Howdy.

Welcome to the Architecture for Health Lecture Series.

Today we have, Page-Stantec joining us on our university campus.

We have Tushar Gupta, principal at Page.

Tushar leads that healthcare sector of Page and his team focuses on curating care with design that is inclusive, empathetic, lean and forward thinking.

We also have Natalie Stephens, principal and regional healthcare Director.

She is experienced in managing, planning, designing of different healthcare projects across the US, and Beth is a principal and architect and she also specializes in healthcare facility design, planning and renovations.

And she's also been involved in designing multi multi hospital systems across the nation.

So please help me welcome Tushar, Natalie and back to the podium.

It's really going to.

Bring you over here.

Okay.

So I think we're all.

And I think I'd go for you.

Take the stage.

Okay, great.

Well, Harry, good afternoon.

And, great to be here once again.

I'm a proud, class of 2000, so it's always great to be back at my alma mater.

And, with, the future of our profession.

You know, as I was, kind of saying that this is really a great opportunity to kind of come and make those connections.

Obviously we're going to be here sharing some few thoughts.

Hopefully that will inspire some ideas.

But what we really want this to be more of a dialog.

So, you know, of course, you know, we were going to go through our presentation, but anywhere along the way you feel like there is a question that sparks up.

Please feel free to, raise your hand, ask the question.

But as we'd like to, this could be more of a conversation.

We also I'm excited that we'll be saying, a little bit after for some of, project reviews and things like that.

So really, really excited about, that engagement as well.

Today, you know, when you got invited, first of all, thank you for the invitation.

We're really honored to have been included in the fall lecture series.

And, I think the, the focus over the last year not just has been, you know, around a very important, topic that is a societal, real societal need written around behavioral health.

Right?

It's a different, genre of patients and, and community.

But this is something that is so important right now.

And our firm very passionately believes that, you know, it is our role as designers to help destigmatize and humanize that part of care, because there's so much damage that some of that sometimes comes with.

So today we're hoping that through our discourse in the broader context of that, that we're going to focus on certain attributes specific to what we then emergency care is kind of a hybrid evolving model.

So we're going to probably start with, we're going to start and with just a kind of an overview of kind of thinking about the broader context of just getting and setting the stage of what you're seeing around, in the country as a, as a state of being, but then kind of established that how do we see things within the construct of emergency?

And that kind of, urgent care that you need within the construct of adults and what has been sort of the traditional paradigm, but then very quickly start to transition and talk about how that is evolving, both in in hybrid care.

Well, we're now starting to create we're almost saying that these elements of hybrid care that are coming in like the crisis and, and I kind of I know many of you are focusing on your projects around that are becoming almost kind of gateways to empathize that care to come in so you don't have to go through the traditional kind of a funnel of coming in and needing that sort of care.

So we're going to kind of talk through that.

And then finally, I think we're going to kind of bring it back towards thinking about design attributes, because as designers and as architects and planners, as thinkers, that is a big part of what we do.

So how do we can take some of those ideas, the manifest that will obviously share with you.

So several case studies along the way to help you kind of, you know, put that into context.

But that's kind of a, I would say a simplified of course, we have the formal brief right here, but that is sort of what we are planning to cover through the course of this presentation.

So as we start to think about, you know, kind of the the state of being, there are some really, really compelling facts.

Again, I think the message here is and, you know, we could kind of each one of those, but the message really is that this is something that is very creative and something that needs immense amount of work and help.

You know, I also sort of say as a as a healthcare designer, it's a big responsibility, you know, because we, you know, what we can do is ask for help is not just kind of create spaces that heal themselves, are also something that creates a journey and a bad place.

So this is something that, you know, we're very passionate about.

And we hope as you sort of continue through your journey at school and and beyond in the profession, that you can carry this forward, not just in this particular building, but how do we continue to change the face of healthcare across the country?

Dignity and humanity are three components of that.

So as I said from a design perspective, what we can do at the role, you know, we work and collaborate with clinicians.

They kind of bring the magic, they bring the secret sauce.

But then you need a vessel in which you can provide that.

And that's the role that we can do.

And so from being those designers that sort of approach this kind of foundation from empathy, but then bringing sort of the dignity to the space and the the care process is really important.

But and we kind of talked through a little bit more about context.

Natalie.

Yeah, let's do that.

So jumping into a little more context, I'm sure unfortunately or fortunately many of you have received care probably in an emergency department or urgent care center.

So you're familiar and and honestly, they've become the default front door for behavioral health services.

And that's not by design.

It's not intentional.

It's often just because there are gaps in the system.

Right.

So, you know, over the past decade we've seen a really big surge in behavioral health ed visits.

And there's been a corresponding lack of increase or even decrease in inpatient behavioral health services.

So really the the result of that is boarding patients are in the Ed for 12 hours, 24 hours, sometimes multiple days.

And they're in an environment that is disorienting.

It's, bright.

It's loud.

It's definitely not conducive to healing or moving past a behavioral health crisis.

So, you know, we see issues like operational blurring between medical and behavioral health, not having the clarity needed.

And so patients will fall through the cracks or, you know, things like funding misalignment, crisis stabilization services.

Often their reimbursement is somewhere between inpatient and outpatient and not well defined.

So it's really challenging for hospitals to navigate.

And then staffing shortages.

That's a challenge really across the board in health care.

But in behavioral health, folks that are specifically trained for trauma informed type of nursing for, security, they're just they're hard to recruit and they're very difficult to retain.

So this cycle of crisis and recovery, I mean, ideally requires multiple points of intervention, right?

So we're trying to reduce the need for that crisis intervention in the emergency environment.

And really even trying to reduce the need for more inpatient psychiatric beds, we want folks to be getting care in the community.

So these hybrid care environments are starting to kind of address that.

The idea is that there's best practice, evidence based design in these spaces that, allow people to receive care early and avoid crisis to begin with.

So you can kind of think of these hybrid environments kind of along a continuum.

And we're going to throw a lot of terms out today.

And honestly, different hospitals, different places, different jurisdictions will call these facilities different things.

I'm sure in your research on your crisis projects, you're seeing that that's true.

But kind of the idea is that it moves from hospital based, through to kind of independent and more integrated facilities.

So, I mean, historically, we know the consult model where somebody is in the Ed and they get a behavioral health consult directly in the Ed.

And then we've moved towards designing maybe 1 or 2 rooms that are meant for secure holding for safety, or maybe there's a behavioral health pod.

And then we've moved towards things like observational units that are adjacent to the Ed but separate, things like crisis triage centers and community based crisis stabilization units that are separate entirely from the Ed.

We're seeing more of that as well.

And then, you know, in in kind of the future of this care, we're looking at empath units.

And so I'm gonna have to look at this again, emergency psychiatric assessment treatment and healing unit.

So, you know, that's really been a buzzword for a little while now.

And we're starting to see these units come along more, and we're seeing the benefit of kind of all the lessons learned of all these different types of behavioral health emergency environments being addressed and applied to these types of spaces.

So, you know, I'm running the evidence space design is foundational to the work that's happening across.

But I'm really excited here.

This is, of course, the work that was led by Mardell, who I had the privilege as my studio professor here right at.

And I'm so she's obviously somebody that I have great regard for.

But the work that they've done specifically in kind of creating these sort of attributes, I wanted to kind of touch upon a few of them.

We're not going to go through all of them, but but a few of them, starting with another foundation around nature and daylight, you know.

Well, it goes back even before to the work of Roger that, when even here I again was really fortunate that Rick was here and we had an opportunity to engage with him.

But the access to daylight and views is so foundational.

We take it for granted that of course there's going to be a window, of course there's going to be light, but it is still a primitive.

It's not in the in the real world, you know, those can that equity can still be a challenge.

It is not just something that you can assume.

And the access to light and daylight especially is not just that.

Okay.

Just because I have a window is there is that is the thing that I can do.

You know, now we have so much more research around circadian, our circadian rhythms.

There's a project that we did at Fulton State.

You know, it's a it's a really amazing, behavioral health facility, which has become a kind of a paradigm shift.

It's really kind of defining the ways we're designing behavioral health facilities, where we realized that we had an immense amount of skylights and windows that we had provided.

But as we went back and did some post occupancy studies that we realized that the quality of the light was still not appropriate to and kind of attuned with the circadian rhythm of the body.

So we had to come back and, you know, kind of work through kind of some artificial light enhancements to kind of make sure that those circadian rhythms were being rendered.

So it's again, light is is a very foundational but a very important part of of that.

Now, security is, is something that we're dealing with across the board, you know, in healthcare, but even more so, within behavioral health, as we say, you know, we're sort of now we're hoping to change the paradigm from containment to compassion, right?

That's where we're going.

So how do you kind of provide safety and security, both for the patient but also for the care providers?

It's really, really important for us.

And we are obviously now in addition to kind of the way we are designing the spaces, user technology is becoming really an important part of that.

You know, how do you use technology in that process, both for kind of remote monitoring but also from security perspective, but do it in a humanizing way so that it's not it's almost like technology is omnipresent in the space.

Control, you know, is is again, foundational.

You know, how do you provide a sense of control to your spaces?

Can you have that in their environment so you can tune the environment to your needs?

Is is a really, really important consideration as you sort of think through that.

And what we are really seeing is that some of those, that body of work that we are doing, whether it's in academia, is coming right through into the guidelines that we have to design, because so, like FGA is now taking a lot of that work into the revisions cycles as they go through that.

And I think that's really great to be able to see some of that work that is happening from an evidence based design process becoming part of the mainstream requirement, not just something that you would, just sort of do because, you were committed to that.

So as Natalie mentioned, there's a there's a range of spaces that are evolving.

And so we kind of just want to walk you through some case studies going over that range.

So really starting with the baseline, this is what we've traditionally have seen as a well designed emergency department.

And we'll work around that treatment room, that exam room and focus so much on the medical needs of the patient and then say, well, we need a behavioral health room.

So how do we make the room we just designed for an emergency patient appropriate for a behavioral health patient.

So what you often see is the window at the door from the corridor, often across the nurse station.

And then you see our solution kind of literally a garage door in front of that head wall.

The guidelines are not as clear as far as all the fixtures you need.

So really you're doing intense conversations with your stakeholders on their risk and safety assessment.

Because while we might promote ligature resistant fixtures in here and make it a safe environment, it's very gray.

You can still not necessarily have that garage door.

You can have a sink in the room, some of the light.

So we really go through a matrix going through those details.

Another point of this room is an emergency department.

This room's not intended to be a long term stay, as Natalie and Tushar mentioned.

And you have no access to daylighting so many times.

Patients are in here for a long length of time figuring out what their treatment protocol is going to be.

So this space is just not ideal.

The goal is to get medically clear and then move into an environment that's more appropriate for the behavioral health patient.

That is more conducive and calming, because being in this space, they can continue getting agitated.

Also, the window along the corridor while they have a view to them, you're kind of on display.

People walking by that corridor and everything.

There's not a lot of privacy and dignity there.

When you're in the midst of the, emergency department.

Another kind of evolvement of that space is they do recognize that it's not a great environment, but what can we do?

So we can still have all those features in the room, have the safety in it, but give the patient some choice of how to sue that environment while they're in there.

And so we did work with children's, Health Medical Center of Dallas on with Philips, their ambient intelligence system.

So looking at how we can use technology to change the lighting in the room, interact with the space and just give them a better experience while they're there.

And as we start moving out of the emergency department, what can we do that's better?

Let that room be for the medical treatment and go adjacent to the emergency department with more of an extended observation for behavioral health.

So what is that starting to look like?

And that's where Natalie mentioned two, four, six rooms that are off of the main ed.

And the benefit of looking at this in design is also what can we do to bring in daylighting into those rooms and views to nature in the garden.

And we were able to achieve that with Hackensack, Ocean Medical Center.

And Tushar kind of worked closely on this one.

So if you want to add any, that's what you see right here in purple.

Again, this is more of that.

This is sort of in that journey where the behavioral health unit is still inside the emergency room.

Right?

It's that it's a component of the emergency room.

And what do you see like that.

You know, kind of the the bottom right corner, the purple, area is where that behavioral health unit.

But we very strategically located it there because we wanted it right next to a garden.

We wanted to create apertures for daylight, and we wanted to have that access to nature.

So what you see right here is that, you know, kind of, I would say a pocket park that is, you know, kind of almost kind of carved out of the floor plan to drop that in.

And given that we have it's it's an ocean.

Yeah, it's a Hackensack Meridian system, but this is Ocean Medical Center and brick new Jersey brick, new Jersey.

Right?

Yeah.

So this is and the is so given that we are a practice that's committed to evidence based and we often will go back and do a lot of post occupancy work.

So right here, this is a project where we went back and really tested that hypothesis.

You know one of the what was our hypothesis around this study where we were thinking, okay, by providing that access like first and foremost, they were coming from a, a unit that was not what we designed.

We were coming from an existing unit, moving them into a new unit, into a private environment for each private room with access to light.

And our hypothesis was that we thought if we were to do this, we could reduce, restrain, you know, anxiety or agitation, as well as a reduction in medication.

And what the study actually eventually kind of found was that we did not have enough data on the medication side to make a conclusive inference.

So at that point, we had to kind of do it.

By the way, we collaborated in this case with Cornell.

You know, Rana, who, some of you might know, is there.

So she was a third party.

Consultant for us and helped us with all, kind of the, the statistical analysis.

But so while we didn't find that was the first inference, but there was still a learning where when we went first to do statistical analysis, there was definitely, a drop in the restraint.

Now, from a statistical standpoint, was not statistically significant, however.

So we were like, oh, did that actually make a difference?

And our research collaborator on the hospital said, no, this is still significant because it's clinically significant.

Any decrease in that level of agitation, we are moving the needle.

So while we did this, this is again this was done, open in two about 13 years ago.

So it's kind of in this inception of the work that was happening.

Obviously there's a progression from there, but that's what this, this and what you will see on the next case study.

This is a project in, for UC health in Aurora, Colorado.

What I wanted to point out for you, if you remember that behavioral health and how it was kind of tucked in, this is the progression where now behavioral health is almost becoming a gateway.

Well, this is not a crisis center, dedicated crisis center.

It is starting to behave like that.

So what you see is the the main is up there.

This is sort of the kind of the entrance and the triage area.

But the behavioral health unit was very strategically kind of pulled out from it, almost kind of creating its own little gateway.

So you had what we would call an off ramp when you came to the emergency.

You don't have to go through the system of the emergency department to get to the.

You actually had an off ramp where you can go right into the Beaver.

So here you're starting to see that progression, the hybrid, as we were saying, the hybrid model of evolution from a more traditional way to something that's sort of becoming much more focused around that kind of care.

And while we've been designing, within, hospitals and outpatient centers, really, we talk about that Ed in the front door.

But the reality is this happens all throughout the facility, and patients are arriving in multiple locations, or they may even already be a patient within the facility and having a behavioral health crisis in, in having meet.

So really we started looking at Intermountain Children's a continuum of care and meeting the patients where they're at.

So filling those gaps in between.

So looking at from that emergency department, what's needed adjacent from a crisis center point of view, then connectivity and a continuum of care in the observation or the inpatient unit for behavioral health, and also their recognition of the outpatient clinic that's also on the campus.

So now that as a service, they can be talking and communicating with each other and be a more cohesive alignment.

So being adjacent off of the Ed as we talk about the secure holding room in that pod, but also recognizing in these spaces they're not necessarily mean to be confined to a room or a bed.

So allowing for spaces where they can be in a lounge, setting a group therapy session, have safe observation to the staff.

But then also in those room environments, what's appropriate and comfortable for that patient.

And then also another example of the inpatient unit where it kind of sits in between more extended observation in the inpatient unit is that group therapy classroom space.

And not just having, views in nature and access to daylighting, but the ability to step outside and take a breath.

So patients that are there for a longer period of time just to be able to go out and just kind of decompress for a moment, collect themselves or even the staff and physicians and family.

But also take it in mind when you do those outdoor spaces, the safety that's incorporated into the design for them to be able to do that.

So there's an example is of a psychiatric emergency department.

Again, you can see kind of the pretty large emergency department.

This is Nanaimo and Vancouver Island.

So the department on the left, you, you can see it's multiple pods, but that parent circled in red where the, psychiatric emergency unit is, and you can see there's a big courtyard.

And then there's that open space.

There.

That's what we call the therapeutic milieu.

And so, like I said, the idea is that you're not having to confine somebody to a bedroom necessarily.

Yes, there are private rooms in a psychiatric emergency department.

And that can be very, in that sense, necessary.

But there can be a lot of benefit to allowing space for movement, allowing space for socialization, and then allowing for that to flow in and out with the outdoors.

I think that's what's especially beautiful and successful about this space.

You can see this is that milieu space here, and that's the courtyard.

And they can open up that wall between.

So you really get natural light, you get additional space and you get the opportunity to kind of, these stimulate if you're somebody who's in a behavioral health crisis.

One of the things that or a couple of the things that we saw with this are this client saw with this project is that boarding times for the behavioral health patients were reduced from multiple days to less than 12 hours on average.

The unit achieved high discharge rates either directly to outpatient or community stabilization programs.

And then, they definitely saw an improvement in staff safety, which also then resulted in lower staff burnout and better retention.

And so it kind of shows you that, like that purpose built space can be really valuable.

One of the distinctions of this space is that you're not coming into the Ed first.

You're actually going here immediately.

You're receiving your medical clearance in the behavioral health space.

So you're sharing a back of house, you're sharing an operational function of the EDI, but you're not having to go to that space with the garage door and wait for a long time to receive a medical clearance and then go to an appropriate space.

You're you're getting brought to an appropriate space right away.

So this this one isn't a it's a crisis receiving and stabilization center.

So this one's different.

This one is not adjacent to a hospital.

It's not within a hospital.

It is a standalone facility.

So, I think the closest there's two beds that are nearby, about three miles away.

And so the idea behind this was that you would have 24, seven walk in.

You've had EMS and police be able to drop off patients.

They have a short term residential program and a withdrawal management unit.

They do outpatient therapy and wellness programs.

So it's a community service as well.

You're not just coming here in crisis.

You're able to come here for additional services beyond that.

And so what they're saying is, is this is getting closer to what we would call an empath environment, where you really have that open milieu, the daylight and the flexible zones for the treatment space.

And you're really starting to incorporate some more trauma informed care principles.

Throughout the facility.

But this is, in its long view, behavioral health in Larimer County.

So it's in Fort Collins, Colorado.

So when we went through the design of this, this building, we talked with them about what we thought the future would be for their services.

We were expected to divert 60 to 70% of the behavioral health crises from those local Eds.

And then, though we don't have the numbers back yet, the suggestion so far has been that that has been successful.

It leads to a degree.

We were looking at the waitlists in particular, and there were 445 people on the waitlist to come in and receive services.

And after this facility opened, that went down to 250.

So there was a significant reduction.

And their units were immediately within 36 hours of opening full.

So there was definitely a community need.

And we're starting to see really promising results.

So from all of those case studies, we'll talk a little bit about kind of what the future is in a moment.

But what can we learn from these examples?

Right.

We can learn that purpose built space can make all the difference in the world, not just for the staff and the patients, but for the operations of the hospital, for limiting the confusion and for being clear when it comes to kind of the financial pieces and the reimbursement.

And then, you know, ideally, what we're trying to do is keep patients out of the Ed altogether, if that's possible, prevent crisis before it happens.

But when it does, be treating it in a way that focuses on kind of a rapid medical clearance and therapeutic, as opposed to that containment or confinement that that was mentioned earlier.

So what is empath?

We've mentioned it a couple of times, and, you know, all of these types of spaces can can go by different names.

And path is definitely something that's gaining popularity.

And different states will kind of treat these units differently from, authority having jurisdiction standpoint.

But the core concept really is that open therapeutic value, and it is the specialized multidisciplinary staff that's really I think the biggest differentiator.

You have psychiatrist, you have trauma informed trained nurses, you have social workers, everybody working as a multidisciplinary staff to treat these patients.

So typically empath is adjacent to the Ed.

You can kind of see what, what they tend to look like here.

Because then you're benefiting from that rapid medical clearance, you're benefiting from that kind of operational back of house support that you can share.

So you're still dedicating a space that is, convenient and can catch people when they're on their way into the Ed to go to this empath unit, if what they're really experiencing as a behavioral health crisis, Here's just an example, one that we're working on now.

I can't say where it is or who had floor, but, you can see that the idea is that it's an open shared environment.

You're not having an isolated room every time we're trying to incorporate this, not just a view to or daily, but access to the outdoors.

And then obviously soft finishes and, residential form, you know, furniture as much as possible within the behavioral health realm.

So really make it a comfortable, safe.

And then you can see again on the floor plan this this should look familiar at this point.

Right.

We have our open milieu.

It's adjacent to the outdoor space.

And then you have your support spaces in your private rooms around the perimeter.

And so that's a model we're starting to see more and more be developed.

And and executed.

So just getting back to meeting, where the patients are, this is an example of, be an imagined room.

It is right off of an inpatient unit at, Saint Jude.

So the length of stay is very long for the patients as well as their families and their siblings.

So being able to just go to a space and feel like I've escaped that environment and then I can, can change and control that environment, whether it's just a quiet space or I want to go to the moon, I want to go to Mars, I want to go under water.

So giving them just somewhere to detach and just kind of collect themselves.

So, this room has been very successful from the patient side all the way to the families and siblings.

Is that in terms of Saint Jude Children's?

Yes.

Yes.

That's meant and that's okay.

So as we're talking about kind of what happens within the medical environment, within the hospital or within the emergency department or even a standalone care setting, what about trying to intervene, especially when we're talking about adolescents and children before crisis is reached?

Right.

So taking these evidence based design principles, taking the trauma informed care and what we're learning from designing these environments and start applying them in community spaces and academic environments and places that are really going to have an impact on those individuals who have behavioral health issues.

They're suffering from, developmental issues, or they have neurodivergent, you know, trying to really address that in a sit with a sensory responsive design.

So this is an example of a school, actually, that treats, that that sees and treats children.

So it's combined with a comprehensive care clinic.

And so a lot of the students that are at the school have full time nurses to come to school with them.

They have complex, medical needs.

And in addition to, a recent cohort of them having behavioral health issues.

So the idea is that we're really trying to create calming, adaptable environments that are supporting these patients, allowing them to learn to self-regulate, heading off crisis before it begins.

And really de-escalating using the environment and the design as much as possible.

So here's a few additional images from that.

So it may not look like a school and a clinic, but in school and a clinic.

And so, there are a lot of opportunities for, multi-sensory environments, either for stimulation, which some children might need, or deep stimulation.

We have as universal design as possible to allow the maximum amount of accessibility and then allowing for alternative therapies, you know, therapy animals and other things like that to really address as much of this as possible and get that kind of wraparound support for these children.

Okay.

So, but not on purpose.

We did a little preview of the rest of it.

Okay.

So when we get we talked about trauma informed, I said that a couple of times.

I will, just I'll touch on this briefly.

Not going into too much detail, but really trauma informed design is it's about creating spaces that recognize that there is a widespread impact of trauma in our communities.

And so the space should really intentionally promote trust, safety and healing.

And so, you know, we're trying to reduce stress triggers.

We're trying to design environments that really support, somebody being somebody and the environment, both being active participants in recovery.

And you can apply that anywhere.

Right.

So we talked about applying that in school in a clinic.

It could be in emergency department.

It could be in therapy offices, outpatient spaces.

So in some of our studies we're looking at like the exam room and what we can do to really apply these trauma informed principles throughout the exam room, you know, providing a variety in those spaces and usually have one place to sit.

And it's on that crinkly paper that nobody likes.

You can have sensory modulation.

I mean, wouldn't it be great if you could adjust the lighting in that space because it's very uncomfortable, and turning it down would make you feel a lot more safe.

Providing positive distraction for other ways for you to really kind of interact with the staff member that are in there with you.

Yeah.

And then in the waiting areas, I did that backwards.

Sorry, guys.

Waiting areas.

You know, variety of seating, sensory modulation.

Some of the things that we can learn from environmental psychology are as simple as the arranging of chairs and then being able to benefit you, being sat 90 degrees from each other on equal ground, as opposed to across from a table, which is a little more confrontational, just little things that can make an impact for people that are in a heightened sensory state.

Okay.

So I think as we sort of wrap wrap up our presentation, we just wanted to kind of summarize in kind of three, key really areas.

The first and foremost, I think if you were to take something from our presentation, is, I think the idea of meeting the patient where they are.

I think we talked extensively about that.

You know, we're we're changing the paradigm from, you know, confinement to compassion.

You know, we're taking this sort of a person or even the space that's been fragmented and making it more that sort of close together, a place that becomes almost a new aperture, a front door that receives people in a way that is much more, you know, kind of built around empathy is would be a key component.

Now, as you've sort of seen through the course of our presentation, that care model has a is evolving.

It's going from kind of the more traditional to more sort of hybrid and even continues to evolve, you know, and bath is a great place where we are today, but we're excited to kind of continue to take that into the future and see where it might go.

And then finally, as I mentioned even a moment ago, empathy is kind of the grounding fact, you know, how do we really design these spaces again, to humanize them, to personalize them and to demystify them?

Because at the end of the day, we are trying to make sure that we're destigmatizing, you know, this whole association with behavioral tenant and make it much more available to folks in, in, in a dignified way.

So with that, we'd like to open up for questions and thoughts.

So yeah.

Okay.

So, let's take some questions.

You mentioned from the students and our studio students over here who are working on the topic, that is very related to the presentation that you just gave.

Grace, I feel like you have a question.

Okay.

I noticed in a lot of your sensory rooms it was pictures of children or in children's centers.

I was wondering, how you would manage, sensory need or a discussion need when it comes to the more adult population.

And if a lot of those strategies carry over, or if you have to do different things to manage the age gap, I'm curious about that.

A lot of strategies you absolutely carry over.

So we just completed a project in Austin with the state hospital, which is a little facility every unit has a sensory space, and so in that space they can play music.

There's very soft furnishings.

There's a beanbag chair.

They can control both the color and the amount of light that's in the space.

So it's not quite there's not quite as much stimulation in that space.

There's not quite as much of the games and the different things that you'll see on the wall.

But we'll see you in the children's spaces.

But there is the opportunity to have an auditory stimulation.

The staff will often include, diffusers in those spaces as well, so somebody can control the scent that happens in that space when they're using it.

So we definitely are using them in more environments than just children's environments.

But you do tend to modify kind of a little bit to tailor to the individual that's going to be in there.

But usually if you stick with the senses, you'll be in good shape, right?

So you have the ability to take control, smell, sound the light in the space, and then you provide different textures and things in there that are great for, for feel.

And then you can cover really most people that might have a different issue that are, that are interested in using that space.

Well, I'm just going to add to that.

Well, to see an example of what Natalie just mentioned, the sensory room that we have built.

And it is right there in the lobby space.

We recently got a device from Stantec which provides a projector.

And, you know, sounds of nature.

You can adjust the lighting.

So if you want to see an example of that, we can plan, basically, maybe we can schedule some appointments and experience it in that sensory room.

Okay.

Yes.

Let's.

Sally.

Okay.

It's kind of adding on to, her question.

It's, how do you collect the information or do you use the location or the culture or the specific place where you're building this, to make the decision on which options to give to them?

I'll start and then I'm happy to pass it off to others examples of, so we the ideal situation is for us to partner really with our clients to include stakeholders.

So it's not just the clinical frontline staff or the folks that are working in the facility, but we're trying to solicit feedback from families from patients, from advocates, especially in the behavioral health environment.

So there are a lot of organizations out there like Nami, that will help to provide peer advocacy.

And, people are interested in sharing if they've been in these environments and they're given the opportunity to talk to a designer about how to make them better, they want to do that.

And so we're trying to to make sure that we're including as much as possible that, that feedback.

And there's kind of a growing movement in behavioral design called co-design.

And that's what that's talking about specifically.

So it's people that are peer counselors, people with lived experience that are coming out and providing consultation services for people like us to help us do a better job in designing these environments.

So there's definitely a movement in that direction.

I'm not sure.

There's another example you want to, I would add by what we're getting the opportunity to work with many clients that are pushing the boundaries and have become a resource to us.

We also have on the other side, clients in communities that don't have these resources.

They don't have, a crisis centers or, their counties or cities are just so limited.

So we're leaning on getting them to look at other benchmark facilities that are doing this and have that conversation, because oftentimes they're looking to us and we don't have that resource in our community, but we know the space we have those people in is not appropriate.

So that's what's when we start talking about some of these hybrid models and what's going to fit best for them.

And so we so there's a balance of the conversation kind of looking out, but then also what they can do within with the resources that they have or the lack of we actually have a plan.

Marty Martin, from who we worked with, and Fulton State Hospital when we did that project and, she since retired from, you know, the facility that has become a big advocate and somebody she knows who speaks and writes and travels the country.

But she also sort of building with Beth was saying in places where there is a gap of some of that voice like that, but she's sort of coming in and becoming that voice that will bring along with us in that journey, because we want to make sure that we're bridging that, you know, between kind of a state of where they are, where they should consider to go and how we can get them there in that process.

Wonderful.

Thank you so much.

We can get one more question.

So George has a question.

Emily.

So, George, we're gonna get Emily's question, and then we're going to get to you.

Hello.

My question relates back to lighting and circadian rhythm.

So I was wondering, what are some of the key considerations when designing spaces that are in tune with the body's circadian rhythm?

That's a good question.

It can be challenging because sometimes there are differing needs.

So regulating your sleep patterns can be extraordinarily challenging when you're in, hospital environments.

The lighting is not conducive to the sound is not conducive to it.

You're getting woken up every hour and poked and prodded.

So, you know, we do the best we can to make sure that we're leveraging that natural light as much as possible.

But the size of these facilities is such that you're going to have internal spaces.

And so a lot of times those end up being staff spaces.

So sometimes when we have these circadian rhythm conversations, I'd say more often than not we're actually talking about staff spaces.

Not that we don't do it in patient spaces, but we're trying to help nursing staff who may be on a different shift than a typical circadian rhythm, actually use the environment to help them, adjust to that.

And so by providing that kind of control and say, like a nurse station environment or in their workspace, we're kind of giving them that opportunity to fight a little bit of that, because they're being asked to work, stay the night shift.

Yeah.

Oh, I just can say it in, in patient spaces.

You know, I definitely medication is a big factor in this as well.

So in behavior, health environments, medication really does make it very challenging for patients to regulate themselves.

And so the lighting is helpful.

I would say a lot of times our clients are actually not particularly interested in investing in circadian lighting versus other things that they feel are going to have a bigger impact on patient wellness.

But it's definitely something we're seeing at the heart of the unit that is further away from the exterior windows, at least applying it in that space, in that milieu, if it's not right on a courtyard, because that's the space, they're going to get the biggest return on their investment for that type of technology.

The example that I had mentioned was actually a day room, which was in the middle of they could still had sort of access, you know, through.

Sorry, but did not we weren't able to tune it just I wanted to kind of reinforce the point, Natalie, that you made, which is especially in behavioral health.

You know, we are obviously talking about trauma informed design from a patient's perspective.

But the staff is in some ways kind of going through that journey themselves and having to deal with a lot of that.

So really, I think caring for the caregiver is a very, very important attribute of design, as you sort of think about these facilities, which is where I think, especially if those kinds of, staff areas fall away from that light pattern, I think this could be a really good intervention strategy to to deploy, because, again, you know, happy care providers, happy patients.

So I think it's just that we just want to kind of really underscore that for you guys as you start to kind of continue to think about that.

You know, I had the fortune of working on a plane treat, project many, many years ago.

And if you guys are not familiar with ang Lee and she believes in person centered care is what every person that is impacted by the end run, I'm encouraging to look that up a plane tree institution and they really believe in balance.

It's about taking care of the patient is always at the center of the universe.

Their care providers, their family, the community, but also people that are sort of in that living every day and day out.

So just kind of thinking of a holistic way to look at.

Alright, let's sing karaoke.

What a pleasure.

And what a very excellent presentation.

I'd like to go back 25 years because I believe I was chair of your at graduate committee, and I look forward to seeing Tushar.

He had a ponytail that came down to his belt one.

And I told him in the beginning, anybody who has more hair than I do has to take the course again.

And, so.

But he did give the hair to, Children's Hospital kids being treated for cancer.

But there was a sense of humor.

There was an optimism.

There was a smile and a can do attitude, which has even gotten even as good as it was.

It's gotten better.

He was president.

Were you the youngest president ever won the academy?

Maybe one of them.

Yeah, but he was a president of the Academy for architecture, for health, and, helped us in a lot of ways.

He graduated, but never went away.

So, I would urge you to think about the spirit of what they presented.

Also, he's a leader, and he brought along, to have his colleagues who are involved with mental health.

I've met one before, and the other was Newt.

So this was a wonderful day.

Now I'm going to do so.

I'm going to turn the tables on the students.

How many emails did you get from any student saying they're looking forward to seeing you?

Signed with their signature card and everyone everywhere.

Well, you can still sign.

And he's on.

That means he got zero potential for me.

Yeah, I did have some reach outs from.

Yeah, you had some reach out.

Oh.

Do you remember their names?

I'm going to.

I'm going to not call people out, but you know who you are.

Yeah, right.

Well, you know, I'm at the point where I, try to get a point across.

We're getting ready to go to the health care design.

And I would hope those of you who haven't emailed them, email them before they get to their car, because look what happened in their world.

Tushar was w.h.o.

r which became NYP, which became page, which is now page Stantec totaling over 6000 people.

Right.

They're not looking for sleepy heads.

And, I get a kick out of Trump's, comment about his predecessor.

And so, it's not very nice, but we don't want to have sleepy heads, apply for jobs at companies like yours.

You should copy your professors so they know that you're communicating.

And, and in a way, this is this is where the today's page stand to stay in the sunshine.

And there are others coming, and I'm afraid you guys, if you don't act now, you're not going to get to be president in the academy.

Thanks for giving me.

I just got a text from my mother to shut up.

Thank you so much, George.

And again, thank you so much.

Paige.

Stantec, Tushar, Beth, Natalie, for joining us.

I really appreciate it.

It was a wonderful it was our honor and privilege.

Oh, no.

No, I just say thank you is our honor and privilege.

Thank you.