Behavioral Health by Jenna Sacks

Jenna Sacks

Behavioral Health

Jenna Sacks Capstone Research & Programming Lisa Phillips Fall 2015

I dedicate this book to...

The Interior Design Professors of PhilaU I have learned a wealth of knowledge from each professor that I have had the opportunity of taking throughout my four years at PhilaU. Although interior design is a technical ield, I enjoyed the focus on creativity, inspiration, and positivity from everyone. In my future, I hope to become a professor and inspire future generations of designers, just as I was inspired.

My Grandma, Esther D. Schwarz Two years before moving into college, my gradmother passed away. She has always been the biggest supporter of my artwork throughout high school. I know she would have been proud to see what I have accomplished over the past four years as a designer and one of her golden girls.

My Family, Mom, Dad, Justine, and Robyn Justine and Robyn--you both never failed at making me laugh and I enjoy our many adventures, even though they may be cut short due to my design work. Dad--I enjoy our car rides to and from Philly. I enjoy bonding with you whenever you are not too tired from working. Mom--I can always count on you to call me at least once a day to make sure I am breathing, and even though our phone calls might be brief from my work or stress, I look forward to our short talks and seeing you over breaks. You all have been the best fans, friends, and role models anyone could ask for. I want to thank you for all that you do for me and helping support my dream of becoming a designer. At the end of the day, I know that...

â&#x20AC;&#x153;I am everything I am because you love me.â&#x20AC;?

Table of Contents

"What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well.â&#x20AC;? ~Glenn Close

Section I: Introduction

Section II: Historiography

Section III: Case Studies

Westchester Medical Center Newark Beth Israel Medical Center Zucker Hillside Replacement Hospital Nemours Childrenâ&#x20AC;&#x2122;s Hospital

Section IV: Ergonomic & Technical Criteria

26 38 52 64

Section V: Topical Exploration

104

Section VI: Existing Site, Context, Climate, & Zoning

118

Section VII: Program Development & Documentation

130

Section VIII: Building Analysis, Code, Regulations, & Standards

140

Section IX: Executive Summary

156

Section X: Appendix

162

User Survey: Westchester Medical Center User Survey: Newark Beth Israel Medical Center

164 167

Section I

"You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle." ~Julian Seifter

Introduction

study performed by psychiatrist Jean Twenge revealed that 46% of college students today had at least one mental illness in the past twelve months. Out of that population, twenty percent met criteria for alcohol abuse or dependency, twelve percent experienced anxiety disorder, and more than ten percent suffered from mood disorders including depression or bi-polar disorder (McNally 6). In total, less than twenty percent of the students with mental disorders sought treatment prior to the survey (McNally 6). Behavioral and mental disorders are diagnoses that are believed to be conceived by society. In comparison to conditions such as cancer and diabetes, mental illnesses are belittled; however, in terms of treating psychological disorders, patients are treated as if they have a comparable illness in a setting that is not conducive for patient success. It has been seen by many professionals that children and adolescents with a record of mental or psychological disorders are bound to return. Some studies have shown that individual attention or treatment that a patient receives directly affects the length of their treatment; If there is a large patient-tonurse ratio, the patient is more likely to have a longer hospitalization period (Avallone, Day, Sanders).

Today, healthcare facilities are constantly renovating, not only to keep up with current technologies and scientiic indings, but to reevaluate their interiors in order to accommodate the patient and aid them on their road to recovery. Shockingly, these advancements have not taken affect in behavioral health centers. The design of such facilities hinder the recovery of the patient and also prove to be dangerous to the patients as well as the staff. This is because the amount of space allotted towards behavioral health units cannot keep up with the increase of mental health disorders in todayâ&#x20AC;&#x2122;s society. Behavioral health centers are usually designated to a certain area or building and are renovated when a problem occurs. It is evident that there is a lack of order and understanding of mental disorders and how the interior environment plays an important role in the recovery of each patient. The goal of the proposed project is to create a functional behavioral health facility that will serve as a comfortable residence for patients and will promote creativity and safety for patients and staff. Statistics have shown that when a patient with a mental illness is treated in a larger facility with little one-on-one attention, their stay is elongated, whereas patients that are in a more quaint setting with a smaller amount of patients

are more likely to have quicker recovery. In addition, there is a great need for behavioral health facilities that will utilize the principle of Continuum Care to transition patients from the health center back to their normal routine (Avallone, Day, Sanders). By creating a smaller scale facility with outpatient treatment options, each patient can be evaluated and treated based on their own needs. All facts, statistics, and data will be acquired by scholarly books written by psychologists that focus on normal and abnormal behaviors in children and adolescents. Research will also be found in design magazines that analyze existing behavioral health treatment facilities, as well as interviews with registered nurses who work within these settings and utilize similar facilities. The interviews will be vital as they will serve as real-life accounts of situations that may happen on a day-to-day basis. They may also provide insight towards material decisions or schematic planning based off of the behaviors and situations that they have witnessed. In order to ensure a safe environment, all zones of the facility need to be evaluated. These include low risk, medium risk, and high risk zones. Low risk zones, such as corridors, are areas in which the patients are observed or

FIG. 1.1 Stigma

FIG. 1.2 Seeking Help

accompanied. Medium risk areas are those where patients are in small groups but are still supervised, for example laundry rooms, dining rooms, and day rooms. Higher risk areas that need to be considered are areas where the patient may spend time alone and has a higher risk of hurting themselves. These spaces include their bedroom, toilet room, and shower (Stroupe). Fixtures and materials will have to be carefully selected. Furnishings should either be bolted to the ground or heavy enough so that patients could not harm themselves or others. Fixtures including door handles, toilet lushers, and sinks should not have any knobs that have a ledge that could make it easy for a patient to suffocate themselves. Attention to detail will be imperative in picking out materials to reduce the risk of bed bugs and health hazards among patients and staff. In addition, this facility should include multiple nursesâ&#x20AC;&#x2122; stations to monitor the population, creating areas for natural lighting, and a touch of personalization to each room in order to make each patient feel like they are at home. Sustainability will be incorporated and will have a large impact on the design objectives for this 10

behavioral health center. First and foremost, the most important fact to note is the adaptive reuse of the Haverford Community and Environmental Center. This building itself focuses heavily on sustainability and environmental education. Haverford Community Center is a LEED Gold Certiied building and uses systems such as chilled and warm water loops as well as geothermal heat exchanges in order to regulate the buildingâ&#x20AC;&#x2122;s temperature. The materiality used throughout the building is also sustainable; including the wood approved by the Forest Stewardship Committee (FSC) and stimulated stone which helps to cut down on the effects of quarrying. The vast ields surrounding the building can also serve as locations for education, gardening, and relaxation. The client is a nurse who is passionate about working with children who are not mentally stable. Every so often, she will come across small details around the unit that seem dangerous or areas that are dysfunctional. In addition, she takes note of the various white and beige tones that deine the facility as an institution rather than a setting for children and adolescents. Her reasoning for the project is simple: Not only do the patients need to be guaranteed safety and the right to a

personalized environment, but the doctors, nurses, and staff that work with this population also need to be considered in the face of a dangerous situation and must enjoy the setting they work in. The users will be patients who will have behavioral or mental health diagnosis including bulimia, posttraumatic stress disorder, schizophrenia, depression, and anxiety. In addition, staff will include registered nurses, licensed nurse practitioners (LPNs), psychologists, creative therapists, administrative workers, and more. The location of the Haverford Community and Environmental Center is ideal because of the outdoor opportunities. There is a dog park across the street that can serve as an outlet for the children and adolescents to play and care for animals. It is also located within a close distance of many hospitals, one of which is Kindred Hospital Philadelphia in Havertown. This is very important in case there is a medical emergency that occurs. The needs of the surrounding population calls for a small inpatient unit where patients can interact with each other as well as have their own space and be provided continuum care where they can be assessed and treated as an inpatient while still obtaining outpatient services to adjust back to their lives.

Despite the fact that the main users of this facility will be middle class, behavioral and mental illnesses do not discriminate. Instead, it has been shown in various sources that genetics play a large role in the passing of mental and behavioral illnesses (McNally 100). Whether it is anxiety disorders or schizophrenia, these conditions can be triggered despite age, race, religion, or socio-economic class. In order to accommodate the local population, the furnishings and ixtures need to be of a certain aesthetic in order to appeal to the patients that will be using the space. The demographic of this behavioral health center will be children and adolescents ages four to seventeen in Haverford, Philadelphia, and other surrounding locations. It was recorded that over half of the population is Caucasian, about twenty ive percent are Hispanic or Latino, and a little less than twenty percent are African American. Universal design should be taken in order to ensure that all users of the building will ind themselves working and living comfortably in this space. In addition a higher budget will be set in order to it in with the surrounding area. 11

BIBLIOGRAPHY McNally, Richard J. What Is Mental Illness? Cambridge, MA: Belknap of Harvard UP, 2011. Print. Avallone, Vince, Kevin Day, and Rebecca Kleinbaum Sanders. “Designing for Dignity: Evolving Approaches to Planning Behavioral Health Facilities.” Medical Construction and Design. MCD Magazine, 26 May 2015. Web. 31 Aug. 2015. Stroupe, Jocelyn M. “Behavioral Health Design.” Behavior Health Design. HFM Magazine, 3 Sept. 2014. Web. 31 Aug. 2015.

IMAGES FIG. 1.1: http://www.mercurynews.com/bay-area-living/ci_25281737/last-stigma-mentalillness-and-workplace FIG. 1.2: http://www.time-to-change.org.uk/blog/art-mental-health FIG. 1.3: https://www.pinterest.com/pin/350858627194710839/

Section II

"I had noticed that both in the very poor and very rich extremes of society the mad were often allowed to mingle freely." ~Charles Bukowski, Ham on Rye

Historiography

FIG. 2.1 Skull Trephination

rcheologists have uncovered evidence in the form of a skull showing that some of the earliest cases of behavioral disorders have taken place as far back as 5000 BC. This artifact had been “Trephined or Trepanned— small round holes had been bored in them with lint tools.” (Porter 10). It was hypothesized that the subject had their skull drilled into in order to expel a demonic entity that possessed them. (Porter 10). Medicine has come a long way since the ancient world; however, this thought is an understatement in regards to the study of psychiatry and mental illness. Although it can be argued that the interior environments in behavioral health centers are not one hundred percent safe or comfortable, the awareness of mental illnesses has grown and the treatment of patients with behavioral disorders has improved tremendously. 16

As seen in many scholarly works, the ancient Egyptians and Greeks described those who were mentally ill as “mad.” There were many theories as to why such behaviors surfaced in an individual and how one should be treated to reverse such mental distress. The irst reason that spearhead the negative outlook to mental disorders were the possible ties to religious taboos. The Mesopotamians and Babylonians were convinced that many behavioral outbursts were inluenced and caused “by spirit invasion, sorcery, demonic malice, the evil eye, or the breaking of taboos” (Porter 12). The Greeks and Christians also thought similarly and believed that successful treatment could be achieved through prayer and incantations. The Greeks in particular would sometimes offer sacriices in temples dedicated to Asklepios, the God of Healing; whereas, Catholics would perform masses , exorcisms or pilgrimage

FIG. 2.2 Bedlam Hospital in London

to a shrine (Porter 15, 19). For the longest time, patients were seeking treatment from clergy igures rather than practitioners in medicine (Porter 34). Religion was the leading case that drove the treatment of the mentally ill up until around 1650. This was especially prevalent as the belief of witchcraft fell over Europe. Around the start of the 15th century, it was thought that uncontrollable speech and behavior was linked to witches and their ties to the devil (Porter 21). In turn, this was a lawed system of false accusations and true dysfunction, which surfaced the belief that “the mad were judged to be possessed, and religious adversaries were deemed out of their mind” (Porter 21). Throughout history, the mentally ill were always shunned by society. In the time of the Greek and Roman Empires, those who were “mad” were to be

secluded to their own home so as to not interfere or destroy life, limb and property (Porter 89). Being that they were kept away from society, sometimes abuse would occur at home where they were locked in a basement or under the servant’s command. This system was kept up until around 1400 when public asylums with a deep focus on religion were being created. One of the irst asylums to be founded was the religious house of St. Mary of Bethlehem. It was later known as Bethlem or “Bedlem” (Porter 90). At irst, Bethlem was a hospital for the poor; however, by 1320, most of their patient population was mentally ill. The building that held the patients was a single story facility built around a courtyard with a central chapel. There were twelve patient “cells” as well as areas for kitchen staff and other staff members. (“From Bethlehem to Bedlam”). Being 17

that this hospital was a grand mix between punishment and religion, it was common to see shackles, chains, and isolation chambers on this site; however, it was also noted that it was the nurses duty to feel compassion and understanding towards the “mad” (“From Bethlehem to Bedlam”). In 1660, a movement known as “the Great Coninement” began in France where the mentally ill were able to stay in public asylums run by the government as a means of policing this troubled population. By the eighteenth century, these public facilities—also known as lunatic asylums—were spreading to countries such as England and Russia (Porter 94). Although awareness for the mentally ill was growing amongst the public, this group of people were still shunned away—and this time, more publicly. It was found that a great amount of the “inmates” in these facilities were injured war veterans, vagabonds, or the poor (Porter 102). The downfall to the public asylum was the ability of the owner to run the facility as they saw it. Some patients would be living in tight quarters with others and inspections were never made regularly. York Asylum is one example of a facility that was able to conceal a number of deaths of patients. It was found that patients of a higher status who were mentally ill were treated decently whereas the poorer population

who lacked family support were neglected. Upon one inspection, ive rooms were found off of one of the locked kitchens that held neglected mentally ill patients (The York Lunatic Asylum). By the late nineteenth century, it was becoming clear that more order needed to be brought to the forefront with behavioral healthcare. In London, the Madhouses Act of 1774 was created to ensure that each facility was licensed by a physician who needed to carry out inspections. In addition, there was a cap of maximum sizes for Asylums that needed to be abided (Porter108-109). These acts were constantly improving and eventually required that more humane treatment be administered. For example, detailed reports needed to be taken regarding when restraints were used (Porter 109). Movements such as the Madhouses Act were renewed and re-evaluated; however, government funding became very important in terms of the upkeep of these facilities. In the 1940s, photos had surfaced of Philadelphia State Hospital, also known as “Byberry,” that showed eighty patients conined to one dormitory room. The sight was similar to that of a concentration camp (Hinshaw 78). In addition, with the increased interest in psychology and scientiic research, patients with severe mental illnesses were tested on with new treatments including

FIG. 2.3 Overcrowding

FIG. 2.4 Bath Treatment

FIG. 2.3 Overcrowding in Byberry Hospital

FIG. 2.5 Lack of Stimulation

insulin shock treatment, electro convulsion treatment (ECT) and prefrontal lobotomies were (Hinshaw 78). Up until the end of the twentieth century, there were multiple changes in the ield of psychiatry. First and foremost, the development of antidepressants in 1950 were a success and alleviated much of the mentally ill population in the asylum. Deinstitutionalization was an idea that was also beginning to take form throughout America under Kennedyâ&#x20AC;&#x2122;s presidency. The main goal of Deinstitutionalization was to enhance research in the ield of psychiatry, reduce hospital sizes and encourage community services instead, educate the public on mental disorders, and doubling the

FIG. 2.6 Abandoned Asylum

amount of government money spent on mental healthcare (Hinshaw 79). Soon enough, society realized this was a huge undertaking. Due to the mainstream of many patients into the real world, there were not enough services to help them in managing their prescriptions, inding a job, helping to ind homes, etc. This, in turn, was a relection of the start of asylums (Hinshaw 83). Psychiatry has been the most dificult ield of medicine to research as seen through history. Today, medical centers and behavioral health centers have improved tremendously. Punishment in the form of whippings and chains are no longer an option. Risky procedures such as lobotomies are prohibited. In terms

FIG. 2.7 Abandoned Asylum

of institutional settings, medical centers are beginning to reform in order to accommodate the population that they are treating. Medical Construction & Design Magazine published an article that pertained to “Designing for Dignity.” The article announced the opening of Hope House in Northern California as well as Cordilleras Mental Health Center. Both resemble the modern approach to Behavioral Health Centers. As mentioned earlier, it was seen that the smaller the program or facility, the more attention each individual is receiving, theirfore reducing their stay (Avallone, Day, Sanders). In addition to this focused approach, they found that more home-like designs restore

the patient’s sense of dignity and control of the environment in a safe environment (Avallone, Day, Sanders). They respect the theory of providing continuum care as they lead their patients through the emergency department, clinical assessment, acute care treatment—if needed--, outpatient care, and reintegration among community (Avallone, Day, Sanders). Just as was mentioned before, these modern centers are providing the patients with the community services that will empower them as well as enable them to take control of their lives in the real world. As healthcare facilities continue to modernize, psychiatric and behavioral health clinics are beginning to catch up through the treatment administered and the physical setting.

FIG. 2.8 Negative Stigmas of Asylums depicted through Photos

BIBLIOGRAPHY Avallone, Vince, Kevin Day, and Rebecca Kleinbaum Sanders. “Designing for Dignity: Evolving Approaches to Planning Behavioral Health Facilities.” Medical Construction and Design. MCD Magazine, 26 May 2015. Web. 31 Aug. 2015. “From Bethlehem to Bedlam - England’s First Mental Institution.” Historic England. N.p., n.d. Web. 6 Sept. 2015. Hinshaw, Stephen P. The Mark Of Shame : Stigma Of Mental Illness And An Agenda For Change. Oxford: Oxford University Press, USA, 2007. eBook Collection (EBSCOhost). Web. 6 Sept. 2015. Porter, Roy. Madness: A Brief History. Oxford: Oxford UP, 2002. Print “The York Lunatic Asylum.” King’s Collections : Online Exhibitions :. N.p., n.d. Web. 06 Sept. 2015. IMAGES FIG. 2.1: https://neurophilosophy.wordpress.com/2007/06/13/an-illustrated-history-oftrepanation/ FIG. 2.2: https://historicengland.org.uk/research/inclusive-heritage/dis ability-history/1050-1485/from-bethlehem-to-bedlam/ FIG. 2.3: http://social.rollins.edu/wpsites/thirdsight/2013/09/23/women-in-insane-asylums/ FIG. 2.4: http://www.gutsandgore.co.uk/infamous-asylums/history-of-psychosurgery/ FIG. 2.5: http://mcdmag.com/2015/05/designing-for-dignity-evolving-approach es-to-planning-behavioral-health-facilities/ FIG. 2.6: http://mcdmag.com/2015/05/designing-for-dignity-evolving-approach es-to-planning-behavioral-health-facilities/ FIG. 2.7: http://mcdmag.com/2015/05/designing-for-dignity-evolving-approach es-to-planning-behavioral-health-facilities/ FIG. 2.8: http://mcdmag.com/2015/05/designing-for-dignity-evolving-approach es-to-planning-behavioral-health-facilities/

Section III

"Never underestimate the pain of a person, because in all honesty, everyone is struggling. Some people are better at hiding it than others" ~Unknown

Case Studies

Westchester Hosptial Newark Beth Israel Zucker Hillside Replacement Hospital Nemours Childrenâ&#x20AC;&#x2122;s Hospital

Westchester Medical Center’s Behavioral Health Center

FIG. 3.1 Aerial view of Behavioral Health Center

Overview

estchester Medical Center’s Behavioral Health Center (BHC)— formerly known as the Psychiatric Institute—is located on 100 Woods Lane in Valhalla, New York. It was built in 1932 by Schoield & Colgan Architects located in Nyack, N.Y. In total, the four loors of the psychiatric institute with outpatient treatment cover about 340,000 square feet and contain an emergency crisis center with outpatient services, ive inpatient units, and administrative ofices. Being that healthcare facilities are priced high for construction compared to other medical centers, this project had a moderate budget. Prior to its use as a psychiatric facility, it was a home for the elderly. In 1981, reconstruction

took place within three wings in order to accommodate the inlux of psychiatric patients that were admitted. Reconstruction cost studies were performed and concluded that the job would cost approximately $11 million funded by the county and state of New York (Chalmers). Most of the budget was spent on renovating the wings to bring these spaces up to code for a psychiatric center. Today, renovations are still taking place to modernize the spaces. Westchester is a relevant case study because the behavioral health center not only specializes in the psychiatric care of adults, but also adolescents and children. In addition, they have an outpatient treatment center which is a beneicial program in assessing each individual

patient and their needs. Outpatient services are a necessity because they are able to customize a plan for admitting and transitioning patients from the hospital back to their normal lives using a method of continuum care. Continuum care enables the patient to receive an individualized treatment plan where they are evaluated and undergo a mixture of inpatient and outpatient services. Their location is also unique because Westchester receives patients from all over New York and occasionally northern New Jersey. Westchester Medical Center is owned by Westchester Health Care Corporation which is a privately owned entity. The main users of the Behavioral Health Center are patients with Mental Health or Behavioral diagnosis. Approximately sixty percent of the patient population receive Medicare or Medicaid. The ages ranges also vary upon the census but most patients are adult males and teens. The staff of this portion of the hospital has around 350 employees including psychiatrists, psychologists, licensed mental health counselors, nurses, licensed practical nurses, psychiatric nursing assistants, recreational therapists, discharge planners, social works,

FIG. 3.2 Representation of Interior Structural Columns

administrative staff, and support staff. Some of these positions range from full-time to part-time. Visitors also use parts of the behavioral health center. About seven to twelve visitors come into the building on a daily basis to visit patients in the child, adolescent, or adult units. The outpatient unit handles about 4,500 visits a year. These patients are mainly those who are seeking therapeutic services. The Emergency room also receives approximately 1100 visits a year and about 90 patients average the daily census for inpatient units. Each patient stay averages at about two weeks with a ratio of eight patients to one nurse. Westchester is located on a large green campus off of Sprain Brook Parkway. The campus is near an urban area and is relatively convenient to drive to if one has a car. One can take a train that stops nearby; however, a bus or taxi ride is needed in order to be taken to the campus. Overall, the setting of the hospital is very relaxing. There are a few walkways that patients can use with the presence of an aid. The hospital is located in a middle class area but receives patients from local low-income areas.

FIG. 3.3 Front Entrance of the â&#x20AC;&#x153;Psychiatric Instituteâ&#x20AC;?

Design Concept & Styles

estchester Medical Center is classiied as a modernist building that its within the architectural styles in the 1930s in America. There is very little ornamentation on all the buildings on the campus. This can be seen through the front façade of the main hospital. There are large columns made of brick bearing walls that protrude forward and add more emphasis to the verticality of the low-rise structure. Behind these columns, there is an interior steel frame which holds up seven inch thick loor slabs (Chalmers). The windows are double glazed aluminum frame and are regularized on the building’s façade, enforcing the “form follows function” look of a modern building from the 1930s. The interior special planning also relects the concept of modernism. Going one step further, the interior follows on of Florence Nightingale’s key principles in healthcare design by planning patient rooms around the perimeter of each wing in order to provide sunlight and views to a small courtyard. Characteristics of modernism are represented by the functional special planning of patient units. One enters the building through the main entrance which

FIG. 3.4 Modern Facade of Main Hospital

is the strong central axis of the building. The patient units are located along a datum line that is perpendicular to the axis, thus creating ‘A’ and ‘B’ wings. The irst loor contains the outpatient services and emergency center where patients are brought in after an episode and evaluated medically and mentally. The second, third and fourth loors contain patient units that are stacked and regularized. The fourth loor also contains ofices for the President, Vice Preside, Program Administrator, and the like of the Behavioral Health Center. This is a very functional organization of space because at the irst loor is more public but the private units and ofices are on the second, third, and fourth loors. In addition, the patient units are also organized in a way that the child and adolescent wings share a loor, two of the adult units share a loor, and the third adult unit contains medical assistance and is located on its own loor near the administrative ofices. Together, the interior and exterior focus on the function of the facility and the mental well-being of the patients. The circulation and wayinding is unclear. It is easy to move vertically throughout the behavioral health center because the elevators are conveniently located at the intersection of

FIG. 3.5 Exterior of Behavioral Health Center

FIG. 3.6a 3rd Floor Plan

FIG. 3.6b Second Floor Plan

FIG. 3.6c Ground Floor Plan

FIG. 3.6d Basement Floor Plan

the central axis and datum hallways. Signage is on the irst loor and only indicates that the outpatient services are on the ground level and inpatient units are on the loors above. Also, the signing throughout the building is not cohesive. Some rooms have signage that is plain whereas others have more elaborate room tags that have engravings and borders. The only shared characteristic between them is the olive green color that does not match with the rest of the color scheme. Some of the challenges faced during this renovation were the columns as well as the heating and cooling systems. Each unit contains two lines of steel columns right down the middle of the corridors. In some instances they could not be incorporated

into an ofice or therapy room and were left exposed (article). Also, the low loor to ceiling heights posed to be a problem when incorporating heating, cooling and mechanical systems. From the loor to the bottom of the ireproofed steel beams measured 9 feet which did not leave enough room for heating and cooling ducts to cross over one another. Instead, Mechanical Engineer, Segner & Dalton, proposed that the building use a “twopipe forced water system with fan coil units in each patient room” (Chalmers). The water pipes take up less space than ducts and the “steam for heating loop and chilled water for cooling are provided by the county’s central plant,” (article). After the installation, the corridor height measure 7’-8” which is just 2 inches above the New York state minimum of 7’-6”.

Interior Design

FIG. 3.7 Reception Area Today

hrough the halls of Westchester’s Behavioral Health Center, the most predominant interior materials are vinyl composite tiles (VCT) in the halls and patient rooms, gypsum board for walls and patient ceilings, and ceiling tiles in hallways. Most of these materials are appropriate for both the function and budget of the space. The only material that is not conducive is the VCT looring because it requires a lot of maintenance in a space that is already a 24 / 7 occupied unit. These materials are also not the sustainable. The ixtures, furniture, and equipment for a behavioral health center are to be selected with great attention to detail because everything has to be tamper proof. Westchester’s behavioral health center has doorknobs that will not allow patients to suffocate themselves, shower curtains that do not touch the ground, and faucets that are button operated. The furniture is also unique because they are purchased from a company that specializes in prison furniture. Although these pieces are large

FIG. 3.8 Hallway to Adolescent Unit

FIG. 3.9 Anti-Microbial Mattresses

FIG. 3.10 Patient Room

FIG. 3.11 Lounge Area

FIG. 3.12 Dining Area

light weight plastic, the program administrator bought ten thousand pounds of sand to ill the hollow chairs with so that patients cannot lift them and injure themselves, other patients, or staff. In addition, the mattresses are from this same company and are made of a material that does not allow the sustaining of bed bugs or soiling. The furniture, ixtures, and equipment are used to create a safe environment for all users of the building.

colored white and beige; however, pops of green, blue, yellow, and purple have been brought in through the large plastic furniture, drapery, and painted window frames. Patient rooms also contain these colors as well through their shelving units and bed frames. Color is also brought in through the murals and art projects by the patients. These hang in the dining hall and lounge and create a friendlier and open environment. Brown and olive green are also shown throughout the unit which seems to bring down the look of the color palette and hinders the cohesiveness of the materials. Daylighting is a vital remedy to provide anyone who is spending time in a hospital. Daylight is provided to the patients almost everywhere. Patient rooms have at least one window, and can have even more depending on the size of the rooms and the

The color palette is shown in multiple ways including art and decorative elements but is not cohesive. Being that this healthcare facility is trying to keep up with building maintenance and upkeep, most of the money they receive is going towards ixing leaks and removing harmful building materials like asbestos. Most of the units are still

FIG. 3.14a/b Code Compliant Door Knobs

FIG. 3.13 Window Partition Transfers Daylight to Halls FIG. 3.15 Code Compliant Sink

amount of roommates. In addition, large windows are also located in lounges, day rooms, and dining halls where patients are spending a bulk of their time. Although there is not much daylight in the halls, some measures have been taken to transfer light by creating glass partitions in the dining hall and lounges in order to bring natural light deeper into the building. Natural daylight in these spaces is controlled by the patients through the use of curtains and blinds. Back in 2011, an outside vendor replaced the lights in the inpatient units. The halls used to be dim and eerie; however, the new lighting ixtures provide diffused light that spreads a softer glow through the halls and in patient rooms. The lights are also controlled by the patients in their room. As for the halls, the lights are on 24 / 7. The means of lighting throughout the Behavioral Health Center make sense for the layout and provide the patients with enough control over their light sources to make them feel at home. 32

FIG. 3.16 Code Compliant Patient Bathroom

FIG. 3.17 Nurses’ Station Filing System

really enjoyed my visit to Westchester Medical Center and learned about the attention to detail that goes into designing a behavioral health facility. I found that the staff is very lexible by making the patients feel at home despite the fact that the interior environment does not convey the same message. The interior of each unit looked the same. It was dificult to distinguish the difference between the children’s unit that was built for patients between the ages of four and twelve and the adult unit which handles patients that are eighteen years old and over. As I walked through the units, you could also feel the humidity and stale air in the room from the poor ventilation system. I also couldn’t help but feel anxious when walking into a few of the nurses’ stations and seeing the clutter of papers, iles, toys, and fans stacked on tables and cabinets. It is evident that Westchester is trying their best to keep up with modernizing and renovating their units.

Post Occupancy Survey & Evaluation

hen interviewing the program administrator and the nurses around the unit, their comments focused on the ventilation systems. Because the building is very old, the air conditioners and radiators are outdated and the nurses’ area is constantly cluttered. In addition, there are ofices spaces that have leaking ceilings and electricity outages are very common occurrences as well. Most of the staff also admitted that the atmosphere of the interior seems dull and needs livening up through more color. Overall, the staff came to a inal conclusion that the plan and design of the architecture worked in terms of giving the patients the maximum amount of environmental views and natural daylight. They were also positive that as time goes on, they will begin to add more color and interest to their units in order to provide a more residential and enjoyable atmosphere for the patients.

FIG. 3.18 Nurses’ Staition Air Quality

Westchesterâ&#x20AC;&#x2122;s BHC Room Square Footages Room Name Storage Office Weight Room Nurse's Lounge Staff Bathroom Waiting Room Dining room Pantry Vestibule Nurse's Station Central Lobby Nurse's Breakroom Day Room Staff Laundry Storage Patient Room (3 beds) Patient Room (2 beds) Patient Room (1 bed) Bathroom Janitor's Closet Restraint Room Electrical Closet Treatment Room Med. Room Activites Room Quiet Room Data Office File Room Utility Closet Open Office Training Room Soiled Utility Room Girl's Bathroom Boy's Bathroom Chart Room Conference Room Patient Lounge

Sq. Ft. 200 120 450 170 N/A 100 530 75 250 230 650 75 400 N/A 100 20 200 165 123 N/A N/A 132 N/A 180 50 500 90 225 65 N/A 160 275 N/A N/A N/A 50 250 270

PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT

FIG. 3.19a 3rd Floor Adjacency Plan

PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT

FIG. 3.20 Basic Plan Circulation

FIG. 3.19b 2nd Floor Adjacency Plan

FIG. 3.21 Basic Plan Circulation

PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT

FIG. 3.19c 1st Floor Adjacency Plan

PRODUCED BY AN AUTODESK EDUCATIONAL PRODUCT

FIG. 3.19d Basement Floor Adjacency Plan

BIBLIOGRAPHY Chalmers, Ray. “Psychiatric Institute Finds New Home: Remodeling a County Home for the Elderly Saved $50/sq. ft.” Building Design and Construction Mar. 1986: 88-91. Building Design and Consruction. Web. 27 July 2015. Interview with Program Administrator IMAGES

FIG. 3.1: Chalmers, 89 FIG. 3.2: Chalmers, 91 FIG. 3.3: Chalmers, 89 FIG. 3.4: Jenna Sacks FIG. 3.5: Jenna Sacks FIG. 3.6a-d: Jenna Sacks FIG. 3.7: Jenna Sacks FIG. 3.8: Jenna Sacks FIG. 3.9: Jenna Sacks FIG. 3.10: Jenna Sacks FIG. 3.11: Jenna Sacks FIG. 3.12: Jenna Sacks FIG. 3.13: Jenna Sacks FIG. 3.14a-b: Jenna Sacks FIG. 3.15: Jenna Sacks FIG. 3.16: Jenna Sacks FIG. 3.17: Jenna Sacks FIG. 3.18: Jenna Sacks FIG. 3.19a-d: Contributed from Posen Architects, West Orange, NJ FIG. 3.20: Jenna Sacks FIG. 3.21: Jenna Sacks

Newark Beth Israelâ&#x20AC;&#x2122;s Child Crisis Intervention Service Unit (CCIS)

FIG. 3.22 Site Map of Newark Beth Israel

Overview

ewark Beth Israel’s Children’s Crisis Intervention Services (CCIS) unit is located at 201 Lyons Avenue in Irvington, New Jersey. In 1901, “The Beth” opened its doors to the public as a 21-bed facility that later evolved into a leading hospital in the center of Newark. As census, or number of patients, began to grow, the notable architect—Frank Grad—was selected in 1921 to help expand and move the hospital from High Street to its current location on Lyons Avenue. Amongst the numerous buildings that make up the hospital, the tallest is the central tower which is twelve stories high. The others range between ive and ten loors. The CCIS Unit occupies only 8,141 square feet out of the total square footage of the Medical center which is well over a million.

FIG. 3.23 Signage Ties Back to History

The original budget during the construction of the hospital was middle to high; however, the budget of renovations began to rise at a slow rate in the year 1996 when Newark Beth Israel was bought by Saint Barnabas—one of the largest healthcare systems in the nation. The building is privately owned by the Saint Barnabas Healthcare System today and serves the general public. The main users of the building are those that live in the Newark and Irvington areas. This population consists of lower socio-economic families on Medicare and Medicaid. People come to Newark Beth Israel because they are known for their medical advancements in cardiology; however, they have physicians and services pertaining to other health needs including cancer, diabetes, kidney transplants,

hospice, psychiatry, and more. Their psychiatric services are broken into three units—a voluntary adult unit, involuntary adult unit, and the CCIS unit. The Children’s unit is used by children ages four to seventeen who have behavioral or mental diagnoses. These patients usually come from broken homes in the local area. There is about twenty staff that work with this population, which include nurses, licensed practical nurses (LPN), and psychiatrists. Other users include visitors who are allowed to enter the unit during the week from six to eight at night, and one to four in the afternoon on weekends and holidays. Visitors are usually the parents or siblings of the patient. It is also a limit to two visitors per patient at one time. There is an average of about eight to twelve guests that visit during the week and twelve to twenty ive on the weekends. Newark Beth Israel is located in a prime location in the heart of Newark. They are able to help a greatly underserved community in New Jersey and are located in an area with a reputation for having a high crime rate. It is located in an urban setting on two fairly major arteries in Newark. Due to the major expansions that have taken place since 1901, there are many other buildings and services within a close distance including a second pharmacy and child service facilities.

FIG. 3.24 Original Newark Beth Israel (Exterior)

FIG. 3.25 Original Newark Beth Israel (Interior)

Newark Beth Israel’s CCIS unit is unique in more ways than one because of it’s size and presence in the community. Although the facility does not have outpatient services, they serve the child and adolescent population on a smaller scale. The eighteen-bed unit has a smaller four to one patient to nurse ratio which helps to give more attention to each patient. In comparison to Westchester Medical Center, the scale provides different approaches to treatment and interaction between staff and patients and the rest of the hospital. The location in the center of a major city is also convenient for the users in the area but could also hinder the healing process with the lack of environmental views or expansive outdoor areas. 40

FIG. 3.26 Original Newark Beth Israel Nurses

There is a challenging system of wayinding throughout Newark Beth Israel Hospital that takes one from the lobby of the facility to the inal destination that one needs to reach. In

order to get to the D building, one needs to walk through a series of long halls and follow ceiling mounted signs that indicate where to go to reach each separate building from A to N. Elevators are also a daunting decision because there is no exterior signage that indicates which elevator carts are denied access to certain levels. At the end of the long stretches of hallways, only two of the four elevators can take the visitor to the ifth and tenth loors. The CCIS unit is located on the ifth loor of the D building, which was a ten-story add-on sometime during the mid-1900s. The building’s footprint resembles the Greek cross. This is a very functional form that enables the patient rooms to line the edge of the interior to provide them with light and outdoor views. The unit occupies two wings of this cross that are perpendicular to each other. One wing contains

Design Concept and Styles

he architectural style of Newark Beth Israel is unique because it is a mixture between Romanesque Revival and Spanish Colonial. Features such as regularized windows and entablature on the front façade classify this landmark as Romanesque Revival, whereas, the mass of the brick structures, inner courtyards, and red tiled roofs relect the Spanish Colonial Style. Together, these characteristics fused together to create the tower of “the Beth” that serves as a historical landmark for the heart of Newark. The other buildings branch off of the main building and are made of the same brick with steel construction in order to look cohesive.

FIG. 3.28 Newark Beth Israel Hall 1

FIG. 3.29 Newark Beth Israel Hall 2

FIG. 3.27 Newark Beth Israel (Today)

FIG. 3.30 Newark Beth Israel Hall 3

FIG. 3.32 Diagram of Circulation on Unit

FIG. 3.31 Building Axis Diagram

FIG. 3.33 Diagram of Adjacency on Unit

the more private spaces including the patient rooms and housekeeping functions. The large public day room is also located in the center of all the patient rooms because this is where the patients are able to relax after they have inished getting ready for the day. The other wing is made up of spaces that hold daily activities such as the dining area, sun room, treatment room, and classroom. The nursesâ&#x20AC;&#x2122; station, medicine room, and quiet room are all conveniently located at the meeting of these two wings. In addition, ofices for a psychologist and social worker are also placed throughout the lengths of both hallways along with small storage rooms for games and toys. The most public locations throughout the units are located at the far ends of each wingâ&#x20AC;&#x201D;those areas being the sunroom / dining room and day room. There is more hierarchy allocated to these rooms because of the large square footage dedicated to 42

these spaces where patients can spend most of their free time. The HVAC systems are strung overhead above the ceiling tiles in the halls. Air is provided into the patient rooms through a boxed ixture over the door frame. This is important to take note of as it is tamper proof and does not allow for patients to access the system through their gyp board ceiling. There are also separate units that are scattered throughout the halls and public spaces that are the original systems built with the building and provide extra ventilation. Overall, there was not much thought given to sustainability during the construction of this building. Most attention was geared towards the function of the building and minimal decoration in order to accommodate the daily work and health precautions in the healthcare setting.

he interior of the CCIS unit at Newark Beth Israel is more colorful than most psychiatric facilities. It is noticeable that the facility is aware of the age population that they are serving and is in the process of deinstitutionalizing and modernizing the interior environment. The color palette was originally pastel pinks, blues and greens that can still be seen through the VCT loor patterning and wall paints; however, in recent years, some accent walls have been painted a vibrant orange, yellow, and green. Although the palette is not fully cohesive, it still emanates a positive environment.

FIG. 3.35 Pastel Hallways

FIG. 3.36 New Paint Colors in Hall

Interior Design

FIG. 3.34 a / b HVAC systems

The interior environment is built up of mostly Vinyl Composite Tile (VCT) and painted gyp board. Both materials have their pros and cons and serve the purpose of being affordable while reaching the minimum requirements of safety and construction. The VCT looring is in decent condition despite the fact that it requires the most maintenance. It was noted that some patients peel the paint off of the gyp board walls which could be a safety hazard. In addition, the quiet room on the unit does not follow the speciic standards that the typical quiet room in a psychiatric facility would require. Instead of using a padded material for the walls, there was a misunderstanding in the purchase of materials and the vendor had installed a regular blue gyp board. Today, the wall is two different toned blue gyp board due to the amount of times the walls were kicked in by patients and replaced. Overall, the materials it the function of the unit to a certain extent. Materials in areas such as the quiet rooms and patient rooms need to be reassessed for safety.

Some of the choices in furniture and ixtures used throughout the unit are up to code whereas other are not deemed safe in a psychiatric facility. The chairs that are used in the day room and dining area are typical wooden furniture that are upholstered in vinyl and easy to lift. These can serve as a weapon if there is ever a disgruntled patient. The doorknobs used throughout the unit are also not to code because they have a lat ledge where a patient could injure themselves. Unlike Westchester, Newark Beth Israel does not furnish their patient rooms with mattresses that have antimicrobial capabilities that can also resist damage from soiling. This could be a health and safety issue at one point. Some of the safer

The areas that do not receive natural daylight are the day room, nurse’s station, and hallway. Because the unit is “L” shaped, most rooms are placed along the perimeter of the interior to soak up the daylight with the corridor taking up the remainder of the central space. The day room is very well lit with bright 2x2 light ixtures in an organized layout. This room should have at least a few windows because patients spend most of

FIG. 3.38 Day Room Furniture

FIG. 3.37 Main Feature Wall of Day Room

FIG. 3.40 Patient Room Furniture

furniture and ixtures include the securing of shelving units to the walls and beds to the loors for the safety of patients and staff, the use of automatic toilets and sinks in bathrooms, and safety mirrors and windows that are shatter-proof.

FIG. 3.41 Door Fixture

FIG. 3.39 Patient Bed

FIG. 3.42 Typical Patient Bathroom

FIG. 3.43 Sun Room

FIG. 3.45 Basketball Court

FIG. 3.44 Calm Room

FIG. 3.46 Sun Room Furniture

their free time in this room. On the other hand, the hallways are dimmer because they are lit by a single line of the same 2x2 ixtures along an eight foot wide corridor. The difference in lighting is not evident until one stands in the day room and looks down the hall towards the nursesâ&#x20AC;&#x2122; station. Each room that has a window is treated with blinds that are controlled by the user of the space. This gives the patients and staff the ability to control the light that comes into their own personal working or living space. Natural light is also brought in through a sun room that was built at the opposite end of the hallway from the day room. The patients are able to use this space to get fresh air and be outdoors. A basketball court extension off of the sun room was also built

FIG. 3.47 Calm Room Paintings

prior to the year 2000 for patients to play outside when the weather is nice out. The art that decorate the walls are found in the dining hall and the calm room. The calm room is a small room that is very dimly lit and serves as a solitary play room. The patients had painted murals of suns and lowers on the wall; however, it will soon be painted over and refurnished with a large lounge chair that will evoke a calmer atmosphere. The murals were a nice addition that allowed the patients to express themselves creatively; however, seeing how the calm room is about 50 square feet; The wall art came across as very busy and chaotic. It is best that the patientsâ&#x20AC;&#x2122; art work be displayed, but in more places than the dining area. 45

FIG. 3.48 Quiet Room Lock

FIG. 3.50 Classroom

FIG. 3.51 Day Room

FIG. 3.49 Quiet Room

Some of the negative feedback given was the dificulty of wayinding around the hospital and the lack of attention to ixtures that are up to code. Newark Beth Israel is a really large hospital with multiple buildings that are labeled A through J; however, the buildings are not labeled in alphabetical order. The building is so confusing that on occasion,

patients will be dropped off at the CCIS unit in the D building, when they need to be admitted into the pediatric unit in the B building. The attention to ixtures on the unit was also a concern of the nurses because they have experienced unsafe situations brought on by the interior environment. One story that was shared was the original door used in the quiet room. There was a disgruntled patient placed in the quiet room who broke down the wooden door, ripped out the small glass window, and chased nurses and staff down the halls threatening them. Eventually, security had arrived and restrained the patient; however, the staff is now more aware of how important materiality can play a role in safety on the unit. Today, the quiet room has a metal door that can only be opened with a key. It is sad to say that Newark Beth Israelâ&#x20AC;&#x2122;s CCIS unit only renovates or reconsiders furniture and ixtures after such problems arise.

Post-Occupancy Survey

couple of the registered nurses of the CCIS unit agreed that the layout of the unit is very functional. It is beneicial that the patient rooms are located on one axis of the building and all other daily acivities such as the eating area, sun room, and classroom are located on the other axis because it psychologically breaks up their day. The patients are never stuck in the same four walls of their room or in the same orientation of the unit. They were also positive about the renovations and bright colors that were giving the interior environment a more uplifting vibe.

Evaluation

fter visiting Newark Beth Israel’s CCIS unit, I immediately compared my notes to my visit with Westchester Medical Center in New York. I was very surprised at the vast differences and the similarities between the two. Two of my concerns stem from the use of certain furniture and ixtures as well as the location and materials in some rooms. It is a gamble and liability that the hospital waits for an accident or problem to arise before they decide to select other materials that are up to code in behavioral facilities. The location of the quiet room next to the nurses’ station is also a concern because there is a two-way window where the patient can view the nurses’ and vice-versa. I think that this is a poor decision that could cause more angst within the patient and result in them becoming violent for being placed in a solitude-like environment. I believe that a one-way mirror would be a better decision that would allow the nurses’ to see the patient and monitor their activity. I would also enforce that the quiet room have the required walls that it needs in order to combat more damage to the walls and injuries of the patient.

I agreed with the nurses and staff when they were explaining the adjacencies of the rooms and how certain daily functions are located on another wing in order to serve as diversion and break up each patient’s day. The location of the nurses’ station being in the center of the unit near the entrance is also a positive feature as they are readily available to reach both ends of each wing quickly and can monitor all who enter and leave. I also like how the hospital had built an exterior sun room and basketball court for the patients. This room serves as an open and airy space for patients to spend time and relax on a rooftop exterior area. The inal trait that I appreciated about Newark Beth Israel’s CCIS unit is the location. This psychiatric facility is able to accommodate each patient from the local region and can even accommodate patients from other areas with lower patient to staff ratio than Westchester. This means that on average, they are able to shorten each patient’s stay to about ive to seven days, whereas Westchester kept patients for at least two weeks.

Newark Beth Israel Room Square Footages Room Name Storage

Office

Treatment Room

Nurse's Lounge

Staff Bathroom

Dining room Nurse's Station (includes filing) FIG. 3.52 Window in Quiet Room

Sq. Ft.

Day Room Laundry Patient Room (2 beds)

200 130 400 50 120

Patient Room (1 bed)

Janitor's Closet

Quiet Room

Med. Room

Calm Room

Clean Utility Room

Soiled Utility Room

Classroom

200

FIG. 3.53 Quiet Room Finishes

BIBLIOGRAPHY Interview with Registered Nurse on the CCIS Unit IMAGES FIG. 3.20: Google Maps search “Newark Beth Israel Hospital” FIG. 3.21: Jenna Sacks FIG. 3.22: Jenna Sacks (pictures framed in Hospital Hallways) FIG. 3.23: Jenna Sacks (pictures framed in Hospital Hallways) FIG. 3.24: Jenna Sacks (pictures framed in Hospital Hallways) FIG. 3.25: Jenna Sacks FIG. 3.26: Jenna Sacks FIG. 3.27: Jenna Sacks FIG. 3.28: Jenna Sacks FIG. 3.29: Jenna Sacks FIG. 3.30: Jenna Sacks FIG. 3.31: Jenna Sacks FIG. 3.32: Jenna Sacks FIG. 3.33: Jenna Sacks FIG. 3.34: Jenna Sacks FIG. 3.35: Jenna Sacks FIG. 3.36: Jenna Sacks FIG. 3.37: Jenna Sacks FIG. 3.38: Jenna Sacks FIG. 3.39: Jenna Sacks FIG. 3.40: Jenna Sacks FIG. 3.41: Jenna Sacks FIG. 3.42: Jenna Sacks FIG. 3.43: Jenna Sacks FIG. 3.44: Jenna Sacks FIG. 3.45: Jenna Sacks FIG. 3.46: Jenna Sacks FIG. 3.47: Jenna Sacks FIG. 3.48: Jenna Sacks FIG. 3.49: Jenna Sacks FIG. 3.50: Jenna Sacks

Zucker Hillside Replacement Hospital

This facility is located on a hospital campus in a suburban neighborhood in Long Island serving

a population that is middle socio-economic class. Other buildings in the medical complex include an ambulatory center, the Long Island Jewish Medical Center, The Cohen Children’s Medical Center, the Ronald McDonald House of Long Island, etc. The area outside the campus is residential consisting of mainly apartment style living. Glen Oaks experiences all fours seasons throughout the years, which means that all structures in the community must be able to withstand a range of temperatures between a low and high average of twenty four and eighty four degrees Fahrenheit and weather ranging from snow to rain (“Glen Oaks (zip 11004), New York”).

Overview

ucker Hillside Replacement Hospital is located in Glen Oaks, New York at 79-59 263rd Street (“Array Architects”). This facility is a two loor hospital that is a total of 139,000 square feet and was completed in 2013 by Array Architects (“Array Architects”). The total budget for the construction of the project was very high, averaging at about $528 per square foot (“North Shore Long Island Jewish Health System Zucker Hillside Hospital - Glen Oaks, New York.”) in order to bring the three pre-existing inpatient cottages up to date. Some of the costs contributed towards implementing more sustainable systems as well as interior materials that will enhance the attitude of patients and staff.

Zucker Hillside Replacement Hospital is owned by North Shore Long Island Jewish Health System, which is one of the largest healthcare

FIG. 3.54 Site Map

systems in the New York Metropolitan Area. They focus on treating patients in every stage of life with quality care and promote community health, research and Education (“North ShoreLIJ Reports and Fact Sheets”). Zucker Hillside’s facility specializes in treating psychological and behavioral illnesses in adolescents, adults, and geriatric patients. They also have a Behavioral Health College Partnership with multiple universities including St John’s and Adelphi University that serves to “address behavioral health crises on campuses through emergency protocols, enhanced school / hospital communication and specialized evaluation and treatment” (“North Shore-LIJ Reports and Fact Sheets”). The length of adolescent patients ranges between four to seven days (“North Shore-LIJ Reports and Fact Sheets”). Other users of the space include visitors, nurses, doctors, administrative assistants, and other support staff.

FIG. 3.55 Color around Exterior

This facility is unique because of the application of knowledge and attention on behavioral health and psychological illnesses across a multitude of ages. The National Institute of Mental Health even “established a Clinical Research Center for the study of schizophrenia at the hospital, making it only one of four such facilities nationwide” (“The Zucker Hillside Hospital”). In addition, this hospital was recognized in Behavioral Healthcare Magazine’s May / June 2013 issue for receiving an honorable mention in the Design Showcase (“Array Architects”). Array architects specialize in healthcare design and understand the presence of increased security and acute care along with residential, warm, and inviting design.

FIG. 3.56 Aerial View from behind Rotunda

FIG. 3.57 Front Entrance to the Rotunda

FIG. 3.55 Exterior of Rotunda

FIG. 3.58 Aerial View of Hospital

FIG. 3.59 Separate Entrances

Design Concept and Styles

ucker Hillside Replacement Hospital is a contemporary structure that successfully pushes the boundaries between form and function. The facility is constructed of steel and large spans of glazing. The overarching concept of this facility is to create a space where patients feel at home, comfortable, and safe, while promoting healing and recovery through special relationships, familiar materials inspired by nature, and bringing in an inlux of daylight (“Array Architects”). Both the interior and exterior designs relect this statement as seen through the vast amount of daylight that enters the facility through the exterior courtyard, curtain windows in the rotunda, and exciting colorful materials. The main entrance to the Zucker Hillside is the two story rotunda that also serves as a lobby and over low area for visitors to wait and for staff to congregate while grabbing a quick coffee. This is located in the center of the three quadrants. The other two entrances are concealed; one of which is designated for staff and the other for patients being admitted from

FIG. 3.60 Public and Private Spaces in Quadrant 2

the emergency center (“Array Architects”). Zucker Hillside is organized using the approach of the three corridor system which groups the public zone, staff services, and patient zones (“Array Architects”). The public space for visitors is a hallway that is accented with furniture around the perimeter of the building where they can enjoy scenic views of the courtyard. The central core of each unit contains services such as support spaces and consultant ofices that attach to both the patient and stafing hallway. The stafing services include the medication dispensing station with a ixed polycarbonate glass, consultation ofices, a seclusion suite, and a centrally located nurses station that allows them to see to the end of each hallway (as seen in Case Study 2 Newark Beth Israel) (“Array Architects”). The patient rooms are located on the perimeter opposite the courtyard. Hallways and circulation paths allow movement around activity areas and dining areas (“North Shore LIJ Health System The Zucker Hillside Hospital, Inpatient Care Center”). This method of arrangement increases the safety

FIG. 3.61 Natural Light

FIG. 3.62 Organization of Building

FIG. 3.63 Three-Zone Circulation

of all users of the building while decreasing the institutional look and feel (“Array Architects”). There is hierarchy seen in diagrams that support the importance of patient spaces verses public spaces as well as the value of private patient’s spaces verses group spaces. The circulation and wayinding methods throughout the facility are very unique. The three corridor system helps to deine the safety required in each zone. The patient corridor is solely meant for visitors to neander before or after visiting a patient. This zone in particular does not need as much attention to safety as other areas because patients usually walk along this corridor with a nurse. Each unit can be accessed by the visitor corridor. The patient and staff corridors branch off from this entrance and run parallel along each other. The staff corridor cannot be accessed by patients and therefore are also not required to contain all safety ixtures and materials (“Array Architects”). The adult and adolescent units were planned on the irst loor closest to the exterior courtyard in order to accommodate the more active population (“Array Architects”). Most of the wayinding is achieved by strategically placing large scale art at key checkpoints throughout the units. This is especially useful for patients with dementia (“Array Architects”). Zucker Hillside Replacement Hospital is “a conventional steel-frame structure, with concrete loors and an exterior shell of panels and curtain walls” (“Zucker Hillside Hospital”).

FIG. 3.64 Shading Detail

This facility is LEED Silver accredited. Some of the features that attribute to the certiication is the use “construction materials with recycled content, locally manufactured products with no or low PVC content, installation adhesives and sealants that have low VOCs, and FSC-accredited wood products. In addition, there are green screen planters attached to the building that are maintained via drip irrigation (“Zucker Hillside Hospital”). FIG. 3.65 Interior Rotunda Wood Detail

I Interior Design

t is crucial to note that most inishes and materials for this project are either monolithic, tamper proof, and promote anti-ligature. Most of the materials that can easily be seen are solid surface, gyp board, large tiles, vinyl upholstery, and decorative thick backlit plastic panels. The plastic panels are very unique because they are not only contemporary accents, but they are also shatter proof and have a sustainability factor because they are made from recycled material.

bathroom are loor mounted rather than wall mounted in order to keep patients from easily disengaging them from the wall. Grab bars around the toilet must be anti-ligature as well meaning that patients should not be able to tie anything around them to harm themselves. Instead, the grab bars that are installed have a solid block on the back side that still support the use of a grab bar but donâ&#x20AC;&#x2122;t allow materials to wrap around it. This facility also installed fully recessed toilet tissue dispensers that are mandated to follow New Yorkâ&#x20AC;&#x2122;s Laws for The ixtures found throughout Zucker Hillside Behavioral Health Care Centers. In addition, meet codes of New York as well as the pressure hooks were installed to hang coats; standard of the Ofice of Mental Health Patient however, if a heavier object is placed on the Safety Standards and Guidelines. The most hook, the mechanism will turn downward essential ixtures are found in the bathroom in order to keep patients from harming and private rooms where patients spend time themselves. Another interesting feature is the independently. Some of these include attention inward swinging doors in the patient rooms. to toilets grab bars, coat hooks, toilet tissue Although this might sound dangerous in the dispensers, and door locks. The toilets in the event that there is a barricading instance, there

(a)

(c)

(b)

FIG. 3.66 (a) Adolescent Bedroom (b) View from Nursesâ&#x20AC;&#x2122; Station (c) Bathroom

is emergency release hardware on the door that enables it to swing outward for nurses and staff to enter the room in the case of an emergency (“Array Architects”). Natural Lighting is one of the largest components of the concept of Zucker Hillside and is brought into the facility in numerous ways. Daylight is brought in through the large windows in the two stories rotunda. The large curtain system along the public hallway and windows in the patient rooms also help daylight to enter. Light is also transported deeper into the facility through the activity and dining areas which “feature partial-height partitions and glass walls to provide visibility from the [staff] zones” as well (“Array Architects”). The artiicial light used resembles the essence of natural light as well. The ixtures in public areas are diffused and cove lighting is used in a few feature areas that admit light that is relected off of the white ceilings. The interior color palette is very successful. The colors range from a poppy red and orange in the

FIG. 3.67 Rotunda Interior

public areas to a calming blue and green in the patient rooms. These hues are complimented by warm grays that deine the soothing atmosphere and create a home-like atmosphere. They are also shown through the art and decorations that are displayed throughout the halls as a means of wayinding. The large panel pieces are large graphics of nature scenes that also have small benching areas for one to sit along the hallway. It is also very thoughtful that the color schemes and room designs for the adolescent verses the geriatric patients are unique in relation to their age. For example, the geriatric rooms have handrails on the walls and cubical curtains in case they are receiving an exam; whereas the adolescent patient rooms have specially designed wardrobes and desks that create a zone separate from their bed. The wall paint above the bed is magnetic which also allows patients to customize their space (“Array Architects”). The attention towards each patient population and the spaces they need is a special feature of Zucker Hillside Replacement Hospital.

FIG. 3.68 Visitor Hallway

FIG. 3.70 Small Kitchen Area

FIG. 3.69 Patient Public Area and Nursesâ&#x20AC;&#x2122; Station

emergency or barricading situation. Some negatives I had seen are the use of institutionalized furniture in the patient community lounge area. I feel that the design is upscale with the decoration of 3form panels and digital art wallcoverings. The look of the furniture does not seem to it in with the contemporary architectural style. Instead, they look institutional. Overall, Array Architects are knowledgeable in designing healthcare facilities and Behavioral Health Centers. They were overqualiied and succeeded at redesigning Zucker Hillside Replacement Hospital and it is well deserved that they were recognized in Behavioral Health Magazine from their design showcase.

Evaluation

ucker Hillside Replacement Hospital is a remarkably designed facility from the detailed ixtures to the attention towards patient populations. The quadrants create standardized units that are easy to navigate through. The three corridor system for patients, staff and the public also help to group functions together and creates a more structured, safe, and residential environment for the patients and staff. In addition to zoning, I found it unique that the patient rooms are able to lex from private to semi-private if census goes over the 19-bed constraint. I also thought that it was intriguing to see a lot more options for door locks and bathroom ixtures. I was especially impressed when I saw that the patient doors can swing in and out of the patient rooms in case of an

FIG. 3.71 Patient Public Area

BIBLIOGRAPHY “Zucker Hillside Hospital.” Current: Zucker Hillside Hospital. Gotham Construction Company, 2012. Web. 30 Sept. 2015. “North Shore LIJ Health System The Zucker Hillside Hospital, Inpatient Care Center.” Ennead Architects. N.p., n.d. Web. 30 Sept. 2015. “North Shore Long Island Jewish Health System Zucker Hillside Hospital - Glen Oaks, New York.” Behavioral Healthcare. N.p., 30 May 2013. Web. 30 Sept. 2015. “North Shore-LIJ Reports and Fact Sheets.” North Shore-LIJ Reports and Fact Sheets. North Shore LIJ, 2015. Web. 03 Oct. 2015. “The Zucker Hillside Hospital.” Architect. The Journal of the American Institute of Architects, 8 Jan. 2013. Web. 30 Sept. 2015. “Array Architects.” Zucker Hillside Replacement Hospital. N.p., n.d. Web. 03 Oct. 2015. “Glen Oaks (zip 11004), New York.” Sperling’s Best Places. Bert Sperling, 2015. Web. 3 Oct. 2015.

IMAGES FIG. 3.54: Google Maps search “Zucker Hillside Replacement Hospital” FIG. 3.55: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.56: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.57: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.58: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.59: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.60: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.61: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.62: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.63: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.64: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.65: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.66: https://www.behance.net/gallery/17731087/The-Zucker-Hillside-Hospital FIG. 3.67: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.68: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.69: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.70: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/ FIG. 3.71: http://array-architects.com/projects/north-shore-long-island-jewish-health-system/

Nemours Childrenâ&#x20AC;&#x2122;s Hospital

FIG. 3.72 Site Map

Nemours Children’s hospital is located in a highsocio economic suburban corner of Orlando,

Florida. The facility is surrounded by 60 acres of greenield with apartments and housing developments nearby (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). The average family income in this area loats around $117,000 (“Orlando, Florida Climate.”). Some of the functions that were incorporated into the hospital, such as an outdoor performance space and overnight rooms for parents, were inluenced by the population surrounding and its distant location. The terrain proved dificult to work with because it is located on a water table with little vegetation or pleasant outdoor views (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). In addition, the subtropical environment is highly uncomfortable with a majority of days consisting of high humidity and harsh sun. Temperatures throughout the year generally fall between the average low and

Overview

emours Children’s Hospital is located in Orlando Florida. This facility is comprised of seven loors (Behm, Cailtin) that totals to 630,000 square feet (“Nemours Children’s Hospital.” The project was led by architect and interior designers Stanley Beaman & Sears along with associate architects Perkins + Will (“Nemours Children’s Hospital.”). In total, Nemours Children’s Hospital cost $260 million shown which can be seen through the implementation of the latest sustainable systems, colorful and welcoming aesthetics, as well as additional entertainment and family spaces that create an environment that supports the healing of children (“Nemours Children’s Hospital.”)

FIG. 3.73 Curved Southern Facade

high of 50 and 92 degrees Fahrenheit (“Orlando, Florida Climate.”). These landscape and climate factors greatly impacted the design of Nemours Children’s Hospital by raising the entry level by one story to combat the high water table, implementing shading devices to shade the interior and exterior areas, as well as landscaping the surrounding land to create outdoor seating areas and soothing environmental views seen from patient rooms. Nemours Children Hospital is owned by Nemours Children’s Health System. Nemours philosophy is centered on the best interest of the child—no matter what age—and they play a large role in treating this population on an international level (“About Nemours | Nemours”). The family unit is also a large focus on supporting patients from

FIG. 3.74 Outdoor Landscaping

all walks of life (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Children who come to Nemours generally have “chronic conditions, as well as complex medical diagnoses and life-threatening illnesses” (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). These can include oncology, digestive health, primary health, and more. In order to accommodate this population, Nemours understood the importance of family support and the presence of parents and medical professionals as a solid support system in the healing of young patients. With that in mind the visitor is also a main user of the facility as they are able to spend a night or two in an overnight room which includes laundry facilities (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Other users of the building are also support staff and medical professionals.

Nemours Children’s Hospital is a facility that has transformed the design standard for healthcare facilities. The amount of attention that was spent towards creating a sustainable structure as well as the creating an inviting environment is well respected. It is evident that all design decisions were designed based off of what would most beneit the child in an facility that is centered upon healing. Arch Daily described Nemours Children’s Hospital as “designed to reassure and inspire, engage and delight.” This simple statement describes Nemours impact on the child’s road to recovery and is a successfully designed interior serving as a healthcare facility for the child and their parents. FIG. 3.75 East Facade

FIG. 3.76 Outside Main Entry

FIG. 3.77 Northern Facade

Design Concept and Styles

emours Children’s Hospital is a contemporary style structure characterized by the many outdoor lounges, use of natural light, and large spans of glass along the exterior. The goal of the hospital was to design the exterior and interior and interior to evoke “a life-afirming quality sure to reassure parents and delight children” (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). In addition, the increased importance of sustainability became a focus as well as creating purpose to the wetland landscape that the hospital occupies. The execution of the concept and attention to sustainable consciousness was successfully achieved.

The hospital consists of seven loors and contains inpatient and outpatient services along a main axis with a semi-grand entryway in the middle. The location and relationship between the two services is unique and functional with more square footage and hierarchy attributed to the inpatient portion. Each inpatient and outpatient unit that are similar in medical treatment are located in adjacent wings, which helps to develop a consistent care regimen among nurses and staff as patients use both units if needed (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Near the entry, there are more public amenities including a learning center, auditorium, administration, cafeteria, and retail area. There is also a valuable service called The KidsTRACK which is centrally located. This program

educates parents on the illness or condition that their child may have and trains them how to care for them at home. Trainings include how to clean or use special equipment such as special wheelchairs or ventilators as well as how to cook for certain conditions. A kitchen is also included in this service to demonstrate (Matambanadzo, Shandi). Other spaces that are more private are organized on other loors including 95 patient rooms, 76 exam rooms, an emergency facility, overnight accommodations for parents, laundry facilities, lounges and playrooms, rooftop terraces, and more (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Circulation through out the building is fairly simple and broken down by small reception desks ports to aid the navigation of parents who are visiting their child in the hospital. Elevators are centrally located between the inpatient and outpatient unit. In addition, there are small clerical ports stationed in each elevator lobby in order to help direct visitors to certain areas of the hospital both vertically and horizontally. This live interaction lessens the stress of one who is visiting a patient in the hospital setting (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). To illustrate the strength of Nemours Children’s hospital structure, it was “designed to withstand the effects of a category three hurricane” (Behm, Cailtin). The material palette of the exterior architecture include vast

FIG. 3.78 Ground Floor Plan

FIG. 3.79 Diagram of Inpatient v. Outpatient Services

FIG. 3.80 Second Floor Plan

FIG. 3.81 Fourth Floor Plan

amounts of curtain walls in addition to precast concrete, terracotta, metal panels, and patterned glass (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). The structure itself is mainly constructed of reinforced concrete with steel framing around the mechanical penthouses. The rest of the hospital is reinforced with reinforced concrete columns. Each loor is also a concrete slab ranging in thickness from nine to fourteen inches (Behm, Cailtin). Because one of the curtain walls is curved, it is supported by slanted structural columns for bracing (Behm, Cailtin). The HVAC systems used throughout the facility are very successful because they are spread throughout the structure. “The central energy plant houses the large mechanical equipment such 70

as chillers, cooling towers, and boilers” (Behm, Cailtin). Other stations of HVAC systems include a mechanical penthouse located above the hospital and clinic as well as a mechanical mezzanine containing air handling units (Behm, Cailtin). Additional systems that were inspired by the environment include the shading devices and the ramp to accommodate the building’s location on a water table. Numerous solar studies contributed to the organization of shading over outdoor spaces. In addition, a ventilated skin of terra cotta was applied to the south façade which allows for air low on the portion of the building that is prone to heat gain (Matambanadzo, Shandi.). The long curved driveway ramp was designed in response to the environment. The signiicance of this element is the elevation of the irst level from the delivery

FIG. 3.82 Diagram of Public v. Staff Zones

FIG. 3.83 Diagram of Planned Environmental Spaces

FIG. 3.84 Diagram of Circulation

FIG. 3.85 Diagram of Natural Light

and service drop off area in the basement. It also serves to create an environmental element that continues along the campus, “through the building and beyond, where it skirts alongside outdoor garden rooms, concluding in another landscaped destination” (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). The honeycomb design also creates hierarchy on the site as it leads the visitor to and from main entries into the hospital (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Sustainability has been a focal point for Nemours Children’s Hospital. It is one in three children’s hospitals in the nation to be deemed LEED Gold Certiied (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Stanley Beaman & Sears have

designed two of those three structures (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Some elements include the amount of landscaping that encouraged the growth of vegetation on the 60 acre plot that was originally not useful (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). In addition, the wetlands proved useful in creating storm water retention ponds to combat looding (Matambanadzo, Shandi.). There are also green roofs that are accessible to patients, sun shading additions that lessen the load of the HVAC systems, as well as luorescent type lighting that were minimized to a LEED certiied level in order to cut down on light pollution (Behm, Cailtin).

Interior Design

utting edge and well-known materials were selected to create an open and inviting interior atmosphere. Some of these materials include 3-form resin wall panels, Carnegie wallcoverings, Armstrong ceiling systems, Interface and Shaw carpeting, and more (Matambanadzo, Shandi.). The hue of materials that were selected are saturated and poppy colors that appeal to the fun personality of each child in order to create an interior that is unrelated to the term “institution.” These materials are appropriate for this environment because of the stellar repot of these manufacturers as well as the ability to transform a hospital into a space where children can heal as well as play in endless playrooms and enjoy framed scenic views of the landscaped campus. The furniture used for this project are all different shapes, styles, and colors, which deines each space and gives the user a variety of different ways to sit or lounge around. Some furnishings seen in photographs are

FIG. 3.86 Patient Unit

more functional and orthogonal whereas others are more organic in shape and can slide together and connect with other pieces of furniture. Fixtures that are also used follow healthcare codes by substituting sharp corners for rounded edged counter tops and using high performance materials to keep a clean and modern aesthetic environment (“Nemours Children’s Hospital / Stanley Beaman & Sears.”). Color is successfully brought into the space in numerous ways and deies the usual institutional color scheme. Hues such as magenta, rich blues, muted and saturated greens, bright oranges, as well as other hues of the rainbow are included in each space in order to create an environment that every child would enjoy. Colors are brought into each space through means of wall paints, looring designs, and textiles selected for furnishing. The art and decorative elements created by Distinctive Art Source also created pieces that were inspired by the palettes on

FIG. 3.87 Cafeteria

each loor and send the visitor on a visual journey of garden views inspired by the exterior environment as well as the colors of nature. A bulk of the lighting is daylighting, which is brought in through the curtain walls, especially on the North façade. Natural light was a priority in creating a facility that was sustainable and evoked an environment that allows healing. Artiicial lighting, as stated before, is mainly luorescent lighting which is also a sustainable mode of illumination. Florescent ixtures help to cut down the amount of light pollution and reduced the building’s energy usage. Other forms of lighting used are accent lights that prove to be fun and colorful in different spaces including the lounge areas and patient rooms. The accent lighting in patient rooms is especially unique because each patient is able to personalize the color of light illuminating their room. The effects can be seen from outside as they create an artful building façade of colorful blocks that speak volumes about this healthcare facility geared towards children (“Nemours Children’s Hospital / Stanley Beaman & Sears.”).

FIG. 3.88 Colorful Facade Controlled by Patients

FIG. 3.89 Interior Lounge Area with Unique Lighting

FIG. 3.90 Rooftop Garden

FIG. 3.91 Patient Room with Accent Lighting

Evaluation

emours Childrenâ&#x20AC;&#x2122;s Hospital is a successful case study that shows the priority of creating a healthcare facility geared towards their target population, which are children. Not only does the color palette clearly suggest the intent and focus on the younger generation, but the opportunities that are provided also create a fun and interactive atmosphere that enable the patient to enjoy their time while they are being hospitalized. Such opportunities include ample play rooms, outdoor garden areas, and a performance stage

for small shows to take place. In addition, the encouragement of the family unit were also thought of in terms of creating verbal wayinding through concierge desks at elevator lobbies, training and education areas for illness and equipment care, as well as overnight amenities to enable parents to stay with their child during treatment. Nemours Childrenâ&#x20AC;&#x2122;s Hospital is a center that was designed through extensive studying and surveying as well as compassion from the designers and client.

FIG. 3.93 Lounge Area

FIG. 3.92 Lounge Area

FIG. 3.94 Exam Room

FIG. 3.95 Patient Unit

FIG. 3.96 Serving Area

BIBLIOGRAPHY “About Nemours | Nemours.” About Nemours | Nemours. The Nemours Foundation, 2015. Web. 08 Oct. 2015. Behm, Cailtin. “Building Statistics.” Nemours Children’s Hospital: As Part of the Nemours Foundation. AE Department, 29 Apr. 2012. Web. 08 Oct. 2015. Matambanadzo, Shandi. “Nemours Children’s Hospital: Project Breakdown.” Healthcare Design Magizine. N.p., 20 Mar. 2013. Web. 08 Oct. 2015. “Nemours Children’s Hospital.” Stanley Beaman Sears RSS. N.p., 2013. Web. 08 Oct. 2015. “Nemours Children’s Hospital / Stanley Beaman & Sears.” ArchDaily. ArchDaily, 24 Oct. 2013. Web. 08 Oct. 2015. “Orlando, Florida Climate.” Sperling’s Best Places. Bert Sperling, 2015. Web. 08 Oct. 2015.

IMAGES FIG. 3.72: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f5746e8e44e988d00005b-nemours-children-s-hospital-stanley-beaman-and-sears-site-plan FIG. 3.73: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.74: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.75: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.76: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.77: http://stanleybeamansears.com/wp-content/uploads/2013/03/Nemours.pdf FIG. 3.78: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f5673e8e44e713c00005a-nemours-children-s-hospital-stanley-beaman-and-sears-level-1-plan FIG. 3.79: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f5673e8e44e713c00005a-nemours-children-s-hospital-stanley-beaman-and-sears-level-1-plan FIG. 3.80: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f56cde8e44e2451000064-nemours-children-s-hospital-stanley-beaman-and-sears-level-2-plan FIG. 3.81: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f55a3e8e44e2451000060-nemours-children-s-hospital-stanley-beaman-and-sears-level-4-plan FIG. 3.82: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f5673e8e44e713c00005a-nemours-children-s-hospital-stanley-beaman-and-sears-level-1-plan FIG. 3.83: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f56cde8e44e2451000064-nemours-children-s-hospital-stanley-beaman-and-sears-level-2-plan FIG. 3.84: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f5673e8e44e713c00005a-nemours-children-s-hospital-stanley-beaman-and-sears-level-1-plan FIG. 3.85: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f56cde8e44e2451000064-nemours-children-s-hospital-stanley-beaman-and-sears-level-2-plan FIG. 3.86: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f5784e8e44e2451000067-nemours-children-s-hospital-stanley-beaman-and-sears-photo FIG. 3.87: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.88: http://stanleybeamansears.com/wp-content/uploads/2013/03/Nemours.pdf FIG. 3.89: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.90: http://www.archdaily.com/439396/nemours-children-s-hospital-stanley-beaman-andsears/525f57b5e8e44e2451000068-nemours-children-s-hospital-stanley-beaman-and-sears-photo FIG. 3.91: http://www.khss.com/our-work/project/nemours-childrens-hospital/ FIG. 3.92: http://stanleybeamansears.com/project/nemours_childrens_hospital/ FIG. 3.93: http://www.khss.com/our-work/project/nemours-childrens-hospital/ FIG. 3.94: http://www.khss.com/our-work/project/nemours-childrens-hospital/ FIG. 3.95: http://www.khss.com/our-work/project/nemours-childrens-hospital/ FIG. 3.96: http://www.khss.com/our-work/project/nemours-childrens-hospital/

Section IV 76

"The strongest people are not those who show strength in front of us, but those who win battles we know nothing about." ~Unknown

Ergonomic & Technical Criteria

echnical Criteria regarding interior design decisions are exponentially ampliied in behavioral health facilities. This is because this particular setting cares for patients who have been hurt by others, hurt themselves have psychiatric disorders or stress related illnesses, or must modify their behavior (Malkin 291). Whichever the case, a couple of broad based interior criteria for behavioral health centers include prohibiting anything that is sharp, ingestible, or easily thrown, implementing tamper proof hardware including screws and grills for HVAC systems that are located on ceilings or high on walls, and prohibiting items that could be shattered or destroyed such as mirrors. One should also consider installing door knobs that are designed in a way that cannot be tied together with a belt, pantyhose or shoelace. Another safety consideration would be to implement a FireSafe-Fire system that enables ire doors to open in case a ire alarm sounds. These are just a few examples of the amount of detail that is present when designing and specifying ixtures as well as furnishings for spaces in a facility that supports a range of people with behavioral problems. The remainder of this section will go more into depth in regards to interior design considerations including, furniture, daylighting, sustainability, and more.

Furniture

n in-patient behavioral health facility contains all types of furniture including bedding, sofas, ofice furniture, and more. It is imperative that all furnishings located in patient rooms, dining areas, and day rooms are stable, easy to maintain, contain no sharp edges, and are heavy enough that patients will not be inclined to use them as a weapon. For that reason, bean bag chairs can also be appropriate for some areas because if they are thrown, they will not hurt anyone (Malkin 294). Oak wood furniture is also acceptable because it is heavier and can be sanded in-house if damaged or vandalized (Malkin 294). Furniture should also be constructed of tamper proof fasteners to ensure safety and stability (“The Mental Health Policy Implementation Guide”). Patient bedrooms, which are generally considered high risk areas, contain the most restrictions for furnishings. Foam mattresses should be speciied. Mattresses cannot be box springs and should not have zippers or pockets. In addition, vinyl covers should accompany

FIG 4.2 Seattle Children’s Hospital Behavioral Health Unit

the mattress so that it will not rip and expose inner materials. In addition, furniture should be either bolted to the ground or bolted to a wall in order to avoid injuries as well as discourage patients hiding from staff. In general, furnishings should have soft corners rather than sharp points or edges. Furniture should also be durable and nontoxic. Weighted blankets or heavy pillows are also suggested for children’s bedding in order to calm them (Nussbaumer 184). It is safe to say that most furniture should be monolithic; however, if this is not the case, joinery details should be carefully evaluated in order to withstand abuse and should contain “notched or recessed inger pulls rather than surface mounted handles” (Malkin 294). Placement of bolted furniture should be considered mainly in terms of safety. The proximity to doors and hidden corners is one feature to note so that patients and nurses are not taken off guard or attacked by patients who can hide behind furniture and surprise the staff (Malkin 294).

FIG 4.3 Fun Furniture

FIG 4.1 Norix Furniture is it for Prisons as well as Behavioral Health Facilities

FIG 4.4 Hallways

FIG 4.5 Anthropometric Data for children ages 3-18

FIG 4.6 Dynamic Kid Movements

Ergonomics

t is essential to focus on the ergonomics, anthropometrics, and proxemics of the spaces that will be used by the patient user groups, staff, and visitors. Ergonomics is deined as the designing of objects so that users interact more eficiently and safely with them shown in diagrams of reaching, sitting, and stepping. Anthropometrics is the focus of designing with the dimensions and needs of the human body in mind shown through chart diagrams of childrenâ&#x20AC;&#x2122;s measurements and igure diagrams. Proxemics is the study of the nature, degree, and effect of the special separation individuals naturally maintain and how this separation relates to environmental and cultural factors illustrated in diagrams of typical patient rooms, bathrooms, waiting rooms, ofices, and more. Ergonomics and anthropometrics play a large role in child and adolescent behavioral health facilities because body measurements vary so vastly due to growth. There will be a variety of rooms and custom designs that will be usable by users of all sizes and ages.

FIG 4.8 Standard Body Dimensions of Children

FIG 4.7 Standard Body Dimensions (Standing / Sitting)

FIG 4.8 Standard Kitchen Spacing

FIG 4.9 Standard Waiting Area Spacing

FIG 4.11 Stair Railing Details and Measurements FIG 4.15 Threshhold Measurements

FIG 4.12 Universal Railings

FIG 4.13 Standard Nosing Measurements (Stairs)

FIG 4.14 Standard ADA Elevators

FIG 4.16 Ergonomic Kitchen for Average / Tall / Short

FIG 4.17 Ergonomic Workstations (Standing)

FIG 4.19 Chair Adjustability

FIG 4.18 Ergonomic Workstations (Sitting)

FIG 4.20 ADA Ofice Set-up

FIG 4.18 Ergonomic Workstations

FIG 4.21 Conference Tables / Workstations

FIG 4.22 Handicapped Bath Tubs

FIG 4.23 Handicapped Showers

FIG 4.24 Standard Bathrooms Sharing Plumbing Wall

FIG 4.26 ADA Shower Setups (Plans)

FIG 4.25 ADA Bathrooms

FIG 4.27 ADA Bathrooms

FIG 4.28 Reaching Distance in Wheelchair

FIG 4.30 Minimal Door Swings

FIG 4.29 ADA Hallway Width

FIG 4.31 ADA Corridor

FIG 4.33 Typical ADA Bathrooms

FIG 4.31 Typical Bathroom FIG 4.34 Typical ADA Toilet and Urinal

85 FIG 4.32 ADA Toilet with Grab Bars

FIG 4.35 Typical Toilet Stalls

FIG 4.36 ADA Compliance with Visually Impaired

FIG 4.37 Stair Codes for Visually Impaired

FIG 4.38 Components of Signage

FIG 4.41 Typical Door Openings

FIG 4.39 Length of Female Reach in a Wheelchair

FIG 4.40 Wheelchair Meaurements

FIG 4.42 Door Distances from Corners for the Handicapped

FIG 4.43 Components and Placement of Signage

FIG 4.44 Universal Signage FIG 4.45 Standard Ramps

FIG 4.46 Maneuvering Chances at Doorways

FIG 4.47 Typical Patient Room FIG 4.50 Typical Patient Rooms

FIG 4.48 Typical Waiting Room

FIG 4.49 Typical Out-Patient Facility

FIG 4.51 Typical Out-Patient Facility

FIG 4.52 Typical Out-Patient Facility

FIG 4.53 Typical Patient Rooms

FIG 4.54 Typical Patient Rooms

FIG 4.55 Typical Patient Rooms

FIG 4.56 Typical Patient Rooms

Materials

electing materials for behavioral health facilities are very challenging because they must be able to be durable and easy to maintain in the healthcare setting as well as have an aesthetic value and therapeutic attributes to contribute to patients who are not well (“The Mental Health Policy Implementation Guide”). It is also desirable for these materials to be affordable, sustainable, safe, and ire retardant (“The Mental Health Policy Implementation Guide”). Materials throughout behavioral health center should meet all minimum standards for lammability and contain antimicrobial characteristics as regulated by healthcare codes. Some examples of materials include wooden doors because they are easy to sand down in-house when damaged, matte inished surfaces that don’t relect faces, and non-toxic paint. It was found that painted walls are

more desired over vinyl wall coverings because they are easier to repair and patients usually pick at vinyl wallcovering seams. In addition, carpeting should be directly glued rather than tacked in place. They should also be solution dyed in order to resist fading and contain an antimicrobial backing in order to sustain in a setting of constant cleaning and moisture (Malkin 292). The Ofice of Construction & Facilities Management at the Department of Veterans Affairs published DesignGuide for Healthcare Facilities that was published in December of 2010 and was later revised in August of 2014. Section 4.4.4 lists and describes types of materials, their characteristics as well as their location in this type of facility. This list is as follows:

Flooring Finishes: should promote a warm, bright, and healing environment. The looring material should be secured to the loor, not easily torn or dislodged and free of tripping hazards. Floors with high glare can cause dificulty for psychotic patients and older patients and, therefore, should be avoided. Resilient looring--including rubber looring, linoleum or sheet vinyl--are manufactured in a variety of attractive patterns and colors, are sustainable, durable and easily maintained. Sheet vinyl is the only resilient looring available in a wood grain pattern. As part of the stated objective to create a residential feel, this wood grain look is strongly recommended for use in inpatient rooms and units. Other colors and patterns may be used elsewhere in inpatient and outpatient facilities. Vinyl Composition Tile has been previously used by the VA but is not recommended due to the high maintenance cost over the life of the product. Ceramic or porcelain tiles are also an option. Through body porcelain tiles carry their color and pattern through the entire thickness of the tile making them virtually impervious to wear. They may be considered for waiting areas, patient dining areas, and other congregate areas where durability and maintainability are of concern. Ceramic tile, no larger than 2â&#x20AC;? x 2â&#x20AC;?, may also be used in inpatient bathrooms for loor surfaces only. The tile should be installed with no exposed edges to prevent a patient from dislodging a tile and using it as a weapon. Porcelain tile or ceramic tile should have a coeficient of friction no less than 0.7 COF.

FIG 4.57 Colorful Flooring

Carpet tile is recommended due to its ability to be replaced. Carpet backing should have an upgraded moisture guard or moisture resistant backing system. It is recommended to use backings with a lifetime warranty to protect against de-lamination and edge raveling. Carpet tile should be used in supervised patient areas such as group therapy and in staff areas such as conference rooms and ofice areas. Epoxy loor inishes may be used in seclusion bathrooms but is not recommended in general inpatient bathrooms because of its negative institutional appearance. Solid surface shower base used in both accessible and non-accessible models allow a durable monolithic shower loor surface that is preferable to ceramic tile in inpatient bathrooms. Floor base materials such as rubber cove base are recommended where the looring material is carpet, carpet tiles, sheet vinyl or rubber. In areas where a more residential look is desired, upgraded rubber bases that simulate wood base is recommended. Where ceramic or porcelain tile is used, the base should match the looring. Care should be taken that this base cannot be easily dislodged by patients. Thresholds should be avoided wherever possible to prevent tripping hazards and use as a weapon. They should be irmly secured to the loor with tamper resistant and fasteners if required. Thresholds should be no higher than Âžâ&#x20AC;? above the loor.

FIG 4.58 Interactive Nature Installation through Halls

Wall Finishes: should be durable, easily cleaned and non-toxic. Common wall inishes include paint and vinyl wallcoverings. Warm paint colors with accent tones should be used in patient rooms and common areas. Vinyl or non-breathable wallcoverings should not be used on exterior walls due to moisture and mold concerns. Wallcoverings can be used in public areas to provide texture, pattern, or color to the wall surface. An eggshell paint inish is recommended instead of a lat inish in most applications. Eggshell is easier to clean, maintain, and match when patching. A level 4 inish for drywall is required along with one coat of primer and two top coats of paint. Inpatient bathrooms and patient toilet walls should be painted with epoxy paint. High impact paneling and trim come in a variety of colors and textures and can provide an aesthetic beneit of creating a wainscot in a corridor, a headboard or miscellaneous trim in a patient room while providing the functional beneit of enhanced impact resistance to walls.

to areas such as reception and waiting areas where this material cannot be easily scratched or damaged. 2â&#x20AC;? x 2â&#x20AC;? Ceramic wall tiles are acceptable for outpatient and resident bathrooms and toilet rooms in mental health facilities where the potential for abuse is minimal. Ceramic wall tile should not be used in inpatient mental health bathrooms and toilets. Solid surface panels are recommended in showers for inpatient bathrooms. This material is attractive, durable and easy to maintain. Corner guards and other wall protection are mandatory. All edges and corners should be protected by corner guards. When using handrails specify a bracket enclosure preventing an anchor point. Fasteners should be concealed Acoustic wall panels help absorb sound in areas with mostly hard surfaces. The fabric material of the acoustic panel should be durable and nonabsorbent. These panels should be located in areas not easily accessed by patients.

Wood paneling and trim create a warmer, more residential environment, but should be limited

Ceiling Finishes: Moste ceilings, especially those in patient rooms, will be painted gypsum board. All gypsum board ceilings shall be painted with an off-white color, eggshell inish. Acoustic Tile may be applied in spaces used by patients that are continuously observed may be acoustic tile, with the tiles clipped in place to the grid. Acoustic tile ceilings facilitate maintenance access above the ceiling provide good sound absorption, and are less costly than gypsum board ceilings. The ceiling height should be higher than standard to inhibit patient access to the ceiling. Acoustical plaster is typically between 1â&#x20AC;? and 2â&#x20AC;? thick and can be applied directly to gypsum board ceilings to improve acoustic performance in a space and is recommended in inpatient dayrooms and dining areas when gypsum board ceilings are used. To prevent patients from tampering with the devices recessed in the ceiling, raise the height of the ceiling to a level where it is dificult for a patient to reach. Patient areas with hard ceilings should be a minimum of 9 feet high, particularly in areas where patients are not continuously supervised such as patient bedrooms and bathrooms. Patient activity areas should have a minimum ceiling height of 10 feet if acoustic ceiling tiles are used.

FIG 4.59 Colorful Waiting Area with Unique Lighting

Lighting

rtiicial lighting as well as natural lighting with environmental views are valuable when designing any healthcare facility that is promoting a relaxing and healing environment. When using both types, it is imperative to avoid creating harsh shadows. In addition, artiicial lighting ixtures should be recessed in ceiling or walls and be tamperproof. This means that they require unbreakable covers and are vandal-proof. This especially stands for lighting in bedrooms and bathrooms. Wall mounted sconces, pendant lighting and loor or table lamps are prohibited in inpatient settings. It is also helpful to have a full range of luorescents as well (Malkin 292). In general, natural daylight is valued because exterior views also accompany natural lighting providing inpatient with sensory stimulation and a rhythm of the time of day (â&#x20AC;&#x153;The Mental Health Policy Implementation Guideâ&#x20AC;?). With this standard in mind, artiicial lighting should really only be considered to supplement day lit areas during evening hours as well as rooms that do not have access to daylight. Guidelines in regard to natural light and artiicial light were also provided by the Ofice of Construction & Facilities Management from the Department of Veterans Affairs DesignGuide.

natural light:

artiFiCial lighting:

Controlled natural daylight should be maximized in the design. Speciic goals related to acheiving maximized daylighting is to plan the design around providing natural light in feasible areas in appropriate quantities. This light should be distributed uniformly where possible, with no signiicant dark spots. Lighting ixtures that are sensitive to daylighting will enable them to be turned off when not needed and are a reputable sustainable measure. Sun control is essential, but exposed sun control devices such as drapes, blinds and other interior shading devices should be avoided in inpatient group congregate areas wherever possible. Window sizing should also be considered in order to reduce undesirable heat load and glare causing visual discomfort or visual disability.

Artiicial lighting should be implemented in areas where natural lighting cannot reach. Lighting levels shall be appropriate to the use of the space. Variable lighting levels should be provided in inpatient areas to allow different lighting levels based on the activity and time of day. One should also provide accent lighting, both interior and exterior where appropriate. Interior accent lighting should highlight art work and other feature walls. Exterior accent lighting in spaces viewed from the inpatient unit prevents looking out into a black hole at night. While maintaining safety and security is essential, avoid excessive illumination in spaces such as corridors or exterior courtyards that reinforce an institutional image and interfere with normal day/night rhythms.

FIG 4.60 The Future of Garden Environments in Healthcare

Sustainability

ustainability is usually very challenging to implement into the design of healthcare facilities. Sustainability will be more of a consideration with regards when specifying materials such as looring, ceilings, and luorescent lighting systems. For example, although rubber and vinyl are the most highly recommended in healthcare for being safe in terms of comfort; however, they contain the most carcinogenic compounds and give off the most off gas (Kopec 269). In addition, HVAC systems could be chosen to support a more eco-friendly space; however, this will be an obstacle because windows will not be able to open enough to provide a substantial amount of natural ventilation. Other means of sustainability might require environmental systems such as water retention ponds, constructing shading devices, and other innovative initiatives to be implemented into the landscape. It may also be a requirement to follow certain federal and state regulations in terms of water and energy usage. Some of these codes include the Energy Independence and Security Act of 2007, Executive Order 13423 and EPAct 2005 (Kopec 268). Other means of sustainability could be using sustainable operations and maintenance, nontoxic materials, and increasing natural daylight.

FIG 4.61 Roberts Pavilion with Natural Light

FIG 4.62 Acoustic Gyp. and Glazing Partition

FIG 4.63 Acoustic Treatement in Plenum

isual control is needed in public areas on the unit. For example, the nurse’s station is generally centrally located and is able to visually see both ends of the unit. The only means of privacy that patients receive are usually in their bedrooms as well as bathrooms; however, even rooms will have small windows framed on patient room doors in order to ensure safety as staff walk by. Visibility can also be in shower rooms if some patients have a higher risk at harming themselves. In this case, curtains are attached to the rod with Velcro. The shower curtain should also be cut at least one foot off the ground so that feet can be visible for the aid. The same procedure may apply to toilet stalls.

Visual Control

Acoustical Control

coustical control is imperative in certain spaces such as physician patient consulting areas where medical information is being exchanged and is now mandated under Health Insurance Portability and Accountability Act or HIPPA. This provides privacy and conidentiality and also reduces extra noises from other areas. Patients should not be able to hear information disclosed between staff or staff and other patients. Excessive noise can be a problem and can destroy the calmness of the therapeutic environment and can cause a patient’s fear and anxiety levels to rise. It also affects the staff and their ability to hear and be heard by others using a normal tone. Sound absorption can be controlled based upon partition construction which can reduce sound transmission especially between rooms in a certain adjacency. In gathering areas, sound absorption could be enforced through certain interior wall, ceiling, or looring inishes in order to cut back on extra noise. These inishes should be selected carefully for areas such as corridors, day rooms, and dining spaces (“The Mental Health Policy Implementation Guide”).

Visual control is also crucial when separating onstage and offstage functions such as housekeeping, nursing and staff lounges, and patient spaces. In order to keep from creating an institutional facility, these functions should be separated so patients are not exposed to sounds and visuals of dirty laundry being transported, and nurses on a break are not being viewed by patients going about their day.

FIG 4.64 Children’s Hosptial Colorado Wayinding

Language or jargon used can be a problem for a lot of people who are unable to relate to medical terms and deinitions. Therefore some hospitals have incorporated pictures into their signage in order to relate to a larger population of people. Brail and raised letters could also be implemented to reach out to a population of people who are visually impaired. Hierarchy refers to the differences in signage. For example the difference between room signage verses loor signage that indicates the services on each loor. In addition, the differences between an ofice room sign and a bathroom sign.

Legibility is a key factor that enables the sign to be read based off easy to read text fonts and large lettering. Also contrast of colors as well as lighting placement can also play a key role in enabling someone to be able to read signage. Placement of the information indicates how it will be received. Most signs should be around the average sight line; however, the way in which they are delivered, for example a sign suspended from the ceiling will probably serve a larger population verses a sign that is located next to a door which is probably communicating with someone who is within a closer range.

Wayfinding

ayinding is a concern in stressful settings such as healthcare facilities and affect every user of the building from all walks of life, whether they be a user, patient, staff member, or handicapped. Numerous factors go into creating successful signage.

FIG 4.65 Children’s Hosptial Signage

In general, signage should serve the purpose of allowing a visitor to navigate the facility with minimal assistance. “Signage in inpatient units should be attached to walls with concealed tamper resistant fasteners and have beveled edges to prevent the signage from being removed and used as a weapon” (“The Mental Health Policy Implementation Guide”). In addition, ceiling suspended signage is prohibited because they could easily be dismounted. 99

Security and Universal Design

100

ecurity is heightened in areas that involve patient privacy. When patients are given privacy, premeasures of safety are shown through the ixtures, materials, and systems in their rooms such as reducing the use of ledges that enable patients to hang from as well as implementing a thirty pound limit to hooks, drapery rods, and other ledges that can be used as a point of suspension. Other areas such as dayrooms, dining areas, and recreation rooms are deined as lower risk areas because patients are being monitored by staff. Furnishings and materials must still be selected carefully but it is not a requirement for theses selections to be the same standard as those placed in high risk areas.

Security is also shown through systems such as ire exits where “fail-safe” systems come into play. Fail-Safe ire exits function in a way that when a ire alarm goes off, ire exits automatically open to ensure the safety of the patients and staff; “fail-secure” is a different system that requires the staff to

open ire exits with a key when a ire alarm goes off. This can prove to be an unsafe system in time of panic. The entrance to a unit usually requires Physical Access Control Systems (PACS) that are ID card readers. This enables only certain personnel to enter the unit. Other doors such as medicine rooms and storage rooms that contain patient belongings from their time of admittance are stored usually in a room with a keypad lock. As for psychiatric ofices and housekeeping functions, doors are locked with keys that are only given to those who need access to those functions.

niversal Design is very important in today’s day and age because it enables spaces fulill the needs and abilities of the user. In order to achieve universal design, attention will be spent towards ADA accessibility in corridors, bathrooms, patient rooms, and all levels. In addition, signage, reaching distances and desk or counter services will be of an accessible height with an open area for leg room for those in wheelchairs.

FIG 4.66 Security Partition Constructed of Gyp. Board and Glazing

FIG 4.67 Security Wall Construction Stragegies

101

BIBLIOGRAPHY Malkin, Jain. Hospital Interior Architecture: Creating Healing Environment for Special Patient Populations. New York, NY: Van Nostrand Reinhold, 1991. Print. â&#x20AC;&#x153;The Mental Health Policy Implementation Guide.â&#x20AC;? PsycEXTRA Dataset (2010): 4-20--30. Department of Veterans Affairs. Ofice of Construction & Facilities Management. Web. 18 Oct. 2015. Kopec, David Alan. Environmental Psychology for Design. New York: Fairchild, 2012. Print. Nussbaumer, Linda L. Human Factors in the Built Environment. N.p.: n.p., n.d. Print. IMAGES FIG. 4.1: http://www.norix.com/seating.asp FIG. 4.2: http://www.healthcaredesignmagazine.com/article/photo-tour-seattle-children-s-hospital-psychiatry-and-behavioral-medicineunit FIG. 4.3: http://www.healthcaredesignmagazine.com/article/photo-tour-seattle-children-s-hospital-psychiatry-and-behavioral-medicine-unit FIG. 4.4: http://www.healthcaredesignmagazine.com/article/photo-tour-seattle-children-s-hospital-psychiatry-and-behavioral-medicineunit FIG. 4.5: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.6: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.7: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.8: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.9: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.10: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.11: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.12: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.13: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.14: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.15: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.16: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.17: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.18: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.19: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.20: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.21: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.22: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.23: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.24: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.25: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.26: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.27: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.28: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.29: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.30: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.31: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.32: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.33: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.34: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.35: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.36: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.37: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.38: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.39: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.40: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.41: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.42: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.43: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.44: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.45: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.46: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.47: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.48: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.49: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.50: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.51: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.52: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.53: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.54: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.55: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.56: Human Factors in the Build Environment By Linda L. Nussbaumer FIG. 4.57: http://www.interiordesign.net/projects/detail/2103-over-the-river-and-through-the-woods/ FIG. 4.58: http://xo-inmyroom.com/2013/02/06/jason-bruges/ FIG. 4.59:http://www.archdaily.com/401607/aia-selects-12-projects-for-national-healthcare-design-awards/ FIG. 4.60: https://blueprint.cbre.com/healthcare-spaces-of-the-future-smart-design-healthier-patients-2/ FIG. 4.61: http://125.cooperhealth.org/2012/05/roberts-pavilion-cooper-opens-doors-era-healthcare/ FIG. 4.62:Interior Construction & Detailing for Designers and Architects By David Kent Ballast FIG. 4.63: Interior Construction & Detailing for Designers and Architects By David Kent Ballast FIG. 4.64: http://arthousedenver.com/portfolio/childrens-hospital-colorado/ FIG. 4.65: http://arthousedenver.com/portfolio/childrens-hospital-colorado/ FIG. 4.66: Interior Construction & Detailing for Designers and Architects By David Kent Ballast FIG. 4.67: Interior Construction & Detailing for Designers and Architects By David Kent Ballast

102

103

Section V

"Not all wounds are visible." ~Unknown

Topical Exploration

FIG 5.1 Depressed Child

Human Behavior

106

ehavioral health centers accommodate a particular demographic of people who have unpredictable behaviors and may be prone to harming themselves or others. There are numerous similarities between behavioral health centers and general healthcare facilities in terms of creating a comfortable and tranquil environment for patients while keeping their dignity and giving them control over their environment. Today, there are many negative preconceived notions of health facilities inluenced by pop culture, all of which exaggerate the large concrete or brick construction, long echoing corridors, and controversy of control between the nurse and patient (Kopec 264). These behaviors are further heightened by numerous factors that arise from the stress of facing an illness or disorder. For this reason, one must consider the unique population that will be utilizing this particular behavioral health facility in order to alleviate stress and accommodate the needs of the patient, visitors, and staff.

The targeted population is children ages ive to eighteen who have behavioral and psychological disorders. This is a very unique demographic because they are especially vulnerable to stress. Children are most comfortable in environments that they are familiar with and rely on safety from their parents. Adolescents—although they may seem to be more mature and independent—still rely on their parents, as well, for comfort and safety (Kopec 265). Both groups have similar coping abilities as they both fear the future in regards to their health (Kopec 265). Healthcare facilities can heighten these stresses due to the separation from their family, friends, and home. “Studies have shown that the presence of family members in the health care environment provides many beneits for the sick child” (Kopec 265). This spearheaded family-centered healthcare where additional spaces were implemented in order to allow children to spend quality time with their families. In addition, private rooms began to become more popular in helping to protect the privacy of patients.

Other studies found that “children created associations between a negative event such as an injection with the environment where the injection was give” (Kopec 265). On the other hand, procedures that take more time, for example dialysis, should be performed in the child’s room so that they do not experience further separation from their personal space (Kopec 266). By taking the amount of time taken for procedures, the child will feel safer in their environment. Adolescents are a unique population group because they are beginning to separate themselves from children but are not quite considered adults. “During this period, individuals tend to experience extreme thoughts and beliefs, and they understand

the world in profound ways. Likewise, as a teen’s body develops into its adult form, he / she may become insecure about its appearance” (Kopec 266-267). With that being said, privacy as well as occasional peer interaction are main focuses for adolescents. Some spaces including a gaming room, lounge, or itness facility might also be included into facilities to accommodate such activities. Doors with locks can also be implemented; however, it is imperative that an override system be included with this ixture in case of an emergency situation. Personalization in the patient’s room is also a large factor in promoting comfort for adolescents. Anything can be implemented from magnetic paint to post pictures or spaces for display of memorabilia are just a few suggestions.

FIG 5.2 Depressed Teen

107

Stress and anxiety is naturally produced from illness and the severing of attachment between a patient and their home. This is due to the “profound sense of loss. Everything about the person with the exception of their illness becomes invisible and psychological loss of control results from not being allowed to make decisions about their lives and the activities they can take part in” (Kopec 261). High levels of stress and anxiety can lead to more intense physical and psychological effects, such as depression. Often times, the comfort of the patient begins with the irst impression of the building. It has been found that most low rise buildings are perceived as less intimidating because the user inds it easier to enter and exit the building. Most healthcare facilities evoke institutional characteristics which include large massive spans of brick or concrete and oversized elements on the façade. These elements can overwhelm the patient or visitor and already instill a feeling of stress and disorientation. The scale of the front façade should be considered in addition to breaking the single lat span of masonry. This can be done by implementing homier, protective, and human-scale architectural elements including canopies or varying materiality, and differing roof lines in order to break the lat plane of the façade, create hierarchy, as well as frame an entrance for the visitor to be drawn into the facility. Other necessary services such as security and other institutional functions should be incorporated into the building in order to camolage institutional functions. Layout issues as well as wayinding could be other anxiety-producing elements of large healthcare facilities. Stress is produced from environments when one does not have a clear understanding of space or visually distinct features to serve as a mode of wayinding. This lack of consistency can simulate a labyrinth-like layout and cause anxiety amongst users of the space. Healthcare facilities that have a more residential feel with centrally located lex spaces FIG 5.3 Art depicting Stress and Anxiety

108

would create less stress for patients, visitors, and staff and serve as a wayinding system through progression from public to private zones. Providing views of nature is one way to alleviate stress and anxiety in a healthcare facility. Nature allows one to experience feelings of familiarity as well as relax them. It also serves a portal for visual stimulation and personalization of space. “Research has shown that gardens and green spaces that promote privacy also promote healing for all patients” (Kopec 261). This is especially true for long term facilities including behavioral health settings. It has been proven that gardens incorporated into the overall design helps to increase participation amongst the patients to perform “future-oriented exercises” which include planning, planting, tending and more (Kopec 261). Actions such as tending and nurturing plants can be beneicial and therapeutic to the patients by “restoring patients’ sense of control, give patients a sense of purpose and meaning, and keeping patients mentally active” (Kopec 262). Gardens can also help to destress family members and can provide momentary distractions and enhance mood. Nature depicted in artwork is also proven to have similar effects. A study conducted by Roger Ulrich in 1984 revealed that “psychologically appropriate artwork, such as nature scenes (especially those of water and trees), can also positively affect patient outcomes in an acute care setting by reducing blood pressure, anxiety, intake of pain medication, length of patients ‘ hospital stays, and sadness and depression” (Kopec 262). It was also indicated that patients with a pleasant view to the landscape have shorter hospital stays, require smaller doses of painkiller, and experience lower levels of stress. The incorporation of nature should be through lexible design strategies that allow the patient to view nature from both indoors and outdoors. The implementations of gardens and green patio spaces are also very positive features to have in order to alleviate the stress of the patients and staff.

109

Lighting is another interior factor to consider in a healthcare facility because it affects the ability of all users to perform daily tasks as well as regulates the circadian rhythm and mood of the patients (Kopec 273). In healthcare environments, it is imperative to increase the amount of natural daylighting throughout the facility and use artiicial lighting as supplementary lighting. Due to the amount of research, studies have shown that daylight can have incredible effects on human behavior that will prove to be crucial in a behavioral health facility. For example, “there is evidence that morning sunlight is twice as effective as evening light when treating some forms of depression such as Seasonal Affective Disorder” (Kopec 273). Other studies of light showed that patients diagnosed with bipolar disorder had a longer hospital stay of 3.67 days longer when their room had a room along the western façade. Although the sun is the most intense from the east and west, this case shows that eastern sunlight has more therapeutic qualities than western sunlight. It is also important to note that the sun is the brightest from the South and the weakest from the north (Kopec 273). Another study showed that depressed institutionalized adults felt less depressed and resumed regular activities when they were exposed to thirty minutes of bright light therapy a day for ive consecutive days (Kopec 273). Materials and Color are other factors that can vary when considering the amount of guidance and time that patients spend in each space in a behavioral health facility. It is imperative that materials be selected that are—irst and foremost—easily cleaned. This usually entails that the materials be shiny or glossed which can create glare and prove to be uncomfortable for the patient. “[…] People with cognitive impairments either caused by high levels or stress or dementia have decreased capacity to recognize and understand sensory experiences” (Kopec 274). This may increase their sensitivity to certain sensory stimuli. Designers must be aware 110

of the sun and moon patterns within the facility in order to produce the glare from materials. “Glare has the potential of ‘washing out’ colors and patterns, causing temporary blindness and pain, or generating optical illusions related to elevation changes” (Kopec 274). Colors are also requested to be selected with care and used mainly as a means of wayinding; however social spaces should also have color in order to create interest but should not hinder the comprehension of the space. Designers should avoid color extremes, for example, choosing schemes that are too dull, too bright, or too busy (Kopec 247). High contrasting colors could also prove to be a hazard because they can produce the illusion of three-dimensionality and promote falls. The key to color schemes is selecting one that has a variation of hues and saturations that will give interest to each space but also promote a tranquil and calm environment.

FIG 4.4 Therapeutic Daylight

FIG 5.5 Color and Human Behavior

with psychological disorders had more shock responses to red than any other color (Tole 41). Furthermore, he found that schizophrenics suffered from color shock when they were shown color cards after being presented with black and white cards (Tole 41). In general, there is no set color scheme that is agreed upon amongst color theorists that are deemed most appropriate for behavioral health or healthcare facilities. Instead, Color In Healthcare Environments created a chart of colors and descriptions from psychologists about their meaning, inluence on behavior, and suggested locations for these colors (Tole 5057). For example, Marberry & Zagoon (1995) report that Red is deined as having qualities of high energy and passion and can also excite and raise one’s blood pressure. Conversely, Malkin (1982, 1992) reports that reds and yellows should be used in creative and social areas in order to excite and encourage people.. Patients with depression might also be inluenced by

Color

olor theory affects behavior in more ways than one in behavioral health centers. The effects of color have been analyzed dating back to Egyptian times where colored minerals and animal parts including red clay, white oil, and yellow ochre were prescribed to treat patients (Tole 38). Today, there are many theories about color and their presence in inluencing behavior as well as diagnosing and healing ailments. One study in particular is the Rorschach Inkblot test which tested normalities and abnormalities in psychiatric patients’ and their reaction to different colors (Tole 39). Rorschach’s hypothesized that responses to color are the measures of the emotional state of the subject (Tolev 41). These measures would prove his point that subjects with psychological disorders are more likely to experience “color shock,” or rejection to color, which would be relected through their delayed reaction when exposed to a color blot (Tole 41). In his research, he found that patients

111

this color; however patients with epilepsy or other neurological ailments might need to be avoided (Tole 50). Other important color considerations from this chart are as follows: Orange denotes verbal expression of emotion; emits great energy, warmth and reassurance. Peach and salmon are cheerful colors and are popular in dining rooms and healthcare environments (Tole 50). Yellow and yellow-orange are considered optimistic, mood enhancing, and must be carefully considered because it causes thought associations with aging and yellow skin tones replicating jaundice. It is usually used in creative / social environments and can increase illumination in poorly lit areas (Tole 50). Green and Yellow-Green emit qualities of nurturing, healing, and unconditional love. They may lessen eyestrain for surgeons as they focus their eyes from body tissue to surrounding contrasting environment. They should be used in areas that require more quiet and extended concentration as well as high visual acuity. Green is associated with pleasant odors and tastes, whereas yellow-green and purple relections will make patients look sickly (Tole 50). Blue is known to lower blood pressure and is an excellent healing color for nervous disorders. The sight of blue can relieve headaches, bleeding, open wounds, and so on. It is used in areas that require more quiet and extended concentration and high visual acuity. Blue allows for relaxation and recuperation and is popular in bedrooms (Tole 50). Purple is a stress reducer and creates feelings of inner calm (Tole 50).

112

Overall, Color Theorist, Mahnke (1996), illustrates the following recommendations for mental health centers (Tole 48): 1. Color speciications for mental facility corridors, patients’ rooms, and examination rooms should follow the guidelines presented for other medical facilities in general. However, the emphasis must be on eliminating the “institutional look” even to a greater degree than in other medical facilities. The designer should strive to create a more “idealhome” atmosphere. 2. Recreation areas, lounges, and occupational therapy rooms should be in cheerful, stimulating colors selected speciically to serve the function of each area. Some imagination should guide design choices in recreation areas—especially for children and adolescents. 3. Quiet or seclusion rooms should not look like punitive environments. If a patient is to be isolated, he or she should be in a cozy, inviting, sparsely and safely furnished space. This does not mean it should be barren—just simple and uncluttered. The room should give an impression of refuge, protection, and recuperation—not punishment. Sensory overload should be avoided and relaxation furthered by cool colors. Choose your colors carefully, so that they won’t look institutional. Lighting should be on the warm side. Avoid lighting that is too uniform, that doesn’t produce shadows. Shadows are a natural experience in the environment and help deine the three-dimensionality of items. On the other hand, shadows should not be too extreme as to create effects that might be perturbing (Mahnke, 1996: 165).

Personalizing Patient Spaces

he most daunting thought that one has when being admitted into an institution such as a healthcare facility, the fear of limited control and freedom. In recent years, healthcare facilities such as oncology centers and childrenâ&#x20AC;&#x2122;s hospitals have modernized their interiors and updated their color palettes and inishes in order to it the desires of their targeted demographic; however, the same cannot be said for behavioral health facilities. In the past, safety, security, and seclusion were the main focuses of these types of clinics (DiNardo). This meant that the nursesâ&#x20AC;&#x2122; station was encased in glass creating a disconnect between patients and staff, family was discourages to visit, and no color or artwork was implemented in design (DiNardo); however, in the past ten years, these characteristics have been challenged to create more homely and therapeutic environment that restore the patients with a sense of dignity and control over their space (DiNardo). Avera Behavioral Health Center in Sioux Falls, South Dakota was the irst facility to take on this challenge and push the envelope of design in psychiatric facilities (DiNardo). They serve as a reputable reference for applying design elements that put the patient irst while creating a calm environment for them that reduce environmental stressors, provide positive distractions, create areas for socialization and support, and give the patient a sense of control (Smith and Watkins).

FIG 5.6 Teen Game Room

FIG 5.7 Family Lounge

FIG 5.8 Inspirational Mural

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REDUCE ENVIRONMENTAL STRESSORS Some methods that could be used to reduce or eliminate stressors are simple aesthetics and space planning that creates an organized and pleasing environment. Such elements that were previously mentioned include artwork that evokes soothing and calming paintings, reducing unwanted noise through acoustics, and proper lighting as well as access to natural lighting and nature views in order to help regulate patients’ circadian rhythm (Smith and Watkins). Sometimes smell can serve as a positive implementation if it is positive and unobjectable by others (Smith and Watkins). It can serve as a ground for creating or recalling positive memories. In terms of personalizing patient rooms, other methods of reducing stress include providing open space in bedrooms so that patients don’t feel as though they are conined to four walls; however, the open area should not be so large that the room echoes and creates an eerie setting (Smith and Watkins). By providing, extra room, patients can also feel free to decorate the room as they wish with drawings. Also, by implementing a sidelight by the patient’s door, a nurse can easily glance into the space to monitor them while still allowing them privacy (DiNardo). This design suggestion was implemented into the Avera Behavioral Health Center and is a great mode of providing the patient with self-control and safety (DiNardo).

POSITIVE DISTRACTION Positive distractions should be provided to patients in order to keep them busy and instill a healthy mindset. Such positive distractions including gardens, outdoor views, and providing paintings of art are the most popular forms of positive distractions (Smith and Watkins). Other methods include creating fun activities or rooms for patients to partake in healthy activities that they can always bring home with them. Some of these activities include meditation or prayer (Smith and Watkins). By providing these two services, patients can create an outlet for themselves to heal spiritually. Other rooms include interaction with music or even mild physical exercises in order to keep the patients moving throughout the day. Pets have also been noted as being excellent stimulation for patients because they help to restore the patient’s sense of positive wellbeing (Smith and Watkins).

FIG 5.9 Interactive Digital Wall

FIG 5.10 Child Interacting with Digital Wall

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FIG 5.11 Child-Parent Support

ENABLE SOCIAL SUPPORT Social support is also very crucial and can help a patient—especially children—feel safer. Family zones are now being incorporated in numerous places throughout behavioral health centers. These areas include patient rooms, family kitchens for weekly dinners, accommodations for parents to be present during exam or treatment processes, and interactive play rooms (Smith and Watkins). In recent years, patients as well as groups including Family Focus Groups and Family Advisory Councils have been present in the process of helping to design behavioral health centers in order to reassure that FamilyCentered Care is present in the healing process of any patient (Smith and Watkins). In addition, sociopetal spaces, or public spaces that encourage social interaction and development, should be implemented and include furniture that is not ixed to the loor, round tables to encourage group activities and discussion and more (Smith and Watkins). This is particularly evident in the Avera Behavioral Health Center. Before the project was started,the staff reported that family members were never really encouraged to visit loved ones and instead, priests and doctors were more present; however, after the implementation of large day rooms and color, families are more inclined to visit and enjoy spending time in these social and positive environments (DiNardo).

CONTROL The most imperative factor to consider in healthcare environments is giving the patient a sense of control. “The ability of the patient to control the environment directly contributes to successful patient outcomes. A sense of control extends from privacy and lighting to choosing artwork being hung in the patient’s bedroom during hospitalization” (Smith and Watkins). Such control allows the patient to create a calming environment that they would enjoy through artwork, wall decorations and others. As was pointed out in previous case studies of Westchester Medical Center and Zucker Hillside replacement Hospital, magnetic wall paint and chalk board paint were some methods of allowing patients to personalize their space. Also, giving the patient partial power as to activities they would like to partake in or separate them from is also a great way in doing so. Avera Behavioral Health Center gave the users control and personally met with patients and staff in order to design a working model of what the interior environment should include (DiNardo). Because of the consideration of user requests, user surveys that were conducted after the fact came back as positive (DiNardo). Overall, the Design of the Behavioral Health Facility effects the treatment of patients. Patients from Avera Behavioral Health Center reported that they “felt more like they could open up, communicate, and come out of their shells, and that it helped family members understand their illness” (DiNardo). The design of behavioral health facilities is beginning to become more pleasant and humane—focusing on patient-care verses control-care.

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BIBLIOGRAPHY Kopec, David Alan. Environmental Psychology for Design. New York: Fairchild, 2012. Print. DiNardo, Anne. “Rethinking Behavioral Health Center Design.” Healthcare Design Magizine. Healthcare Design Magazine, 1 May 2013. Web. 31 Oct. 2015. Smith, Ron, and Nicholas Watkins. “Therapeutic Environments.” Whole Building Design Guide. Whole Building Design Guide, 18 June 2010. Web. 31 Oct. 2015. Tole, Ruth Brent. Color in Healthcare Environments. United States?: Coalition for Health Environments Research, 2004. Health Design. 2003. Web. 27 Oct. 2015.

IMAGES FIG. 5.1: http://www.ibtimes.co.uk/child-mental-health-one-10-us-children-admitted-hospital-1440746 FIG. 5.2: http://everydayfeminism.com/wp-content/uploads/2015/06/Screen-Shot-2015-06-26-at-12.10.29-PM.png FIG. 5.3: https://www.pinterest.com/pin/126452702012249656/ FIG. 5.4: http://www.thedailysheeple.com/sunshine-a-free-source-of-health-and-happiness_032013/sunlight FIG. 5.5: http://www.psych2go.net/rainbow-connection-psychology/ (COLOR WHEEL) FIG. 5.6: http://www.childrenscolorado.org/about/your-visit/hospital-services/teen-zone FIG. 5.7: http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/services_amenities/places_respite/quiet/family_lounges.html FIG. 5.8: https://urbnexplorer.iles.wordpress.com/2012/05/luriechildrens0512_09.jpg FIG. 5.9: http://interfacedesignspace.com/design-that-makes-a-difference/ FIG. 5.10: http://interfacedesignspace.com/design-that-makes-a-difference/ FIG. 5.11: http://singleparents.about.com/od/statebystateresources/a/child_support_and_death.htm

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Section VI

"One personâ&#x20AC;&#x2122;s craziness is another personâ&#x20AC;&#x2122;s reality" ~Tim Burton

Existing Site, Context, Climate, & Zoning

Haverford, PA

avertown Recreation Center is located just outside Philadelphia in Haverford, Pennsylvania. Prior to the 20th century, Haverford was known for its agriculture (Historic Resources Survey); however, with the increase of industrialization, the land proved to be perfect for creating mills that produced lumber, cotton, and more. These points of production were placed near streams and creeks in the area including Darby Creek and Cobbs Creek (Historic Resources Survey). Roads were then produced to link the mills and farms together. One of these was Darby Road which was constructed in 1687 (Historic Resources Survey). Education also became increasingly valued in Haverford Township. “The irst building erected for educational purposes was the Federal School in 1797” (Historic Resources Survey). Throughout the 1800s as well, four one-room schools and one parochial school were erected (Historic Resources Survey).

FIG. 6.1 Map of Haverford

120

FIG. 6.2 Darby Creek

After World War II, even more schools were built and additions were made onto previous structures in order to create the presentday school system (Historic Resources Survey). Today, the township consists of one senior high school, one middle school, ive elementary schools, four parochial schools, and two private schools (Historic Resources Survey). Haverford College was also the irst college founded by the Society of Friends in the United States and has numerous historic structures that are eligible for the National Register as a historic district according to the Pennsylvania Historical and Museum Commission (PHMC) (Historic Resources Survey). As the community began to grow, “large country estates were being built by wealthy families on former farmland in the northern part of the township” (Historic Resources Survey). The Grange and Millbrook are two examples of farmhouses that were transformed

into estates (Historic Resources Survey). In addition to the vast amount of land and creation of gardens and mansions, golf courses were also built to create leisure activities for the growing suburban area (Historic Resources Survey). Haverford Township is home to approximately 9,600 people, a majority of which are white. The remaining racial populations include AfricanAmerican, Asian, Hispanic, or two-or-more of the aforementioned races (Havertown (zip 19083), Pennsylvania). In addition, “the per capita income in Haverford in 2010 was $71,427, which is wealthy relative to Pennsylvania and the nation” (Havertown (zip 19083), Pennsylvania). Also, around twenty-two percent of the population in Haverford are between the ages of four and eighteen (Havertown (zip 19083), Pennsylvania), because this is the targeted population that will be using this behavioral health facility. One key characteristics of Haverford is the large amount of residential complexes. There is a large

range of housing options from single homes, twins, and a few row houses. Two-thirds of the houses in the area were built after 1940. Each residential street is lined with trees and greenery creating cookie-cutter neighborhoods. There are also small retail stores and businesses which provide smalltown industry. Other notable features include the “237 acres of park, playground, and recreational land along with 32.6 acres of Cobbs Creek Park owned by Philadelphia” (Haverford, PA Real Estate and Demographic Information). All four seasons are present in Haverford. Average temperatures in July during the summer are around eighty eight degrees Fahrenheit whereas the average temperature in January during the winter is twenty ive degrees Fahrenheit. Snow is also common during the winter where twenty inches is to be expected. Rainfall averages out to about forty four inches during the year. Wind speeds can also be up to six meters per second. This is mainly a concern in the north and northwest (Havertown (zip 19083), Pennsylvania).

FIG 6.3 Climate Map Shows that Philadelphia can have cooler and more moist weather

121

FIG 6.4 Old Mill

FIG 6.5 Old Mill

122

The architectural style of the residences in the area is conservative and traditional. The houses are mainly constructed of stone, brick, or vinyl siding with gabled roofs and a traditional amount of glazing for a house in the suburban north east. In addition, the retail shops are functional and contemporary. Buildings that are newer are usually found to be larger in scale and accommodate more people; however, it was recorded that the average family size is about three people. This type of architecture represents the area well and states that Haverford is well kept and middle to upper class. “Darby Road / Marple Road median real estate price is $574,735, which is more expensive than

99.1% of the neighborhoods in Pennsylvania and 92.9% of the neighborhoods in the U.S.” (Haverford, PA (Darby Rd / Marple Rd)). In general, this means that most people are wealthy professionals that make this area one of the 15% highest income neighborhoods in America (Haverford, PA (Darby Rd / Marple Rd)). Approximately 64.4% of the residents are “employed in executive management and professional occupations” (Haverford, PA (Darby Rd / Marple Rd)). Other residents are employed in other jobs such as working with large sales accounts, tech support, and more (Haverford, PA (Darby Rd / Marple Rd)). Studies have revealed overall that this area of Haverford has a higher income that 97.8% of communities in America (Haverford, PA (Darby Rd / Marple Rd)).

Darby Rd. // Marple Rd.

averford is comprised of three neighborhoods; town center, Darby Road / Marple Road, and Haverford Road / Buck Lane. Havertown Community Center is located near Darby Road and Marple Road. This area is the most suburban of the three and consists of “small to large apartment complexes / high-rise apartments and singlefamily homes,” built between 1970 and 1999 (Haverford, PA (Darby Rd / Marple Rd)). Houses range from single story to two stories and apartment complexes range from two stories to ive stories (Haverford, PA (Darby Rd / Marple Rd)).

As per the cultural aspect of this area, there is a large presence of ancestry from Croatia and Wales (Haverford, PA (Darby Rd / Marple Rd)). It was also found that although English is the main language spoken, approximately 3.1% of families speak French and a small percentage also speaks Yiddish (Haverford, PA (Darby Rd / Marple Rd)). Other residents will usually identify their culture to come from their ethnicity or ancestry which includes being of Irish, German, Russian, or Italian descent (Haverford, PA (Darby Rd / Marple Rd)).

123

Haverford Reserve

124

avertown Community Center has a unique location on a reservation that focuses heavily on sustainability and educating the community about the environment. The reservation contains a dog park, a freedom playground, hiking trails, and other amenities. There are no other buildings on the site other than the recreation center which has a contemporary style through the use of sustainable materials and increased use of natural lighting. All of these features are used on a daily basis, by all ages and people from Haverford Township. This site is unique because it is used in the education of community members. The recreation center itself contains classrooms that teach environmental science for children. In addition, the facility is connected to the ends of trails that allow people to study the ecology outdoors and bring some of their indings inside. It is not uncommon to see families hiking, biking, and having picnics together on the reserve.

FIG 6.6 Zoning Map of Haverford

125

Site Analysis

avertown Recreation Center is zoned in a Special Residential Development, more speciically, an environmental reserve. This property enforces the health of the community as well as the education of sustainability and environmental awareness. The site was naturally created with this in mind. The land and vegetation that are native to the area are cared for and there was attention to detail towards manipulating the land in order to create walking trails, a playground, a dog park, and a recreation center on site.

126

The environment will promote healing for the children and adolescents with behavioral and psychiatric illnesses. There are vast open lands, sports ields, and a dog park within the reservation that could be utilized to aid the patients through providing fresh air as well as therapeutic activities. Such activities can include gardening or caring for pets. The sound and view of the highway and electrical tower will not be pleasing to patients. In order to create a safe and pleasing environment for the patients, the design of the facility will have views to

nature instead of the highway. In addition, proper fencing that protects patients from the tower and road; however, the fence will not look institutional. The recreation center is located directly off a major road that passes through the reservation towards a development of newly built homes. Trafic is not too congested around the center; however, unless one lives within a walkable distance, it is unapproachable by foot. As for public transportation, one of the closest bus stops is about a mile away on West Chester Pike. This requires one to drive into the reservation. When one arrives by car, the entrance is on a slight slope upward which creates a dramatic entryway. It is good that it is easy to ind the recreation center because as one approaches the parking lot, the view is open and free from trees and other visual obstructions. It is also easy to enter the parking lot and enter the facility.

The greenery helps lessen the effects of wind and sound from the highway. There are trees

along the site along the north, south, and west sides. Trees and bushes are able to serve as a screen that can lessen the speed and impact of winds. They are useful as they can shield the site from winds that predominately come from the north and northwest directions. In addition, the trees also protect the site from some sounds from the main road to the west. Noises may be a concern with the dog park across the street; however, it is not likely that one will hear dogs barking from the inside of the facility. The sunâ&#x20AC;&#x2122;s path will affect some of the shading. The sun will be its most harsh from the south where there are not a lot of trees to shade the facility; however, because this is the side of the structure with the parking lot, there is not a lot of need for shading. There are also soccer and baseball ields that require open space along this side of the site. The sun will also affect the building on the western side in order to provide the patients with the most comfort. It was noted in the previous section that early morning sunlight from the east has a more positive effect than the setting sun from the west. Because the

western side of the building also has negative views to major roads, patient rooms should be placed along the eastern axis and will therefore not be affected by the sun path. Sun exposure from the east and north should be emphasized for the most consistent and positive affect on the patients whereas the sun from the south and west should be shaded and minimized in order reduce exposure to harsh rays and negative impact. The surrounding landscape will provide the patients with a calm atmosphere where they can learn to garden with the use of open land and caring for animals at the dog park across the street. There are multiple opportunities for the patients to receive fresh air, as well, through the inlux of ields on the southern and eastern facades and patios along the norther faĂ§ade. This behavioral health facility will provide the patients with the ability to health through positivity brought through the environment.

127

BIBLIOGRAPHY “Havertown (zip 19083), Pennsylvania.” Sperling’s Best Places. Bert Sperling, 2015. Web. 7 Nov. 2015. “Haverford, PA Real Estate and Demographic Information.” Neighborhood Scout. N.p.,n.d. Web. 07 Nov. 2015. “Haverford, PA (Darby Rd / Marple Rd).” Neighborhood Scout. N.p., n.d. Web. 07 Nov. 2015. “Historic Resources Survey: Haverford Township Delaware County, Pennsylvania.”Report of the Findings Of the Delaware County Historic Resources Survey For HAVERFORD TOWNSHIP Delaware County Planning Department 1994 (1994): 5-8. Web. 7 Nov. 2015.

IMAGES FIG. 6.1: https://en.wikipedia.org/wiki/Haverford_Township,_Delaware_County,_Pennsylvania#/ media/File:H2t.jpg FIG. 6.2: https://www.google.com/search?q=pennsylvania+climate+map&biw=1607&bih=756&sourc e=lnms&tbm=isch&sa=X&ved=0CAYQ_AUoAWoVChMIxunnie7_yAIVxDk-Ch17Wwxr&dp r=0.85#tbm=isch&q=climate+zones+of+usa&imgrc=7IDN4sW1puZDMM%3A FIG. 6.3: http://explorepahistory.com/displayimage.php?imgId=1-2-155A FIG. 6.4: https://www.google.com/search?q=haverford+community&biw=1366&bih=623&source=lnm s&tbm=isch&sa=X&ved=0CAcQ_AUoAmoVChMI2sb3_ZaAyQIVhngmCh1OYQMm#tbm =isch&q=haverford+irst+saw+mills&imgrc=wWjPMhr-xRzQuM%3A FIG. 6.5: https://www.google.com/search?q=haverford+community&biw=1366&bih=623&source=lnm s&tbm=isch&sa=X&ved=0CAcQ_AUoAmoVChMI2sb3_ZaAyQIVhngmCh1OYQMm#tbm =isch&q=haverford+irst+saw+mills&imgrc=wWjPMhr-xRzQuM%3A FIG. 6.6: http://www.haverfordtownship.org/egov/documents/1296760501_630218.pdf

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129

Section VII

“Mental Health...is not a destination but a process. It’s about how you drive, not where you’re going.” ~Noam Shpancer

Program Development and Documentation

Squ. Ft.

Total Squ. Ft.

Privacy (Visual / Acoustic)

Lighting

TBD

165 (1 bed); 200 (2 beds) (15 doubles) (20 singles)

3000

Limited Visual and Acoustical

Natural and Artificial

Quiet Room

Limited Visual and Acoustical

Artificial

Dining Area

530

n/a

Natural and Artificial

Classroom

450

n/a

Natural and Artificial

Lounge Area / Day Room

500

n/a

Natural and Artificial

Game Room

300

n/a

Natural and Artificial

Gym / Multi Puropose Room

750

n/a

Natural and Artificial

Movie Room

200

n/a

Artificial

Patient / Family Interaction Spaces

150

Acoustic

Natural and Artificial

Rooms

Patient Spaces

Patient Rooms (1 bed, 2 beds)

132

Equipment

n/a

Finishes

Acoustics

Perception

Gyp. Bd. Ceilings, anti-microbial residential, matresses, flooirng comforting, Some Acoustics and base should be familiar, tranquil, calm the same material, antimicrobial

Remarks All furniture must be bolted to the wall or floor; patients should have privacy in their room, however a small window should be provided on their door to allow nurses to catch a quick glance when passing in order to ensure that patients are safe

can also have a restraint bed inside that is also bolted to the ground in case a patient is safety is key, being really unruly or a danger and needs to calming color to calm down patients should have the illussion alleviate stress, that they have a private space but nurses minimalistic should be able to monitor the patient from the outside whether via camera, small window, or one sided mirror

n/a

padded walls, rubber flooring, monolithic materials that are soft and discourage potential inuries

High Acoustic Treatment

n/a

should be durable and easy to clean being in an area that involves food

Some Acoustics

calm, social, optomistic environment

Could possibly hold cooking classes for children to learn to cook or cook home-made recipes

Projector

Durable and Safe materials

Some Acoustics

welcoming, enables concentration, fun, focus

classroom is for learning and enabling children to keep on track with schoolwork if they are admitted to stay for a certain length of time

Television

Durable and Safe materials; heavy furniture, soft finishes

social, inviting, warm, technologies should be placed behind Some Acoustics comforting, tempered glass relaxing, tranquil

TBD

safety, durable, varying materials

Some Acoustics

n/a

Rubber Flooring

High Acoustic Treatment

television, DVD, and other technologies

soft finishes that can't be punctured durability

n/a

soft finishes

fun, energized, allows patients to interact with eachother social energizing, fun, can hold a multitude of activities from sports, outgoing, safe dance therapy, fun events, and more

High Acoustic comfortable, technologies should be placed behind Treatment relaxing, calming tempered glass

Some Acoustics

children should be able to spend time with fun, social, their family in privacy; moreso visual privacy warm, enjoyable than acoustical 133

Rooms

Squ. Ft.

Total Squ. Ft.

Privacy (Visual / Acoustic)

Lighting

Medical / Staff Spaces

resuscitaire Exam Rooms

120

240

Acoustic and Visual

Natural and Artificial

Treatment Psychology Rooms (oneon-one)

180

360

Acoustic and Visual

Natural and Artificial

Nurses Station

100

Limited Visual

Artificial

Medicine Room

Visual

Artificial

Room to keep Patient Personal Belongings

Visual

Artificial

Staff Break Room

150

Visual and Acoustic

Natural and Artificial

Offices

150

900

Visual and Acoustic

Natural and Artificial

pressure, vit

resuscitaire

134

Natural and Artificial

Check up / vitals zone

300

Visual and Acoustic

Data Room

150

Visual and Acoustic

Conference Room

200

Visual and Acoustic

Natural and Artificial

File Room

150

Visual and Acoustic

artificial

Counseling Room (outpatient group)

350

Acoustic

Natural and Artificial

artificial

pressure, vit

atural and

Equipment

Finishes

Acoustics

Weight scales, resuscitaire, measuring heart weight, blood sterile, durable, anti- High Acoustic microbial Treatment pressure, vitals, oxygen, wall-mounted diagnostic set

Perception

calming

carpeting, durable

High Acoustic Treatment

computers, printers

durable but decorative

Some Acoustics

medicine dispensar, sink, computer for keeping track of medicine distributed

durable, sterile

n/a

small kitchen area

soft, informal durable, easy to clean, carpet

Some Acoustics relaxing, calming

carpet, woods and Some Acoustics laminates

Weight scales, resuscitaire, measuring heart weight, blood sterile, durable, anti- High Acoustic microbial Treatment pressure, vitals, oxygen, wall-mounted diagnostic set Computers, printers

n/a

File Cabinets

professional, carpet, wood or glass n/a

n/a

durable, resilient

n/a

it is important that there is visual and acoustical privacy in order to comply with HIPAA violations

it is important that there is visual and calming, open, acoustical privacy in order to comply with warm HIPAA regulations Areas need to be guarded so patients and other visitors don't see patient charts and open, important paperwork. The nurses' station in welcoming general is out in the open so nurses can intereact with patients

n/a

computers, printers, copy machines, file cabinets

Remarks

n/a

Simple shelving to store personal belongings that may be of risk to the patient staff should feel like they have their own "offstage" space where they can relax

enhances work enhances productive work productivity

calming, sterile,

n/a

Some Acoustics

n/a

Some Acoustics

Professional, comfortable

n/a

High Acoustic Treatment

inviting enables patient to open up, colorful

Acoustics are important for patient comfort

135

Rooms

Squ. Ft.

Total Squ. Ft.

Privacy (Visual / Acoustic)

Lighting

Elevator Mechanical Room

100

n/a

Artificial

Waiting Rooms

200

n/a

Natural and Artificial

TBD

500 +/-

Acoustic and Visual

Artificial

Storage Clean Storage Dirty Storage Dirty Laundry Clean Laundry Storage Janitor's Closet

1 1 1 1 1 1

200 100 100 100 100 25

n/a n/a n/a n/a n/a n/a

Patio / outdoor area

TBD

n/a

Artificial Artificial Artificial Artificial Artificial Artificial Natural / Artificial lighitng used at night

40%

21,000

n/a

Other

Toilet Rooms

Circulation

136

Articial

hitng used at

Equipment

Finishes

Acoustics

Perception

Remarks

n/a

Some Acoustics

n/a

durable and safe

n/a

welcoming, warm,

n/a

durable, resilient, easily cleaned, secured

Some Acoustics

n/a

n/a n/a n/a Laundry Services n/a Slop Sink

n/a n/a n/a n/a n/a n/a

finishes do not have to be overly durable or safe because it is a zone where patients are All, if not most bathrooms, should be equipped for patients where all fixtures need to be automatic, grab bars can only withstand thirty pounds before dismounting, includes showers with appropriate fixtures, n/a n/a n/a n/a n/a n/a

n/a

durable and safe

n/a

Some Acoustics

inviting, calming, interaction with the environment will enable peaceful, patients to feel calm and refreshed tranquil

n/a

avoid long continuous halls that echo and create drama. Halls should be broken down with seating aresas, art, and architectural interest

137

138

139

Section VIII

"From every wound there is a scar, and every scar tells a story. Turn your wounds into wisdom." ~Unknown

Building Analysis, Code, Regulations, and Standards

Haverford Community Center

averford Recreation and Environmental Center was designed by the irm Kimmel Bogrette in 2013 and is approximately 35,000 square feet that is spread amongst two loors. This facility is classiied as a contemporary structure that embodies the essence of health, wellness, and education. This is seen through the use of sustainable materials and the increase in natural daylight. The attention to detail in lighting and materiality works with the environmental reservation site and supports the interior and exterior concept of educating the community on wellness and sustainability. The Community Recreation and Environmental Center (CREC) host programs for everyone in the community to interact with nature in a thoughtful facility. The Haverford Recreation and Environmental

FIG. 8.2 Front Entrance

142

Center is predominately a steel structure. There are a few large columns that are constructed of four triangulated tree trunks that uphold the roof in the central entryway that are certiied by the Forest Stewardship Committee (FSC) in order to verify that these woods have high sustainability standards. Wood is the main materials used throughout the space and is used for a variety of applications including looring, columns, cabinetry and countertops. As aforementioned, these woods are all certiied by the FSC. The cabinetry and countertops, in particular, are constructed of high density iberboard and particle board that are pre-consumer recycled wood iber which helps to reduce on the use of virgin wood (â&#x20AC;&#x153;CREC Green Featuresâ&#x20AC;?). Stimulated stone is also used on the exterior as well as the interior and is unique because

it reduces the need for quarrying. Quarrying is an energy intensive process that can essentially kill habitats and change the environment permanently (“CREC Green Features”). By utilizing stimulated stone, this material is engineered to be waterproof, sustain weather conditions, needs minimal upkeep, is durable, and still keeps the look and feel of natural stone. Other sustainability measures include using chilled and hot water loops to keep the building at appropriate temperatures and geothermal heat exchange systems. These processes allow for less energy to be used in regulating the indoor air temperatures (“CREC Green Features”). The CREC also participates in recycling programs and the building itself is comprised of 26% recycled materials (“CREC Green Features”). Overall, this building is rated as a LEED Gold structure. The full building will be utilized in order to

function as an inpatient and outpatient behavioral health facility. Because the shape of the building is uniquely bent and has a main central axis, each wing could be used to separate inpatient and outpatient services. These services could also be separated by loor, as well. The existing gym can be renovated and a part of it can be redesigned into a fun activity zone for both children that are staying in the facility and for those visiting. The entryway can also be kept because it is centrally located and convenient for the public. There is also the parking lot and drop of circle that are very convenient for drop-offs, pick-ups, and parking.

FIG. 8.3 Lobby

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FIG. 8.4 Ground Floor Plan

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FIG. 8.5 Lower Level Floor Plan

FIG. 8.6 Gymnasium

FIG. 8.7 View of Front Entrance From Lobby

FIG. 8.10 Workout Area

FIG. 8.8 Reception Desk

FIG. 8.9 Excercise Room

FIG. 8.11 View of Workout Room From Lobby

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FIG. 8.12 Steel Structure in Gym

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FIG. 8.13 Structural Wood Column Inside // Outside

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FIG. 8.14 Unique Patterned Windows

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FIG. 8.15 Front Entry

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Project Data Project Name: Haverford Behavioral Health Center Address: 599 Glendale Road, Havertown, PA 19083 Date of Completion: 2011 Number of Stories: 2 Total Gross Square Feet: 35,000 Square Feet

Applicable Building Code Information Zoning Ordinance: Township of Haverford Fire Code: 2010 Philadelphia Fire Code Building Code & Date: International Building Code (IBC) 2012 Energy Code: International Energy Code

User Group Classiication: Business (Group B) and Institutional (Group I-2) Means of Egress: Protected Sprinklered Dead End Limit: 50’-0”

Gross Square Feet:

Building Code Information

Business Group B (outpatient section): 10,000 Institution Group I (inpatient section): 25,000

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SF / Occupant: Business Group B: 1000 sf Institution Group I: 2500 sf (inpatient treatment / sleeping areas)

Number of Occupants: 100 + 104.16666 = 205 Minimum Corridor Width: 44” (An Emergency Room Corridor will be 72”) Number of Exits: 4 (2 per loor) Exit Access Travel Distance: Group B: 300 ft. Group I-2: 200 ft.

Sanitation (Assume Male / Female % Split is 50 / 50; Assume 50 patients) Group B: WC Male: 2+2= 4 WC Female: 2+2= 4 Urinals Male: 2 Lavatories Male: 2 Lavatories Female: 2 Drinking Fountains: 1 Group I-2: WC Male: 50 WC Female: 50 Urinals Male: 25 Lavatories Male: 50 Lavatories Female: 50 Showers Female: 4 Showers Male: 4 Drinking Fountains: 2

Fire Protection Requirements Fire Enclosures: 2 Hours Shafts and Elevator Hoistways: 2Hours Tenant Space Separations: 2 Hours Smoke Barriers: Assume 30 Minutes Corridor Fire-Resistance Rating: Occupancy load served by corridors Group B: Greater than 30 = 0 Fire resistance rating Group I-2: All = 0 Fire Resistance rating

Incidental Use Areas: • •

Laboratories and vocational shops Laundry rooms over 100 sf

• • •

Storage rooms over 100 sf Group 1-2 waste and linen collection rooms Waste and linen collection rooms over 100 sf

Building Limitations: Ecological Site // Reservation

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FIG. 8.17 Solid v. Void Plan

FIG. 8.18 Structure Plan

FIG. 8.19 Massing Plan

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FIG. 8.20 Solid v. Void Section

FIG. 8.21 Structure Section

FIG. 8.22 Massing Section

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BIBLIOGRAPHY “CREC Green Features.” The Township of Haverford: County of Delaware, PA. Township of Haverford, PA, 2013. Web. 19 Nov. 2015. “Article I: General Provisions.” Township of Haverford, PA General Provisions. N.p., n.d. Web. 24 Nov. 2015.

IMAGES FIG. 8.1: Jenna Sacks FIG. 8.2: Jenna Sacks FIG. 8.3: Jenna Sacks FIG. 8.4: Jenna Sacks FIG. 8.5: Jenna Sacks FIG. 8.6: Jenna Sacks FIG. 8.7: Jenna Sacks FIG. 8.8: Jenna Sacks FIG. 8.9: Jenna Sacks FIG. 8.10: Jenna Sacks FIG. 8.11: Jenna Sacks FIG. 8.12: Jenna Sacks FIG. 8.13: Jenna Sacks FIG. 8.14: Jenna Sacks FIG. 8.15: Jenna Sacks FIG. 8.16: Jenna Sacks FIG. 8.17: Jenna Sacks FIG. 8.18: Jenna Sacks FIG. 8.19: Jenna Sacks FIG. 8.20: Jenna Sacks FIG. 8.21: Jenna Sacks FIG. 8.22: Jenna Sacks

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Section IX

"Recovery is a process of growth." ~Unknown

Executive Summary

FIG. 9.1 Tranquil Mind

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ased on the research that has been conducted, I have found that designing a behavioral health facility will be a challenge when considering sanitation, patient / staff comfort, as well as safety. This type of project is located beneath the umbrella-term of healthcare which emphasizes the use of durable, easy to clean materials. On the other hand, because behavioral health centers can be considered a long-term facility, it is also imperative that the comfort of the patient is considered through means of circulation, varying sizes of spaces to allow interaction and privacy, and the ability to personalize their own space. The key focus of this project will be to keep a balance between healthcare and residential design in this type of facility. Through researching, I have also found that the environment plays a large role in the healing of patients. It had been mentioned that nurturing activities can be very relaxing and beneicial to patients. I found that the dog park across the street will play a positive role in allowing patients to interact with pets. In addition, the amount of vast land around the site will allow gardening activities to take place. This will enable patients to have fresh air, feel connected with the environment, and nurture plants as they grow. The fact that the morning sun rise has more of a positive impact than the light from a sunset is also important to note and can help to indicate where the patient rooms should be located in order to retrieve the most morning sunlight.

The direction that I foresee this project taking is the increase of importance of free activities. There will be a few zones where patients will be able to calmly watch movies, play games with each other, sit outside, as well as health through art and dance therapy sessions. These zones will also be able to accommodate different ranges of groups depending on whether the patient would like to socialize in large / medium groups, or just spend some time alone. A zoning system will be beneicial in order to separate in patient from outpatient services; however, these centrally located activity zones will allow these two populations to interact and lean on each other as they heal. There are numerous conceptual routes that can be taken from the research provided. By implementing a two-zone approach with activity spaces in the center, the interior will be inspired by intense high and low emotions experienced by one who has experienced a mental or behavioral illness shown metaphorically through ceiling level changes and other elements. In addition, a large central space for group meetings can branch off into smaller meeting group areas and activities. Overall, my goal is to empower the role of the patient by providing comfort and varying scaled spaces for the users to interact with others and allow them to embrace their hidden talents of art, dance, sports, and more.

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IMAGES FIG. 9.1: https://society6.com/collection/pinterest-canvas-prints?utm_source=pinterestS6&utm_campaign=1285&c_aid=canvasprints&c_ crid=canvasprints2&utm_medium=cpc&pp=1ASm6ExsdB6u6s9ciHLEYGizIKS6VNrw1DfrML11uTlgUCVaZfBBUx83DGAwc KYELMc2i9LKU8lH2_MKtzLsaR0/

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& Programming. She helped aid me on my research.

Professional Mentor: Lori Klein Position: Director of Design at Posen Architects, LLC. e-mail: lklein@posen.com Proile: Lori Klein works on a variety of project types from corporate to healthcare, which even includes drug rehabilitation centers and Behavioral Health Facilities.

Professional Mentor: Joy Mercedes Position: Program Administrator Phone: 347.601.7667 e-mail: MercedesJ@WCMC.com Proile: Joy works at Westchester Medical Center and was able to give me a breif tour of their Behavioral Health

Capstone Committee

Capstone Professor: Lisa Phillips Position: Assistant Professor at Philadelphia Univerisity e-mail: phillipsl@philau.edu Proile: Lisa Phillips is a professional architect and interior designer who was my professor for Capstone Research

Center over the summer. She has a background in working as a psychologist in prisons and is very familiar with New York codes and laws for patients with behavioral and mental illnesses.

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“About Nemours | Nemours.” About Nemours | Nemours. The Nemours Foundation, 2015. Web. 08 Oct. 2015. “Array Architects.” Zucker Hillside Replacement Hospital. N.p., n.d. Web. 03 Oct. 2015. “Article I: General Provisions.” Township of Haverford, PA General Provisions. N.p., n.d. Web. 24 Nov. 2015. Avallone, Vince, Kevin Day, and Rebecca Kleinbaum Sanders. “Designing for Dignity: Evolving Approaches to Planning Behavioral Health Facilities.” Medical Construction and Design. MCD Magazine, 26 May 2015. Web. 31 Aug. 2015. Behm, Caitlin. “Building Statistics.” Nemours Children’s Hospital: As Part of the Nemours Foundation. AE Department, 29 Apr. 2012. Web. 08 Oct. 2015. “From Bethlehem to Bedlam - England’s First Mental Institution.” Historic England. N.p., n.d. Web. 6 Sept. 2015. Chalmers, Ray. “Psychiatric Institute Finds New Home: Remodeling a County Home for the Elderly Saved $50/sq. ft.” Building Design and Construction Mar. 1986: 88-91. Building Design and Consruction. Web. 27 July 2015. “CREC Green Features.” The Township of Haverford: County of Delaware, PA. Township of Haverford, PA, 2013. Web. 19 Nov. 2015. DiNardo, Anne. “Rethinking Behavioral Health Center Design.” Healthcare Design Magizine. Healthcare Design Magazine, 1 May 2013. Web. 31 Oct. 2015. “Glen Oaks (zip 11004), New York.” Sperling’s Best Places. Bert Sperling, 2015. Web. 3 Oct. 2015. “Haverford, PA (Darby Rd / Marple Rd).” Neighborhood Scout. N.p., n.d. Web. 07 Nov. 2015. “Haverford, PA Real Estate and Demographic Information.” Neighborhood Scout. N.p.,n.d. Web. 07 Nov. 2015. “Havertown (zip 19083), Pennsylvania.” Sperling’s Best Places. Bert Sperling, 2015. Web. 7 Nov. 2015.

Appendix

Hinshaw, Stephen P. The Mark Of Shame : Stigma Of Mental Illness And An Agenda For Change. Oxford: Oxford University Press, USA, 2007. eBook Collection (EBSCOhost). Web. 6 Sept. 2015.

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“Historic Resources Survey: Haverford Township Delaware County, Pennsylvania.”Report of the Findings Of the Delaware County Historic Resources Survey For HAVERFORD TOWNSHIP Delaware County Planning Department 1994 (1994): 5-8. Web. 7 Nov. 2015. Interview with Program Administrator Interview with Registered Nurse on the CCIS Unit Kopec, David Alan. Environmental Psychology for Design. New York: Fairchild, 2012. Print.

Malkin, Jain. Hospital Interior Architecture: Creating Healing Environment for Special Patient Populations. New York, NY: Van Nostrand Reinhold, 1991. Print. Matambanadzo, Shandi. “Nemours Children’s Hospital: Project Breakdown.” Healthcare Design Magizine. N.p., 20 Mar. 2013. Web. 08 Oct. 2015. McNally, Richard J. What Is Mental Illness? Cambridge, MA: Belknap of Harvard UP, 2011. Print. “The Mental Health Policy Implementation Guide.” PsycEXTRA Dataset (2010): 4-20--30. Department of Veterans Affairs. Ofice of Construction & Facilities Management. Web. 18 Oct. 2015. “Nemours Children’s Hospital / Stanley Beaman & Sears.” ArchDaily. ArchDaily, 24 Oct. 2013. Web. 08 Oct. 2015. “Nemours Children’s Hospital.” Stanley Beaman Sears RSS. N.p., 2013. Web. 08 Oct. 2015. “North Shore LIJ Health System The Zucker Hillside Hospital, Inpatient Care Center.” Ennead Architects. N.p., n.d. Web. 30 Sept. 2015. “North Shore-LIJ Reports and Fact Sheets.” North Shore-LIJ Reports and Fact Sheets. North Shore LIJ, 2015. Web. 03 Oct. 2015. “North Shore Long Island Jewish Health System Zucker Hillside Hospital - Glen Oaks, New York.” Behavioral Healthcare. N.p., 30 May 2013. Web. 30 Sept. 2015. Nussbaumer, Linda L. Human Factors in the Built Environment. N.p.: n.p., n.d. Print. “Orlando, Florida Climate.” Sperling’s Best Places. Bert Sperling, 2015. Web. 08 Oct. 2015. Porter, Roy. Madness: A Brief History. Oxford: Oxford UP, 2002. Print Smith, Ron, and Nicholas Watkins. “Therapeutic Environments.” Whole Building Design Guide. Whole Building Design Guide, 18 June 2010. Web. 31 Oct. 2015. Stroupe, Jocelyn M. “Behavioral Health Design.” Behavior Health Design. HFM Magazine, 3 Sept. 2014. Web. 31 Aug. 2015. Tole, Ruth Brent. Color in Healthcare Environments. United States?: Coalition for Health Environments Research, 2004. Health Design. 2003. Web. 27 Oct. 2015. “The York Lunatic Asylum.” King’s Collections : Online Exhibitions :. N.p., n.d. Web. 06 Sept. 2015. “The Zucker Hillside Hospital.” Architect. The Journal of the American Institute of Architects, 8 Jan. 2013. Web. 30 Sept. 2015. “Zucker Hillside Hospital.” Current: Zucker Hillside Hospital. Gotham Construction Company, 2012. Web. 30 Sept. 2015.

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Who designed the building and when? It is unclear who designed the building. From having a contact dig for information, the building was built around 1930 which explains the building’s footprint. It also used to be known as the Psychiatric Institute in Valhalla, New York. I found an article that stated that the architects were Schoield and Colgan Architects.

What was the concept in the design of the building? I think the concept of the building was focused around functionality and applying past principles of healthcare facilities in order to create a successful behavioral healthcare unit. The building has a strong main axis that intersects another long hallway at the center (thus creating the A and B wings). Both of these wings are different units on each loor and at the end of each wing, there is a turn in the hallway that runs parallel with the

User Survey: Westchester Medical Center

main axis. This creates two courtyards on both sides of the main axis hallway where patient rooms can utilize the

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natural daylight and views outside.

Does the building it within a particular architectural style or period? Yes, the architecture of Westchester Medical Center its within the styles happening during the 1930s in American. This is seen on the front of the hospital façade where the vertical columns protrude forward and are more stress than the recessed horizontal brickwork. The windows are square and regularized giving the building a industrial / functional look.

What is the main use of the building? Does it have additional or ancillary uses also? The BHC is a Psychiatric Institution. The building’s main function is as follow: a) Provide outpatient mental health services to adult & child/Adolescent population. b) Provide Inpatient Mental Health services to adult & child/Adolescent population. c) Emergency Room: This is a 24/7 operating serving in the capacity of a Psychiatric Emergency Room Department (not medical emergencies).

Who is the owner of this building? Is it publicly or privately owned? The building is owned by the Westchester HealthCare Corporation. It is a privately owned entity.

Who are the main users of this building (demographics – age group, socio-economic class, gender, etc.) The main users of this building are patients with Mental Health & Behavioral diagnosis. BHC cares for an underserved population. 60% of our patients are medicare recipients. Age mix is mostly adult males and teens.

About how many people work in this facility? How many people visit this facility from the outside? Daily, weekly, or yearly? BHC has approximately 350 employees (Not all full time)…. Stafing patterns consists of a) Psychiatrists, psychologists, Licensed Mental Health Counselors, Nurses, Licensed Practical Nurses, Psychiatric Nursing assistant b) Recreational Therapists, discharge planners, social workers, support staff (admin assistant, unit clerks,

data entry clerks) c) Administrative Staff d) About 7-12 visitors come into the building, daily, for visits to inpatient unit (child, adolescent, adult) ***Number of people that come for other purposes (meetings, interviews, inspections, etc. are not something we track and thus reason info is not provided)

How is this building used on a daily, weekly, monthly, yearly basis? What do people do here? Describe use patterns. About 4500 visits a year for outpatient services – patients seeking therapeutic services About 1084 Emergency Room visits a year About 90 patients average daily census for inpatient units & average length of stay of 14 days This building is used 24/7, providing inpatient and emergency room services to patients in the community.

Were any additions/renovations made? What and when? How did it change the character or functions? Renovations have been made to this building. In 2012, they renovated the 2nd loor to make it into ofice suites. Previously, the space was used as an ECT unit (Electro chock therapy) The Emergency Room Department has had minor renovations

What works best about the building? What does not work? Why? The plan and design of the architecture works for the hospital because each patient is given a view to the outdoors and access to natural light in their room and public spaces. The details that pertain to bedding, seating, door hardware, and sink / shower ixtures are really something to note because they are functional and different; however they opened my eyes to noticing how every facet of the interior needs to be broken down and reevaluated in order to create a safe environment to the patients and staff. In terms of ‘what does not work,’ I would say that the interior is very bland. I was told that halls and most of rooms were more dimly lit at one point; however, there was a recent upgrade in lighting ixtures that occurred in around 2011. In addition, there are not enough ofice spaces for the amount of employees. Some employees have to share ofice spaces. There is also an issue with the distribution of ofice spaces (discharge planners having bigger ofices than executives). This building is very old, poor ventilation, ac and radiators are outdated, the nurses’ area is cluttered, ofice spaces have leaking roofs, electricity outages are a common occurrence as well.

What do you consider the buildings best characteristics or features? Why? One of the best characteristics of the building is that the loors are regular and the same throughout, meaning that each unit is the same. The A wing on the irst loor will be the same as the A wing on the third loor. And the B wings are then relected over the main axis hallway from the A wings.

What is the culture, mood, or atmosphere that the space is trying to express . Does it work? The atmosphere is trying to be light hearted with poppy colors; however, most of the unit is still dull and dingy looking. You can tell that the hospital is just starting to change over and transition into a modern space but they are still far from achieving that, seeing as their budget seems to be very nil.

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Would you change anything about the building? If so, what and why? I would change small minor things about the building to make them more cohesive. Some rooms are larger than others, some doors have windows looking into the rooms and others don’t. I would also want to upgrade a lot of the systems and way inding. They are trying their best with color schemes by implementing poppy greens, purples and blues, but I feel like more can be done. They are on their way to creating more modern looking units.

Is the natural and artiicial lighting appropriate for the building? How is it achieved? Lighting project back in 2011…outside vendor did all the lights in inpatient units. Yes, there is a lot of daylight that comes into the patient rooms. No natural light in halls and stafing areas really but there are plenty of windows where patients are spending most of their time in activity rooms, dining halls, lounges, rooms, etc.

Are the materials and color selections appropriate? Are any wearing poorly, hard to clean, exceptionally good for their use, etc. A lot of the materials are chosen for a reason. The chairs are from norix which specializes in prison and healthcare furniture. The program administrator also illed all of the chairs with sand so that patients wouldn’t throw furniture. Bedding is nailed to the ground and has rails on the bottom for restraints to be tied if needed. Mattresses are chosen with material that is not conducive for bed bugs to inhabit and they feel like they are encased in a soft vinyl that makes them easy to clean and stain resistant. Faucets and ixtures are also chosen well so patients do not self-harm.

What makes the facility unique - why would someone choose this over another? The facility is unique in that it is centrally located both to Westchester as well as other counties that could transfer patients over. The facility itself is just turning it’s design around to becoming more modern by replacing lights, redoing ofices, hiring space planners, etc. It is great to note that this facility is able to provide in patient as well as out patient care. It is also great to see that the staff is very lexible and adapts to change. Below are just two examples: The Norix chairs (HUGE plastic chairs) were so light, patients could use them as a weapon if they had a tantrum. Program administrators bought 10,000 lbs of sand to ill each chair so that they are a decent wait to move them, but they are not light enough to pick up. Children (in the unit ages 4-12) would draw profanity on the walls in their rooms. Program administrators bought chalk board paint so kids could draw and erase.

Are the sq. footages appropriate for each space. Are the assigned functions appropriate? For the most part, I think that square footages in the rooms are appropriate. There were very few rooms that I felt should have been bigger. I feel like lounges could have been more spacious, however, I noticed that there were never too many people in the lounges at once. I found that most meetings or group activities took place in the dining area. The nurses’ stations could have been planned better. They are very cluttered with paperwork, printers, phones, toys, etc. That could easily be ixed with built-in storage.

Is there a sense of place and orientation within the building? How easy is it to navigate and ind ones way? What are the visual cues? Way inding is a little dificult. They have most signs on the irst loor. From that point on, you need to know where to go. The signs also are not cohesive. Some have different fonts, some are fancier, some have borders, some have brail, etc. the only characteristic that is shared is that they are all Olive Green (which has noting to do with their color scheme). 166

The building was designed by Frank Grad in 1900-1901

What was the concept in the design of the building? It is unclear what the concept of the building was. From my research, and from knowledgeable doctors and nurses from the area, the hospital started as a group of houses at one point and then began to slowly expand. There isn’t a cut and dry concept of the building that was documented.

Does the building it within a particular architectural style or period? The building is classiied as a mix between Spanish Colonial and Romanesque revival. It has Romanesque features such as a horizontal emphasis on the front façade. This is shown through the windows and moldings. There are multiple units to the building as well and is very symmetrical. As per the Spanish Colonial characteristics, it is a heavier building that has minimal decoration on the facades, multiple inner courtyards, and red tiled roofs.

What is the main use of the building? Does it have additional or ancillary uses also? The building is a hospital located in inner-city Newark treating many ailments, wounds, diseases, and the like. The building contains the child and adolescence CCIS unit (Children’s Crisis Intervention Services), a voluntary adult unit and an involuntary adult unit. They treat children ages 5 to 17 with mental illnesses for up to seven days minimum. They have group sessions, some school classes for credit, and expressive therapeutic activities like arts and crafts and such.

Who is the owner of this building? Is it publicly or privately owned? The building is privately owned by the Saint Barnabas Medical.

Who are the main users of this building (demographics – age group, socio-economic class, gender, etc.) The main users of the unit are children with Behavioral and Mental Health Diagnoses. These children usually come from broken homes and lower-income families. The hospital cares for mainly patients with Medicaid. There are also voluntary and involuntary adult Behavioral and Mental Health Units.

About how many people work in this facility? How many people visit this facility from the outside? Daily, weekly, or yearly? 20 people work for CCIS unit. During the day, there are 8 staff members (3 nurses, 3 LPNs, 2 psychiatrists), 5 at night (2 nurses, 3 LPNs). Visiting hours, M-F are 6pm-8pm. Weekends and holidays is 1pm-4pm. Visitors are

User Survey: Newark Beth Israel Medical Center

Who designed the building and when?

limited to 2 at a time per patient. Most kids will have a parent visit every day averaging on about 8 to 12 visitors through the week and 12 to 25 on the weekends.

How is this building used on a daily, weekly, monthly, yearly basis? What do people do here? Describe use patterns. Children are admitted by parents or police; they are kept at a minimum 5-7 days as a requirement. On a daily basis, the kids wake up, shower / get ready / make their beds, spend time in the day room, they are given about an hour of class in the afternoon, and have creative therapists come in to engage the kids in arts and crafts and other activities. Kids see the therapists once a day to check in on progress. 167

Were any additions/renovations made? What and when? How did it change the character or functions? There haven’t been any renovations recently, other than the painting of the unit that took place around 2012. The basketball court was built before 2000.

What works best about the building? What does not work? Why? The CCIS unit seems to be pretty functional in terms of the layout. My only concern is the location of some rooms in relation to others. For example, they have a window from the nurses’ station into the quiet room which I feel is not a good idea when there is a disgruntled child in that room. I feel like a one-way mirror would be a better idea. I feel like the building as a whole can get pretty confusing. I’ve heard that buildings A, B, and C are on the complete opposite side of the hospital than buildings D, E, and F. The signage is also pretty confusing as you venture down the long halls, and some of the elevators do not even go to certain loors. There isn’t a sign that indicates this on the outside of the elevators as well.

What do you consider the buildings best characteristics or features? Why? The set up of the unit is very thoughtful. The unit is comprised of two wings that are perpendicular to each other. The Nurses station is located where the two halls meet. This is also the area where visitors and patients enter the unit. Upon entering, all patient rooms are located on the wing to the left which also has a day room, showers, and the calm room. The hall to the right has a class room, the dining room, and sun-room / basketball court area. I like how all of the morning functions of where the patients sleep is located in one area, and then the rest of the activities are around the corner. This gives the patients a feeling of having a diversion throughout the day and enables them to feel like they aren’t stuck in the same spot and are not in the same area for too long. Another great characteristic is the sun room area and basketball court that they built for the unit. This allows the children to get fresh air, even in the winter for a little bit and is a fun, relaxing area. I feel like walking through the unit, I enjoyed that area a lot. It seemed very relaxing.

What is the culture, mood, or atmosphere that the space is trying to express. Does it work? The culture and mood of the space seems to be very poppy and geared towards the child and adolescent population. They have poppy greens and oranges. They have unique loor patterns as well in VCT tiles down the hallway that add more color. It is a very positive looking environment.

Would you change anything about the building? If so, what and why? I would change some of the materials and ixtures that they have. Some of their lighting is very dim and their doors are against code for a psychiatric facility. I would also change the location or design of their quiet room. It is located near the nurses’ station and has a two way window (which explains why the wall with the window is always the one that has been replaced multiple times from kids destroying it). The closet containing the patients’ belongings is also conveniently next to this room. This is another wall which is always being replaced due to children punching / kicking through walls. This room is also lacking padding. And the play room is very very small with only one light that is incredibly dim (see explanation on the ‘calm room’).

Is the natural and artiicial lighting appropriate for the building? How is it achieved? The day room does not have windows but is well lit with artiicial lighting. The hallways are dim but that is only because they have a single line of 2x2 ixtures in an 8’ wide hallway. The patient rooms have windows, but they don’t really spend too much time in their rooms. They have a really nice ‘sun room’ area where they can hang out on an extension of the wing that is enclosed and they built a small basketball court as well for the kids to get fresh air and be kids outside. 168

Are the materials and color selections appropriate? Are any wearing poorly, hard to clean, exceptionally good for their use, etc. In terms of materials, although the unit was a lot nicer looking than Westchester, they are gambling with some of their materials. 1. It is totally understandable that they have VCT tile (both facilities do). 2. Their furniture is NOT from Norix, they are normal wooden furniture that are upholstered with vinyl. This is can pose to be a danger if a patient becomes upset and can retaliate by lifting, swinging, or throwing furniture. 3. TV, does not have a plexiglass cover like Westchester due to a semi-recent accident (a patient shattered it). 4. Some of the patients pick off paint in some of their rooms which can become a problem and danger. 5. The quiet room does not have padded walls. There was a misunderstanding when putting in new walls, the hospital heard they are soft, but they are just patterned gyp board. 6. Mattresses do not have the capabilities of taking care of issues such as soiling and bed bugs that are found at Westchester. 7. Door knobs have a ledge and can be a hazard.

What makes the facility unique - why would someone choose this over another? The hospital has been around for a very long time and is in a prime location. It has a reputable name in terms of surgical procedures and advancements in medicine. The hospital also has a number of people who donate many items to the behavioral health clinic and hospital. It is located in inner-city Newark where there are a lot of children with tragic stories and dificult upbringings. They found that most of their census is from Newark and then other come from other areas of the state if there aren’t beds in southern / central Jersey. It is also a very tiny clinic which makes it very quaint. I visited on a day where there were only 10 kids on the unit. There ratio between patients to staff is also less than Westchester where it is 4:1 (Westchester has 8:1).

Are the sq. footages appropriate for each space. Are the assigned functions appropriate? The square footages were pretty good for patient rooms and public areas. It is a very small unit with at max. 18 patients. I would say that the room that was the most small was the “calm room” it was about 9 by 6 feet and was very dimly lit. There were toys on the loor and the walls were painted by some of the patients with a sun and lowers. It was very cramped. The room is going to be made to be calmer. Sadly they are going to cover up the work of the patients and bring in a curved/wavy couch (as described by a registered nurse). Some ofices were also very tiny. One social worker showed me that when she opens her door, it runs into a guest chair. She says this poses to be a problem when she meets with parents and the child and there are four people in her ofice at once.

Is there a sense of place and orientation within the building? How easy is it to navigate and ind ones way? What are the visual cues? Way inding is a challenge, but luckily, if you know your alphabet, you should be ok. Newark Beth Israel is split into so many different buildings labeled A through (at least) J. The route that I had to take getting up to the D Building 5th loor was a journey from the main entrance. And I have pictures with arrows that list how to reach each individual building. I heard that the ABC buildings are on the opposite end of the DEF buildings, so there is even confusion with staff when patients are being dropped off. (the B building is for Pediatrics and they are sometimes dropped off at the D building where they have child-adolescent psych kids). The elevators were also an issue because when I approached the end of the hallway, I took the elevators to my right which went to every loor except for 1, 5 and 10… REALLY RANDOM. It turns out I needed to be in the elevators on the left hand side. 169

Jenna Sacks jls0321@optonline.net

B.S. Interior Design Minor Construction Management Capstone Research & Programming Lisa Phillips Fall 2015