Coordinated care is more than just an approach that medical facilities are using with patients who have heart disease or diabetes. Coordinated care is expanding as an approach to treating behavioral health patients and to the design of outpatient behavioral health practices, as well.
A perfect example of this trend is the recent project undertaken by Pine Rest Christian Mental Health Services, a behavioral health organization in West Michigan. The organization had a goal of consolidating five community outreach programs under one roof.
The programs shared many of the same clients, but with five programs in four different locations, travel and care coordination could get complicated for clients. Separating staff limited the mentoring and peer support that would be possible in a shared facility. Consultations could occur more easily and regularly when staff is located together. A single facility could also improve operating costs by eliminating duplication of resources and leasing and rent costs over time.
“Very few times in one’s career in the publicly funded service sector do you have the opportunity to consider new space,” says Allen Jansen , Pine Rest Corporate Director. “Typically those of us who manage and provide care in this arena have a ‘make do’ mentality, and it shows. We take whatever we can get because we have the larger purpose of providing care and we know we use the public’s dollars. This notion permeates our belief about what we deserve and what our clients deserve. This project gave us a unique opportunity to create something honoring and respectful for our staff and consumers while keeping the cost of space at our current rates.”
New outpatient facility
As the planning phase kicked off, staff and leadership outlined core objectives against which facility and design decisions were weighed:
· Deliver compassionate care in a safe and secure environment for both clients and staff.
· Balance the mission of trauma-informed care with the reality of security needs.
· Design a welcoming and comfortable place, one that is pleasant and functional for both clients and staff.
· Provide quality care and a quality workplace that operates cost efficiently.
These goals are true of any outpatient facility, but especially important for a single facility treating a wide range of clients, including low- and high-risk probationers, those with mild to severe mental illness, substance abusers, recently released prisoners, the homeless and underserved, and those receiving medications and psychiatric counseling. The new facility would also offer a mix of scheduled and drop-in services that would change daily.
Through the process of working with Pine Rest on the objectives and interior design of their new facility, we have developed considerations for designing a coordinated care behavioral health outpatient facility that is refreshing and functional, inviting and safe.
The waiting area is the central meeting place where clients from any program gather. The mixing, however, has the potential to create a volatile situation. To cluster smaller numbers of clients and avoid potentially aggressive situations, consider dividing the waiting area into sections separated by the reception station. The staff at the reception/check-in area directs clients to a specific section. Minimizing wait time also helps, but in a clinic that serves drop-in clients, scheduling can’t be 100 percent controlled.
Welcoming clients into a comfortable and clean environment, saying hello by name, and offering a snack and water mean so much. Choose a warm color palette, but with enough variety in pattern and tone to keep it refreshing and lively. Chairs should be comfortable, but also heavy enough to keep clients from picking them up and using them as weapons. Windows add much to the mood and feeling of a space. If possible, locate the central public area near windows. People respond to environments and act accordingly. A place that says ‘you matter’ makes a difference and can influence the behavior in and care of the space.
A secure area for receptionists is critical. Provide appropriate barriers by mixing heights of modular walls, including a locking door. Glass sections within the modular walls provide secure visibility. Receptionists in the check-in/check-out area must have visual access to the entire waiting area and to safety features such as alarms or door locks. An open design also contributes to a safer environment.
Storage space in waiting areas and counseling rooms must be considered. It isn’t unusual that clients come to clinics toting duffel bags and backpacks. In cold climates, winter means coats and boots. Some clinics offer lockers in front entrance areas. Simply planning for space around or below seating also works. Therapy rooms need to offer space for client’s belongings, too. Graciously accommodating the needs of clients is a visible sign of hospitality and compassionate care.
Counseling / therapy rooms
Avoid designing 6-foot by 8-foot consultation rooms—which happens to be the size of jail cells. That negative association for certain patients is obvious, but tight spaces, in general, can cause agitation. Patients often need to walk and talk during therapy sessions. Clients may also have a family member, patient advocate, or translator with them in a therapy room. It is important to have rooms large enough to comfortably accommodate everyone.