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Tools for transforming facilities

May 01, 2010

Let's face it: Most of what we do is intangible. We usually have to painstakingly explain our purpose and process to others in order for them to get what we're doing. But a facility is tangible. It provides a visual representation of what we're all about. Our facilities say a lot about us. So whether we're engaging in a simple remodel of an existing program or developing a new facility for a new program, we have an opportunity to send a message to our staff; to those who use our service; and to the community. We can do this without saying a word simply by having facilities that reflect respect for our mission and purpose. But a quick look around will confirm that this is not an area where we've had high scores.

We think the common message that our facilities convey is one of control and risk management. These two things fly right in the face of recovery. If we want people to recover, we have to stop seeing our role as one of controlling and managing people. We need instead to inspire them to live up to their potential. The way we design our facilities says a lot about how we see our role and our mission.

We've given a lot of thought to what a facility would look like if it reflected recovery values and principles. We want a facility that says, “I'm serious about your recovery; I have high expectations for our staff and for those who use our services. I see our role as empowering people to take their life back. I am not a destination, but a place to prepare people to move on and maximize their potential.” How do we get a facility to give this message?

We asked ourselves a series of questions that could guide us in creating a facility that radiated the above description.

What's outside the facility?

Concrete parking lots; bad part of town … Ew! We've got to work on this. Here's what we'd like to see:

A “welcome” sign. Do you have one that is inviting and optimistic? Have you done the other little things that make your entrance as welcoming as possible, like potted plants or flowers-cared for by the staff or people using the services? If not, what's holding you back?

An upbeat, easily accessible location. This should be somewhere regular people come and go, and has plenty of restaurants nearby. There should be a balance between peacefulness (not a lot of traffic) and an active and alive environment.

A free-standing facility. This is usually better than being in a large multipurpose complex. It affords more of an opportunity to be distinct and unique and have a recovery identity. But your facility should still try to be a “Center” that's part of a community, instead of an isolated office or program. This will give you the flexibility to be more agile as you grow into the knowledge of what it takes to be a recovery oriented program. It allows you to add new components and to eliminate those that have outlived their usefulness.

Grass and outdoor social areas. Can you turn some parking spaces into a little park and picnic area? Are there any walking paths or parks nearby? How about some landscaping that provides places for people to sit outside?

Caring neighbors. Got cranky neighbors who create a hostile environment for staff and those who use the facility? Melt them down with kindness and education. Invite them in. Get to know them and respect their concerns. Too often we get cranky back and accuse them of discrimination, and it gets us nowhere. Instead, become a friendly resource in your community.

What's inside the facility?

We want you to set aside everything you think you know about what a facility should look like and leap to a new level of “space” that promotes recovery. This space should include:

Colorful walls and furnishings. Recovery environments don't adhere to the “low stimulation” concepts that often guide the interior decorating plans of behavioral health facilities. Recovery happens best in settings that are attractive and comfortable. This means colorful walls, interesting pictures, and inspiring affirmations. We need some brightness and joy on the walls that lighten the spirit and affirm hope for both the staff and people being served, but we need to balance that brightness and joy with peacefulness and a sense of confidence that allows us all to listen to ourselves and each other.

A welcoming lobby. Designing a big, open room with rows of hard chairs does not send a recovery message. Ask yourself these questions about your reception area: Is it comfortable and welcoming, or is it shabby and dingy? Are there encouraging and attractive wall hangings or just a bunch of “no signs” everywhere (as in no smoking; no loitering; no eating or drinking; and no entrance beyond this point)? Is there a relaxed feeling of openness and positivity, or is there a serious looking security guard who never smiles? The reception area needs to set the tone for connectedness. It needs to shout, “Welcome! We're glad you're here.”

Training space. Even if recovery is not new to you and the people you serve, you'll need space to hold training events and classes. Keep this space flexible so room sizes can change according to the size and needs of various classes and events. Sound-proof, sliding partitions work well for this purpose.

Food. If we are really going to promote wellness, we need to serve healthy food in our facilities and teach the people who use our services how to prepare it-which means we need enough cooking space to teach. This can also provide a foundation for people serving snacks to each other, or even catering outside events. Maybe you want to have a snack bar with tables and chairs where people can sit and talk or use a computer. Maybe this is even open to the community!

Connectedness. This is a key principle of recovery. Having a way for people to stay connected to their natural supports is very important. We suggest you include a “communication center” where people can get online, use the phone, charge their own equipment, etc.

Areas for cleaning up. Include a washer and dryer clients can use, as well as a shower. This can provide another training opportunity to help people get involved with maintaining a healthy lifestyle. Also, keep the place clean-not Pine Sol clean, but tidy and well organized.

Considerations of privacy vs. risk management needs. To promote recovery, guests need to have their privacy respected. This means giving up some of our notions about “line of sight” where people are under constant surveillance. This also means not sharing a bathroom with several other guests, but with as few people as possible. Questions may be raised about risk, and in a recovery environment, risk is shared and not the sole domain of staff. People who are trying to recover need to maintain as much control as possible over their circumstances.

On the other hand, these interior spaces should not include:

Nursing stations. Get rid of them. In fact, get rid of all the places that staff members go to in order to get away from the people being served-even private offices. Let's keep everyone together, connecting and interacting. It's within relationships that recovery surfaces and can be nurtured. Have a couple private interview rooms for personal interviews, then let's all be together in ways that promote recovery.

Seclusion and restraint. By now, you must know how we feel about this-we hate it and believe that it interferes with the recovery process. Many facilities have stopped using this approach altogether, yet, because of licensing regulations, a room must be dedicated to this purpose. This leaves precious space unusable. The good news is that it is never used, and the bad news is that it can't be used for any other purpose.

Bringing recovery-based design to life

We asked Gene Johnson, CEO of Recovery Innovations, Inc., for examples of floor plans for recovery facilities, and he has been kind enough to share plans from two outpatient facilities-known as Wellness Cities-used by Recovery Innovations that promote recovery in their design (figures 1 and 2). If you wish to chat further with Gene about either of these plans, you can reach him directly at gene@recoveryinnovations.org.

Figure 1. Floor plan for Dover Shores Executive Center, a Wellness City in Mesa, A.Z. Illustrations courtesy of Recovery Innovations

 

Figure 2. Floor plan for a proposed recovery center in Tacoma, W.A.

Our ideas about facilities that promote recovery will undoubtedly cause you to say, “Fine, but what about licensing requirements?” We asked Gene if he had any advice for us regarding this. Gene reminded us that many places have been given lots of latitude to create new ways of doing business that stretch existing requirements beyond the rhetoric of past notions related to controlling and managing people. He suggests that if you're up for developing facilities that can support a transformed way of doing business, have a chat with your licensing agencies. Explain what you're trying to do and ask them to help you get there.

We have given you a few ideas to get you started on transforming your facilities. Even if you aren't able to make a lot of changes at once, you can get started and move forward. Ask those who use your programs what they would like to have included. If you wish to read more on the development of recovery-based facilities and programs, you can order the book Offering Wellness from http://www.recoveryopportunity.com.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc. in Phoenix. She is also a member of Behavioral Healthcare's editorial board. William A. Anthony, PhD, is director of the Center for Psychiatric Rehabilitation at Boston University. Behavioral Healthcare 2010 May;30(5):10-13

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