REturning Home by lkeokik

REturning HOME Designing a New Cost-Effective and Modular Rehabilitative Environment for TBI/PTSD Veterans Susan Rodiek, Ph.D. Chanam Lee, Ph.D. Lance Keoki Kubiak, M.Arch. Adeleh Nejati, M.Arch.

REturning HOME Designing a New Cost-Effective and Modular Rehabilitative Environment for PTSD/TBI Veterans

A collaboration between Texas A&M University, College of Architecture and the United States Department of Veterans Affairs

Susan Rodiek, Ph.D. Chanam Lee, Ph.D. Lance Keoki Kubiak, M.Arch. Adeleh Nejati, M.Arch.

2012-2013

Texas A&M University College of Architecture College Station, Texas 77843-3137

Center for Health Systems & Design Texas A&M University Director: Dr. Mardelle McCuskey Shepley, FAIA

Dennis F. Sheils Team Leader, Project Planning & Development Oﬃce of Construction Facilities Management U.S. Department of Veterans Aﬀairs

Bradley E. Karlin, Ph.D. National Mental Health Director for Psychotherapy and Psychogeriatrics U.S. Department of Veterans Aﬀairs

It all started with Lance Keoki Kubiak’s search for his master’s degree design project. He saw a need for providing a place closer to veteran’s homes that could provide therapeutic care for their serious injuries and mental health issues. Using the Fisher Foundation’s donated “Intrepid” centers as a starting point for understanding the treatment of traumatic brain injury (TBI) and PTSD patients, Lance developed a concept for using modular buildings to meet this need. This idea grew into a healthcare design studio course for architecture students, who were joined by landscape design students to utilize the healing aspects of the landscape. Then a multi-media class joined to help document the students’ efforts and designs. The project goal was to develop designs utilizing a modular building structure that would keep the project costs relatively low so that they could be placed on a site at an affordable cost. Each team selected a different Veterans Affairs’ facility as a site, studied that site, and studied the needs of the veterans. Then they developed their design, adapted to the local areas to take advantage of local conditions and landscape. These disciplines combined in amazing team efforts to develop building designs for therapeutic care that also incorporated the healing aspects of a designed outdoor environment.

The physical architecture and environment of care are essential, if often under-recognized, components of high quality, patientcentered care in inpatient mental health facilities. From the initial approach, the exterior design sends important messages to potential patients, family members, and the community about mental health care and the treatment setting. On the interior, healing-oriented and person-centered approaches to the design of the environment of care can promote recovery, enhance staff satisfaction, and promote effective workflow and engagement among patients and staff. Accordingly, promoting the design of healing and recovery-oriented mental health facilities is in important focus of the Veterans Health Administration. I applaud the work of Dr. Rodiek and her students on the Texas A&M Health Care Design Project to Aid Veterans’ Care. This project places important attention and value on promoting evidence-based and recovery-oriented design approaches for mental health facilities serving our nation’s heroes and is a valuable addition to the current knowledge base.

Dennis DennisF.F.Sheils Sheils

Bradley Karlin Bradley E.E.Karlin

Recognition & Preface

RECOGNITION & Veterans PREFACE RECOGNITION PREFACE Texas A&M Health Care Design Project to Aid& Care

ACKNOWLEDGMENTS ACKNOWLEDGMENTS We deeply appreciate the generous assistance of: Department of Defense & Veterans Aﬀairs Advisors US Department of Veterans Aﬀairs, Washington, D.C.

Dennis Sheils, Team Leader, Project Planning and Development, Office of Construction and Facilities Management, VA Central Office Bradley Karlin, Ph.D., National Mental Health Director, Psychotherapy and Psychogeriatrics, Mental Health Services, VA Central Office L. Paul Cherry, P.E., LEED AP, HFDP, Planner, Engineer, Office of Construction and Facilities Management, VA Central Office

Warrior and Family Support Center, San Antonio Military Medical Center, TX Beverly Lamoureux, MHSA, Board Member, Executive V.P., Huﬀman Developments Judith Markelz, Manager

Polytrauma Rehabilitation Center, Audie Murphy Memorial Hospital, San Antonio, TX Rick Ames, PE, CEM, CHFM, MBA, Chief Engineer, South Texas Veterans Healthcare System Thomas Yackevicz, Program Director

National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD James P. Kelly, Director, MA, MD, FAAN, FANA, Defense Centers of Excellence, Director Thomas J. DeGraba, MD, FAHA, Deputy Director, Chief of Medical Operations

Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX Rebecca S. Hooper, PT, Ph.D., COL(R), Program Manager, Center for the Intrepid

01 - Acknowledgments Acknowledgments

Atlanta VA Medical Center, Decatur, GA

Thomas Grace, Associate Director Harold L. Barnes, Jr., PE, LEED AP, Supervisory Project Engineer Alfred Cook, Engineering Technician

Information and Facilitation

David X. Cifu, M.D., National Director of PM&R Program Office, Dept. of Veterans Affairs Jim Schiller, OCAMS, Dept. of Veterans Affairs Jeff White, Capital Asset Manager, VA Southeast Network, Dept. of Veterans Affairs Shane Mcnamee, M.D., Chief, Physical Medicine and Rehab., Richmond VA Medical Ctr. Daniel Colagrande, Architect, Office of Const. & Facilities Mgmt., Dept. of Veterans Affairs Mikeual Perritt, former Chief, Air Force Design Group/Architect of the Air Force Charles Frosolone, CDR, MC, United States Navy, MD, FACS, Trauma Surgeon

Professional Advisors AIA Arthur N. Tuttle Jr. Graduate Fellowship in Health Facility Planning and Design Patrick Down, STERIS Corporation (Fellowship Sponsor) William Schlein, AIA, Associate, WHR Architects, Washington, D.C. Heather Voorhaar, Medical Planner, Perkins+Will, Washington, D.C. Kurt Rockstroh, AIA, ACHA, President/CEO, SteďŹ&#x192;an Bradley Architects, Boston, MA Sarah Meeker Jensen, AIA, LEED AP, President, Jensen + Partners, Los Angeles, CA Frances Ridlehoover, Managing Partner, Jensen + Partners, Los Angeles, CA Kevin Schlaht, AIA, President, The Innova Group, Austin, TX

SmithGroup JJR, Washington, D.C.

Phil Tobey, FAIA, FACHA, Sr. Vice President Christopher Arnold, AIA, LEED Green Associate, Principal Brenna Costello, EDAC, Associate Lisa Fjeld, LEED Green Associate, Sr. Marketing Coordinator

Lake/ Flato Architects, San Antonio, TX Ted Flato, FAIA, Principal Bill Aylor, AIA, Associate Maria Fishback, Administrative Assistant

Quatrefoil Inc., Portland, OR Brian Bainnson, ASLA, PLA

Kari Krueger, Executive Director, Brazos Valley Rehabilitation Center, Bryan, TX Amy Gray, Director, St. Joseph Outpatient Rehabilitation, Bryan, TX Rodney Boehm, COO, GroundFORCE Building Systems, Navasota, TX Bill Epp, AIA, San Antonio A&M Club

Acknowledgments 01 - Acknowledgments

Regional Professionals

ACKNOWLEDGMENTS Texas A&M University System Academic Administration

Karan L. Watson, Ph.D., P.E, Provost Rodney P. McClendon, J.D., Ph.D., Vice President for Administration General Joe E. Ramirez, Jr., Commandant, Corps of Cadets Paul Carlton, Jr., MD, FACS, Director, Homeland Security, Health Science Center Jorge Vanegas, Ph.D., Dean, College of Architecture Louis Tassinary, Ph.D., J.D., Executive Associate Dean, College of Architecture Elton Abbott, D.E.D., AIA, Assistant Dean for International Programs, CARC Forster Ndubisi, Ph.D., Department Head, Landscape & Urban Planning Ward Wells, Department Head, Architecture Mardelle McCuskey Shepley, Ph.D., FAIA, Director, Center for Health Systems & Design

Faculty Team Leaders

Susan Rodiek, Ph.D., NCARB, Associate Professor, Architecture Chanam Lee, Ph.D., Associate Professor, Landscape Architecture Jinsil Hwaryoung Seo, Ph.D., Assistant Professor, Visualization Ben Bigelow, Ph.D., Assistant Professor, Construction Science

Faculty Advisors

Acknowledgments

GeoďŹ&#x20AC;rey J. Booth, Youngblood Endowed Professor of Land Development Tom Ferris, Ph.D., Assistant Professor, Industrial Systems & Engineering Anat Geva, Ph.D., Associate Professor, Architecture D. Kirk Hamilton, FAIA, FACHA, Professor, Architecture Zhipeng Lu, Ph.D., Lecturer, Architecture George Mann, AIA, Professor, Architecture Mary Meagher, Ph.D., Professor, Psychology and Neuroscience Jon Rodiek, Ph.D., FASLA, Professor, Landscape Architecture Jim Smith, Ph.D., PE, AIC, Professor, Construction Science Lisa Whittlesey, Master Gardener, Texas AgriLife Extension

Texas A&M University System Interdisciplinary Funding Support

Action 2015, Education First Commitment for High-Impact Learning Activities San Antonio A&M Club (Art Blackburn, President), Student Travel Support Scott Jarvis, A&M Club Program Coordinator, Association of Former Students

Administration

Chris Novosad, Assistant Dean for Finance, College of Architecture John Peters, Audiovisual Specialist, College of Architecture Judy Pruitt, Administrative Assistant, Center for Health Systems & Design Phillip RollďŹ ng, Director of Communications and Public Relations, College of Architecture

Student Advisors (degree candidates)

Acknowledgments

Serena Conti, Master of Land Development Ken Hurst, Ph.D., Landscape Architecture Saleh Kalantari, Ph.D., Architecture Lance Keoki Kubiak, Master of Architecture Autumn T. Leveridge, Major, U.S. Army, Master of Civ. Eng. Xuemei Li, Master of Landscape Architecture Alejandra Poujol, Bachelor of Env. Des., Architecture Naomi Sachs, Ph.D., Architecture Hessam Sadatsafavi, Ph.D., Civil Engineering Brian Sowell, Bachelor of Env. Des., Architecture Joshua Walker, Bachelor of Env. Des., Architecture Saied Zarrinmehr, Ph.D., Architecture Wenjie Zhao, Master of Landscape Architecture

Table of Contents

TABLE TABLE OF OF CONTENTS CONTENTS 01

Project Overview

Design Solutions

Living with PTSD & TBI Background Research Advisors & Mentors References & Resources

Pre-design Conceptual Design Final Study Projects Studio Projects Visualization Projects Cost Estimates

Jorge A. Vanegas, Ph.D.

Dean of the College of Architecture Texas A&M University

CARC operates within an environment of pluridisciplinary collaboration (i.e., multi-, inter-, cross-, and transdisciplinary), CARC is committed to excellence in the three pillars of its academic mission: (1) research, creative work, and scholarship of discovery, integration, application, teaching, and engagement, within and across multiple disciplinary domains associated with the built, natural, and virtual environments; (2) learning and teaching at the undergraduate, masters, doctoral, postdoctoral, and professional education levels; and (3) engagement with individuals, communities, organizations in the public and private sectors, and society at large on a global scale through collaborative partnerships, outreach, and service. The following interdisciplinary student design project encompasses all three of these pillars. In addition, two foundations support these pillars of the College's academic mission. The ﬁrst is a solid foundation created by the diverse talent embedded within the College's faculty, students, and technical and administrative staﬀ, who are complemented by an extensive network of former students, partners, and associates. The second is a solid founda-

tion created by the advanced infrastructure within the College required by each one of the three pillars of its academic mission. As a result, CARC's talent and infrastructure create a unique capacity to respond to both current and future challenges faced by the professions and the industries associated with the natural, the built, and the virtual environments. This interdisciplinary student design project builds upon these two foundations. Finally, CARC's ultimate strategic goal is to provide, maintain, enhance, and continuously improve the quality of life of people, the quality of place within any of these three environments and at their intersection, and the quality of any activity that people do in a place, not only in Texas, but also in the Nation and the World at large. To achieve this strategic goal, the College is solidly committed to ﬁve tactical objectives: 1) answering questions through research; 2) solving problems through its expertise in planning, land and property development, landscape architecture, architecture, construction, facility management, visualization, and/or other associated relevant knowledge domains; 3) satisfying needs through services; 4) realizing opportunities through entrepreneurship; and 5) fulﬁlling aspirations through empowerment, facilitation, coaching, and training. This interdisciplinary student design project epitomizes this commitment. Jorge A. Vanegas

Foreword

As the Dean of the College of Architecture (CARC) at Texas A&M University (TAMU), I am very pleased with the process followed, and with the results obtained, within the large interdisciplinary student design project that focused of the creation of cost-eﬀective treatment centers for veterans with Post Traumatic Stress Syndrome (PTSD) and Traumatic Brain Injuries (TBIs).

01 - Project Overview

01 Project Overview

PROJECT OVERVIEW PROJECT OVERIVEW Since the start of both Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), an unforeseen pattern of psychological and neurological damage has been pervasive in

US soldiers returning from combat in Iraq and Afghanistan. In 2008, a study conducted by the RAND Corporation discovered that of the 1.6 million troops deployed through October 2007 in the OEF and OIF conflicts, 320,000 soldiers had suffered a Traumatic Brain Injury (TBI) during combat. A concurrent study published by the New England Journal of Medicine reported that out of those who had experienced a TBI, 44% met the criteria for Post Traumatic Stress Disorder (PTSD). About one-third of previously deployed soldiers have reported having symptoms of TBIs, PTSD, or major depression, with a large number having a combination of these conditions. A more startling statistic indicated that about half of persons meeting these conditions sought treatment, and of the treated, only half received an adequate standard of mental health care. More recently, public media has portrayed the increase in these conditions among service members paired with an insufficient network of treatment facilities as a national crisis needing timely and effective resolutions.

Changing the Stigma A long-term goal of investigating such solutions is that the program and design for this community-based facility model will help break the current stigma that most service members have about current mental healthcare models. A 2004 study published by the New England Journal of Medicine brought to light a common opinion among soldiers that superiors, colleagues and the public may perceive those who receive mental health care as weak. The impacts of these self-perceptions have resulted in a substantial amount of troops forgoing mental healthcare, only to suﬀer compounding symptoms later in life. If this stigma can be removed by creating architectural environments that facilitate and inspire healing, we will be achieving an important goal for our soldiers and for our society.

01 - Project Overview

Emerging Trends This dire situation has generated a great opportunity to address military health concerns through architecture and design. Emerging trends in traditional and nontraditional treatment modalities paired with a better understanding of how architectural experience relates to psychological health serves as a catalyst for generating adequate healing environments for our wounded warriors. This architectural study developed sixteen prototype outpatient facilities located at vairous VA medical centers, nationwide, dedicated to the physical and mental rehabilitation of veterans and post-combat service members. Architectural design was based on providing a safe, comforting environment fitted to the specific physical and psychological needs of the veteran and postcombat service member demographic. Special consideration was taken to design spaces that facilitate patient focused care, collaboration between medical practitioners, flexible public and private spaces, noise and sound environmental controls and access to nature. In order to design a fiscally effective prototype center for military health, architectural investigation utilized modularity and prefabrication techniques to create a compact and cost effective solution.

LIVING WITH PTSD & TBI LIVING WITH PTSD & TBI “And probably for a good two minutes I was back in Iraq driving on the road and started looking for threats from all directions. My adrenaline just spiked… all of a sudden I’m looking for threats in all directions just waiting to get hit.” CPT Joshua Brandon US Army (2002 - present) Infantry Oﬃcer Iraq

www.thehealthculture.com

“You have enough experience like that and you just don’t want to be bothered with people. The emotional numbness, it’ll just tear away all of the relationship in your live if you don’t learn to unlock them, get those emotions out.” CPT Sarah C. Humphries US Army (1994-present) Iraq

www.military.com

www.thinkprogress.org

01 - Living with PTSD & TBI

“…being agitated all the time, easily agitated, not being able to sleep, nightmares for a while, stuﬀ like that. I didn’t think anything of it, I just ﬁgured it was normal… I didn’t feel like I had a problem. I still don’t feel like I have a problem but I know that little things if gone unnoticed or unattended can turn into big things.”

“It was almost a promise I made to myself leaving, you know. This is a horrible experience that I’m going to leave over here and I’m not going to take it back with me. And it’s not a promise you can keep.”

SPC Rob Tucker US Army (2009 - present) Small Arms and Artillery Repair Afghanistan www.tearsofwar.com

Images of service members are from sources not aﬃliated with AboutFACE interview excerpts. All Veteran’s statments are excerpts from interviews posted by the US Department of Veteran’s Aﬀairs, National Center for PTSD- AboutFACE program. For more information please visit www.ptsd.va.gov/apps/AboutFace/.

Jeremiah Civil US Marine Corps (2001 - 2005) Cpl, Mortuary Aﬀairs Iraq

BACKGROUND RESEARCH BACKGROUND RESEARCH This multidisciplinary design study addresses the pressing national concern of providing treatment facilitates for Wounded Warriors by developing the space program and architectural design of a compact, modular, and cost effective prototype facility for the treatment of PTSD and TBI conditions in post-combat service members. Prior to the development of design, students were asked to perform extensive research on various aspects of Veteran’s health demographics, emerging military healthcare trends and environmental factors that may affect specialized treatment of returning veterans. Research also covered current Evidence-Based Design and sustainability trends that could be incorporated into architectural prototype development. This preliminary research served as the basis for more informed design development. The hope is that these efforts will illustrate the possibility of establishing programmatic and architectural guidelines for a network of small-scale facilities dedicated to the treatment of TBIs and PTSD. Guideline suggestions are based on student-led literature reviews, interviews, case studies, site mapping, climatological and cultural analysis obtained during the research phase of this project. These guidelines were used to inform architectural proposals for facility prototypes that would be integrated into existing VA medical facilities nationwide.

www.sitrin.com/veteran-care/military-rehabilitation

“The increased emphasis on PTSD was driven most recently by the increased recognition of the problems many Vietnam veterans encountered after that conﬂict. If PTSD and depression go untreated or are under treated, there can be a cascading set of consequences: unemployment, marital problems, drug use, and even suicide. There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general.” Charles Frosolone, CDR, MC, MD, FACS Trauma Surgeon United States Navy

Images series courtesy of Department of Defense - Military Health System

01 - Background Research

cms.montgomerycollege.edu

Military Health Demographics

MILITARY HEALTH DEMOGRAPHICS

27% troops report substance abuse problems

320,000 troops sustained a TBI during active combat

300,000 troops diagnosed with PTSD or major depression

29 deaths -per 100,000 due to suicide among service members

HEALTHDEMOGRAPHICS

01 - Background Research

1.6 Millio Million n troo troops deploy deployed during OEF/OIF conflicts. The overwhelming prevalence of PTSD, TBIs, major depression and substance abuse problems among returning soldiers is believed to result from the intensity of combat, exposure to multiple blasts from improvised explosive devices, and prolonged tours of combat duty (Tanielian, T. L., Jaycox, L. 2008). These ďŹ ndings have prompted the US Department of Defense (DoD) to consider the treatment of TBIs and PTSD a very highpriority item for military health expenditures; this is evidenced by the fact that between 2007 and 2010, more than $2.7 billion was appropriated by Congress for mental health treatment of these conditions (Cesur, R., Sabia, J. J., Tekin, E. 2011).

Currently, there are limited facilities within the DoD and Veteran AďŹ&#x20AC;airs Administration healthcare networks that are adequately designed and equipped to treat both TBIs and PTSD in the same locations. This creates a great opportunity for exploring the programmatic and architectural solutions that could establish a larger network of facilities to address the physical and mental health needs of our armed service members.

Emerging Trends

EMERGING TRENDS ALTERNATIVE MEDICINE Incorporation of non-traditional treatment modalities such as acupuncture, meditation, massage, and yoga therapy with traditional treatment protocols for service members suffering from combat-related injuries have been well received by the Department of Defense and Department of Veterans Affairs. Efforts are being made to incorporate these alternative treatments into functional programs paired with increased psychosocial and physical therapy service in order to alleviate suffering.

VIRTUAL REALITY (VR) THERAPY Posttraumatic Stress Disorder has become a signature psychological combat-related injury from OEF and OIF conflicts. Previous psychological interventions for PTSD relied on Cognitive Behavioral Therapies based in a clinical setting, but developments in the field of VR Therapy have opened new avenues of treatment. The Department of Veterans Affairs has adopted VR as a key component of their exposure therapy for PTSD and are incorporating such treatments into new facility programs.

ART AND MUSIC THERAPY

FAMILY SUPPORT Military health practitioners have acknowledged the importance of involving family in various stages of treatment. Short-term, solution-focused therapies, conducted as individual sessions, marital sessions, group sessions and/or family sessions, have seen increased utilization in treating the psychosocial development of service members returning from combat. Programs are continuing to allocate more resources and space to facilitating such treatment intervention.

Images courtesy of Department of Defense - National Intrepid Center of Excellence (NICoE).

01 - Background Research

Due to the severity of their comorbid condition, soldiers often cannot verbalize their pain and emotion to clinicians. Art and music therapies allow patients to express their angst and anxieties through new avenues of expression. Treatment modalities are moving towards providing more space for these creative therapies to enhance the traditional physical and mental health rehabilitation therapies currently provided to postcombat service members.

Design Considerations

01 - Background Research

DESIGN CONSIDERATIONS

PATIENT CENTERED CARE

PROMOTING COLLABORATION

PUBLIC VS. PRIVATE SPACE

Providing a functional program that allows a patient to receive quality care in a single facility is pivotal to positive healthcare outcomes. Designing a compact space plan will ensure service members a focused level of individual care.

Essential to providing comprehensive physical and mental rehabilitative therapy for wounded warriors is the ability to create a variety of architectural spaces that facilitate the collaboration between and education of patients, staﬀ and health professionals.

Due to the nature of symptoms associated with Posttruamatic Stress Disorder and other combat related injuries, spaces will be designed to have the ﬂexibility of being open and free, without producing feelings of vulnerability among soldiers.

ENVIRONMENTAL CONTROLS

ACCESS TO NATURE

HOMELIKE SETTING

To produce an environment of relaxation and safety for patients, family and staﬀ, eﬀorts are made to implement various interior lighting, noise and temperature control strategies to eliminate stimuli that are a hindrance to physical and mental rehabilitation.

Research has indicated that maintaining a physical and visual connection to nature through access to outdoor gardens and inspiring landscapes can decrease recovery and rehabilitation time among veterans.

To enhance a sense of comfort and familiarity for veterans, materials and furnishing are provided to create a “homelike” environment for treatment. Images courtesy of SmithGroupJJR, Maxwell MacKenzie and the Warrior and Family Support Center.

Existing and Proposed Facilities

EXISTING & PROPOSED FACILITIES

VA Medical Center Vet Center Community-Based Outpatient Clinic

Proposed Modular Treatment Center

Guam

Philippines

Hawaii

Puerto Rico & US Virgin Islands

Locations for each studio project were selected by analyzing current Veteran census data and healthcare service demand models. Students sought to establish target regions with a concentrated demand for outpatient rehabilitative services and to design facilities that would serve larger catchment areas.

Source: VAST Q2FY10 VA Office of Policy and Planning - National Center for Veterans Analysis and Statistics (008A3)

01 - Background Research

VA Community Living Center

Therapeutic Landscapes THERAPEUTIC LANDSCAPES Therapeutic Gardens for Veterans and Active Duty Military Personnel Excerpt from the book Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces by Clare Cooper Marcus and Naomi Sachs, New York: John Wiley and Sons, forthcoming, Fall 2013. Evidence-informed design of healthcare facilities for veterans and active duty military personnel is a new field. To date, little research has been conducted on the effects, both positive and negative, of the physical environment on this population. Even less is known about what types of outdoor spaces, and what elements and activities in those spaces, will be of greatest benefit. The complex combination of physical and neurological injuries, interwoven with longlasting emotional challenges, likely calls for unique design solutions.

01 - Background Research

A strong and growing body of research demonstrates that connection with nature facilitates good health and well-being. In the healthcare environment, both passive and active contact with nature can lead to improved physical, cognitive, and emotional outcomes for patients, visitors, and staff. Qualitative research reveals that nature and natural settings, including designed gardens, are valued by veterans and wounded warriors and their families. A garden in a healthcare facility provides a contrast to, and an escape from, the clinical indoor setting where intense physical and emotional therapy take place. Nature spaces, especially gardens designed specifically for recovering veterans and wounded warriors, act as safe, nurturing, life-affirming places. They facilitate social support, a sense of control and self-efficacy, and a wide range of physical movement and exercise including outdoor rehabilitation in the form of physical therapy, occupational therapy, and horticultural therapy.

Clare Cooper Marcus MA, MCP, Hon. ASLA Professor Emerita Dept. of Architecture & Landscape Architecture UC Berkeley

Naomi A. Sachs ASLA, EDAC Ph.D. Proram Department of Architecture Texas A&M University

Gardening, horticultural therapy, and even farming – all forms of active engagement with nature – are eﬀective at reducing both chronic and acute stress and may be especially beneﬁcial for military personnel. Through growing and nurturing plants, participants regain control of and a sense of agency in their lives physically, emotionally, socially, and perhaps even spiritually. Many participants are able to apply their horticultural knowledge elsewhere throughout their lives, in new jobs or at home with their families.

Outdoor courtyard at the Warrior and Family Support Center. Landscape design by Brian Bainnson, Quatrefoil Inc.

While interdisciplinary collaboration is important for all design, it is even more critical with this population due to the breadth of age, type of combat, and range of symptoms. With so little published research to inform design decisions, “on the ground” collaboration with all of the stakeholders - especially those who will be using the garden - may be the best tool for informing successful design. The design strategy of listening is essential. Additionally, it is imperative that people working in this realm share their ﬁndings, enabling a deeper understanding of the design solutions will best serve those aﬀected by the wounds of war.

Modularity & Prefabrication

MODULARITY PREFABRICATION

Prefabricated roof framing assembled at GroundFORCE.

In order to meet the VA’s growing demands for treatment facilities devoted to such a specialized area of Veterans’ care, architectural prototyping must consider flexible, cost-effective, compact, modular and prefabricated design and construction techniques. This will insure the feasibility of replicating such a prototype facility thought the VA Healthcare System, within a limited time and resources scope. Healthcare architecture already lends itself to modular design, and advancement lies in incorporating prefabrication into construction methods. An article in Healthcare Design Magazine described a pressing need for a more efficient, more cost-effective design and construction process based on an industry characterized by increasing construction costs, soaring material prices, spiraling wages, and a rises in the level of construction activity (Fishking & Hullinger, 2009). It is vital to explore options of prefabrication by looking at industries inside and outside of healthcare, to see when and how these practices might be applicable in Veterans healthcare settings.

Prefab connection diagram by Lake|Flato Architects.

01 - Background Research

GroundFORCE Building Systems of Navasota, Texas creates high-quality prefabricated builidng systems for commerical, residential and healthcare applications. Such manufacturing strategies can increase construction quality while reducing costs.

ADVISORS & MENTORS ADVISORS & MENTORS Mentorship from expert faculty and professionals proved to be quite important in various phases of the project. Students relied on professional and academic insight to guide them into designing eﬀective solutions for Veterans healthcare. Advisors with military background also shared their knowledge of the Veteran experience, so that students gained a true understanding of their major issues and challenges. Former Surgeon General of the United States Air Force, Lieutenant General Paul K. Carlton Jr., M.D. attended project reviews at midpoint and ﬁnal milestones.

Professor George Mann speaks to students at their ﬁnal studio review.

01 - Advisors & Mentors

Lieutenant General Paul K. Carlton Jr., M.D. 17th Surgeon General of the United States Air Force Texas A&M Health Science Center Director of Homeland Security, Professor of Surgery “In almost twenty years involved in the architecture, engineering, construction, and military ﬁelds, is it encouraging to see that students in the Texas A&M Center for Health Systems and Design are trained and mentored in thorough planning and integrated interdisciplinary design through eﬀorts such as the studio, various seminars, and multiple on site visits.” MAJ Autumn T Leveridge Health Facility Planner and Multifunctional Logistician US Army Medical Service Corps

Advisors and mentors play an important role in providing guidance during the early progression of each student project. Professionals lend their expertise as reviewers during mid-point and ﬁnal project presentations.

Ted Flato of Lake|Flato Architects shares professional expertise with students.

Program Director Thomas Yackeviz and Chief Engineer Rick Ames brief students on the Polytrauma Center at the VA San Antonio Medical Center.

“From an Engineering perspective, the eﬀorts made by design professionals to create a pleasant and appealing home like environment yet functional with all the treatment modalities in close proximity adds tremendously to the patient’s healing process.”

“The therapeutic gardens at the Warrior and Family Support Center provide a tranquil environment for Wounded Warriors and their Families on the long road to recovery at Fort Sam Houston, Texas. The gardens are enjoyed for relaxation as well as recreation with covered shade structures, playground, water features and putting green. They are an invaluable addition to the healing environment provided to our heroes who deserve our enduring support.” Beverly Lamoureux explains the signiﬁcance of creating a healing environment through the use of therapeutic gardens at the Warrior and Family Support Center near San Antonio, Texas.

Beverly Lamoureux Executive Director Returning Heroes Home, Inc.

Students tour rehabilitation facility in Bryan, Texas.

“It was an honor to be a small part of the Texas A&M University Architecture project focused on designing high-tech and efficient health care facilities for United States Veterans. The students involved in the project provided awe-inspiring designs that offer functionality as well as comfort to Veterans. It is my sincere hope that these designs will be embraced and utilized in an effort to give back to those who have given so much for their country.” Kari Krueger Executive Director Brazos Valley Rehabilitation Bryan, Texas

01 - Advisors & Mentors

Rick Ames Chief Engineer, South Texas Veterans Healthcare System

02 - References & Citations 01 - References & Resources

REFERENCES & RESOURCES REFERENCES & RESOURCES References 5G Design Collaborative. (2008). Warrior and Family Support Center. Retrieved 5-10-12, from http://www.5Gstudio.com. AboutFACE. (2012). Veteran inteviews. Department of Veteran Administartion, National Center for PTSD. Retrieved 5-7-13, from http://www.ptsd.va.gov/apps/AboutFace/Index.html. ArmyTimes. (2012). Civilian Psych Staff Doubled Since 2007. Retrieved 5-7-13, from http://www.armytimes.com/apps/pbcs.dll/article?AID=2012203220313 Cesur, R., Sabia, J. J., & Tekin, E. (2011). The psychological costs of war: Military combat and mental health (No. w16927). National Bureau of Economic Research. Department of Veterans Affairs, Office of Construction & Facilities Management. (2010). Mental Health Facilities Design Guide. Retrieved 10-13-12, from http://www.cfm.va.gov/til/dGuide.asp. Fishking, T. & Hullinger, R. (2009). How BIM advances cost-saving planning and prefabrication. Healthcare Design Magazine. Retrieved 5-7-13, from http://www.healthcaredesignmagazine.com/article/how-bimadvances-cost-saving-planning-and-prefabrication Gross MD, R., Sasson MD, Y., Zarhy Architect, M., & Zohar MD, J. (1998). Healing environment in psychiatric hospital design. General Hospital Psychiatry, 20(2), 108-114. Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22. Jaffee, C. M. S., & Meyer, K. S. (2009). A brief overview of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) within the Department of Defense. The Clinical Neuropsychologist, 23(8), 1291-1298. Karlin, B., & Zeiss, R. (2006). Best practices: environmental and therapeutic issues in psychiatric hospital design: toward best practices. Psychiatric Services, 57(10), 1376-1378. Miller, G. (2011). Healing the Brain, Healing the Mind. Science, 333(6042), 514-517. Parkins, M. (2011). Soft Touch for a Silent Voice: Creating Outdoor Healing Environments for Veterans with Post Traumatic Stress Disorder. (Master of Landscape Architecture Thesis). University of Oregon, OR. Schneider, S. L., Haack, L., Owens, J., Herrington, D. P., & Zelek, A. (2009). An Interdisciplinary Treatment Approach for Soldiers With TBI/PTSD: Issues and Outcomes. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 19(2), 36-46. SmithGroup JJR, (2007). The Center for the Intrepid, National Armed Forces Physical Rehabilitation Center (Fort Sam Houston, San Antonio, TX). Healthcare Design Magazine. Retrieved 8-28-12, from http://www.healthcaredesignmagazine.com/article/centerintrepid-national-armed-forces-physical-rehabilitation-center-fort-sam-houston-san-an SmithGroup JJR, (2010). National Intrepid Center of Excellence for Traumatic Brain Injury. Retrieved 8-28-12, from http://www.smithgroupjjr.com/ Tanielian, T. L., & Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery (Vol. 720). Rand Corporation. Zoroya, G. (2010). Mental care stays are up in military. USA Today. May 16, 2010. http://www. usatoday. com/news/military/2010-05-14-mental-health.

Online Resources AboutFACE - Veterans Testimonials: http://www.ptsd.va.gov/apps/AboutFace/ Center for Health Systems & Design: http://chsd.arch.tamu.edu Computer Assisted Rehabilitation Environment (CAREN): http://www.motekmedical.com/products/caren/ Congressionally Directed Medical Research Programs: http://cdmrp.army.mil/phtbi/default.shtml Defense Centers of Excellence: http://www.dcoe.health.mil/ Evidence-Based Design Checklist for the MHS: http://www.tricare.mil/ocfo/_docs/EBD%20CHECKLIST%202%202.pdf Freedom Park - Fort Sam Houston: http://www.youtube.com/watch?v=gAlZlN4apXc&feature=youtu.be GroundFORCE Building Systems: http://www.groundforcesystems.com HelpGuide - A trusted Non-Proﬁt Resource: http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm Intrepid Fallen Heros Fund: http://www.fallenheroesfund.org/ Lake|Flato Architects - San Antonio, Texas: http://www.lakeﬂato.com Military OneSource: http://www.militaryonesource.mil/non-medical-counseling?content_id=271165 National Center for PTSD: http://www.ptsd.va.gov National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/post-traumatic-stressdisorder-ptsd/index.shtml National Intrepid Center of Excellence: http://www.nicoe.capmed.mil/SitePages/Home.aspx Returning Home - Honoring Military Families: http://www.returninghomeproject.org TBI & PTSD Quick Facts: http://www.nashia.org/docs/quick_white.pdf

The Veterans Health Administration’s Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans: http://www.cbo.gov/sites/default/ﬁles/cboﬁles/attachments/02-09-PTSD.pdf Therapeutic Gardens for Veterans: http://www.youtube.com/watch?v=y6XWiSO29Cc&feature=youtu.be Therapeutic Landscapes Network: http://www.healinglandscapes.org Warrior and Family Support Center: http://www.returningheroeshome.org World-Class Checklist Tool: https://facilities.health.mil/Checklist Wounded Warrior Project: http://www.woundedwarriorproject.org

01 - References & Resources

Texas A&M University, College of Architecture: http://www.arch.tamu.edu

02 - References & Citations

Texas A&M University, ARCH ONE, e-News from the College of Architecture: http://one.arch.tamu.edu

02 - Design Solutions

02 Design Solutions

DESIGN SOLUTIONS DESIGN SOLUTIONS Susan Rodiek, Ph.D. NCARB, EDAC Associate Professor Department of Architecture Faculty Fellow Center for Health Systems & Design Texas A&M University

To make it possible for veterans and wounded warriors with PTSD/ TBIs to receive effective treatment in their home states, our students developed an innovative design strategy using fabricated modules that could be quickly and inexpensively deployed at existing VA facilities across the U.S. Three Master’s students took on the challenge as their Final Study, and two graduate studios from Architecture and Landscape joined forces to create treatment centers using therapeutic outdoor space to reduce stress and expand the indoor therapy areas. An undergraduate Environmental Design studio also developed treatment centers and researched potential therapies. Teams selected sites with high concentrations of veterans, from Maine, to Mississippi, to Nevada, to Hawaii. The design students were joined by senior undergraduate Visualization students, who developed low-cost, high-tech therapy systems with light, color, movement, and user controls. An undergraduate Construction Science class produced detailed estimates on the cost to build several of the treatment centers. Having approximately eighty students working toward a common purpose was an inspiring experience, and the finished designs suggest a timely and cost-effective approach with the potential to benefit the health and happiness of our veterans and wounded warriors.

Chanam Lee, Ph.D. Associate Professor Department of Landscape Architecture and Urban Planning Center for Health Systems & Design Texas A&M University

Science now shows that well-designed indoor and outdoor environments can support healing and good health. Students from multiple disciplines engaged in a semester-long collaborative process to propose creative and evidence-based design proposals for veterans and wounded warriors. The evidence was gathered from previous research findings, case studies of best practices, visits to similar facilities, needs assessment, site and user analyses, and expert consultations, and used to guide their design decision-making process. Students worked through many iterations to propose effective yet feasible designs that meet several overarching goals which included: to provide both traditional and alternative therapies in a home-like setting, to seamlessly integrate indoor and outdoor settings, and to create a complete healing environment that not only provides therapies but also nurtures good health for the veterans and wounded warriors. These readily accessible and holistic treatment facilities hold significant potential to address the unmet treatment needs of the many and the growing number of veterans. They further function as destinations for diverse healing venues and support programs, serving as pathways to healthy lives for our veterans and their families.

02 - Design Solutions

Development of project design solutions came under the guidance of Dr. Susan Rodiek, Department of Architecture and Dr. Chanam Lee, Department of Landscape Architecture and Urban Planning.

PRE-DESIGN PRE-DESIGN To better understand the role of therapy and the veteran population, the students visited rehabilitation facilities and spoke with therapists in the Bryan/ College Station area. They also took a full-day trip to San Antonio to see the Polytrauma Rehabilitation Center, the Warrior and Family Support Center and Healing Gardens, and visit the offices of Lake I Flato Architects, who developed the module used in the project. Some of the students also visited the Center for the Intrepid at Brooke Army Medical Center, and the GroundForce module fabrication plant in Navasota, Texas, bringing back valuable information to apply in their design processes. “Working with veterans was very rewarding. By participating in the studio field trip I learning the struggles that they go through on a daily basis and how much influence good design can have in creating an adequate healing environment for veterans and their families.”

02 - Pre-design

Sarah Stolting Sophmore, Environmental Design College of Architecture Texas A&M University

Field trip group photo at the oﬃces of Lake|Flato Architects, San Antonio, Texas.

Left: Students board charter bus to tour Brooke Army Medical Center, Fort Sam Houston (above), near San Antonio, Texas.

Students explore a clinical rehabiltation environment designed especially for Veterans at the Polytrauma Rehabilitation Center.

“Through this project, I gained much more realization of the eﬀect veterans have on our country. What a family member has to go through with an injured veteran can be a weary process. That even something like architecture can help families cope in some way with their wounded warriors.” Matt Michalak Sophmore, Environmental Design College of Architecture Texas A&M University

Site visit to Brazos Valley Rehabilitation Center, Bryan, Texas.

02 - Pre-design

Campus map of the Audie L. Murphy Memorial Veterans Hospital in San Antonio, Texas, which houses the new Polytrauma Rehabilitation Center.

Case Studies

CASE STUDIES NATIONAL INTREPID CENTER OF EXCELLENCE Bethesda, Maryland PTSD/TBI Outpatient Treatment Center, SmithgroupJJR The National Intrepid Center of Excellence (NICoE) is dedicated to advancing the diagnosis, clinical care and research of complex traumatic brain injury (TBI) and psychological health (PH) conditions affecting service members and their families. The NICoE accommodates a wide variety of programs under one roof, while creating flexible spaces that can adapt to the center's evolving needs as new findings about TBI emerge. Emphasis was placed on designing flexible healing environments filled with diffused natural light.

CENTER FOR THE INTREPID Brooke Army Medical Center, Texas Polytrauma Outpatient Treatment Center, SmithgroupJJR The Center for the Intrepid’s core mission is to provide rehabilitation for OIF/OEF casualties who have sustained amputation, burns, or functional limb loss, to provide education to DoD and Department of Veteran's Aﬀairs professionals on cutting edge rehabilitation modalities, and to promote research in the ﬁelds of Orthopaedics, prosthetics and physical/occupational rehabilitation. Special program features at the CFI include a GAIT Lab, natatorium, and prosthetics manufacturing facility.

SAN ANTONIO VAMC POLYTRAUMA CENTER San Antonio, Texas Polytrauma Outpatient Treatment Center, SmithgroupJJR The San Antonio Polytrauma Rehabilitation Center at San Antonio is a specialized treatment facility designed to provide comprehensive and intensive rehabilitative care to Veterans and Servicemembers who experienced severe injuries (including brain injuries) to more than one organ system (Polytrauma). At the forefront of design intention was designing adequate space for treating veterans with severe Traumatic Brain Injuries.

02 - Pre-design

WARRIOR AND FAMILY SUPPORT CENTER Fort Sam Houston, Texas Military Community and Resources Center, 5G Studio Collaborative The Warrior and Family Support Center provides a comfortable, welcoming, and friendly environment for Wounded Warriors and their families to relax, have fun, participate in activities and ﬁnd support as they transition from combat back to everyday life. Design concepts focused on creating a safe, homelike environment through shared central spaces arranged around a community courtyard. Use of quality materials, abundant natural lighting and views to nature were important in establishing this homelike experience. Photos courtesy of SmithgGroupJJR and 5G Studio Collaborative.

Site Analysis

SITEANALYSIS

Site analysis played a critical role in the development of each student project. Due to the diverse site selections located across the United States, design solutions were required address a wide range of climate, topographic, socioeconomic and social contexts that changed from region to region. As a result, student teams researched and documented relevant site information, which they applied to their design solutions.

02 - Pre-design

A thorough site analysis is critical in establishing the correct framework and program for the design of each center. Projects acknowledge unique site conditions at each VA Medical Center location and attempt to utilize these conditions in their design solutions.

Space Programming

SPACE PROGRAMMING The implementation of traditional and non-traditional therapies into treatment settings will generate new program demands and spatial requirements. Defining necessary locations and adjacencies of various departments to facilitate adequate treatments hinges on analysis of current effective clinical models and understanding how they might be improved. It is essential to understand design opportunities and pitfalls, and how these aspects affect socialization, safety, work-efficiency and treatment practices in an outpatient setting (Gross, 1998). Only when these aspects are taken into account, can adequate facility design be achieved.

Design Goals

02 - Pre-design

Goals

Description

Safety / Access

Give occupants a sense of security

View

Views to nature and the bay

Indoor / Outdoor

Transition between interior and exterior

Sustainability

Minimize electrical consumption and maximize wind effect

Veteran Appreciation

Emphasize historical context throughout

Indoor

Outdoor

02 - Pre-design

CONCEPTUAL DESIGN CONCEPTUAL DESIGN

Students may explore various architectural styles through concept sketching at early stages of a project.

02 - Conceptual Design

Concept sketches help students discuss preliminary design decisions in a quick and concise way. Sketching provides a platform to investigate space planning, programming, and design details at an early stage in the project, setting the foundations for more technical development. The ability of the designer to produce such process sketches for clients and consultants can aid the collaborative efforts of a project.

02 - Conceptual Design

The above sketches illustrate landscape architecture development associated with outdoor therapy spaces. Students explored the use of both architecture and landscape materials to create adequate spaces for healing.

Concept Modeling

STUDY MODELS

02 - Conceptual Design

3-dimensional digital and physical modeling allows students to investigate design forms at early stages of conceptual design. Using computer modeling, students can perform massing studies, space planning and material studies to quickly compare design alternatives. Students used modeling programs such as SketchUp, Autodesk Revit, and other Building Information Modeling (BIM) software to create conceptual design and detailed design representations of preliminary and ďŹ nal architectural forms.

Students used 3-dimensional gaming to establish a program and campus plan for their design solution. Both physical and digital massing models were helpful in working out preliminary design solutions.

Final module layout based on 3-dimensional programmatic development.

02 - Conceptual Design

3-dimensional modeling gives the opportunity to explore modularity and component design arrangement during preliminary design stages.

03 - M.ARCH & MLA Final Study Project 02 - M.ARCH & MLA Final Study Project

Warrior Rehabilitation Center Atlanta VA Medical Center

1670 Clairmont Rd Decatur, GA 30033

M.ARCH & MLA FINAL STUDY PROJECT Wenjie Zhao, 2nd-year, Master of Landscape Architecture Lance Keoki Kubiak, 2nd-year, Master of Architecture Xuemei Li, 2nd-year, Master of Landscape Architecture Number of Modules: 13 Size of Proposed Facility: 7,080 GSF

Perspective 4 –– Entrance Area Therapeutic

Home-like

• Access to Nature

• Indoor/Outdoor Unity • Garden Places

Social engagement and • Various Seating Options • Design for Staff and Families

This Master of Architecture and Master of Landscape Architecture collaborative final study project investigated the implementation of a 7080 square foot facility dedicated to the treatment of TBIs and PTSD at the Atlanta - VA Medical Center in Decatur, Georgia. This site location was selected after preliminary research indicated an increasing population of veterans under the age of 25 in the Atlanta, Georgia area. Currently Atlanta-VAMC has limited Psychological Services and Physical Therapy available for Veterans suffering from PTSD and TBI conditions. The proposed prototype will provide a level of outpatient services congruent to those seen at the Department of Defense Intrepid Centers, but at a fraction of the design, development and construction costs. By “leveraging” existing Surgery, Imaging, Clinical, and Physical Therapy functions of the existing VA Hospital and supplementing Psychological and Non-Traditional Therapy services in a new outpatient setting, the Atlanta-VAMC can provide an increased standard of care for Veterans suffering from physical and mental service-related conditions. An intergral part of this final study was the multi-discipline collaboration between M.Arch and MLA students which was stressed from the very beginning of this project. By coordinating early in the development of this project, a more holistic design of indoor and outdoor space emerged to create a well planned enviroment for veterans healing.

Sense of honor • Memorial Place • Welcoming Entrance

Sense of freedom

Safety and

The Atlanta VA Medical Center (VAMC), located on 26 acres in Decatur, GA is one of eight medical centers in the VA Southeast Network. It is a teaching hospital, providing a full range of patient care services complete with state-of-the-art technology, education, and research.

Veterans Population by County

Site Information

Services available for veterans that have served in Operations Enduring Freedom, Operation Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) include: • Primary Care • Rehabilitation • Dental Care • Behavioral Health The Atlanta VA Medical Center (VAMC), located • Vision Care • Psychological Serviceson 26 acres in Decatur, GA is one of medical centers in the VA It is a teaching hospital, providing a • eight Polytrauma • Southeast Family Network. Benefits Counseling full of Work patient care services• complete with state-of-the-art • range Social Community Resources technology, education, and research. The Atlanta VA Medical Center (VAMC), located on 26 acres in Decatur, GA is one of eight medical centers in the VA Southeast Network. It is a teaching hospital, providing a Services forcare veterans that have served Operations Enduring Freedom, Operation full rangeavailable of patient services complete with in state-of-the-art technology, education, and Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) include: research. • Primary Care • Rehabilitation • Dental Care for veterans that • Behavioral Services available have servedHealth in Operations Enduring Freedom, Operation • Vision Care • Dawn Psychological Services Iraqi Freedom or Operation New (OEF/OIF/OND) include: • Polytrauma • Family Benefits Counseling Primary Care Rehabilitation • Social • Community Resources DentalWork Care Behavioral Health • Vision Care • Psychological Services • Polytrauma • Family Benefits Counseling • Social Work • Community Resources

Site Information Veteran Population by County

Veterans Population by County Veterans Population by County

72, 50 2, 0 50 15, 00 5, 0 00 110 10 ,0 ,0 00 01 -2 5, 00 25 0 ,0 01 -5 0, 00 0 >5 0, 00 0

2 for Veterans forwith Veterans PTSD/ with TBI PTSD/ TBI

-5

-2

0 00 0,

Key Map N.T.S

Veterans Population by County

Services available for veterans who have served in Operations Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), Services available veterans have served in Operations Enduring Freedom, Operation and Opeartion Newfor Dawn (OND)that operations include:

Reference: http://www.atlanta.va.gov

for Veterans with PTSD/ TBI

Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) include: • Primary Care • Rehabilitation • Dental Care • Behavioral Health • Vision Care • Psychological Services • Polytrauma • Family Beneﬁts Counseling • Social Work • Community Resources

Reference: http://www.atlanta.va.gov

2 Reference: http://www.atlanta.va.gov

-5 0

-2

The Veterans Affairs Medical Center (Atlanta-VAMC) is located 12 miles northeast from the Downtown Atlanta city center on a 26.45-acre property at 1670 Clairmont Road in Dekalb County, Georgia. The United States Department of Veterans Affairs currently owns the land outright. The existing facility consists of 1,003,323 grosssquare-feet of Inpatient, Surgery, Outpatient and Long-term Care program. The main acute-care hospital was constructed in 1963 and has had several major clinical expansions over the past 50 years. An evaulation of the program at VAMC indicated a lack of mental health and therapy services. The Atlanta-VAMC serves as the flagship medical center for VISN-7 (a VA Regional Jurisdiction), which encompasses South Carolina, Georgia and Alabama. This medical center currently provides healthcare services to 89,000 Veterans—a population projected to increase to over 100,000 within the next three years.

03 -&M.ARCH & MLA Study Project 02 - M.ARCH MLA Final StudyFinal Project

-5

-2

01 ,0

00 5,

01 ,0

25 0 00

10 1-

0 00

0 50 2,

Site Information

0 1-

0 50 2, 7-

for Veterans with PTSD/ TBI

Land Use Map and Aerial Photo

Sprin n

t wn C s to Kin ng

Scot t Cirr Vis sta m

d Dr

SW est min ns ter Dogwood Way y

Fa lls sD r Du ran d

Wes tc he

O SC

ster Dr

VD BL

rk s

dl Rid

O SC

irr i de C ns Pe

Cham pl

e um

Low-Medium Density Residential

sttriiall

Agricultural

• Existing administrative oﬃce and parking structure in northwest corner of campus have been slated for demolition.

Lando v er

Emo ory Dr Ne

ter Lu llw wa

Rd N

Land Use Classifications (DeKal

ed Mae

le D da

S va

Che l

E Cl ifton

Clairrmo ont Run

Dur and Mill D

il W

Ne e

w l lo Wi

r Ave

tD rN

Ne D H DEC A T UR R Dec atur Rd

N Sup perio or Ave

ar v

Ox for dR dN e

rell G amb

AL ER D

RD NO

h rigg

w ttw Easst

e Ln My rtle

P ow ell Ln

Durand Dr Ne

La dson C t

ngt on Burl in

Ri dg

d Ne

ND E

ell R

ster Wa y N e W est mins Ne

o ew

rn Co

irr nt C

mo a ir Cl

r Ne

1 D

te r D r

e r g ate D

SITE

on t Dr

Av a Pl

W ebs

rv i

® v

r yD ol e

d R d Ne

LL I V

Densley

Dr N e

n it

ns Dr Me an

for Veterans with PTSD/ TBI

r ly l

k Ln Parr

e li ff R d N Ct N e arpark Bria

CD Way y Ne C Pw

ri arc

t on

V LI

dB Old

o nt L a k e

Dep

• Facility does not currently meet outpatient space program demands for patients.

Road d Nettwork k

Pub blic / Insttituttionall

Low Density Residential

Inttersttatte High hway

Very-H High h Densiity Resiidenttiall

Parks and Open Space

Major Roads

High Density Residential

Transportation/Communications/Utilities

Other Roads

Medium-H High Density Residential

Vacant

SiteAnalysis Analysis Site

Off f ice Professional Hig gh Intensityy Commercial Off f ice-Mixed Use

Medium Density Residential

Low Intensity Commercial Reference: http://www.atlanta.va.gov

• Western boundary of property is shared with Emory University Estate; opportunities are available to create stronger connection with the university though landscape redevelopment.

03 & - M.ARCH & Study MLA Final Study Project 02 - M.ARCH MLA Final Project

ar cD

La ke

rm laair

® SITEv ood ew

® v

Emory University

Fr at er

r y Rd Ne

Site Analysis

rc Pa

Soutthe rn Ln

G ¹

nor P

n Ln W E

oo d

Vis stav ia a Cirr

Butlerr Ln

Gat e w

Will ivve e

L RD

to n

® v ® v

r s Cir Ne

D ar

n Dr dan Wend

M IL

H ou s

dM A SO ON

Mi ll Rd N

il l R

B lac

Æ c

Williv ve e D r

r Ne Burton D

M as o nM

# *

HO US T

de vid

Willia amsb burrg Dr

r ds D oo nW

DR UID HIL LL S RD

o Mas

Mil leed g

nne el l D

a Dr van ia Sylv N D ruid d Hills Rd N

Pro

P l Ne S te p

A z a a C irr le

Her ittag e Tw o H er it age Sq

MI LL

pir re

Wea th e rs to ne

¹ d

CL AIR

Rai

• Severe traﬃc congestion at northeast and southeast entrances to the site is a daily occurrence.

• Opportunity zones for development exist at the northwestern corner and southern edge of the campus.

L ive

d sR Hill

d uid Dr

South hland dV Dr

• Atlanta-VAMC’s property is currently landlocked; expansion must take place within current site boundaries; South Fork Peach Tree Creek deﬁnes western edge of site.

Merry Ln N e

An initial visit to the Atlanta-VAMC indicated several key site concerns that must be addressed early in schematic design:

Atlanta VA Medical Center is surrounded by campus of Emory University to the south and west side. To the north of the site are ofﬁce buildings and low-density residential, and to the East are student housing and some ofﬁce buildings.

Site Analysis

Site Analysis LANCE KEOKI KUBIAK

LANCE KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

MASTER OF ARCHITECTURE CANDIDATE

・

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

・ LANCE FALL 2012 KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

MASTER OF ARCHITECTURE CANDIDATE

・

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

・

FALL 2012

LANCE KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

MASTER OF ARCHITECTURE CANDIDATE

・

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

・

FAL

FALL 2012

Reference: http://www.atlanta.va.gov

Site Inventory Site Slope Slope

Existing Site Conditions Site Conditions Legend

>25% 15%~25% 5%~15%

Outpatient Building 2F

<5%

6 Parking Garage to be Removed 2F

Site to be Developed

Forest

Main Building

Trail to Forest

Main Hospital Building 2F

Surface Parking

Main Hospital Building 7F

Parking Garage 5F

Parking Garage

50 ft

Despite the dense development within the exisitng Atlanta -VAMC, the northwest corner of the campus was selected deemed adequate for the prosposed treatment facility. The site’s proximity to existing hospital outpatient services and parking structure makes it an ideal location. Once an existing small, two-story parking garages is demolished, suﬃcicient space will be left for the building prototype and its related landscape design. The proposed enterance to the facility is also within 100 feet of a trail head that would allow veterans, family and staﬀ access to nature and inspiring landscapes.

02 - M.ARCH & MLA Final Study Project 03 - M.ARCH & MLA Final Study Project

for Veterans with PTSD/ TBI

Parti

03 - M.ARCH & MLA Final Study Project 02 - M.ARCH & MLA Final Study Project

NDIDATE

Goals and Objectives Indoor/ Outdoor unity

Garden Places Design for staff and families

Home-like

Social engagement and entertainment

Therapeutic

Access to nature

Various seating options

Restorative natural environment for patients with PTSD and/or TBI

Sensory stimulation

Design Parti Create culture identity

・

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

・

LANCE KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

Memorial place

MASTER OF ARCHITECTURE CANDIDATE

Open View

Accessibility

Sense of freedom and control

FALL 2012

Holistic approach; tranquility of nature Targeting physical, psychosocial and emotional distress !! Finding balance within the overlap

!! !!

Sense of honor and dignity

Site Plan Welcoming entrance

・

Promote various activities

LANCE KEOKI KUBIAK ・ TEXAS A&M UNIVERSITY ・ MASTER OF ARCHITECTURE CANDIDATE ・ 2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

Safety and security

Enclosure

Concept Overlay Movable furniture

LANCE KEOKI KUBIAK ・ TEXAS A&M UNIVERSITY ・ MASTER OF ARCHITECTURE CANDIDATE 2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN ・ FALL 2012

・

FALL 2012

for Veterans with PTSD/ TBI

Opportunity for rehabilitation therapies

・

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLAN

Rehabilitation Paths

Outdoor Yoga Area

Gard den e for Staff// G oup Th Gr herapy

Cent Ce n ral Plaza

Pergola Eagle Sculpture with Bird Feeder

Port Po rtable rt ab Gas Fire ab e Pit D op-off Area Dr

Raised Planting Bed Me M em mo ori rial a Plaza Ou utd doo oor or Loun u ge ge

Staircase

Walking Path under Woods Horttic culture Gard den

Art Display Area/ Seating Area

Pe erg gol oa

Children Playground

Op pen n Law aw wn

La aby yri rintth Trellliliss Trel Tr

Parking Ga ara rage ă&#x192;ť

FALL 2012

40 ft

03 -&M.ARCH & MLA Study Project 02 - M.ARCH MLA Final StudyFinal Project

ESIGN

Master Plan

Design Goals Evaluation Design Goals Evaluation Design Goals Evaluation

Sense of freedom control engagement and entertainment Social Social engagement andand entertainment Accessibility ••Promote various activities

• Promote various activities Open view ••staff Design forfamilies staff and families • Design for and •Various Movable furniture • seating • Various seating options options

Group Group Gathering Gathering

Bird Group Watching Gathering Group Movable Furniture Gathering

Outdoor Lounge

Walking Trail

Cultural CulturalSymbol Symbol

Memorial Outdoor Memorial Plaza Outdoor Lounge Plaza Lounge Outdoor Lounge

Accessible Gardening Planters

Walking Trail Children Playground

Children Playground

Open Lawn Labyrinth Walking

Gardening

Open Lawn Labyrinth Walking

Garden Path

No obstacles of views Cultural Symbol Cultural Symbol

Memorial Plaza Memorial

Plaza

13 for Veterans with PTSD/ TBI

03&- M.ARCH MLA Final Study Project 02 - M.ARCH MLA Final&Study Project

for Veterans with PTSD/ TBI

Outdoor Yoga

Enclosure/ Well-deﬁned Boundary

for Veterans with PTSD/ TBI

Bird Watching

• Create culture identity Open view ••Memorial • Memorial place place • Welcoming entrance • Welcoming entrance

Walking Path

Walking Path Outdoor Yoga

Safety security Sense ofand honor and dignity Sense of honor and dignity Enclosure ••Create culture identity

Design Goals Evaluation

Therapeutic

Home-like Sense of freedom and control

• Opportunities for rehabilitation therapies • Sensory stimulation • Access to nature

Yoga Therapy

Simulated Apartment

Massage Therapy

Garden Place

Yoga Therapy

Group Therapy

Sensory Stimulation

Outdoor Garden Movable Fire Pit Place Furniture 14

Virtual Reality Horticulture Therapy Art Therapy

Horticulture Garden

Outdoor Lounge

for Veterans with PTSD/ TBI

Outdoor Lounge

Accessible Planters Children Playground

Open Lawn

Labyrinth Walking

Garden Garden Path Path

02 - M.ARCH & MLA Final Study Project

Balance Rehabilita-

• Indoor/Outdoor unity • Accessibility • Garden • Open view Places • Movable furniture • Design for staff and families

03 & - M.ARCH & Study MLA Final Study Project 02 - M.ARCH MLA Final Project

Virtural Reality Therapy module.

A-A Classrooms for art, music and hoticultural therapies.

Main entrance lobby with main waiting, family lounge, library and adjacent exam room. SECTION A-A

View of library from main waiting.

Contrasting light, that could be bothersome to veterans with TBIs, is controlled though the use of shading devices, overhangs and trellises located around the building. Clerestory windows equipped with light shelves bring in natural light and reďŹ&#x201A;ect it into treatment spaces, creating a comfortable and evenly-lit environment.

Central Axis/East-West Section Pergola with an arch

Eagle Sculpture with A Bird Bath

Bubbling Water Fountain

50 Stars Paved on the Courtyard Representing 50 States

Portable Gas Ignited Fire Pit

Memorial Plaza

Key Map N.T.S

Central Axis/East-West Section

Virtural Realty (VR) Treatment and classroom modules. Eagle Sculpture with A Bird Bath

Yoga studio, massage therapy suite, conference room, and PT simulated apartment unit.

Bubbling Water Fountain

50 Stars Paved on the Courtyard Representing 50 States

Portable Gas Ignited Fire Pit

Memorial Plaza

9 for Veterans with PTSD/ TBI

Key Map N.T.S

for Veterans with PTSD/ TBI

Forest

Pergola

Sensory Garden Eagle Sculpture with A Bird Bath

Bubbling Water Fountain

Planting Beds

Portable Gas Ignited Fire Pit

Courtyard with Movable Furniture

Porch Way

Lobby

Parking Deck

Driveway

Bar Table

Sensory Garden

Eagle Sculpture with A Bird Bath

Bubbling Water Fountain

Planting Beds

Portable Gas Ignited Fire Pit

0 10 20 40 Courtyard with Movable Furniture

Porch Way

80 ft

Lobby

Parking Deck

Driveway

Bar Table 0

80 ft

02 - M.ARCH &03 MLA Final Study Project - M.ARCH & MLA Final Study Project

Pergola with an arch

03 - M.ARCH & MLA Final Study Project 02 - M.ARCH & MLA Final Study Project

Mechanical Systems

Split HVAC System for Phases 2, 3 & 4

The facility will utilize two mechanical system types. Site built and contiguous building elemetns will utilize a The facility will utilize mechanical system forced air system, whiletwo subsequent phases of facility will types.split SiteHVAC built units. and buildings contiguous to it allows will for utilize The combination system unitized apressure forced air system, positive within while each subsequent module, reducing phases of facility will utilize splitair, HVAC units. infiltration of outdoor humid while establishing multiple controlled climate zones.

Structural System

Forced-air System for Phase 1: 2550 nsf nsf Force Air System for Phase 1: 2550 LANCE KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

MASTER OF ARCHITECTURE CANDIDATE

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

・

In order to meet the VA’s growing demands for treatment facilities devoted to such a specialized area of Veterans’ care, architectural prototyping must consider flexible, cost-effective, compact, modular and prefabricated design and construction techniques. The typical prefabricated treatment module will utilize several technical systems such as a prefabricated slab attached to helical piers, lightweight rigid metal frame structure, and both forced-air and ductless HVAC split systems. Typical prefabricated modules will be delivered and installed on site. They include pre-installed mechanical and electrical systems, and come fully furnished with hospital grade finishes. This type of prefabrication insures a readily repeatable and deployable treatment module to use at the Atlanta VAMC and other locations across the nation.

Typical Module Section

FALL 2012

Tube steel frames will support modular units. Interior wall partitions will be metal stud in nested track construction with Tube steel frames will support modular units. Interior wall 5/8” gypsum-wallboard, eachin side. partitions will be metal stud nested track construction with

Prefabricated Slab 5/8” gypsum-wallboard, each side.

LANCE KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

MASTER OF ARCHITECTURE CANDIDATE

・

2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

・

FALL 2012

ective 1 –– View from Parking Garage Pre-tensioned concrete slabs placed on aondrilled helical pier pier system. Pre-tensioned concrete slabs placed a drilled helical Slabs can Slabs be prefabricated in the factory and placed onplaced installed system. can be prefabricated in the factory and piers when delivered on-site. on installed piers when delivered on-site. LANCE KEOKI KUBIAK

・

TEXAS A&M UNIVERSITY

・

eutic

Home-like

o Nature

• Indoor/Outdoor Unity • Garden Places

MASTER OF ARCHITECTURE CANDIDATE

・

Section through VR Therapy and Classroom modules. 2012-2013 AIA/AAH TUTTLE FELLOWSHIP IN HEALTH FACILITY PLANNING AND DESIGN

Social engagement and

・

FALL 2012

Sense of honor

Sense of freedom

Safety and

Perspective 5 –– A Memorial Plaza The use of color is critical when the goal is to make people feel comfortable. Warm colors have been suggested to elicit a positive mood (Alexander et al.,1977). High contrast color combinations and very bright colors are avoided in this design to reduce over-stimulation for Veterans sensitive to light. Natural materials are repeatedly used in this design for their comforting characteristics that make a space warmer to experience.

02 - M.ARCH & MLA Final Study Project

Utilizing a pervious paving with a base and sub-base allows the movement of storm water through the surface. In addition to reducing runoff, this paving type effectively traps suspended solids and filters pollutants from the water.

02 - M.ARCH & MLA Final Study Project 03 - M.ARCH & MLA Final Study Project

• Garden • Garden Places Places

• Accessibility • Accessibility

• Enclosure • Enclosure

Perspective 12 –– Labyrinth rspective 12 –– Labyrinth The Healing Garden Design for post-combat Veterans facilitates self-initiated and independent engagement in ordinary outdoor activities by providing access to

restorative natural environment for the treatment of PTSD and TBI conditions. Development of the landscape architecture at this site aims to establish a landscape design model of home-like, sensory stimulating therapeutic healing that could be replicated at other VA locations, using regional mateirals.

for Veterans with PTSD/ TBI

Perspective 7 –– Central Courtyard

Perspective 6 –– Garden Entrance Home-like

• Access to Nature

• Garden Places

Social engagement and • Various Seating Options • Design for Staff and Families

Sense of honor

Sense of freedom

Safety and

• Memorial Place • Welcoming Entrance

• Accessibility • Movable Furniture

•Open View

Key Map N.T.S

for Veterans with PTSD/ TBI

View through central courtyard and ﬁre pit area from central lobby.

Covered outdoor space between central lobby and educational module.

02 - M.ARCH & MLA&Final 03 - M.ARCH MLAStudy FinalProject Study Project

View of Veteran’s Memorial Garden and horticultural area & classroom module, beyond.

Therapeutic

Key Map N.T.S

for Veterans with PTSD/ TBI

Perspective 8 –– Rehabilitation Paths Perspective 8 –– Rehabilitation Paths

Perspective 9 –– Sensory Garden

Therapeutic

Home-like

• Access to Nature • Rehabilitation Paths

Therapeutic

• Garden Places

Social engagement and Home-like

• Access to Nature • Rehabilitation Paths

••Garden Places Various Seating Options

Sense of honor

Social engagement and • Various Seating Options

Seven-circuit labyrinth located near existing parking structure. Veterans can navigate the labyrinth for physical therapy and relaxation. Key Map N.T.S

for Veterans with PTSD/ TBI

02 - M.ARCH & MLA&Final Study 03 - M.ARCH MLA FinalProject Study Project

A dialogue between indoor and outdoor space was promoted to eﬃciently utilized the compact site. Architecture captures outdoor space between built form to create in-between spaces used for therapeutic treatments. A seamless integration emerged between indoor treatment and outdoor healing garden areas, to create a wholistic environment for healing. Meditation gardens located on the north side of facility.

Sense of freedom

Sense of honor

• Accessibility • Movable Furniture

Safety and

Sense of freedom

Safety and

• Accessibility • Movable Furniture

• Enclosure

Perspective 2 –– View from Bridge

Perspective 4 –– Entrance Area 27 Therapeutic

Home-like

• Access to Nature

• Indoor/Outdoor Unity • Garden Places

Social engagement and

• Various Seating Options • Design for Staff and Families

Sense of honor

Sense of freedom

Safety and

Therapeutic

Home-like

• Access to Nature

• Garden Places

Social engagement and

Sense of honor

Sense of freedom

Safety and • Enclosure

• Memorial Place • Welcoming Entrance

Key Map N.T.S

Entry sign and courtyward with trellis.

South view of facility.

for Veterans with PTSD/ TBI

23 for Veterans with PTSD/ TBI

for Veterans with PTSD/ TBI

Front covered dropoﬀ entrance of central lobby.

Horticultural therapy area adjacent to classroom module.

02 - M.ARCH MLA Final Project 03 & - M.ARCH & Study MLA Final Study Project

Perspective 13 –– Horticulture Garden

02 - ARCH 605 + LAND 601 - Studio Projects

“Before this project, I knew a little about US Veterans. But, I was quite excited when we had the opportunity to design for their speciﬁc conditions and needs. The opportunity to visit existing VA facilities and research emerging in Veterans’ Healthcare greatly informed my project and gave insight into how to design for the Veteran community.” Mark Liang 1st-year, Master of Architecture College of Architecture Texas A&M University

GRADUATE STUDIO PROJECTS GRADUATE STUDIO

ARCH 605 + LAND 601 students at mid-review with visiting reviewers Wenjie Zhao, Autumn T. Leveridge, Lance Keoki Kubiak, Dennis Sheils and Xuemei Li.

Graduate Architectural Design Studio

Graduate Landscape Architectural Design Studio

Susan Rodiek, Ph.D., Instructor

Chanam Lee, Ph.D., Instructor

Yasaman Bagheri Xiaoxi Bi Jiayu Chen Victoria Alexis Garcia Farzad Golestanirad Chia-En Hsu Renee LaCroix Jianyi Li Mark Liang Wanyuzi Wang Yue Wang

David Danielson Ruisi Guo Zhihuang Li Siman Ning Wonmin Sohn Xiaotian Su Yucheng Wang Bitong Yang Yue Yao Yixun Zhang Jinglin Zhao

LAND 601 - Theory and Practice

02 - ARCH 605 + LAND 601 - Studio Projects

ARCH 605 - Architectural Design I

Treatment Center for Veterans Matsunaga VA Medical Center

495 Patterson Road, Honolulu, Hawaii 96819

TEAM 1 Wanyuzi Wang, 1st-year, Master of Architecture Yue Wang, 1st-year, Master of Architecture Jingling Zhao, 1st-year, Master of Landscape Architecture Siman Ning, 1st-year, Master of Landscape Architecture

Merit Award Recipient, 2013 Texas Society of Landscape Architects

03 - Team 1 - ARCH 605 + LAND 601 - Studio Projects 02 Design Solutions

Number of Modules: 4 Size of Proposed Facility: 2,880 GSF Estimated Cost: $190/SF

Access to Road

Access to Airport

02 03 - Team 1 - ARCH 605 + LAND 601 - Studio Projects

Main Road

Sidewalk

nner Path

Nature Trail

Private

Semiprivate

Public

Traffic and Privacy Analysis

Section looking north, showing terraces with ocean view

We designed many open spaces because the weather is mild and there are wonderful views. The corridor is a transtion space to integrate outdoor space with indoor space. We provided

We designed open spaces because theart/music weather is mild there are wonderful views. The corridor is afortranstion space tocan integrate outdoor diverse outdoor many therapies such as horticultural therapy, therapy andand outdoor massage. We also provided some outdoor activities veterans where they enjoy sunbathing, space with Weinprovided diverse outdoor therapies chatting in theindoor outdoorspace. bar, reading the hammock or sitting in the outdoor cafe. such as horticultural therapy, art/music therapy and outdoor massage. We also provided some outdoor activities for veterans where they can enjoy sunbathing, chatting in the outdoor bar, reading in the hammock or sitting in the outdoor cafe.

Trtititmtitit Ctitittir ftir Vtittirtitis titith TtiI/PTSD titi HtititititilulutiHtititititi

Stitti

VA Mtidtictil Ctitittir

Mtititi Htistitittil The Entrance Plaza

Walkway

Thtimtis: Ltitisurti Ttimtiti tiutdtitir rtitimti Mtititidtirtititi trtitilsti Rtiltixtitititi

Nature Trail

Adtititittititis: Grtitit titititis (stititisutistit)ti Chtilltitititis: Ttirrtitititi Ntirrtiti Stitictiti Strtittitititis: Itidtitir-tiutdtitir Trtitistitititititi titititititititititititititititititititititititititititititititititititititititititititititi

Sunbath Area

Team Instructors: Team11 Yue Wanyuzi WangWtititi (Architecture) Susan Rodiek YutiWan, Wtitititi Wtitiyuzti (Archtitticturti) Dr.Itistructtirs: Sustiti Rtidtiti Siman Zhao (Landscape) Dr. Chanam LeeChtititim Ltiti StimtitiNing, NtitititiJingling Jtititiltititi Zhtiti (Ltitidsctititi)

Since our building is located on a very steep slope, we have very limited space. We put four modules along the contour line, and designed a covered corridor to connect them

Since our building is located veryand steep slope,inwe very limited space. Weand putoutdoor four modules along contour line, and feel designed together. Veterans come intoon thealobby are received thehave ďŹ rst module. We design the indoor cafe areas to makethe veterans and their families relaxed. a covered corridor to connect them together. Veterans come into the lobby and are received in the first module. We design the indoor and outdoor cafe areas to make veterans and their families feel relaxed.

Homelike Healing Center Charles George VA Medical Center 1100 Tunnel Rd, Asheville, NC 28805

TEAM 2 Xiaox Bi, 1st-year, Master of Architeture Jiayu Chen, 1st-year, Master of Architecture Yucheng Wang, 1st-year, Master of Landscape Architecture Bitong Yang, 1st-year, Master of Landscape Architecture

Honor Award Recipient, 2013 Texas Society of Landscape Architects

02 - TeamDesign 2 - ARCH 605 + LAND 601 - Studio Projects Solutions

Number of Modules: 7 Size of Proposed Facility: 5,100 GSF Estimated Cost: $160/SF Our healing center is located in the southwest part of Charles George VAMC. The original site is a piece of large lawn, with very small elevation change. The boundary of this lawn is higher, which can block view of heavy traďŹ&#x192;c and its noise. The healing center shares parking lots with the Mental Health Clinic near it, providing easy accessibility for patients to get into it. The connection with the Mental Health Clinic can be readily created, so it can provide medical assistance and other help to our healing center. They can share information about patients as well. Our facility also utilizes existing trees on the site. They are included in our healing garden, acting as a part of an attractive landscape for visual therapy. Additionally, it is relatively near the main hospital campus, which can more or less provide some help to the healing center.

3 - ARCH + LAND 601 - Studio Projects 02 - Team Team 2 - ARCH 605 + 605 LAND 601 - Studio Projects

Homelike Healing Center

Charles George VA Medical Center - Asheville, NC SITE LOCATION Parking Lots

Charles George VA Medical Center 1100Tunnel Road Asheville, NC 28805

Reception

Entrance Plaza Water Fountain

CONCEPT Homelike Healing Center

Tree Plaza

GOALS Safety & Security Accessibility Sustainability Therapy

Existing Trees

Medication

Bamboo Planter Consulting Room

Green Space

Communication Room

Bamboo Planter

Wellness Center

Cafe Dining Room

Yoga Space

Green Space Wellness Facilities Virtual Reality

Simulated Apt.

Living Room

Bamboo Planter

Flexible Sofa

Fountain Plaza

Resting Area

Barbecue Area Gallery

Pergola Art Workshop

Resting Area

TRAFFIC

SPACE PROGRAM

Team 2: Yucheng Wang, Bitong Yang (MLA) Xiaoxi Bi, Jiayu Chen (MARCH) Instructors: Dr. Chanam Lee, Dr. Susan Rodiek Texas A&M University 2012 Fall LAND601 ARCH605 Date: 2012/12/05

Our seven seven modules follow the contours to reduce to elevation changes and to changes meet ADA requirements. the arrangementMoreover, of modules mimics the ďŹ&#x201A;ow of water, Our modules follow the contours reduce elevation and to meetMoreover, ADA requirements. the arrangement of which modules mimconnects with water features in the central part of the healing garden. Since we believe water represents hope and renewal, the healing center can provide veterans hope and hope and ics the flow of water, which connects with water features in the central part of the healing garden. Since we believe water represents make them feel optimistic about life. renewal, the healing center can provide veterans hope and make them feel optimistic about life.

Homelike Healing Center

Charles George VA Medical Center - Asheville, NC THERAPY Outdoor:

Visual Therapy, Walking Therapy, Group Therapy, Social Support, upport, Exercise Therap uppor Y Yoga Therapy, Massage Therapy, Aromat Therapy Indoor:

Exercise Therapy, Virtual Reality, Physica Therapy, Art r Therapy, Simulated Apart rt par men part Speech Therapy

Consulting Room

Reception

Keymap

Waiting Room

Entrance Plaza

Garden Entrance

Bamboo Planter

Pergola Pergola

Bamboo Planter

Garden Entrance

Entrance Plaza

Team 2: Yucheng Wang, Bitong Yang(MLA) Xiaoxi Bi, Jiayu Chen(MARCH) Instructors: Dr. Chanam Lee, Dr. Susan Rodiek Texas A&M University 2012 Fall LAND601 ARCH605 Date: 2012/12/05

The main withformal formal plant and linear attract and lead peopleand to the mainpeople entranceto ofthe our healing On both sideshealing of the main path, aOn treeboth The main pathpath with plantstructure structure and paving linearpattern, pavingcan pattern, can attract lead main center. entrance of our center. plaza with ďŹ&#x201A;exible chairs underneath is proposed, providing a beautiful place for people to communicate with each other. A water fountain at the end of the main path provides sides of the main path, a tree plaza with flexible chairs underneath is proposed, providing a beautiful place for people to communicate with each a feeling of welcoming and arrival, where people can feel peaceful and comfortable. other. A water fountain at the end of the main path provides a feeling of welcoming and arrival, where people can feel peaceful and comfortable.

Healing Veterans with Honor Hampton VA Medical Center

100 Emancipation Drive, Hampton Virginia 23667

TEAM 3 David Danielson, 1st-year, Master of Landscape Architecture Wonmin Sohn, 1st-year, Master of Landscape Architecture Victoria Garcia, 1st-year, Master of Architeture Renee LaCroix, 1st-year, Master of Architecture

Number of Modules: Modules: 44 + Site-built Size of Proposed Facility: Facility: 2,700 2,700GSF GSF Estimated Cost: $165/SF $165/SF

02 - Team 3 - Design ARCH 605 + LAND 601 - Studio Projects Solutions

The proposed design combines conventional and holistic therapies with conscious attention to the region’s historical importance. Both implicit and explicit design conventions connect visitors with their shared history and excitement for the furture. Five primary goals guided our design decisions. These goals included safety and accessibility, views of nature and the adjacent Chesapeake Bay, ﬂuent transitions between interior and exterior spaces, passive climate control, and an emphasis on veteran appreciation. “I learned just how large a problem PSTD/TBI is for our veterans and their families. It’s an issue that needs a solution. Seeing how it aﬀects the families and how facilities need to accommodate them as well made it a more personal project.”

Victoria A. Garcia 1st-year, Master of Architecture College of Architecture Texas A&M University

02 - Team 3 - ARCH 605 + LAND 601 - Studio Projects

HEALING VETERANS WITH HONOR HEALING VETERANS WITH HONOR A Modular Treatment Center

Texas A&M University Arch 605 + Land 601 Dr Rodiek + Dr Lee Fall 2012

Modular Treatment Center

ampton,Hampton, Virginia Virginia

Group Therapy

Central Plaza

^ĞĐƟŽŶ Ͳ ͛ ƚŚƌŽƵŐŚ ĞŶƚƌĂů WůĂǌĂ

Victoria Garcia Renee LaCroix David Danielson Wonmin Sohn

Individual Therapy 0

dŚĞ ƉƌŽƉŽƐĞĚ ĚĞƐŝŐŶ ĐŽŵďŝŶĞƐ ďŽƚŚ ĐŽŶǀĞŶƟŽŶĂů ĂŶĚ ŚŽůŝƐƟĐ ƚŚĞƌĂƉŝĞƐ ǁŝƚŚ WƌŝǀĂƚĞ ƐĞĂƟŶŐ ďǇ Ă ďĂƌĞĨŽŽƚ ƉĂƚŚ ƉƌŽǀŝĚĞƐ Ă ƋƵŝĞƚ ŽĂƐŝƐ ůů ƚŚƌĞĞ ďƵŝůĚŝŶŐ ŵŽĚƵůĞƐ ĂƌĞ ĐŽŶŶĞĐƚĞĚ ǁŝƚŚ ĐŽǀĞƌĞĚ ǁĂůŬǁĂǇƐ͘ Ǉ ĐƌĞĂƟŶŐ ƚŚĞƐĞ ĐŽŶƐĐŝŽƵƐ ĂƩĞŶƟŽŶ ƚŽ ƚŚĞ ƌĞŐŝŽŶ͛Ɛ ŚŝƐƚŽƌŝĐĂů ŝŵƉŽƌƚĂŶĐĞ͘ ŽƚŚ ŝŵƉůŝĐŝƚ ĂŶĚ ĨŽƌ ǀĞƚĞƌĂŶƐ ǁŝƚŚ ŵĂŶǇ ĚŝīĞƌĞŶƚ ƚǇƉĞƐ ŽĨ ƉůĂŶƚƐ ĂŶĚ ŽƵƚĚŽŽƌ ĐŽƌƌŝĚŽƌƐ͕ ĞĂĐŚ ŵŽĚƵůĞ ŝƐ ĚĞƐŝŐŶĞĚ ǁŝƚŚ ŵĂǆŝŵƵŵ ĂƌĞĂ ĞĸĐŝĞŶĐǇ͘ dŚĞ ĞǆƉůŝĐŝƚ ĚĞƐŝŐŶ ĐŽŶǀĞŶƟŽŶƐ ĐŽŶŶĞĐƚ ǀŝƐŝƚŽƌƐ ǁŝƚŚ ƚŚĞŝƌ ƐŚĂƌĞĚ ŚŝƐƚŽƌǇ͘ ŇŽǁĞƌƐ ƚŽ ĐƌĞĂƚĞ Ă ƌĞůĂǆŝŶŐ ĞǆƉĞƌŝĞŶĐĞ͘ ŚĂůůǁĂǇƐ ǁƌĂƉ ĂƌŽƵŶĚ ĐĞŶƚƌĂů ƉůĂǌĂ ƉƌŽǀŝĚŝŶŐ Ă ƐĞĐƵƌĞ ƐĞƫŶŐ ƚŽ ǀĞƚĞƌĂŶƐ͘

The group therapy room incorporates natural light and views to comfort veterans.

The main foyer is a taste of home to the veterans and their family during a visit.

Conceptually focused on healing andveterans. honoring We conventions drew on existing conventions forsigniﬁcance communicating historical Conceptually wewe focused on healing and honoring Weveterans. drew on existing for communicating historical and military sacriﬁce. significance We researchedand military contemporary for treating post-traumatic stress disorder traumaticpost-traumatic brain injury to develop our therapy-oriented elements. sacrifice. Wepractices researched contemporary practices forandtreating stress disorder anddesign traumatic brain injury to develop our therapyoriented design elements.

HEALING VETERANS WITH HONOR HEALING VETERANS WITH HONOR A Modular Treatment Center

Texas A&M University Arch 605 + Land 601 Dr Rodiek + Dr Lee Fall 2012

A Modular Treatment Center

Hampton, Hampton, Virginia Virginia

Victoria Garcia Renee LaCroix David Danielson Wonmin Sohn

Main Hospital

North Entrance

^ĞĂƟŶŐ ůŽŶŐ dƌĂŝů

Walking Trail Outdoor tĂŝƟŶŐ

Outdoor Living Room

ĚŵŝŶŝƐƚƌĂƟŽŶ

ĂƌĞĨŽŽƚ Loop

tĂŝƟŶŐͬ Lounge ZĞĐĞƉƟŽŶ

Main Foyer

Outdoor ĐƟǀŝƚǇ Therapy

Outdoor Cafe Circular Planters

&ƌĂŶ

DĂƐƐĂŐĞͬ DĂŐŶĞƟĐ Therapy

Central Plaza

0 10 20

Wind Mobiles

Group Therapy DƵůƟĨƵŶĐƟŽŶĂů Rooms

Virtual Reality

South Entrance ^ŚĂĚĞĚ ^ĞĂƟŶŐ with View

Outdoor Lounge

Fire Pit

>ĂƟĐĞ ǁŝƚŚ Climbing Vines

ůǀĚ͘

ƵƐŚŝŽŶĞĚ ^ĞĂƟŶŐ DĞĞƟŶŐ Counseling & Speech Room Therapy Room

ŬůŝŶ

Main Entrance

Speed ƵŵƉƐ

Fire Pit

Individual Therapy

^ĞĐƟŽŶ Ͳ ͛ sŝĞǁ ƚŚƌŽƵŐŚ ƚŚĞ DĂŝŶ tĂůŬǁĂǇ ƚŽ ƚŚĞ ŚĞƐĂƉĞĂŬĞ ĂǇ

Field of Honor

ŚĞƐĂƉĞĂŬĞ ĂǇ

The site was designed to respect both the axis of the main hospital ĂŶĚ &ƌĂŶŬůŝŶ ůǀĚ͘ &ŽƵƌ ƉƌĞͲĨĂď ŵŽĚƵůĞƐ ǁĞƌĞ arranged around a central plaza to provide ample views to ŚĞƐĂƉĞĂŬĞ ĂǇ͘ dŚĞ west half of the site is primarily for private therapy, while the east half is predominately for group therapy.

Outdoor Living Room

/ŶĮŶŝƚǇ WŽŶĚ

ŚĞƐĂƉĞĂŬĞ ĂǇ

Outdoor Living Room

Recep. / Admin.

Main Foyer

Family

Outdoor Cafe Individual Therapy Central Plaza

Group Therapy N

Memorial Walk 0

5 10

Main Entrance

^ĞĐƟŽŶ Ͳ ͛ sŝĞǁ ƚŽ ƚŚĞ EŽƌƚŚ ƚŽǁĂƌĚƐ ƚŚĞ ǆŝƐƟŶŐ ,ŽƐƉŝƚĂů

Outdoor Cafe 0

Outdoor corridors area efficiency andaround wrap the around providing a secure proposed firepoint pit stands as a Outdoor corridorsmaximize maximize area efficiency and wrap centralthe plazacentral providingplaza a secure setting. The proposedsetting. propaneThe fire pit stands as apropane sculptural focal and encourages in Hampton’s colder months. Transitions were achieved through overhangs, outdoor seating, windows, and carefully placed visual barriers.seatsculptural focaloutdoor point gatherings and encourages outdoor gatherings in Hampton’s colder months. Transitions werelarge achieved through overhangs, outdoor Features like the outdoor café and fire pit invitevisual users outside whileFeatures encouraging a casual, home-likecafé atmosphere. ing, large windows, and carefully placed barriers. like the outdoor and fire pit invite users outside while encouraging a casual, home-like atmosphere.

Veteran’s Home VA Medical Center - Menlo Park

795 Willow Rd, Menlo Park, CA 94025

TEAM 4 Farzad Golestamid, 1st-year, Master of Architeture Yasaman Baghari, 1st-year, Master of Architecture Yi Xun Zhang, 1st-year, Master of Landscape Architecture Xiaotian Su, 1st-year, Master of Landscape Architecture

Merit Award Recipient, 2013 Texas Society of Landscape Architects

02 - Team 4Design - ARCHSolutions 605 + LAND 601 - Studio Projects

Number of Modules: 5 Size of Proposed Facility: 3,600 GSF Estimated Cost: $180/SF

“Doing a real world project seems very important as it helped me to be concerned about real issues. To know about veterans problems and how to reﬂect them in the design really made the whole process more challenging.” Farzad Golestamid 1st-year, Master of Architecture College of Architecture Texas A&M University

02 - Team 4 - ARCH 605 + LAND 601 - Studio Projects

One ofthe thegreat great features in the selected site is theadjacencies. adjacency to existing components. Having outpatientnext clinics, and administration next One of features in the selected site is the compatible Having outpatient clinics, psychiatry, and administration to ourpsychiatry, facility will help reduce the size of these spaces in our project, and leave more space for new and innovative therapies. to our facility will help reduce the size of these spaces in our project, and leave more space for new and innovative therapies.

Our project aims to provide a home-like environment for treatment. The function of outdoor and indoor spaces are well connected with each other and create an environment th

has bothaims physical mental functions. We tried to make multi-functional spaces toof fulfill the needs ofindoor differentspaces people--not but also their families and staff Our project to and provide a therapy home-like environment for treatment. The function outdoor and are only wellveterans connected with each other working in the clinic. and create an environment that has both physical and mental therapy functions. We tried to make multi-functional spaces to fulfill the needs of different people--not only veterans but also their families and staff working in the clinic.

Circle of Life Treatment Center VA Medical Center - Biloxi

400 Veterans Ave, Biloxi, MS 39531

TEAM 5 Jianyi Li, 1st-year, Master of Architecture Chia-En Hsu, 1st-year, Master of Architecture Zhihuang Li, 1st-year, Master of Landscape Architecture Ruisi Guo, 1st-year, Master of Landscape Architecture

02 - Team 5 Design - ARCH Solutions 605 + LAND 601 - Studio Projects

Number of Modules: 7 Size of Proposed Facility: 4,900 GSF Estimated Cost: $155/SF

“Starting a new life does not mean forgetting the past. We hope these young veterans can recall the past, rethink the inﬂuence which combat has brought upon them, and ﬁnd an experience that can bring them positive attitude and comfort to start their lives after rehabilitation.” Ruisi Guo 1st-year, MLA College of Architecture Texas A&M University

Solar Analysis

Elevation showing typical module units and landscaping.

Wind Analysis

Sketch of massage therapy area.

Program Analysis

Team 6 - ARCH 605 + LAND 601 - Studio Projects 02 - Team 5 - ARCH 605 + LAND 601 - Studio Projects

Site Access

This project willwill provide veterans with a place to recover from and PTSD withTBI a series treatment devoted traditional and non-traditional It will beand a place This project provide veterans with a place to TBI recover from andofPTSD withareas a series oftotreatment areas devotedtherapies. to traditional non-tradiof honor and comfortItwhere veterans can be in recalling the past, but still take the necessary steps in living a normal life. tional therapies. will be a place of calm honor and comfort where veterans can be calm in recalling the past, but still take the necessary steps toward living a normal life.

The river beside the site brings us a perfect view towards the north. Individual units are arranged along a contour line. In this orientation, every therapy space has a view of the river.

The river beside the site brings us a perfect view towards the north. Individual units are arranged along the site contours, and every therapy space This linear arrangement also makes for simple circulation between diďŹ&#x20AC;erent units and outdoor spaces. has a view of the river. This linear arrangement also makes for simple circulation between different units and outdoor spaces.

Outpatient Clinic & Healing Garden VA Medical Center - Waco

4800 Memorial Drive, Waco, TX 76711

TEAM 6 Yue Yao, 1st-year, Master of Landscape Architecture Mark Liang, 1st-year, Master of Architecture

02 - Team 6Team - ARCH + LAND - Studio 6 -605 ARCH 605 +601 LAND 601 - Projects Studio Projects

Number of Modules: 6 Size of Proposed Facility: 4,400 GSF Estimated Cost: $160/SF

â&#x20AC;&#x153;Before this project, I knew a little about U.S veterans. But after visiting the VA Medical Center in San Antonio Texas I began to understand their needs for rehabilitation. I was touched by meeting these disabled veterans and wanted to design a building based on their needs rather than my own design intentions.â&#x20AC;? Mark Liang 1st-year, Master of Architecture College of Architecture Texas A&M University

Outpatient Clinic and Healing Garden Design for VA Medical Center of Waco, Texas

Roof View

Corridor This healing center design is based on the concepts-- to treat, to comfort and to return, targeting at the improvement of the life standard of the veterans who have physical or mental sickness and pain. The beautiful view from any point indoor or outdoor is an outstanding characteristic of this site. Besides, the whole healing center is emphasized on therapeutic functions.

Site Plan

In Addition, people have access to outdoor destinations by the shortest walking path.

This healing center design is based on the concepts of providing comforting spaces for treatment and improving the standard of life for veterans struggling with physical and mental pain. Architecture provides beautiful views of the outside landscaping and gives access between the indoor and outdoors for therapy. Both indoor and outdoor environThis healing center both design is based on the concepts of providing comforting spaces for treatment and improving the standard of life for veterans ments emphasize physical and psychological rehabilitation.

struggling with physical and mental pain. The architecture provides beautiful views of the outside landscaping and gives access between the indoor and outdoors for therapy. Both indoor and outdoor environments emphasize both physical and psychological rehabilitation.

02 - TeamTeam 6 - ARCH 605 +605 LAND 601 - 601 Studio Projects 6 - ARCH + LAND - Studio Projects

Team 5: Yue Yao & Mark Liang, Directed by Dr. Chanam Lee & Dr. Susan Rodiek, Texas A&M University

02 - ARCH 205 - Studio Projects

“Through this project I learned that research is intergral to understanding how We can design for people with speciﬁc needs. When designing for Veterans all stakeholders’, especially family should be considered.” “I learned how important it is to know who you are designing for. Without the research we conducted, we wouldn’t have been able to design facilities to meet all their needs.” Amy Brodeur Sophomore, Environmental Design College of Architecture Texas A&M University

Alex Wigton Sophomore, Environmental Design College of Architecture Texas A&M University

UNDERGRADUATE STUDIO PROJECTS UNDERGRADUATE STUDIO

ARCH 205 students at mid-review with visiting reviewers Lance Keoki Kubiak, Naomi Sachs, Joshua Walker, Brian Sowell, Dennis Sheils and George Mann.

Undergraduate Architectural Design Studio Susan Rodiek, Ph.D., Instructor Garrett Barker Angelia Bloodsworth Amy Brodeur Robert Clanton Victoria Codrington Megan Girvan Dylan Kanipes Matthew Kohman Ryan Lawrence

Odette Leal Matthew Michalak Alexander Nelson Mathew Rocha Brandon Smith Sarah Stolting Jason Teal Christopher Thackrey Alexandra Wigton

02 - ARCH 205 - Studio Projects ARCH 205 - Studio Projects

ARCH 205 - Architectural Design I

Modularity is More Overton Brooks VA Medical Center 510 E Stoner Ave, Shreveport, LA 71101

TEAM 7 Garrett Barker, Sophomore, Evironmental Design Ryan Lawrence, Sophomore, Evironmental Design

02 - Team Design 7 - ARCH 205 - Studio Projects Solutions

Number of Modules: 4 Size of Proposed Facility: 2,880 GSF Estimated Cost: $155/SF

â&#x20AC;&#x153;Designing a real world project for veterans and their families helped me to learn how to design for the special needs of others and not just for my personal preferences. I also learned the true power of architecture and how it can be used to better lives.â&#x20AC;? Garrett Barker Sophomore, Environmental Design College of Architecture Texas A&M University

Plan view of proposed facility consisting of 4 standard modules.

View across central courtyard.

02 - Team 7 - ARCH 205 - Studio Projects

View of facility front entrance.

Veteranâ&#x20AC;&#x2122;s Therapy Clinic VA Puget Sound Health Care System

9600 Veterans Drive Southwest, Tacoma, WA 98433

TEAM 8 Megan Girvan, Sophomore, Evironmental Design Dylan Kanipes, Sophomore, Evironmental Design

02 - Team 8 -Design ARCH 205 - Studio Projects Solutions

Number of Modules: 6 Size of Proposed Facility: 4,500 GSF

The new Community Living Center has a very modern, contemporary design that stands out compared to the existing historical buildings of the American Lake Division. By using similar colors and textures with a contemporary look similar to that of the existing center, our Clinic makes the area more visually cohesive.

Physical therapy treatment area. 3-dimensional model showing final module arrangement.

Rendering of modules showing relationship between indoor and outdoor therapy areas.

02 - Team 8 - ARCH 205 - Studio Projects

Main waiting area with view of nature.

Modular Mental Health Clinic Roseburg VA Medical Center

913 NW Garden Valley Blvd, Roseburg, OR 97471

TEAM 9 Matt Kohman, Sophomore, Evironmental Design Matt Michalak, Sophomore, Evironmental Design

02 - Team 9Design - ARCHSolutions 205 - Studio Projects

Number of Modules: 5 Size of Proposed Facility: 3,750 GSF

The VA property is a beautiful piece of land that initially oďŹ&#x20AC;ered three locations to build on. The site provided has an ample amount of parking located next to one of the main entrances. Distance from the main hospital was an issue due to the fact that patients would be going back and forth to the main hospital. Finally, the site allows for room to grow in the future in case more modules are needed to match the increasing demand.

02 - Team 9 - ARCH 205 - Studio Projects

Group therapy porch (left) and outdoor porch connects treatment modules together (above).

Veteranâ&#x20AC;&#x2122;s Therapy Clinic VA Medical Center - Togus

1 VA Center, Augusta, ME 04330

TEAM 10 Brandon Smith, Sophomore, Evironmental Design Jason Teal, Sophomore, Evironmental Design

Design Solutions 02 - Team 10 - ARCH 205 - Studio Projects

Number of Modules: 6 + Site-built Size of Proposed Facility: 6,420 4,500 GSF GSF Estimated Cost: $160/SF

Existing VA Medical Center in Togus, Maine.

Floor plan showing module units and integrated site built elements.

8 - ARCH - Studio Projects 02 - TeamTeam 10 - ARCH 205 205 - Studio Projects

The final site location was chosen for its close proximity to an exisitng pond on the north end of the VAMC - Togus campus.

Modular Design for Healthcare North Las Vegas VA Hosptial

6900 North Pecos Road, North Las Vegas, NV 89086

TEAM 11 Angelia Bloodsworth, Sophomore, Evironmental Design Alex Wigton, Sophomore, Evironmental Design

Number of Modules: 5 Modular Design for Healthcare: Treatment Center for Veterans Size of Proposed Facility: 3,750 GSF

Las Vegas, Nevada

Solutions 02 - TeamDesign 11 - ARCH 205 - Studio Projects

Design Strategies 1.

Climate: An important aspec 30s to the low 100s, we had each porch that is provided. summers. During the winters

Energy Efficiency: It is imper captured with clerestory stor The buildings are placed on a

Natural Environment: Peopl conducted outdoors. It was i features are used throughou

additional therapy. The landscape

Angelia Bloodsworth and Alex Wigton

Texas A&M University

Modular Design for Healthcare: Treatment Center for Veterans with PTSD/TBI Las Vegas, Nevada

PROJECT STATEMENT The purpose of this design is to provide an additional treatment center for veterans suffering from TBI and PTSD. It will use modular units like those of Lake Flato which are more cost efficient and ideal for this treatment center. These units will be arranged to provide the most optimal use of the space and for the types of treatments that they will feature. MAIN GOALS 1) The design should be simple and easily accessible to aid the veterans in the healing process. •

•

with PTSD/TBI

The interior of the modules will have multipurpose rooms and areas for both individual and group therapies. Hallways and rooms will accommodate those in need of wheelchair access as well as multi-surface spaces for therapy.

2) This design is meant to be a complimentary addition to the existing hospital and will feature mostly unconventional treatments to allow for assisted alternative therapies for the veterans. • •

The modules near the entrance will be used for family and lounge spaces for socializing as well as a few small offices for administration purposes. The therapy modules will feature art and music rooms and will accommodate the individuals’ needs.

3) Use modules influenced by porch house designs to merge the indoor and outdoor space. Nature plays an essential part in the healing process and the outdoor space should be available for comfortable use year round. • •

50 ft

Angelia Bloodsworth and Alex Wigton

Texas A&M University

ARCH 205 Fall 2012

er in our design was the climate conditions. With temperatures ranging from the mid te the best design to suit these conditions. Trellises are made in heavy use, covering isters that are intertwined among the trellises allow cool shade throughout the hot aces can be placed to provide heat.

gn this facility with energy efficient aspects. Natural and reflective lighting are and curtain walls. Northern lighting is captured in designated areas for art therapies. n where the winter sun can warm the buildings throughout the day.

from PTSD and TBI need a various amount of therapies, some of which are better r us to combine a dry climate’s native plants with an oasis setting in mind. Water peaceful and serene environment. A labyrinth was also included to provide an

a meditation area where patients can simple sit and reflect on their past experiences

The main goalof of our our design is toisprovide a safe haven for the wounded warriors, while progressing withwhile their individual therapywith goals.their This addition to the existing building willThis admain goal design to provide a safe haven for the wounded warriors, progressing individual therapy goals. ARCH 205The Fall 2012 provide unconventional treatments and therapies that are not provided in the main hospital. These modular units provide a cost-eﬃcient design with a home-like, comfortable dition to the existing site will provide unconventional treatments and therapies that are not provided in the main hospital. These modular units setting, while providing support for veterans with PTSD and TBI.

provide a cost-efficient design with a home-like, comfortable setting, while providing support for veterans with PTSD and TBI.

02 - Team 11 - ARCH 205 -205 Studio Projects Team 7 - ARCH - Studio Projects

25 ft

The outdoor space will also have areas for therapy including a small training area, labyrinth, and trail. A water feature, small stream, and dry bed will create an oasis in the desert for veterans and provide a sense of refuge.

Modular Outpatient Therapy Center VA Puget Sound Health Care System

9600 Veterans Drive Southwest, Tacoma, WA 98433

TEAM 12 Victoria Codrington, Sophomore, Evironmental Design Odette Leal, Sophomore, Evironmental Design

02 - Team 12 - ARCH 205 - Studio Projects Design Solutions

Number of Modules: 4 + Site-built Size of Proposed Facility: 3,500 GSF Estimated Cost: $165/SF

“The objective for this project was to create a therapy center for veterans who either have traumatic brain injuries or posttraumatic stress disorders. By studying the symptoms or issues that PTSD or TBI patients may have, it became evident that certain design factors do in fact improve a veteran’s health.” Victoria Codrington Sophomore, Environmental Design College of Architecture Texas A&M University

02 - Team 12Team - ARCH - Studio ProjectsProjects 7 -205 ARCH 205 - Studio

VA Puget Sound is located in Tacoma, Washington next to the American Lake. As a team, we decided that Tacoma was in need of a medical center due to the large number of veterans located throughout Washington. After thoroughly studying the site map, we decided to locate the new facility near existing parking, so that no new parking had to be added. Nature is a prominent aspect of our design, and the site location was chosen with that in mind.

Modularity for Healing Cheyenne VA Medical Center

2360 E Pershing Blvd, Cheyenne, WY 82001

TEAM 13 Amy Brodeur, Sophomore Evironmental Design Sarah Stolting, Sophomore Evironmental Design

Design Solutions 02 - Team 13 - ARCH 205 - Studio Projects

Number of Modules: 4 Size of Proposed Facility: 2,400 GSF

â&#x20AC;&#x153;Designing a real world project made me very aware of problems that arise when choosing a site and perfecting design details. Working with veterans was very rewarding; learning the things that they go through on a daily basis and making sure my design did not hinder them but helped their recovery.â&#x20AC;? Sarah Stolting Sophomore, Environmental Design College of Architecture Texas A&M University

Greenhouse located between two treatment modules.

Covered porche provides a protective pathway for traveling between treatment modules. Porches also create a comfortable homelike environment for Veterans healing.

Team 10 -205 ARCH 205 - Projects Studio Projects 02 - Team 13 - ARCH - Studio

Final 3-dimensional model showing module arangment, connecting porches and trellises, and material selection.

A Modular Facility for Veterans Salem VA Medical Center

1970 Roanoke Blvd, Salem, VA 24153

TEAM 14 Robert Clanton, Sophomore, Evironmental Design Mathew Rocha, Sophomore, Evironmental Design

Design Solutions 02 - Team 14 - ARCH 205 - Studio Projects

Number of Modules: 6 Size of Proposed Facility: 4,500 GSF

02 - Team 14 -Team ARCH7205 - Studio - ARCH 205 -Projects Studio Projects

View of a loung area, where veterans can relax with family.

Modular Health Design for Veterans Portland VA Medical Center

6QYCTFU C /QFWNCT

3710 SW US Veterans Hospital Rd, Portland, OR 97239

TEAM 15 Alex Nelson, Sophomore Evironmental Design Chris Thackrey, Sophomore Evironmental Design Number of Modules: 5 Size of Proposed Facility: 3,750 GSF

Spatial Relationships

Outdoor Space Healing Gardens

Obstacle Course

Simulated Apartment

Tai Chi Horticulture

Solutions 02 - TeamDesign 15 - ARCH 205 - Studio Projects

Yoga

Kitchen

Visual Therapy

Reception

Consultation

Living

Exam

Spatial Breakdown Porch Space

Speech

Parallel Bars

Bedroom

Porch Space

Exam

Outdoor Space

2,750 sf

Wellness Bridge

Healing Gardens 1,580 sf Obstacle Course 750 sf Tai Chi 420 sf

Occupational Therapy Horticulture 275 sf

Massage/ Acupuncture

Physical Therapy Space

1,535 sf

Physical Therapy

Visual Therapy 140 sf Consultation 150 sf Simulated Apartment 720 sf Speech Therapy 72 sf Art Therapy 178 sf Massage/ Acupuncture 177 sf Bridge for Wellness Functions 486 sf Yoga 488 sf

1,151 sf Art Therapy Treatment Spaces

Porch Space

720 sf

4000 (CNN

Reception Area 200 sf Office Space 100 sf Exam Room A 80 sf Exam Room B 80 sf Childrenâ&#x20AC;&#x2122;s Play Area 260 sf

SQUARE FEET

Modula

V )QCNU

UGV CPF UVTKXGF HQT VJTQWIJQWV VJG GPVKTG UGOGUVGT YCU F OCMG VJGUG OQFWNCT DWKNV EQORQPGPVU ECOQWHNCIGF D[ 8GVGTCPU CTG WUGF VQ UGGKPI VJG KPUKFG QH C YJKVG CPF CN VJGTGHQTG QWT FGUKIP IKXGU PQ KPFKECVKQP VJCV VJGUG KP C TGJCDKNKVCVKQP ENKPKE %QUV GHHGEVKXGPGUU YCU PQV VQ DG G FGXGNQRKPI QWT KFGCU 6JG WUG QH PCVWTCN CPF YCTO R RTQOQVG C YCTO JQOG[ HGGN HQT VJG XGVGTCPU YKVJQWV DCPM .CUV[ EKTEWNCVKQP VJTQWIJ KPFQQT CPF QWVFQQT URCEGU HCEVQT KP QWT FGUKIP 6JG RTQFWEVKQP QH OQFWNCT DWKNV RTGUGPVU VJG RTQDNGO QH VKIJV EQTTKFQTU CPF JCNNYC[U HQT 9KVJ VJKU KP OKPF YG YCPVGF VJG OCKP EKTEWNCVKQP VJTQWIJQWV DG QWVFQQTU CNQPI C ITQWR QH QXGTJCPIU CPF VTGNNKUGU 6JKU G KPVGITCVKQP QH PCVWTG YKVJKP VJG HCEKNKV[

Thesmall, small, thin context of theofmodules provided aprovided perfect medium to integrate each space with the therapeutic eďŹ&#x20AC;ectwith of outdoor healing gardens.effect Many paths on the location, The thin context the modules a perfect medium to integrate each space the therapeutic of outdoor healing garwandering between healing garden vistas, also serve as a means to distract them from stressful thoughts. Open connections to view the outdoors help to blend the modules into dens. Many paths on the location, wandering between healing garden vistas, also serve as a means to distract them from stressful thoughts. a beautifully landscaped setting and make the spaces seem larger and more calming. Windows and skylights in the modules were also designed to take full advantage of the Open connections to view the outdoors help to blend the modules into a beautifully landscaped setting and make the spaces seem larger and winter sun. more calming. Windows and skylights in the modules were also designed to take full advantage of the winter sun.

linic for Progressive Healing

02 - TeamTeam 15 - ARCH 205 -205 Studio Projects 7 - ARCH - Studio Projects

GCNVJECTG

VISUALIZATION PROJECTS VISUALIZATIONPROJECTS In this multidisciplinary collaboration, VIZ students challenged themselves to design an interactive system for a real-life scenario, PTSD therapy. Dr. Seo led two teams of visualization students in the senior VIZ studio to create therapeutic virtual reality treatment applications to aid PTSD/TBI patients for VA modular facilities. In a video game designed by Visualization students Ivan Currey and Kevin Li, patients could work on balance and motor coordination, shifting their body weight on a 360-degree tilting platform to control a spaceship traveling through an abstract universe. The game is a low-cost alternative to the Computer Assisted Rehabilitation Environment (CAREN) System, a state-of-the-art virtual reality rehabilitation system. In a separate project, an augmented-reality room developed by Visualization students Katherine Farley, Kevin Loney, and Thomas Storey, allows patient to enter a meditative state while exploring a large space with an ultraviolet ﬂashlight, activating geometric elements that provide emerging narratives.

Jinsil Hwaryoung Seo, Ph.D. Assistant Professor Dept. of Visualization Texas A&M Univeristy Computer Assisted Rehabilitation Environment (CAREN) System at the National Intrepid Center of Excellence.

02 - Visualization Projects

These projects suggest important research into the future of rehabilitation for our wounded warriors, who in many cases must wait more than a year to receive treatment with the CAREN system. Low cost, alternatives like these can be installed more quickly in more places and at a fraction of the cost while maintaining much of the beneﬁt of the full system. In addition, interactive and aesthetic experience can be considered as a new approach in PTSD therapy or other types of conditions. Physical therapy sessions could be fun and thought provoking.

Student visualization projects may provide a more cost-eﬀective solution for implmenting Virtual Reality based therapies for PTSD around the country.

Department of Visualization, “Road to Recover” project in use, inspired by the CAREN System.

The Road to Recovery

Ivan Currey and Xiao “Kevin” Li, B.S. Visualization

Students setting up “The Road to Recovery” VR Therapy protoype.

"The Road to Recovery" is an interactive VR game that encourages body movement and balance control for PTSD or TBI patients. In collaboration with Architecture and Landscape graduate studios, Curry and Li focused on designing a navigable physical rehab installation integrated with a Virtual Reality (VR) immersive environment and Biofeedback, in a health care environment. This project was inspired by the CAREN (Computer Assisted Rehabilitation Environment) system that is a state-of-the-art virtual reality rehabilitation system used at Walter Reed Army Center in Washington, D.C. They tried to create a low-cost alternative game, in which users were able to navigate an abstract virtual landscape via a balance board. The virtual landscape was designed in a manner to minimize visual clutter and distractions to maintain the patient's attention. Tall and red obstacles were scattered in the virtual landscape to encourage the user to shift their body weight on the balance board. The interactive game visual was then rear-projected to a curved screen. "The Road to Recovery" was created using one PC, one projector, Unity3D, Madmapper, Arduino and accelerometer. The entire system is fully portable so this can be installed in VA facilities anywhere, at minimal cost.

Satellites

Katherine Farley, Kevan Loney, Thomas Storey, B.S. Visualization

Interface diagram for “Satellites” VR Therapy prototype.

02 - Visualization Projects

"Satellites" is an interactive therapy system that is implemented in an augmented reality environment. As a visual design team, they focused on designing a new way of interactive art installation that evokes emergent narratives and open aesthetic treatment for PTSD patients. The idea was to help PTSD sufferers deal with and move past their condition through a personal narrative experience. We used an extended astronomical metaphor for the experience of life with PTSD. The subject is in orbit of a black hole, representing the inability of someone with PTSD to escape the vivid, horrific memory of a traumatic experience. As they travel their elliptical orbit, they move cyclically closer to and farther from the black hole, and when they come close enough to the black hole, it reacts violently and unexpectedly. This relates to the ebb, flow, and unpredictability of living with PTSD, and the dramatic effects of the “trigger” experiences that persons afflicted with PTSD have to deal with. While orbiting, the subject explores with a UV flashlight, revealing symbols painted on to the environment surface. These symbols represent concepts related to PTSD treatment, but are purposefully abstract to invite personalized interpretation. When the user finds a symbol, it creates a satellite that begins orbiting him or her. The satellites are manifestations of friends, family, supporters and the positive effects of PTSD treatment. They follow the subject on their journey and change the sound of the space from dark, empty and ominous, to bright, calming and positive.

COST ESTIMATES COSTESTIMATES The key to verifying the cost-eﬀectiveness of each studio design is the ability to project the detailed costs of construction and materials. Junior-level Construciton Science students led by Dr. Ben Bigelow, assistant professor of construction science, worked to created detailed cost estimates for selected projects. Based on general construction assumptions, the necessary construction type, materials and site design requirements of each project, students generated total and per square foot estimates for eight modularly designed projects. For this collaboration, students, working in teams of two or three, utilized various cost estimating tools to produce cost estimates. For site work and development the macro building information modeling (BIM) tool D-Proﬁler was utilized, which provided students with unit costs as they digitally constructed models of the rehabilitation centers. The RS Means cost database was used to provide unit prices within the estimates to come up with total direct costs.

Ben F. Bigelow Assistant Professor Dept. of Construction Science Texas A&M University

A modular building being delivered and installed on-site.

02 - Cost Estimates

Included in Cost Estimates -

Concrete ﬂoor/ foundation integral with module (reduces sitework)

Helical piers installed by manufacturer (minimal site prep, removable).

Modules are 15’ x 48’, and transported to site (100-miles included).

Roofs are standing-seam metal or composition shingles, as shown.

HVAC mini-split units in each module for separate temperature control.

Floors are stained concrete, ready for ﬁnish ﬂooring of owner’s choice.

Walls are light-gauge steel framing, with climate-appropriate insulation.

Not Included in Cost Estimates

Exterior ﬁnish is wood siding or exterior insulation ﬁnish system (EIFS).

Site preparation, grading, and drainage

Interior ﬁnish is textured, painted gypboard, or as shown.

Utilities and sanitary sewer lines to modules

Casework/cabinets factory-installed, unless noted.

Porches, awnings, or trellises (est. $50/ sf)

Sprinklers installed in all interior spaces.

Outdoor walkways and paving

Wiring and plumbing is factory-installed.

Landscaping

ADA-compliant ﬁxtures installed in restrooms.

Appliances

Cafés are built as residential kitchens.

Furnishings

Construction Science students visit job site.

Team 2 Location: Asheville, North Carolina 5,100 Square Feet (7 Modules) Estimated cost for buildings: $160/SF

Team 3 Location: Hampton, Virginia 2,700 Square Feet (4 Modules + Site-built) Estimated cost for buildings: $165/SF

Note: Large covered spaces for outdoor usage (some even penetrate modules). Steep site requires retaining walls for outdoor terraces, and grading for accessible walkways.

Note: Roofs easy to build; modules connected with porches, trellises, and pergola at east end. Multiple water features in outdoor spaces.

Note: Raised part of Foyer and clerestory rooﬁng built on site. Paved areas have patterns, color, and texture, terminating in reﬂecting pool at edge of Chesapeake Bay.

Team 4 Location: Menlo Park, California 3,600 Square Feet (5 Modules) Estimated cost for buildings: $180/SF

Team 5 Location: Biloxi, Mississippi 4,900 Square Feet (7 Modules) Estimated cost for buildings: $155/SF

Team 6 Location: Waco, Texas 4,400 Square Feet (6 Modules) Estimated cost for buildings: $160/SF

Note: Single slope roofs are built in factory. Shallow reﬂecting pools located near walkways. Outdoor usage areas, such as BBQ, massage, and entertainment patio.

Note: Some single slope roofs above shipping height, need to be completed on site. Paving and decks utilize several materials, and connect to indoor areas.

Note: Complex roof shape is completely site built, adds to cost. Steel mesh trellises connect modules. Site layout maintains and utilizes existing trees for shade.

Team 7 Location: Shreveport, Louisiana 2,880 Square Feet (4 Modules) Estimated cost for buildings: $155/SF

Team 10 Location: Augusta, Maine 6,420 Square Feet (6 Modules + Site-built) Estimated cost for buildings: $160/SF

Team 12 Location: Tacoma, Washington 3,500 Square Feet (4 Modules + Site-built) Estimated cost for buildings: $165/SF

Note: Roofs can be factory-built. Project utilizes existing parking lot, and connects modules with porches/ trellises. Water feature at front entry.

Note: Modules overlap and ﬁt together to create larger spaces, such as Physical Therapy. Main all segment and greenhouse are the primary non-modular building elements.

Note: Entry cupola and large hallway connecting south modules is site-built. Covered outdoor entry arcade has site-built arches.

02 - Cost Estimates

Team 1 Location: Honolulu, Hawaii 2,880 Square Feet (4 Modules) Estimated cost for buildings: $190/SF

Texas A&M University, College of Architecture and all invovled in this design study would like to dedicate this book to the men and women who have proundly served and continue to serve and protect our great nation. Thank you.

REturning HOME ÂŠ Susan D. Rodiek Texas A&M University College Station, Texas 2013