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Design Focus: Removing barriers to care

December 13, 2018
Like many behavioral healthcare centers, Centerstone facility in Bradenton, Fla., was facing hard questions about how to meet the needs of its community with an aging facility and a shortage of beds. “The demand for detox, addiction treatment and mental health services has been growing for some time, especially now that we are in the middle of the opioid addiction epidemic,” says Centerstone's Melissa Larkin-Skinner, regional CEO, Florida. Not surprisingly in this environment, expansion came to be seen as vital to the facility’s ability to serve its population. At the same time, Centerstone's leadership viewed expansion and renovation as an opportunity to create a facility that would support both patients and staff. Any facility built in the past 20 or 30 years would have been designed in a very different time that had different approaches and philosophies for behavioral healthcare. A product of that era, the Bradenton facility was dark without adequate sources of natural light or views of nature and access to the outdoors. In addition, the layout and materials used created visual and physical barriers between patients and staff. “It sent a message to patients that, ‘we don’t want you in this space,’ ” Larkin-Skinner says. Addressing those types of barriers became a key focus of the renovation. Working with local architecture firm, Shumake Architecture, PA, Centerstone undertook a renovation and expansion that increased space and the number of beds in two units—one from 27 to 37 beds and the other from 24 to 30 beds. Given that the facility serves three populations—adult men, adult women and children—the design needed to create some flexibility to add beds to serve each population as the patient census fluctuated. For example, the redesigned property includes two sets of interior doors that can be opened or closed and locked to expand or reduce the number of beds available for each population. Overall, Larkin-Skinner expects the facility to be large enough to meet community needs for the next five to seven years, if the current demand does not grow stronger. “More people are willing to seek help, especially with addiction issues, due to education and outreach efforts,” she says. Patient stays for detox average five days, while some psychiatric patients remain on a 30-day hold or longer if they are considered a danger to themselves or others. A new approach To make sure the facility meets the needs of both patients and staff, Centerstone sought feedback from both groups. “It’s important to involve the people who will be using the space,” Larkin-Skinner says. For example, when designing a built-in desk in the admissions area, staff noticed that the height made it uncomfortable to use. Although the desk height itself was the same as the desk being replaced, the addition of a countertop added a couple of inches that changed the ergonomics of the setup. In addition, staff wanted to be more accessible to patients. In the old facility, plexiglass dividers created a physical barrier between staff and patients and their families during the check-in process. The renovated admissions area features a counter with no barriers that is similar to a hotel check-in area, Larkin-Skinner says. She also looked for ways to get input from patients by asking a few questions about their experience using the old space and asking for “wish list” suggestions of what they would want in the newly renovated and expanded new space. With that input from both staff and patients, Larkin-Skinner did research on specific costs of new features and analyzed the viability and the pros and cons of using them in a behavioral health setting. The overall result is a facility that meets the needs of both patients and staff. “We now have spaces that help people feel cared for and welcome,” said Larkin-Skinner. “We believe that spaces can be healing and bring about healing and our focus has been on creating those types of spaces.” Of course, the feeling and utility of spaces are only two parts of the equation. These must also be balanced with safety. To that end, the facility is now an anti-ligature environment, which is a major change from the original facility with exposed pipes and other potential danger areas. “We replaced all of the fixtures for greater safety,” said Larkin-Skinner. In the new space, for example, the bathrooms are designed so that nothing sticks out, including toilets with a button for flushing instead of a handle and grab bars with metal plates that prevent patients from tying anything around them. Curtains are designed to break away from their tracks when pulled or any weight is put on them. Bedroom furniture is also built in with open shelves for belongings instead of dressers or drawers. Bringing in light and nature Increasing natural light was also a major focus of the new design. “Before the renovation, our public spaces had no natural light coming in,” notes Larkin-Skinner. The new space includes skylights above the nurses’ station and large windows facing a wooded area in the children’s section. “When you look outside, there is a lot of green and that creates healthier feelings,” she says. The green theme extends to the interior color choices, with light green and cream featured throughout the facility. “Not ‘hospital green’ but a warmer color meant to be soothing and relaxing,” says Larkin-Skinner. The LED lights throughout the facility are also warmer than fluorescent lights. Larkin-Skinner also advocated for using carpet and wood laminate instead of tile. “There was a lot of concern about wear, but carpet helps to cut down on the noise,” she says. “The units can have a lot of noise and stimulation, so these materials help to create a quieter environment.” “Our goal was to create a space that you might want to be in and that doesn’t remind you every second of where you are,” says Larkin-Skinner. “Our message to patients is that this is a nice place where you are welcome and will be taken care of.” This message also resonates with staff. “They take more pride in where they work, and they want to take care of it,” she said. Joanne Sammer is a freelance writer based in New Jersey. Photo credit: Shumake Architecture, PA
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