff, and the people for whom you provide services.

10

Behavioral Health for Children and Adolescents

SAFETY

RESIST RETRAUMATIZATION

Protect individuals and staff. Provide visible security, and well-lit public and exterior spaces.

TRUST Involve end users in the decision-making process.

Consistent, open, respectful and compassionate communication. Prioritize privacy and confidentiality.

CONNECTION Plan for varying levels of social density. Give individuals the choice to engage or disengage.

Respect boundaries.

CHOICE Empower individuals to make their own choices & have as much control of their environment as is safely possible.

EQUITY & INCLUSION Being aware of how an individual’s culture affects how they perceive trauma, safety, and privacy. Provide adequate and equal access for those with physical or developmental disabilities.

HOLISTIC

RESILIENCE & RECOVERY

Consider the whole health of individuals. Provide a welcoming environment with access and views to nature.

Page Southerland Page, Inc.

11

Featured Clients Adamsville Regional Community Health Center / Atlanta, Georgia Austin Independent School District New Rosedale School Children’s Comprehensive Care Clinic / Austin, Texas Baptist Medical Center J. Wayne and Delores Barr Weaver Tower Wolfson Children’s Hospital / Jacksonville, Florida Bradley Children’s Hospital Renovations / Providence, Rhode Island (Oldest inpatient child psych facility in the United States.)

Children’s Health Dallas Emergency Department Behavioral Health Unit / Dallas, Texas Commonwealth Center for Children & Adolescents Therapeutic & Security Survey & Design Recommendations / Staunton, Virginia Dell Children’s Medical Group Comprehensive Care Clinic / Austin, Texas Intermountain Health Primary Children’s Hospital / Lehi, Utah Kennedy Krieger Institute Harry & Jeanette Weinberg Center for Developmental Disabilities / Baltimore, Maryland LCMC Health Children’s Hospital New Orleans BH Emergency Unit / New Orleans, Louisiana Mercy Health South Behavioral Health Facility / St. Louis, Missouri Regional Institute for Children & Adolescents School / Rockville, Maryland Saint Francis Health System Laureate Psychiatric Clinic Hospital Eating Disorder Unit and Clinic / Tulsa, Oklahoma Sheppard Pratt Adolescent Behavioral Health Center / Baltimore, Maryland Star Care Behavioral Health Hospital Pediatric Wing / Lubbock, Texas Texas Children’s Hospital Autism Center Renovation Multidisciplinary Clinic / Houston, Texas UTHealth Behavioral and Biomedical Sciences Building / Houston, Texas Virginia Department of General Services New Central State Hospital with Adolescent Wing / Petersburg, Virginia Virginia Department of Behavioral Health and Developmental Services Comprehensive Therapeutic and Safety / Security Assessment of Nine Campuses / Virginia

Integrating best practices in Children’s Health and Behavioral Health design can instill confidence while engaging and reassuring patients and families. pagethink.com/behavioral-health

12

Behavioral Health for Children and Adolescents

Children’s Health Dallas / Dallas, Texas

UTHealth Behavioral and Biomedical Sciences Building / Houston, Texas

Saint Francis Eating Disorder Unit / Tulsa, Oklahoma

Page Southerland Page, Inc.

13

pagethink.com