HEALING CITY IN THE
A blend of innovation and evidence-based design for a rooftop garden in Houston Methodist Hospital
By: Niti Tataria Committe Chair: Dr. Chanam Lee Committe Members: Professor Bruce Dvorak & Dr. Zhipeng Lu External Advisor: Mr. Andrew Albers May 1, 2020
Table of Contents
01
Background • Background Information.............................................................................................6-7
Site Location Demographics Diversity
• Texas Medical Center...................................................................................................8-15
02
Employers of Houston History of Texas Medical Center Urbanization of Texas Medical Center Connectivity Climate: Houston Urban Heat Island Effect: Houston Urban Heat Island Index: Texas Medical Center Site Surroundings • Houston Methodist.....................................................................................................16-17 Mission Statement Their Values: ICARE Paula and Joseph C. (Rusty) Walter III Tower Centennial Tower
Site Analysis
• Building Analysis.........................................................................................................20-21
View Analysis Centennial Tower 14th Floor Plan • Sun and Shade Analysis............................................................................................22-24 Summer Solstice, Fall Equinox & Winter Solstice Average Number of Hours in Shade Concentrated Reflection of Sunrays • Wind Analysis...................................................................................................................25 Wind Rose Diagram Summer Wind Flow Winter Wind Flow • SWOT Analysis.............................................................................................................26-27 Strenghts, Weakness, Opportunities, Threats
03
Case Studies & Literature Review
04
Design Development
• Case Studies...............................................................................................................30-37
Betty Ruth & Milton B Hollander Healing Garden Nelson Mandela Children’s Hospital Fiona Stanley Hospital Boston Children’s Hospital Rooftop Healing Garden Reading Healthplex for Advances Surgical and Patient Care Khoo Teck Puat Hospital Palomar Medical Center Summary of Case Studies • Literature Review....................................................................................................38-43 Healing Garden Benefits for Patients & Visitors Healing Garden Benefits for Hospital & Staff Landscape Elements and their Benefits What is a therapeutic garden? What is evidence-based design?
• Design Goals..............................................................................................................46-47 • Design Concept........................................................................................................48-49 • Master Plan Options...............................................................................................50-53
05
Option 1 Option 2 Option 3
• Design Proposal.......................................................................................................54-87 • Conclusion.................................................................................................................88-89
References ..............................................................................................................90-92
01
Background
Background Information Site Location
USA
Texas
Houston
Demographics
Texas Medical Center New York
Chicago 3rd Largest City in USA
Largest City in USA
Population: 8,601,186
Population: 2,679,044
Los Angeles 2nd Largest City in USA Population: 4,057,841
Houston 3rd Largest City in USA Population: 2,359,480
Image Source: GIS Stack Exchange[1]
According to data from the US Census Bureau, a total of 10 US cities have a population that has surpassed the ‘1 million’ milestone. Of these 10 cities, California and Texas account for 60%, with each being home to three cities each that have a population of over 1 million. Texas also has the distinction of having the largest number of fastestgrowing cities with a total of six out of the top 13. Half of the top ten cities with the largest population gains were located in Texas. [2] 6 | Healing in the City
Diversity
Houston: most
diverse city in USA
7% Asian 24% White 0.1% American Indian
44.9% Hispanic
2% Races +2 22% Black
Image Source: Races in Houston[4]
Several studies in recent years have shown the Bayou City at the top of the list for ethnic and racial diversity. The city has no ethnic majority and nearly one-in-four residents are foreign-born. Houston today mirrors what demographers forecast the U.S. population will look like in four decades. [3] Healing in the City | 7
Texas Medical Center
More employment at Texas Medical Center demands higher recreational infrastructure needs.
Employers of Houston[5] 6 % Tech 6 % Transportation 3 % Restaurant
30 % Oil
5 % Construction 3 % Food Service 7 % Grocery 40 % Health
Texas Medical Center is the 8th Largest Business District in the U.S.[6] Home to world’s largest Children Hospital Texas Children’s Hospital [6] Home to world’s largest Cancer Hospital MD Anderson Cancer Center [6]
10 Million 8 | Healing in the City
Patient visits per year [6]
+13,600+
Total Heart Surgeries[6]
History of Texas Medical Center
1925
1968
1991
2012
Hermann Hospital opens to the public and admits its first patient.
Dr. Denton Colley performs one of the first heart transplants in the U.S. at Texas Heart Institude.
Texas Heart Hospital releases first patient in the world with an electirc, portable, battery-powered heart pump.
Texas Children’s Hospital delivers Perkins sextuplets the only surviving in Texas - at 30 weeks.
1943 The City of Houston provides 134 acres next to Hermann Hospital to establish a hospital district.
Source: History-Texas Medical Center[7]
1971 Texas Children’s Hospital collaborated with NASA to construct plastic isolator bubble for boy born with severe immune disorder.
2011 Researchers from Rice University and Baylor College of Medicine discover a way to grow blood vessels and capillaries.
2014 Over 150 member and community leaders gather to discuss the future of TMC and position it as the world’s leader in life sciences.
Healing in the City | 9
Urbanization at Texas Medical Center 1944
1953
1989
2004
Texas Medical Center
Texas Medical Center
Texas Medical Center
Texas Medical Center
Image source: Google Earth
2019
Texas Medical Center
With the rapid growth of urbanization and over cramping of space for development, green outdoor spaces, and natural landscapes are vanishing and getting converted to concrete jungles. The challenges caused by rapid urbanization are Urban heat island effect, decreased outdoor activities and increasing environmental hazards. To mitigate urban heat island effect many people use solutions like painting urban roofs white or implement a rooftop garden. An increase in building density has led to a decrease in open and recreational spaces.
10 | Healing in the City
Connectivity
Legend Bus Routes Metro Train Red Line Route
Site
Healing in the City | 11
Climate: Houston
Image Source: Wather Spark[8]
Urban Heat Island Effect: Houston Image Source: Geo Lab[9]
Maximum Temperature 95°F Minimum Temperature 66°F Average Temperature 88°F
Upto
13.0° Hotter
in the City then in nearby rural areas
With more than 80 percent of Americans living in cities, these urban heat islands — combined with rising temperatures caused by increasing heat-trapping greenhouse gas emissions — can have serious health effects for people during the hottest months of the year. Heat is the No.1 weather-related killer in the U.S., and the hottest days, are associated with dangerous ozone pollution levels that can trigger asthma attacks, heart attacks, and other serious health impacts.[8] There is a need to mitigate the urban heat island effect in Texas Medical Center to decrease the serious health hazards associated with it. 12 | Healing in the City
Urban Heat Island Index: Texas Medical Center
Urban Heat Island Index Legend 0.95
0.47
0.00
Site Value
Houston City Average
10
21
Traffic-related air quality (TRAQ)
10.55
11.51
Urban Heat Island Index
0.77
0.55
Percentage Tree Canopy
Image Source: Trees and health app[10]
TMC has a higher urban heat island index as compared to the city average. There is a higher need for green spaces, which can help mitigate this effect.
Healing in the City | 13
Site Surroundings Legend Health Care Facilities
Metro Bus Routes
College
Metro Rail Routes
Garage
Proposed Houston Methodist Building
14 | Healing in the City
Healing in the City | 15
Houston Methodist Mission Statement To provide high quality, cost-effective health care that delivers the best value to the people we serve in a spiritual environment of caring in association with internationally recognized teaching and research[11].
Their Values: ICARE [11] I ntegrity We are honest and ethical in all we say and do.
C ompassion We embrace the whole person and respond to emotional, ethical and spiritual concerns as well as physical needs.
A ccountability We hold ourselves accountable for our actions.
R espect We treat every individual as a person of worth, dignity and value.
E xcellence We strive to be the best at what we do and a model for others to emulate.
#1 Hospital In Texas for Patient Care [12]
U.S. News & World Report has named Houston Methodist Hospital the No. 1 hospital in Texas and among the top 20 hospitals in the nation. Houston Methodist’s reputation for outstanding care, treatments and research attract patients from Texas, the nation and around the world. Their teams of surgeons, physicians, researchers and other experts collaborate to solve medicine’s biggest challenges and turn discoveries into new therapies and treatments[12]. 16 | Healing in the City
Image Source: Dynamo Dash Youth [13]
Paula and Joseph C. (Rusty) Walter III Tower Image Source: Houston Methodist[14]
Houston Methodist Hospital’s new Paula and Joseph C. “Rusty” Walter III Tower offers the most advanced treatments and innovations available, transforming the complex heart and neurologic care we deliver to patients worldwide. The 22-story structure, with nearly 1 million square feet, includes sophisticated neurosurgery and cardiovascular surgical suites specially designed for highly technical and minimally invasive image-guided heart and brain procedures. Additionally, it has two intensive care and six acute care floors, as well as a helipad, to increase the speed at which we care for patients in need of lifesaving treatments[14].
Centennial Tower Houston Methodist has planned phase two of the Walter tower which will be an addition to the current master plan. The vision of this tower is to add advanced facilities for its users. Currently, the 22-story Walter tower hosts multiple ICU, acute care and advanced units. The units in Centennial tower will increase their bed capacity. Both towers will be connected with a bridge. There is an opportunity to have a non-accessible rooftop garden in the Walter tower and a healing rooftop garden in the Centennial tower. Evidence suggests that access to nature helps reduce stress and increases the healing capacity of patients. The rooftop garden in the Centennial tower would be a good location for a healing garden. Healing in the City | 17
02
Site Analysis
Building Analysis Centennial Tower
View Analysis
Floor 28th
These rooftop gardens will not only give healing benefits to people accessing this space but will also be viewed by people from the floors above.
Paula and Joseph C. (Rusty) Walter III Tower View
Floor 22nd
Floor 20th
ew
Vi
Acute Care
Floor 18th
en
Acute Care
Floor 19th
rd
Ga
Acute Care
Gar
Floor 21st
den
Acute Care
Acute Care
Floor 17th
Mechanical Floor
Floor 16th
Universal
Floor 27th
Universal
Floor 26th
Universal
Floor 25th
Universal
Floor 24th
Universal
Floor 23rd
Mechanical Floor
Floor 22nd
Universal
Floor 21st
Universal
Floor 20th
Universal
Floor 19th
Universal
Floor 18th
Universal
Floor 17th Floor 16th
Mechanical Floor ICU
Floor 15th
ICU
Acute Care
Floor 14th
Healing rooftop garden
Floor 15th Floor 14th
Floor 13th
Universal
Floor 13th
Floor 12th
ICU
Floor 12th
ICU
Floor 11th
Floor 11th Floor 10th
Non accesible rooftop garden
Floor 7th
ICU
Floor 10th Mechanical Floor
Mechanical Floor
Floor 7th
Floor 5th
Floor 5th
Floor 3rd
Floor 3rd Lobby
20 | Healing in the City
Centennial Tower 14th Floor Plan
Legend Rooftop Garden ICU Units Family Room Elevator and Staircase Lobbies
Rooftop Access (Secondary)
Lobby Space
Need for privacy
Rooftop Garden Location
ICU Units
There is a need for privacy for ICU units facing the rooftop healing garden.
Rooftop Access (Primary)
ICU Units Family Room
Family Room Lobby Space
N
0
20’
40’
80’
Elevator Lobby
Healing in the City | 21
Sun and Shade Analysis 20th June 9:00 am W
Summer Solstice
Summer solstice, also the longest day of the year has 14 hours and 4 minutes of daylight.
S
Solar Information: Azimuth/Altitude: 97.24°/64.03° Rise/Set: 05:21/19:25
e
Sit
e
N
E
N
Sit
Fall Equinox W
22nd September 9:00 am Fall equinox, falling on 22nd September has 10 hours and 30 minutes of daylight.
S
Solar Information: Azimuth/Altitude: 134.86°/51.69° Rise/Set: 06:09/18:19
E
N
Sit
e
Sit
e
N
Winter Solstice W
Winter Solstice, also the shortest 21st December 9:00 am day of the year has 10 hours and 14 minutes of daylight.
S
E
N
22 | Healing in the City
Solar Information: Azimuth/Altitude: 150.69°/30.76° Rise/Set: 07:12/17:26 Both the towers cast a lot of shade on both rooftop gardens.
Sit
e
Sit
N
e
20th June 3:00 pm
20th June 12:00 pm
Sit
Sit
e
Sit
e
Sit
e
Sit
e
Sit
e
N
e
N
N
22nd September 12:00 pm
22nd September 3:00 pm
Sit
22nd September 6:00 pm
Sit
e
Sit
e
Sit
e
Sit
e
Sit
e
e
N
N
21st December 12:00 pm
N
21st December 3:00 pm
Sit
21st December 6:00 pm
Sit
e
Sit
e
Sit
Sit
e
N
20th June 6:00 pm
e
N
e
Sit
e
Healing in the City | 23
Average Number of Hours in Shade N
The Walter tower is south facing building with the rooftop garden located towards the north side on the 10th floor. The Centennial tower is towards the north side with the rooftop garden on the 14th floor. Both the towers will cast shade on these rooftop gardens which are surrounded by buildings. Rooftop garden in Walter tower will be in shade most of the time. Whereas the rooftop garden in Centennial tower will have good sunlight.
Concentrated Reflection of Sunrays 23rd September 10:45 AM
23rd September 11:45 AM
23rd September 12:45 PM
N Legend
3500 2780 2208 1754 1393 1106 879 698 554 440 0 wh/m2
The Walter tower has a reflective glass facade. Centennial tower might also have a similar elevation as the Walter tower. Due to the reflectiveness of the glass heat concentration of sunrays can be created on the rooftop garden.
24 | Healing in the City
Softscape on the rooftop garden will absorb the reflected sun rays and prevent further reflection.
Wind Analysis Wind Rose Diagram
Wind Rose Legend
W
WSW
> 17 mph
WNW
SW
> 12 mph > 7 mph > 3 mph
NW SSW
The average hourly wind speed in Houston experiences significant seasonal variation over the year. The windier part of the year lasts for 7.7 months, from October 16 to June 6, with average wind speeds of more than 7.8 miles per hour[8].
NNW S
N SSE
NNE SE
NE ESE ENE
E
Summer Wind Flow
Winter Wind Flow
W
W
S
S N
E
The majority of summer wind flows from the south and southeast. Most of the wind would be channeled away from the building but a wind tunnel is formed when wind flows from the southeast.
N
E
Winter wind flows from the North most of the time. These winds will majorly be channeled away from the rooftop garden because of Centennial tower’s height. Healing in the City | 25
SWOT Analysis Strengths
Weakness Heat island effect: The building density and lack of open spaces have led to the heat island effect in Texas Medical Center.
Easy access: The rooftop garden is easily accessible to all the users of Walter and Centennial tower through elevators and staircases. Need for privacy: The ICU units on the rooftop garden level need privacy.
Part shade: The tower casts shade on the rooftop garden. This allows having comfortable spaces for people who would have shade, without a shade structure.
No sunken slab: Raising the level of the rooftop garden is required because of no sunken slab.
Planting limitations: The plant palette will be limited due to the shade of towers.
26 | Healing in the City
Opportunities
Threats Environmental health hazards: Urban heat islands combined with rising temperatures caused by increasing heattrapping greenhouse gas emissions can have serious health effects.
Healing spaces: The rooftop garden in both towers holds a great opportunity to built healing spaces with a natural environment.
Views from other rooms: The rooftop garden in both towers can be viewed from rooms on the upper floors. This allows people to get healing benefits even if they can’t use the space.
No exterior view: It is difficult to have exterior views because of the location of the towers and rooftop gardens.
Wind tunnel: Though the winter winds are blocked, there is a possibility of the summer winds forming a wind tunnel.
Reflection of sunlight from glass: The building facade for both the towers is proposed to be glass. Glass would reflect sun rays which will create a concentration of heat.
Healing in the City | 27
03
Case Studies & Literature Review
Case Studies Betty Ruth & Milton B Hollander Healing Garden Hospital: Smilow Cancer Hospital at Yale-New Haven Location: New Haven, CT, United States Landscape Architect: Towers| Golde Architect: Shepley Bulfinch Status: Built 2010 Budget: $1M-5M Design Features: • Seventh-floor rooftop healing garden • An outdoor place for relaxation, contemplation or intimate conversation • Governed more by the needs and desires of cancer patients the circulation loop (wheelchair accessible) • A Naturalistic and re-circulating stream meanders through the garden, terminating in a reflecting pool • • • •
Naturalistic Healing Circular looped walkway Variety of seatings
•
Quiet places for contemplation
Fewer shade structures
Creating beautiful views for people indoors
Source: Architizer [15]
Water stream design element using natural materials and plants 30 | Healing in the City
Nelson Mandela Children’s Hospital Location: Parktown, Johannesburg, South Africa Project completion: December 2016 Client: Nelson Mandela Children’s Hospital Trust Architect: Sheppard Robson International, GAPP Architects and Urban Designers, John Cooper and Ruben Reddy Architects Landscape Architect: GREENinc Landscape Architecture Design Features: • The therapeutic landscape design for this hospital rests on four pillars namely: visual & physical accessibility to the landscape; ease of mobility for people with movement difficulties; a variety of functional spaces that meet different needs; and the provision of sensory stimulation. • Visitors’ and patients’ first impression of the facility will be formed by the Arrival Court • • • • •
Building peripheral green spaces Series of gardens Welcoming experience Kid-friendly spaces Sensory garden
•
Playful spaces for kids
Gravel flooring for one garden makes it unaccessible for wheelchair users
Source: World Landscape Architect [16]
Unique water feature integrated with plants
Welcoming entrance features
Welcoming seating arrangement Healing in the City | 31
Fiona Stanley Hospital Location: Perth, Western Australia Client: Brookfield Multiplex / Government of Western Australian Scale: 320,000 sqm precinct / 65,000 sqm planted landscape Year: 2014 Design Team: The Fiona Stanley Hospital Design Collaboration (comprising: HASSELL, Hames Sharley and SILVER THOMAS HANLEY) Design Features: • Lakeside parklands • Intimate rehabilitation courtyards • Intensive rooftop gardens and urban plazas • A 400-meter concourse unifies the site, passing all of the main open spaces and plazas • Integration of landscape-based therapy tools • Artworks offer vibrancy and assists with wayfinding • • •
Variety of spaces Access to nature throughout Use of art for positive distraction
•
Pocket terrace gardens
Fewer shade structures
Source: Landezine [17]
Peripheral garden spaces 32 | Healing in the City
Intensive rooftop gardens
Boston Children’s Hospital Rooftop Healing Garden Hospital: Boston Children’s Hospital Location: Boston, MA Landscape Architect: Mikyoung Kim Design Design Features: • Eleventh-floor rooftop garden • 8000 sq.ft. rooftop • Free play, diverse seating options, and lush plantings • Skyline and harbor views • Healing space specially designed for kids • Interactive elements like star gazing keep kids busy • Interaction with nature and biodiversity while in a city • • • • •
Flexible lawn space Colorful landscape elements Variety of seating options Play elements for kids Shade elements
•
Planter and seating arrangement bringing people close to nature
More hardscape as compared to softscape
Star gazing from the garden
Source: Mikyoung Kim Design [18]
Green roof view
Healing in the City | 33
Reading Healthplex for Advances Surgical and Patient Care Client: Tower Health System Year: 2016 Location: West Reading, PA Size: 88,000 Square feet Landscape Architect: Jonathan Alderson Landscape Architects Design Features: • Patient rooms would then have views of the serene healing garden • Patients and families have access to natural light and garden spaces • Tranquil fountain area giving pleasing sound • Pergola offering shade in the summer • Strolling meadow walk • • • •
Variety of plants Biophilic design Pleasing views and walkways Wheelchair accessible
Source: greenroofs.com [19]
•
Water feature creates pleasing sound
Fewer shade structures
Accessible walkways
Sensory awakening along the walkway 34 | Healing in the City
Khoo Teck Puat Hospital Client: Ministry Of Health/Alexandra Health PTE Ltd. Year: 2010 Location: Yishun Central, Singapore Size: 79,000 ft² Design Features: • A hospital in a garden, the gardens of Khoo Teck Puat Hospital • Creating gardens with nature and people in mind • Implementing energy and resource-efficient • Therapeutic green spaces • Garden views from different angles, and to provide for a calming surrounding that soothes and rejuvenates • Each roof garden portrays interesting themes to keep them engaging and educational • Few roof gardens cater to specific patient needs • • • • •
User-centric design Integrating nature into the built mass Horticulture therapy Sensory gardens Indoor and outdoor relationship
•
Horticulture therapy
High maintenance
Source: greenroofs.com [20]
Landscape integrated into the building
Courtyard landscape Healing in the City | 35
Palomar Medical Center Client: Palomar Health Year: 2012 Location: Escondido, CA Size: 60,000 Square feet Landscape Architect: Spurlock Landscape Architects Design Features: • Vision: the entire site to act as a therapeutic garden • Integrating sustainability by using natural materials and native plants • Garden spaces at every level of the 11-story nursing tower • Green roof views from the patient rooms • Garden terrace cafe • Natural light in the interiors because of skylights • • •
Use of native plants Outdoor cafe space Multiple outdoor landscape spaces
Source: Spurlock Landscape Architects [21]
Pocket garden spaces 36 | Healing in the City
•
Flexible furniture with wider walkways
Missing outdoor activity/ event space
Garden terrace cafe
Green roof merging with the natural landscape
Summary of Case Studies
User-centric approach:
Use of native plants and materials:
Keeping users in mind, each healing garden design will be altered according to their needs
Brings sustainability, low maintenance and blends with the surrounding landscape
Universal Design:
The healing garden space should be accessible by all. There is a possibility of patients being brought on hospital beds
Summary of Case Studies Flexibility:
Innovative shade structures:
Flexibility increases the usability of a space like movable furniture
Shade structure could be designed to be aesthetically pleasing as well as serve its function
Biophilic and therapeutic design:
Principles of biophilic and therapeutic design add to the healing benefits of a garden
Sensory awakening:
Inclusion of therapy:
Few therapies like horticulture and physical therapy can be done outdoors in the healing garden
Portions of the garden can have sensory awakening elements for patients to enjoy Healing in the City | 37
Literature Review What is a therapeutic garden? “A therapeutic garden is a plant-dominated environment purposefully designed to facilitate interaction with the healing elements of nature. Interactions can be passive or active depending on the garden design and users’ needs. There are many sub-types of therapeutic gardens including healing gardens, enabling gardens, rehabilitation gardens, and restorative gardens. [44] ”
Characteristics of Therapeutic Garden [46] 1. Scheduled and programmed activities
A horticultural therapy program guiding and promoting a program of activities and experiences in the garden is ideal. 5. Benign and supportive conditions
The provision of shade and other protective structures offer personal comfort and refuge to the garden user. 38 | Healing in the City
2. Features modified to improve accessibility
Garden elements, features and equipment are all selected or modified to provide accessible places. 6. Universal design
Therapeutic gardens are designed for the convenience and enjoyment for people of all ages and all abilities.
3. Well defined perimeters
Edges of garden spaces are often intensified to redirect the attention of the visitor to the garden components. 7. Recognizable placemaking
Placemaking heightens the visitor’s focus on plantrelated sensuality, comfort, and experience within a therapeutic garden.
4. A profusion of plants and people/plant interactions
Therapeutic gardens are organized into legible and verdant, plant-dominated open spaces to promote sensory stimulation.
What is evidence-based design? “Evidence-Based Design (EBD) is the process of basing decisions about the built environment on credible
research to achieve the best possible outcomes.� – The Center for Health Design
Or in our own words, Evidence-Based Design is the use of quantitative, and sometimes qualitative, research to design environments that facilitate health and improve outcomes. In some settings, design based on intuition or common sense is fine. But when it comes to creating spaces for specific people with specific needs (and where the space is designed for a specific outcome or result), design must be based on sound research. [45]
Organizational readiness
Define EBD goals and objectives
Design
Pre-design
Find sources for relevant evidence
Critically interpret relevant evidence
Create and innovate EBD Concepts
The Evidence Based Design Process [47] Occupancy
Measure postoccupancy performance results
Design
Construction
Monitor implementation of design & construction
Collect baseline performance measures
Develop a hypothesis
Healing in the City | 39
Literature Review Healing Garden Benefits for Patients & Visitors
Economic
Medical • Decreases Stress[23] • Reduced recovery time[22] • Encourages physical activity[25] • Improves motor skills and strengths [27] • Promotes a sense of optimism [28]
• Decreases amount of medicines needed [23] • Reduces the amount spent on recovery facilities [23]
Ecological • Increases biodiversity [30] • Provides fresh air [31]
Mental & Emotional • Provides positive distraction [26] • Provides a place of contemplation [32] • Influences patients to be positive [28] • Provides escape from stress [33] • Establish confidence about getting through treatment [34]
• Reduces feeling of depression or pain[24]
40 | Healing in the City
Healing Garden Benefits for Hospital & Staff
Medical • Reduces the number of resources needed by a patient [23] • Provides relief from harmful chemicals [31] • Encourages physical activity [25] • Attracts more healing gardenrelated research programs
Economic • Faster recovery means, more beds available [23] • Reduces stress of staff, hence better mood at work [35]
Ecological • Provides fresh air [31] • Reduces the amount of stormwater runoff from roofs [29]
Mental & Emotional • Increases staff’s enthusiasm at work [35]
• Provides break out spaces to rest [36]
Healing in the City | 41
Landscape Elements and their Benefits
Water Feature [28]: • Water sound can filter noise and give privacy. • It lowers body temperature and steady pulse. It calms people. • It adjusts the surrounding microclimate.
Sensory garden [37]: • It stimulates the patient’s sense of texture. • It relieves stress and pain through pleasant natural aromas. • Reduces eye fatigue and gives motivation.
Horticulture therapy [38]: • Reduce the risk factors for dementia. • It improves brain activity such as memory and cognition. • It reduces depression and promotes emotional growth.
Music/ Natural sound [39]: • Soft music and natural sound make bad-sleepers entertained. • It gives a positive distraction. • Keeps people calm.
Art Works [42]: • It inspires people to learn, create and communicate. • It acts as a positive distraction.
Open Lawn [35]: • It elevates mood and reduces depression due to activities on the lawn. • Increases appetite by being outdoors.
42 | Healing in the City
Green Wall [40]: • It increases visual comfort as compared to concrete walls. • It provides enclosure and privacy.
Enclosed spaces [37]: • It provides a private space for contemplation, where people can release sadness.
Pathways [25]: • It allows patients to do physical therapy in natural environment.
Elevated Planter [35]: • It allows people to stretch their arms. • It gives a good opportunity for privacy.
Seating [37]: • It provides a resting place at intervals. • It can also work as a dining space for staff.
Color Therapy [41]: • Colorful elements elevate people’s moods.
Healing in the City | 43
04
Design Development
3
Design Goals
2
Healthy lifestyle p • • • • •
Flexibility and sense of control:
• Proposing spaces with flexible furniture and interactive elements giving an experience of a sense of control. • Designing a multipurpose area allowing holding various activities and events like yoga, pet therapy, staff events, etc. • Flexible spaces with opportunities to socialize as well as get privacy.
1
Green therapy: Encouraging Interactive activities to edu Horticulture therapy with u Positive distraction along w Reduce urban heat island e
Welcoming and sense of arrival:
• Creating an aesthetical entry to the rooftop garden with the help of innovative design features. • Ease of wayfinding with interactive signage at critical junctions to guide through the healing spaces proposed in Houston Methodist Walter and Centennial tower rooftop gardens. • Inclusive and accessible facilities for all users. • Using natural local materials at the entrance to create a homely feeling.
Mission Statement:
To propose a series of comfortable spaces which prov in Houston Methodist Walter and Centennial tower ro evidence-based design strategies for faster recovery visitor and staff satisfaction, and promote a healthy li Site analysis implication 46 | Healing in the City
Inspired from case studies
Evidence from literature
HEALING IN
A blend of innovation and evidence-ba in Houston Method
promotion and education:
g physical therapy outdoors. ucate families and patients about healthy lifestyle habits. urban agriculture space. walking pathways to encourage physical activity. effect and surface temperature.
4
24X7
Active and useful : • Proposing interactive light elements and fixtures to activate outdoor landscape spaces at night. • Using native plantation to increase sustainability and create an ecological habitat. • Creating comfortable microclimate outdoors. • Creating a robust calendar with weekly activities encouraging patients and caregivers to socialize and participate.
Emotional resilience and stress
5
reduction for all users:
vide a healing environment always accessible ooftop gardens by using innovative design and and wellbeing of patients, relief from stress, ifestyle in a natural environment.
• Mental refuge spaces and elements inducing privacy along with vantage points. • Positive distraction with nature and art sculptures. • Using sensory awakening of smell, touch and sound to have a healing experience. • Provide recreational spaces for caregivers, family members and visitors. • Holding monthly, seasonal and yearly events to create a sense of home for long-stay patients as well as caregivers of the hospital.
THE CITY
ased design for a rooftop garden dist Hospital
Healing in the City | 47
Design Concept
Centennial Tower
Maintenance storage
Secondary Access
1 Private Area
Need of privacy for ICU patients and pleasant view for all users
ICU Units
Horticulture therapy
4
3 1 9 5
2
SemiPrivate Area
Need of flexible open space for various activities
2
Activity area
6
3
Welcoming entrance Family Room
Embracing Dome: Semi-private spaces for comtemplation
4
5
Ent
ry
Family Room
Elevators
Legend Focal point/ Positive distraction
Need of buffer between garden and the adjacent building 48 | Healing in the City
Isolation pod: Private spaces for people to comtemplate and release sadness
Buffer (Need for privacy) Visual connection Walkway connection
6 Walter Tower Food Kiosk: Flexible furniture for user comfort
7
View garden: View for ICU rooms
ICU Units
7 View for ICU Units
8
8
View Garden
Wind Sculpture: Positive distraction for patients
9
Horticulture therapy: Use of horticulture therapy Healing in the City | 49
Master Plan Options Option 1
Embracing Dome
Isolation pod Horticulture therapy
Layered plantation
Berm integrated into the dome
Food/Coffee Kiosk
Hardscape for maintenance
Canopied pathway Seating arrangement
Entrance canopy
0
N
• • •
20’
40’
80’
Multiple isolation pods with few accessible to wheelchair users Food/coffee kiosk area Balance of softscape and hardscape
50 | Healing in the City
• •
Missing welcoming entrance Sharp intersections of walkways, making it difficult for patients on stretchers
Mist poles
Option 2
Embracing Dome Isolation pod
Berm integrated into the dome
Water feature Food/Coffee Kiosk
Hardscape for maintenance
Seating arrangement
Entrance canopy
Layered plantation
Mist poles
Horticulture therapy
0
N
• • • •
20’
40’
80’
Food/coffee kiosk area Canopied entrance Multiple isolation pods of different sizes Food/coffee kiosk area
• • • •
Sharp intersections of walkways, making it difficult for patients on stretchers Less space for berm integrating dome Need more softscape Missing continuous walkway
Healing in the City | 51
Option 3
Embracing Dome Horticulture therapy
Isolation Pods
Food/Coffee Kiosk
Berm integrated into the dome
Wind sculpture
Hardscape for maintenance
Canopied pathway
Entrance canopy
0
N
• • • •
20’
40’
Food/coffee kiosk area More softscape than hardscape Canopied entrance Continuous canopied walkway
52 | Healing in the City
80’
• •
Not a welcoming entrance Missing looped walkway
Layered plantation
Option 4
Interactive VR room
Outdoor private rooms Horticulture therapy
Isolation Pods
Food/Coffee Kiosk
Berm integrated into the dome Hardscape for maintenance
Canopied pathway
Entrance canopy
0
N
• • • • •
Wind sculpture
Wind sculpture
20’
40’
Layered plantation
80’
Outdoor private rooms and VR room Food/coffee kiosk area More softscape than hardscape Canopied entrance Continuous walkway
• •
Less space for berm integrating dome Fewer isolation pods
Healing in the City | 53
Design Proposal
25
24
18 8 18
7
Centennial Tower
8 23
15
10 26
21 19
17
13
9
17
14
12
6
3
22
2 1
Ent
ry
N
54 | Healing in the City
0
15’
30’
60’
5
11 4
Legend
Welcoming and sense of arrival: 1 Welcome signage 2 Ramp 3 Steps
Walter Tower
Flexibility and sense of control: 4 Movable furniture 5 Temporary food & beverage kiosk 6 Social plaza with movable furniture
Healthy lifestyle promotion and education:
26
7 8 9 10
Horticulture therpy Raised planter Outdoor space to hold events Canopied pathway (200 ft long)
Active and useful 24X7: 11 12 13 14
Tensile shade structure Blue polycarbonate shade structure Lighting fixtures Native plantation
14
Emotional resilience and stress reduction for all users: 16 20
26
15 Water feature with green wall 16 View garden 17 Isolation pods 18 Embracing dome 19 Berm with living walls 20 Wind sculpture 21 Color therpay with interactive art 22 Multifunctional event lawn 23 Hope canopy 24 Secondary staircase entry/exit 25 Maintenance storage 26 Maintenance area
Healing in the City | 55
Centennial Tower Healing Garden
Active and useful 24X7: +4.00 ft
• Tensile shade structure • Blue polycarbonate shade structure • Lighting fixtures • Native plantation
+2.00 ft
Healthy lifestyle promotion and education:
+2.00 ft
• Horticulture therpy • Raised planter • Outdoor space to hold events • Canopied pathway (200 ft long)
56 | Healing in the City
+5.00 ft
N
0
7.5’
15’
30’
Welcoming and sense of arrival: +0.00 ft
• • • •
Entrance plaza Welcome signage Educational signage Flowy hardscape pattern • Steps and ramp
+2.00 ft
Flexibility and sense of control:
• • • •
+2.00 ft
Social plaza with movable furniture Temporary food & beverage kiosk Movable furniture Variety of resting and sitting spaces
Emotional resilience and stress reduction for all users: • • • • • • • • •
Water feature with green wall View garden Isolation pods Embracing dome Berm with living walls Wind sculpture Color therpay with interactive art Multifunctional event lawn Hope Canopy
Healing in the City | 57
Welcoming and sense of arrival: There are three signages proposed on the healing rooftop garden. The entrance plaza welcomes the visitors with a sign. It will indicate people there are entering a different space away from the chaos. The other two signs would for educational purposes. Horticulture therapy sign would educate people about its benefits, importance and how it can be done. Physical therapy sign will give facts on how to use this garden for physical therapy and maintain a healthy lifestyle.
Physical therapy Educational Signage Horticulture Therpay Educational Signage
Welcome Signage
58 | Healing in the City
Entrance Plaza
Healing in the City | 59
Social Plaza
60 | Healing in the City
Flexibility and sense of control: Open lawn area with movable furniture provides the flexibility to use that space as the users need. This sense of control is comforting for its users [44]. The social plaza can be used to hold staff events, educational seminars, physical therapy and space for people to enjoy nature. It would be in part shade and sun creating a comfortable microclimate for people.
The entrance plaza has a few movable tables and chairs. This gives a chance for people to step outdoors and get fresh air [31], even if they don’t have much time. It can also be used by doctors and staff to get their lunch. A temporary food kiosk will be step up once in a while in this space acting as an attraction point for most.
Evidence from literature Benefits of movable furniture: • Sence of control43] • Multiple uses of the same space
Flexible outdoor space
Healing in the City | 61
Healthy lifestyle promotion and education: Design can influence body movements of people, especially in a setting like the Houston Methodist healing garden. Using raised planters for horticulture therapy makes people stretch their hands and bend. The horticulture therapy space in this design also creates a pleasing walkway for passerby.
Evidence from literature Benefits of Horticulture therapy [38]: • Reduce the risk factors for dementia. • It improves brain activity such as memory and cognition. • It reduces depression and promotes emotional growth. Benefits of Elevated Planter [35]: • It allows people to stretch their arms. • It gives a good opportunity for privacy. Benefits of Sensory garden [37]: • It stimulates the patient’s sense of texture. • It relieves stress and pain through pleasant natural aromas. • Reduces eye fatigue and gives motivation.
62 | Healing in the City
Horticulture Therapy Area
Healing in the City | 63
Healthy lifestyle promotion and education: Multifunctional open lawn space and pathways in the design encourage people to move around and be active while using this space. Multiple pathways can be used if a patient wants to do physical therapy. The central social plaza can have events like yoga demonstration days, self-help care seminars and educational events like promoting a healthy lifestyle.
Walkway distance
64 | Healing in the City
Evidence from literature Benfits of Open Lawn [35]: • It elevates mood and reduces depression due to activities on the lawn. • Increases appetite by being outdoors. Benefits of Sense of Control [43]: • It reduces restriction and gives comfort.
Walk 2: Distance: 340 ft Time: 7 mins
Walk 1: Distance: 230 ft Time: 4.5 mins
Benefits of Pathways [25]: • It allows patients to do physical therapy in nature.
Yoga event on the social plaza
Healing in the City | 65
Active and useful 24X7: Shade structures and lighting design make the healing garden useable during the day as well as night. The circular polycarbonate shade structure in both the healing gardens is an iconic structure that would provide shade during the day, lighting at night and becomes an icon for people viewing the garden from above. Materials and plant palette also define a space’s character. Many case studies have suggested using natural materials to make them aesthetically appealing. The use of native plants helps to get the feel of the local landscape and makes the garden low maintenance.
Walter tower view garden lighting design
66 | Healing in the City
Centennial tower healing garden lighting design
Material Plan
Beige colored paver blocks Blue colored paver blocks
Varied colored concrete and aggregate mix
Varied colored leaf impressions
Mirror
Smooth finish concrete
Beige colored paver blocks
Limestone
Slate stone
Finished wood
N
0
15’
30’
60’
Wooden panels (custom shaped)
Varied colored concrete and aggregate mix
Healing in the City | 67
Seasonal Variation
Trees
A
A
Rhus lanceolata Flameleaf Sumac Maintenance: Medium Light Needs: Partial to full
Magnolia grandiflora Southern Magnolia Maintenance: Medium Light Needs: Part shade
Seasonal color change
N
68 | Healing in the City
Rhus lanceolata, Flameleaf Sumac Magnolia grandiflora, Southern Magnolia Cercis canadensis, Eastern Redbud Laurus nobilis, Sweet Bay Callicarpa americana, American Beautyberry Sophora secundiflora, Texas Mountain Laurel
Section A-A
Cercis canadensis Eastern Redbud Maintenance: Low Light Needs: Part shade, shade Jan
Laurus nobilis Sweet Bay Maintenance: Medium Light Needs: Partial to full
Callicarpa americana American Beautyberry Maintenance: Low Light Needs: Part shade
Sophora secundiflora Texas Mountain Laurel Maintenance: Low Light Needs: Partial to full
Dec
Healing in the City | 69
Shrubs, Groundcovers & Turf
N
Seasonal color change Hymenocallis liriosme, Texas Spiderlily Hydrangea quercifolia, Oakleaf Hydrangea Russelia equisetiformis, Firecracker Plant Conoclinium coelestinum, Blue Mistflower Nolina texana, Texas Beargrass Muhlenbergia capillaris, Muhly grass Leucophyllum frutescens, Texas sage Phyla nodiflora, Texas Frogfruit Hedeoma drummondii, Drummond’s False Pennyroyal Vinca minor, common periwinkle Cooperia drummondii, Evening Rain Lily 70 | Healing in the City
Jan
Hymenocallis liriosme Texas Spiderlily Maintenance: Medium Light Needs: Part shade
Russelia equisetiformis Firecracker Plant Hydrangea Maintenance: Medium Light Needs: Partial to full
Hydrangea quercifolia Gatsby Pink Oakleaf Hydrangea Maintenance: Medium Light Needs: Shade
Conoclinium coelestinum Blue Mistflower Maintenance: Medium Light Needs: Partial to full Dec
Nolina texana Texas Beargrass Maintenance: Low Light Needs: Part Shade
Leucophyllum frutescens Texas sage Maintenance: Low Light Needs: Partial to full
Hedeoma drummondii Drummond’s False Pennyroyal Maintenance: Low Light Needs: Part shade
Cooperia drummondii Evening Rain Lily Maintenance: Medium Light Needs: Partial to full
Muhlenbergia capillaris Muhly grass Maintenance: Low Light Needs: Partial to full
Phyla nodiflora Texas Frogfruit Maintenance: Medium Light Needs: Partial to full
Vinca minor Common Periwinkle Maintenance: Medium Light Needs: Partial to full
Zoysia japonica Zoysia turf Maintenance: Medium Light Needs: Shade
Phlox drummondii Drummond Phlox Light Needs: Partial to full
Amblyolepis setigera Butterfly Daisy Light Needs: Shade
Few horticultue therapy plants (Annuals):
Gaillardia pulchella Indian Blanket Light Needs: Partial to full
Phacelia congesta Blue Curls Light Needs: Partial to full
Healing in the City | 71
Water feature and hope canopy
Hope Canopy The hope canopy has positive words like healing, care and love inscribed in the structure. The shadow cast by this shade structure creates these imprints on the floor. 72 | Healing in the City
Emotional resilience and stress reduction for all users: Many design elements give emotional resilience and stress reduction in many ways. In this design, water features, different seating spaces, artwork and enclosed spaces are proposed for people to contemplate, get privacy or even interact with people. All the spaces are accessible by all its users. These ideas are a blend of innovation and evidence.
Evidence from literature Benefits of Seating [37]: • It provides a resting place at intervals. • It can also work as a dining space for staff. Benefits of Art Works [42]: • It inspires people to learn, create and communicate. • It acts as a positive distraction.
Color therapy using Dichroic film art
Benefits of Water Feature [28]: • Water sound can filter noise and give privacy. • It lowers body temperature and steady pulse. It calms people. • It adjusts the surrounding microclimate.
Dichroic film art sculpture When light strikes a Dichroic film at an angle, some color generated light is reflected on the bottom surface. This interactive art would attract people and become a positive disctraction.
Healing in the City | 73
Isolation pod area
Evidence from literature Benefits of Music/ Natural sound [39]: Benefits of Enclosed spaces [37]: • Soft music and natural sound make • It provides a private space bad-sleepers entertained. for contemplation, where • It gives a positive distraction. people can release sadness. • Keeps people calm. 74 | Healing in the City
Wheelchair accessible isolation pod
Technological features
Music Connection to soothing music by using available earphones or connecting your own
Charging point Charging point available for people wanting to use a laptop
Flexibility to turn Flexibility to turn the pod gives a sense of control and select the amount of privacy Healing in the City | 75
Embracing dome pathway
Evidence from literature Benefits of Enclosed spaces [37]: Benefits of Seating [37]: • It provides a resting • It provides a private space for contemplation, place at intervals. where people can release • It can also work as a sadness. dining space for staff.
76 | Healing in the City
Embracing Dome The concept of embracing dome is to create a space for people where they can get privacy as well as interact with people. Because of its form, it gives a feeling of an enclosure with a nice view outside. One of the key concepts is to use a mirror as its floor so that there would be a constant reflection of the sky. It can be used by the hospital’s staff as well as doctors to eat lunch or interact.
Healing in the City | 77
View of garden from ICU Room
78 | Healing in the City
Evidence from literature Benefits of Nature view through window [22]: • Helps in faster recovery • Decreases amount of medicines needed [23] • Reduces the amount spent on recovery facilities [23] • Promotes a sense of optimism [28]
• Decreases stress[23]
Healing in the City | 79
Walter Tower Healing Garden
80 | Healing in the City
View of the visual garden from the ICU units
Wind Sculpture
Blue pavers replicating the shade structure in Centennial tower
The wind sculpture is a positive distraction for the patients from their rooms. It constantly keeps changing making it an interesting and eye catching art sculpture.
Wind sculpture
Evidence from literature Benefits of Nature view through window [22]: • Helps in faster recovery • Decreases amount of medicines needed [23] • Reduces the amount spent on recovery facilities [23] • Promotes a sense of optimism [28] • Decreases stress[23]
Maintenance area
N
0
15’
30’
60’
Healing in the City | 81
Roof Details
Key plan with grading levels
+4.00 ft
Ramp
ps
Ste
+0.00 ft
+2.00 ft +7.00 ft +4.00 ft +4.00 ft
1.5 ft
5 ft
10 ft
+5.00 ft
Engineered Soil 82 | Healing in the City
Filter fabric
Extensive Roof Detail Growing media/ planting soil mix
2 ft
2 ft
2 ft
2 ft
2 ft
5 ft
Filter fabric Geocomposite drainage layer Root barrier Waterproof membrane Insulation layer Vapor Barrier Concrete slab
Tree Rootball
Concrete Slab
Paver Blocks
Insulation
Foamboard/ Polystyrene filling
Healing in the City | 83
Typical Drainage Detail
Planting as mentioned Wind erosion control
Large Aggregate (No. 57)
Growing media
Drain access box
Insulation layer
Perforation for triangular conduit
Moisture retention mat Root barrier Polypropylene staple fiber Concrete slab
84 | Healing in the City
Geocomposite drainage layer Garden drain
Structural Load Calculation Example Planting as mentioned
Garden drain board
Growing media
Filteration layer
Bulk Density (weight) of Green Roof System with Drainage Board Component
Unit: Wt. ft3
Growing media
74.23
Drain board
Weight: Per/in
Total depth: Inch
Total weight: Lbs/sf
6.61
21�
138.81
-
-
-
6.3
Fabric protection layer (saturated)
-
-
-
1.2
Filtration layer
-
-
-
0.024
Vegetation maximum
System total weight at saturation
31.34
177.67
Healing in the City | 85
Living laboratory using smart technology
86 | Healing in the City
Legend Interactive Screens: These screens will have information about
the garden and will encourage people to give feedback and participate in research. This garden can act as a living laboratory by this research and aid future designers.
Infrared Cameras:
Infrared cameras will not only aid in security but will also collect data for this research. People’s movements and surface temperature can be recorded to analyze various elements of this healing garden.
Healing in the City | 87
Conclusion Using the healthcare garden evaluation toolkit developed by Naomi Sachs, this project is evaluated to see if the design proposal is an evidence-based therapeutic healing garden. The five assesssment tools mentioned below justify various landscape elements.
Healing garden assessment tool for evaluators:
1. Access and visibility
2. Sense of being away
Visual access to the garden
Sense of being away
Visible from main public indoor areas Visible from indoor areas that involve waiting Visible from floors above Entrance is easy to find Doors to the garden are glass or have a window next to it Garden looks appealing from indoors Signage to the garden
Physical access to the garden Space just outside the main doorway is coverd/roofed Outside doorway there is space for a tleast one wheelchair and at least seating for two people A destination feature draws people into the garden 88 | Healing in the City
Desirable sense of enclosure in the garden Privacy in at least one part of the garden People cannot look into adjacent private indoors areas There is at least one fully covered/ roofed area Atleast one seating area is protected from climatic/weather extremes
Aesthetics and maintenance Feature providing multi-sensory experience Free from unpleasant sounds Free from bad odors Plants hide or soften unsightly views Shed or other place to store tools There is at least one trash can
3. Nature engagement
Planting More than half of the garden surface areas are planted Rich variety of plants Plants at multiple heights Plants that stimulate the senses Year-round interest Bright colored flowers Plants are sturdy to tolerate extreme weather
Other natural elements Plants provide food and habitat for birds and butterflies Garden has at least one water feature Water feature design minimizes slipping hazards and splash Sound from water feature is pleasing Seating is available near water feature
4. Walking and activities
5. Places to rest Legend Strongly agree Somewhat agree Somewhat disagree Strongly disagree
Primary walkway Relatively flat Non-skid when wet At least six feet wide Seating at every 30 ft
All paved areas Gaps or cracks in paving are narrow Does not create glare Trees don’t drop a lot of leaves
Lighting, wayfinding and amenities Signage/landmark to navigate people Lighting for night use Walkways are lit Lighting does not shine into patients rooms
Variety & activities More than one walkway Spaces for therapists to work with patients Safe for children
Seating availability Many places to sit Variety of seating Movable seating 50% of seating has back and arm rest Places where people can lie down for rest
Private or social Separation between private and social area 3 or more people can sit together Allow to interact with people passing Semi-private seating for one or two Possible to watch others from a distance
Aesthetics and sun
Key Findings
77.8% of
the items in the evaluation checklist are strongly agreed
22.2% of
the items in the evaluation checklist are somewhat
agreed
Seat doesn’t produce galre Seating doesn’t get too hot or cold Seating has attractive views
Table Seats have tables next to them Large enought for four or more Can accommodate wheelchairs or scooters Healing in the City | 89
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39. Castillo-Pérez, S., Gómez-Pérez, V., Velasco, M. C., Pérez-Campos, E., & Mayoral, M. A. (2010). Effects of music therapy on depression compared with psychotherapy. The Arts in Psychotherapy, 37(5), 387-390. 40. Weinmaster, M. (2009). Are green walls as “green” as they look? An introduction to the various technologies and ecological benefits of green walls. Journal of Green Building, 4(4), 3-18. 41. Hamid, P. N., & Newport, A. G. (1989). Effect of colour on physical strength and mood in children. Perceptual and Motor skills, 69(1), 179-185. 42. Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American journal of public health, 100(2), 254-263. 43. Marcus, C. C. (2007). Healing gardens in hospitals. Interdisciplinary Design and Research e-Journal, 1(1), 1-27. 44. American Horticultural Therapy Association: About Therapeutic Gardens. Retrieved from: https://www.ahta.org/ about-therapeutic-gardens. 45. Therapeutic Landscapes Network: What is Evidence-Based Design?. Retrieved from: https://healinglandscapes. org/resources/what-is-ebd/ 46. Hazen, T. Therapeutic Garden Characteristics. American Horticultural Therapy Association. Retrieved from: https://www.ahta.org/assets/docs/therapeuticgardencharacteristics_ahtareprintpermission.pdf 47. Evidence-Based Design Process: The Center for Health Design. Retrieved from: https://www.healthdesign.org/ certification-outreach/edac/about
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Thank You for reading Contact for feeback and comments Niti Tataria
Phone: +1 979.739.7199 Email: niti.tataria@gmail.com ; nititataria92@tamu.edu LinkedIn | Portfolio
Dr. Chanam Lee
Email: chanam@tamu.edu