First impressions

The transition to treatment begins when the patient enters the site for the first time-the moment a person crosses from the world of addiction to the realm of hope. Patients and families form their first impressions of the facility upon registering. Using natural materials, such as wood, stone, and slate, in finishes and furnishings as well as incorporating water and fire elements help to create a warm, residential feeling rather than an institutional or clinical appearance. At the same time, design restraint avoids going “over the top” and creating a resort atmosphere.

For example, at Hazelden Springbrook, an adult residential treatment facility in Newberg, Oregon, the main entrance lobby and registration area of buildings scheduled to be completed/renovated early next year will set the tone. The space will be characterized by a warm and professional reception area with private waiting spaces for patients and loved ones. Large expanses of glass with translucent scenes of Northwest woods will balance a sense of openness with the need for patient privacy (as seen in the current lobby, figure 1). The new space will be professional and inviting, not clinical. In addition, fireplaces in several locations within the new facility will create an inviting residential atmosphere, and natural stone surrounding the fireplaces will be carried through to the building's exterior.

Figure 1. Hazelden Springbrook's current lobby features translucent scenes to balance openness and privacy. Photographer: Peter Eckert

Living with peers

Patient living areas must be designed to enable patients to live, learn, and experience fellowship with their peers. Thus, residential units must create distinctive zones for patients in primary treatment and those in an extended treatment program, while also providing opportunities for positive, well-managed interaction between the sexes and among those at various stages of recovery.

In many cases, men and women live in the same building, and the layout must be designed to separate them in separate wings or floors, with further distinctions for primary and extended care. Each population needs living areas for relaxation, small group meetings and, in some cases, preparing snacks and beverages. These spaces should create a warm, homelike atmosphere in which patients can relax comfortably (figure 2). They also should be places that allow people to develop relationships with others going through the same experiences and that allow individual contemplation without promoting isolation. Each treatment community space should be arranged to prevent interruptions by patients from other treatment units.

Figure 2. This rendering of the gathering and living space at Hazelden Springbrook shows the importance of creating an inviting and residential feel. Large windows allow ample light in and provide views of the outside. The space has several places to gather. Rendering by Mike Munson

Different patient populations should have opportunities to interact under supervision in lecture rooms and common dining rooms. Designers can create a sense of place for each sex or treatment level, for example, by creating an L-shaped room with separate seating areas. Also important is creating staff-only zones so they can relax and interact informally with their colleagues.

Designing for specific populations

In some cases, facilities are designed for specific populations. For example, at Hazelden's Center City, Minnesota, campus, the Women's Recovery Center provides specialized treatment programming that addresses issues unique to women in recovery. Opened in 2006, the center has three 22-bed primary care units and one extended-care unit. In the schematic design phase, the architects developed a space plan that responds to the center's treatment approach for women. First and foremost, the design ensures privacy, which is very important to women in recovery. The facility has appropriately sized spaces for small groups. Designers selected finishes and colors, including light woods and natural tones, to create an attractive, yet not stereotypically feminine, environment. (To view a slide show of the center, visit http://behavioral.net/design1206.)

Adolescents in treatment and their families have special needs. Separating the sexes is a significant issue, as are safety and security, and families are an integral part of treatment. Thus, a facility's design must be sensitive to these issues. For example, at Hazelden's Center for Youth and Families in Plymouth, Minnesota, a patient resides in a spacious room with three other peers, sharing a bathroom and balcony. This design promotes the center's emphasis on a cooperative learning environment. Each patient is expected to keep his/her portion of the room neat and orderly, yet the entire room's orderliness is reviewed by staff. The staff have capitalized on the rooms' arrangement to stress the importance of responsibility, cooperation, and interdependence. Thus, architecture informs the clinical programming, and the clinical programming informs the architecture.

Designing for safety and security are essential in any drug and alcohol residential treatment facility-especially one for youths. The design must avoid creating opportunities for isolation, and proper lighting is a must. Good sight lines along corridors and into rooms accessible by patients are essential, and small alcoves and dead ends, where people can isolate themselves, should be avoided. Decentralized staff areas increase staff travel through corridors so they can observe patients' activities. Opportunities for self-harm can be reduced by carefully selecting door locations, hardware, and bathroom fixtures.

Flexibility

Ideal buildings enable owners to respond to patient census changes by reassigning rooms according to sex or treatment stage. One solution is to provide for flexibility at the intersection of treatment units. For example, two “swing” rooms can be located where an extended care and primary care unit meet. Design elements can create an identifiable visual transition between the two zones, such as a wider point in the corridor where the two zones meet, reinforced by changing finishes and colors. Yet these swing spaces must be well-integrated into the appropriate patient areas so that patients feel included within their specific treatment unit and not isolated from their peers.

This technique will be used at Hazelden Springbrook. Two three-person rooms will be able to be used by women in primary treatment or extended care. As census shifts, the rooms will be used by either program. While each program will have a clearly designed identity, their proximity to one another, as well as the absence of walls and doors between the two programs in favor of an open space that serves as “neutral territory,” avoids an unwelcome feeling of separation.

Connecting with nature

Connecting with nature has been found to have a positive influence on physical, emotional, and spiritual healing. Therefore, buildings should be oriented toward views of natural and landscaped areas. Effectively using glass optimizes views and admits abundant natural light.

Landscaping should be designed to promote activities that enhance well-being and reflection, such as walking among natural and landscaped areas. A walking path can be designed with opportunities for patients to stop along the way and reflect on the 12 Steps, perhaps pausing at a small seating area with a sculpture or water feature. At the same time, the landscape should be designed for patient security and privacy. A master plan could orient the buildings inward toward a courtyard or a natural feature, such as a lake, with an open lawn between them. Hazelden Springbrook's master plan places buildings to create a commons that includes a semicircular seating area in the center, a place for quiet, undisturbed conversations without isolation (figure 3).

Figure 3. This partial site plan illustrates how landscaping can create opportunities for conversation and gathering as well as quiet contemplation. Rendering by Murase Associates Landscape Architects

Final thoughts

As these principles and examples suggest, effective design has the power to support the goals of alcohol and drug treatment programs while providing flexibility to meet future challenges. A designer experienced in behavioral healthcare facility design, and passionate about supporting providers' goals, can create a threshold of hope for patients and their loved ones.