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New Seattle Children's behavioral health unit aims to add capacity

November 18, 2014
by Megan Combs, Associate Editor
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When Seattle Children's made the decision to renovate its behavioral healthcare unit, restoring normalcy and patient dignity was at the top of the goal list. 

Debra Gumbardo, Anita Rossen and Martha Boes shared the design process and its finished successes on Nov. 17 at the Healthcare Design Conference in San Diego. Their session was entitled "Shining a Light: Patient-Focused Children's Behavioral Health Design."

Seattle Children's serves a four-state region, said Gumbardo, MS, RN, NE-BC, Chief, Psycho-Social Services at the hospital. The old unit had 25 behavioral healthcare beds. 

"The prevalence of mental health (issues) in children is skyrocketing," Gumbardo said. "We had to turn children who needed help away because we didn't have enough beds. At any given time we had 10 to 20 children on our waiting list."

Since the behavioral health unit was operating at 100 percent capacity for a couple years, Gumbardo said the unit also expanded at the time of the remodel. 

"The majority of our space was not useable, and often times patients who wanted to de-escalate used the hallways outside of group therapy rooms to pace," which was disruptive to healing, Gumbardo said.

Below is a list of the renovations made to the Seattle Children's behavioral health unit:

·         All 41 patient rooms are private, and families are encouraged to stay overnight with the patients. Parents were also given all of the same access to rooms and corridors that staff had.

"When we asked parents what they wanted, they said it was important to have a space where they could get comfortable and cuddle with their kids," Gumbardo said. "But the patients also wanted a place where they could cuddle on their own."  

·         Seclusion rooms were replaced with "comfort rooms," where patients could go to de-escalate or pace on their own. They can go in and out of these rooms as they please. The unit hadn't been using seclusion methods for years, rather they wanted a space where chidren could go to feel alone, but also safe.

"We didn't want this to look like a punitive environment in any way," said Boes, a Seattle Children's owner representative. To plan these areas, designers looked at data from the hospital that showed how the different spaces on the unit were used throughout the day.

Data showed that low stimulation and autism spectrum disorder patients had the highest need for supervised isolation in the comfort rooms and those areas. The placement of the comfort rooms is reflected in the new design using that data.

"It's all about giving kids space where they can feel secluded (safe), but also be supervised while they de-escalate," Boes said. 

·         All materials were tested by staff and patients. 

"These kids are able-bodied and intelligent, and often times they don't want to be there," Boes said. "So they act out. We had to test the durability of our materials and still use products that weren't institutional and maintained normalcy."

During the process, staff threw chairs at walls and tried to move ceiling tiles with long objects in the rooms.

·         The interior design of the unit used biophilia and gestault methods to create a "close to nature" feel, said Rossen, ZGF Architects principal. 

Biophilia is the instinctive bond between human beings and other living things. Gestault is when members of a group work alone but come together to rely on each other for a greater good.

"We used curved edges, natural light and natural materials," Rossen said. "For wayfinding, we used lighting, furnishings and color."

And instead of using built-in architectural features, Rossen said she chose comfy chairs that were larger and shaplier than normal chairs. 

When it comes to lessons learned, Boes, Rossen and Gumbardo had these to share:

·         Collect data to support anecdotal evidence and to gain deeper understanding

·         Trust that design will influence behavior

·         Use design of a behavioral health unit to educate members of your team and to dispel myths and reduce stigma 

·         Test materials under conditions they'll be used 

·         Stay focused on your vision when complexities of the project threaten your goals for creating a transformational experience

·         Focus on what is essential to creating that experience, and deep dive into areas where you have competing priorities

 

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