Welcome to the 2026 Architecture for Health Lecture Series.

Today we have Stacey Johnson.

She's the hospital president and the Riverside Health System and the Mental Health and Recovery Center.

Stacey joined Riverside in 2018 as the executive director of the center, and became the hospital president in 2020.

In this role, she has led operational and strategic oversight for the region's dedicated psychiatric hospital while attending integration of behavioral health services within the Riverside broader caregiving system.

So please help me welcome Stacey Johnson.

Thank you so much.

I appreciate it.

It's exciting to be here.

What a beautiful campus and a pretty cool town you guys have have here.

So when I first heard from Roxana, she asked me to come speak with you guys.

And she said, yeah, it's it's, you know, an architecture school.

And I was like, oh, I don't know if I'm if I'm your girl because I am not in architecture.

I can't even draw.

I can hardly read my own writing.

So hopefully I can still bring some some value.

I definitely bring a different perspective and a lot of things that I've learned through the years.

So a little about me.

I started my career as a social worker and I grew up clinically, really got to a place where I wanted to continue to help more people.

And so at that point, I made the decision to switch over to administration, and that's kind of where I've been and found my love and passion and really been able to help some organizations grow and meet some needs in the community.

So today we are going to talk a little bit about where, and I'm going to refer to Riverside Mental Health and Recovery Center as our mark, where we were in 2019, where we are now, and then how we got there, which is a lot of folks like you that have helped us along our way.

And then just some of the amazing outcomes that we've had since opening our site.

So with that, so our see actually started in 1960 as Baby Psychiatric Hospital.

So we are in an area of Virginia, Hampton Roads community.

The facility itself is in Hampton, Virginia.

And then the location that we're in right now was built in 1983.

So probably older than the majority of you guys.

And when I got there, it hadn't been touched since 1983.

So some of those retro pictures you see online, we had that that going for us.

So it's more tile, lots of wallpaper, pink countertops.

It just wasn't great.

And at that same time, there were new regulations for psychiatric facilities related specifically to ligature risks.

So I'll talk a little bit about that here in a minute.

But at that point in time we're about 113,000ft².

So not a huge, huge facility, but pretty big in and of itself all once one level.

And we had a total of three different programs.

The first one we call RTP Adolescent Residential Treatment Program that was running at about 30% capacity.

The program itself actually was being phased out in Virginia, and it's a service that's no longer provided.

So we needed to take a good look at what we were doing there with that.

And then we had two adult inpatient psychiatric units.

The first one, we called it intensive treatment Program.

And that unit is really dedicated to those with psychotic disorders, those who are not inpatient on a voluntary basis, 36 beds, as you can imagine, with a group of psychotic patients is really, really stimulated.

And so we knew on that probably wasn't the best layout.

And then we had a second unit called AP or adult psych, and that was a 20 bed unit.

And that's where you would find a lot more of our mood disorder.

So depression and anxiety, things like that, folks that weren't really able to be in the community weren't safe.

Suicidal ideation and things of that nature.

So all of our rooms were semi-private, so two patients per room.

But if you've got a very aggressive psychotic patient, you can't have a roommate in there.

So we ended up locking a lot of beds.

So just from a layout standpoint, it didn't make a ton of sense.

At the same time, the need for mental health services was really increasing.

So we were in a community where we had crisis intervention that occurred, and that often happened in medical emergency departments, really not where there were a lot of behavioral health experts.

We had standard outpatient.

That's really like you guys seeing your primary care physicians once a year, maybe once every 90 days, if you've got something that they're tracking and then standard inpatient.

So there is nothing in between.

But what we know in medicine is that the continuum of care really works.

So really having all the services available so that you can enter into that or exit into that whenever, wherever most appropriate for you.

So our goal was to create this at Riverside Mental Health and Recovery Center.

So we wanted to create an emergency department dedicated to mental health and substance use disorders, a crisis stabilization.

And that's really if you don't meet inpatient care.

But maybe you aren't ready to be out individually in the community really helps you there.

Inpatient.

And then we have these two other programs called PHP and IT.

So PHP is partial hospitalization program.

It's a day treatment model.

And then IUP is where you would step down.

And that's intensive outpatient.

So just an idea of that.

PHP runs about six hours a day.

Five days per week where it is three hours a day.

It's a lot of group work.

It's some individual therapy work providers and then our standard outpatient.

So that's what we have on the medical side.

So if you have a hip replacement you might go in, you know, have a crisis to be to begin with.

From there you might spend the night or two in the hospital, then go to a rehab facility.

Then you're going to spend a lot of hours doing physical therapy in a day treatment facility.

That's really what our goal was.

It works.

Let's let's try it on the mental health side as well.

So I'm going to fast forward to where we are today and then kind of back up and talk about how we got there.

I think just from a flow perspective, it's going to make the most sense.

So where we are today, we have a full continuum.

I think I skipped the slide.

We should have there we go.

Inpatient services.

So now we have a total of four inpatient units.

We have an adolescent acute unit which was a new unit for us.

But the need for mental health services for that population was growing.

We treat on that unit ages 12 to 18.

And then we have a total of three inpatient adult units.

So quick map 90 beds overall in the facility.

So pretty good size.

We took however, that large unit where I said we had a lot of our psychotic patients or those that aren't there voluntarily, and we made two units for that 17 beds.

Egg unit has three private rooms, definitely quiet, much less stimulating for our patient population.

And then we took our larger unit and made that dedicated to those with mood disorders, depression and anxiety.

We also started treating substance use disorders and did a lot for detox related to that.

Then on the outpatient side, both continuum of care.

We've actually got three separate tracks for our partial hospitalization and intensive outpatient.

The first one is for mental health, the second one is for substance use disorders, and the third is specific to unhoused.

And you could have a combination of any of those.

We have a fair number of unhoused individuals in our communities.

Our goal is to really be able to treat their unique needs.

And then on the general outpatient side, we do assessments, provider visits, therapy visits, etc.

then we have our psychiatric emergency department so that space has a total of 20 treatment areas.

And it's a mix of kind of an empath model.

Are you guys familiar with those.

Have you learned?

Yeah.

Okay.

So we're kind of taking a standard emergency department and an empath model and combining them together.

And I'll talk a little bit more about this in depth as we go on.

But we really the population that we treat in our community is severely mentally ill.

So having the only space to treat patients in a big, open environment didn't meet the needs of our community.

So we do have private rooms on both the adult and pediatric side, and we're able to treat ages five and up.

We've got calming sensory de-escalation areas as well.

So just the this is one of our waiting rooms.

This happens to be our pediatric side.

So we've got that open area, but we've also got private rooms.

That's one of the few rooms.

They all look very similar.

And then this is a picture from our care team station just really looking over our adult services area.

But it's all open so you can kind of see everywhere.

That was a big thing for us.

Okay, so where we are today is at a place where we have created this real hub and spoke model.

We've created the continuum of care not only at our mark but also our organization overall.

So really, when I say our dark, we also have a behavioral health substance use service line that leads that up.

She's amazing and she's part of our facility.

So really our patients can kind of move between all of these at whatever level of care might be needed.

We bring psychiatric services on a consultation liaison basis to our medical acute care facilities.

Oftentimes they might step down to us on the outpatient side, as you guys are working down the line with clients and health care organizations, one thing to be really mindful of is readmissions.

About 50% of readmissions have a secondary substance abuse or mental health diagnosis on the medical side.

So really, how can we intertwine the services that we provide and care for the whole person.

So just a little food for thought.

So we're able to provide these services within the full organization overall.

Pause there.

Any questions for me so far okay.

All right.

So the design and restructure.

So as I said when I started I'm not an architect I'm not a draw.

I'm not any of that.

But our director of facilities and I sat down and said we got to change something.

And we drew this picture that I am forever.

And Marissa, if you guys ever meet our architecture HDR, they will they will laugh.

But we wanted to create this treatment home where everyone could provide, you know, get whatever care they needed.

Our patients had a safe place to come to and, and really just be able to do everything for them, whether it means say hi or inpatient psych treatment, whatever it might be.

So we got here with a bunch of great ideas, and we wrote those all down, and we called our friends and had some really, really amazing designers.

And I think that, you know, one of the key things was having a group that really listened to our needs and took what all these ideas were that probably didn't make a ton of sense on the pages we handed them to to make sense for us.

Our our designers and architects are actually able to take on the role we had.

So at Riverside, you know, our our desire is to care for others as we care for those we love.

And that's really what we were trying to create within this.

And our designers really took that on and embrace that and became part of the team.

It wasn't in us, in them.

It was how do we solve this?

And I think that's really, really important because there is no way to find the success otherwise.

If it's just what the provider wants or just what the architect wants.

So through this, we had our facility that I mentioned hadn't been touched in a number of years, and we wanted to move everything and we had to do that while we were open.

So we started our our redesign in 2021.

Remember what happened in 2020.

So everything shuts down, but the need for site services goes through the roof.

So you think, okay, maybe we'll have some beds we can close for a week or two?

We didn't have that ever.

We have a two day experience that either.

So we really needed to to work together to determine how we could have the maximum numbers of beds open and do it safely for our patient population.

So with this patient population, are you guys familiar with ligature risks and what those are.

So anything you can kind of hook something on and harm yourself for.

So that was a big thing that we were trying to solve on our inpatient units.

But being able to do that without having access our patients access, accessing the equipment and things like that of our team, that was really important as well.

So we kind of drew up all of these things to to move our units and build new units, create space for our psychiatric emergency department, and then again sat down with HDR.

And they took our very elementary color coded items and, and made a formal master plan.

How do you maintain operations while really restructuring everything?

So what we did in this so this area was previously AAP, if you remember, we decided to opt out of that.

So this was after there was part of it that went to about here, but that was not down.

One thing I learned is actually it's it's more cost effective to start from the ground up when you want to be able to grow up later on.

So our first unit to renovate was this one.

We then moved our adolescent inpatient adolescent unit there and we just moved moved on from there.

The problem was we were so busy by by the end of the construction that we had to actually do four different stages on our inpatient 85 unit.

So we took the first part, all of these rooms, then all of those rooms, then these rooms, that those rooms, it was really, really challenging.

And they really did hard wall containment around all of those areas.

So we operated fully functional units while they did top to bottom renovations, which was really, really impressive and something without the collaboration of our architects, we would never have been able to get there.

The other big part of that is patients with the construction team and really having them involved at the table and saying, okay, well, we can't do this.

How do you like floor down in the middle when you've got a hard wall containment going down the middle of that?

So it really was a lot of conversations and looking at what products are most beneficial to really help us be successful and still be a beautiful place to get care at the end of the day.

Okay.

So questions.

Yes.

All right.

So the psyche D. So our psychiatric emergency department is the first first specialty emergency department in all of Virginia.

So it hadn't been done before.

There was a lot of licensing regulations and things like that that we needed to really talk through.

And a lot of the questions were, what are the problems that we're trying to solve?

And the problem we were trying to solve was sight boarding in emergency departments.

When you get into the health care world, that's going to be something that comes up today and it's going to come up in five years from now, because there isn't a lot of dedicated space for those in psychiatric emergencies.

A lot of the parts that are building now are amazing.

And within EDS.

And again, as said, I wanted to be able to treat those that can be in a large community environment and those that needed to be on an involuntary basis in those private areas.

So we really worked together to say, what are our goals and how do we get there together?

And the first and foremost thing is always maintaining the patient at the center of this, but really ensuring that your team and your patients are safe.

So we said, okay, safety is first.

And that's when we took a real look at how we were going to to build this unit, whether it be from using, you know, two panels of drywall.

So a patient can't punch through that, or are 80 pound chairs that are filled with sand, fresh air.

As I said, I started my career as a social worker.

I'm a firm believer that fresh air can heal a lot of things.

So how can you create an outdoor space where somebody can step outside, get a little bit of sun, and really take a moment for themselves?

So creating outdoor spaces that were both safe and therapeutic.

And then of course, I mentioned all the look at your resistance stuff as well.

So secure perimeter was also key.

So it's chatting this morning with with George.

And he said you know what.

What could an architect do different to help you.

And I think one of the things that we found is we got halfway through our processes.

How do we really build the clinical model and then the environment to match.

So I think so often in healthcare, we're tied to our environments and we create our clinical model based on the environment that's already there.

So a couple months in we said, okay, let's pause here.

Step back.

And what is the right process for the patient.

And with that, we determined that the expert model, which is screening, brief intervention, referral and treatment was the best model to quickly assess our patients, get them to the right level of care and ensure our team is safe.

So when we had that, we were able to then take our environment and build our environment to match our clinical design.

And that was what was really, really important.

And I wish I had had that in my initial scribbles and colored pencils designs when I initially called HR or HDR rather.

So if you take a look at this, this is our front door.

So you come in, you start your screening here you have your initial interventions within our these are our triage rooms.

Have your initial intervention there.

We've got an idea on your referral before you hit our community treatment area.

But while you're in our brief intervention we're making a decision.

Do you need to be in a private room or do you are you okay in a community environment?

And just an example on that.

If you've got a very loud, aggressive 18 year old, you probably don't want to put them in your open treatment area.

But if you've got a depressed 90 year old, putting them in a private room also creates a risk.

So really finding that balance was was important to us.

And then we are able to begin treatment and then our facility is over here.

And just to get the inpatient facility should say just to give you a lay of the land.

Everything on the south end of this is all of our adult area.

And then on the top it's all of our pediatric area, almost identical, which is great for workflows.

Our adolescent or child area is smaller than our adults just due to the volumes we have in our community.

Another thing I want to point out is our ambulance daddy.

So this was something that was really important to to me as I sat in my first city.

Is that what was then Behavioral Health center, now Army Jersey?

I remember watching patients coming in and, you know, unfortunately have an opportunity to do criminalize mental health.

And they were in handcuffs as they were being walked in because they were involuntary.

And it was right out in the open.

And that broke my heart.

And so and we are between two residential communities.

So here in the apartment buildings to the right, you can kind of look over and see just it's dehumanizing and really not necessary.

So having a secure area was really important to us.

And so this is our ambulance bay.

The doors close.

We don't need to have handcuffs or shackles to get a patient in law enforcement.

Or you can drive right in there.

And then we follow our same escort model.

So we go through our screening, our metal detections, all of that brief intervention.

Then you have your room and then you it's determined which area that you should go to from there.

Okay.

So another really important thing as you guys enter the architectural world really is how to look at the safety and security risks.

So this is our blueprint essentially.

And each one of these and and again this is with the help of HDR.

I'm not not the architect here.

We were able to determine the level of risk of each of these spaces where a patient can be alone, where they can't be alone, where they need to be supervisor, where they shouldn't be going at all.

And as you can see, our are areas where patients could potentially be alone are a different color.

And that's early on in the in the screening process.

And then we've got areas such as an exam room.

We would never let a patient go in there alone because there's no way to avoid ligature risks.

When you have a vital Signs machine on your wall, or you've got your suture kit or whatever it might be in those areas.

So those are areas where you would never want a patient to be alone.

Our treatment rooms were really important, as well as as spaces that a patient could be without somebody knowing the population we have, we also have viewing the nodes in each of our treatment areas.

So those rooms could potentially function as seclusion if necessary, but hopefully not.

We do have two rooms I didn't mention in the middle.

These are flex rooms.

So they could go to the pediatric side or the adult side.

And I think flexibility in space was just super important for us, so that we were able to increase volumes in one area or the other.

And this is just a little bit of of that in greater detail.

So these are some pictures of our emergency department.

That's like the area where I mentioned patients wouldn't be alone just because of the medical equipment there.

But in our sensory room, our escalation room, we have a sky factory television.

We've got diffusers.

And that's a place where we want a patient to be able to be alone so they can begin to de-escalate.

This is the ambulance bay I mentioned, and I should mention those are also Sally Hawkins.

So the front door of the ambulance bay cannot be open if the back door is open.

So very similar to all infants on all of our units then are outcomes.

So just take a couple minutes on on this.

So since opening so we open here this one that the Ethiopian November 1st 2023.

So these are all the patients we were able to take in our facility prior to the PD opening.

So as you can see we've been able to treat more patients, particularly when we add in in the lower line to be able to bring more patients to our get them out of the medical AEDs and we're able to do it quicker.

So prior to this, IPD opening, the average length of stay for a patient was between 600 and 700 minutes in a medical lead.

So as you can see, we've cut that in half, which is really amazing for the patient experience.

And those ordered psych patients that I mentioned.

So these are our total of boarded psych minutes in 2022.

And this is just that one of our acute care facilities, our largest one though I will mention that we had 38,000 units that we fast forward to 2025.

We only had 3107.

So that is just amazing.

And something we couldn't do if we didn't have this continuing to care for patients.

Another thing worth noting that has had a tremendous impact on our community is law enforcement hours.

So in Virginia, anybody that is under an Echo, which is an emergency custody order or a temporary detention order that has not been yet in place, an officer needs to stay with them.

So the amount of time that officers are off the street sitting with patients was really significant.

So this is just a single community, and we also work with sheriffs and things like that that we've really been able to impact.

So again, nearly cutting that in half by the close of last year.

And on the next slide similar you can see a little hiccup here.

But I think the other thing to note is the number of patients that had PCOS.

And T-Boz did not decline, just the number of hours.

So that was a lot of stuff.

What questions do you guys have for me?

Well, thank you so much.

Great presentation.

And this one alignment with the project that students are working on this for the studio.

So let's start with questions.

Which one.

That Francisco.

Hi.

So I really enjoyed what you said about fresh air in the courtyards.

That's something we're touching up on right now in our studio.

Could you elaborate more on the effects of how fresh air and like, open space, like, works with the patients?

Yeah, absolutely.

And I think we need to loop in there even just body movement.

So we are very lucky to have a gym within our facility.

So if you've met a ten year old that's able to sit still for 24 hours, you're probably the only one.

So really creating space where patients can move, get their serotonin up, I think it's just really, really critical.

So I challenge all of you guys to take a deep breath when you go outside after a long day of school and see how you feel.

So that doesn't change as you get older.

That still happens when you're adult and when working.

So, you know, there's there's medical impacts such as vitamin D and things like that.

But being able to do that in a safe space is important, and particularly with kids fun spaces too.

So go back to actually this one once.

So the floor on this, it's a ton of fun.

So it's like one of those rubbery playground floors.

So it's also safety is really important.

So being able to move your body and jump around and have a little fun without your getting hurt is important.

I also want to note all that these are obviously concrete walls.

So the day I walked out there before they had been painted, I was like, oh, this is also, they believe actually was the interior designer in HDR.

She kind of made the, you know, kind of mountain range look, but the, the use of paint those a really long way.

I think we have one that.

Oh okay.

I'm gonna walk with you.

So I thought it was really interesting as well so far.

But I'm wondering I know that the patients are facing different problems, like when they come there, so you can't really have too much, like, stuff around.

But when I see the pictures of, like, these renderings and photos, the decor still like very minimal.

So how do you guys deal with maybe including plants or greenery, like on the inside of your projects or.

Yeah, just like how how can you make it a little bit more engaging?

How happy to talk about that.

We've had so many conversations on that.

It's really interesting when we were really, you know, after we had all the, you know, initial finishes done, it's what colors do you want?

Should we have the built in wall objects for the children?

We had so much conversation on that and I'm so glad we did.

But the one bit of feedback that we get and we'll just take like our adolescent sided just so happens to be here, is that it's a home.

And that's what we get from our patients and our family.

It's not like, you know, going into a stark doctor's office.

It's comfortable like a living room.

So we also use those areas to provide therapies, whether it be in the Ed or on the unit.

So I think that's something that's that's incredibly important.

And then we're also really lucky to have an amazing group of art and rec therapists.

So every day each unit gets some of these.

We don't keep that art work out.

You know, during the day we don't keep their plants out just for safety reasons, but we're able to at least have those throughout the day.

So while it does look minimalistic, the goal is to have that as comfortable as one's home might be.

Okay, I have a question.

And then, George, we will get to a question.

I have a question regarding the animal spay or the Sally for.

Yeah.

And we've had this ongoing debate regarding how we should design the ambulance bay, specially since we are also working on an addition to the existing facility for the studio project and, and Mesa Springs.

And we're trying to accommodate both adults and adolescents.

So we're wondering how would including one ambulance bay impact drop patient drop offs for adult and adolescent units?

And if if you think maybe including two different ways would be more conducive to care for clubs.

Sure.

Yeah.

And and the volume of arrivals will certainly impact that.

So as mentioned, we are building this in the height of Covid.

And what happened to prices.

Everything doubled right.

It's hung out there.

So the cost of doors literally doubled.

And they were really hard to find, which was very interesting for somebody who doesn't know this world.

So we actually started in our initial drawings.

We had a double bay ambulance in one of the areas that we scaled back was to single.

And, you know, hindsight 2020, I'm actually very comfortable with that because the goal is when an ambulance arrives or a police car or whatever it might be, is to get that patient out and ruined as quickly as you can.

So I'm going to take this.

So this is where our ambulance bay is kind of cut off in this area.

So this is our EMS entry.

So it was created in such a way that whether you're an adult or a pediatric, you can use the same bed.

So if you come in here.

Go through our escort screening.

Everything here is for adults.

And then the top is key.

So you actually just if you're going to the side you would bypass.

Adults go through these secure doors so the adults can't get to the meetings.

And then you would enter that treatment area.

So one day is actually able to work for both populations.

Thank you.

Sure, George.

Sure.

This one I sing karaoke.

Yes.

Sing it.

Let's hear what you got.

We.

First of all, thanks for coming on.

Thank you for having me.

I enjoy having breakfast with you and Santa.

The students are in school, Mayo, and it's really them and the professor.

And it doesn't have all the variables that there aren't.

And you're the client from your point of view.

Could you talk about maybe some of the things that architects do that are very inspiring to you?

And maybe if you have run into some architects who are not inspiring, maybe you could talk about those experiences.

Sure, sure.

So I'm really lucky to have worked with, with and obviously I'm biased with some of the best architects, whether it be here or in other roles.

So I think what's most inspiring is they take these scribbles and make them something that that functions.

And I alluded to this, but I think I should probably be a little bit more precise.

I think what's important when in early design is that the architect does ask, what is your clinical workflow?

What does that look like?

Because we are so trained to figure it out in the spaces that we have.

And if you can challenge us to go back and develop those clinical workflows, then we really can get to a place where we're meeting all the needs of the clinical team, while from a mechanical and equipment perspective, etc.. So I think that's probably what's most important.

I think the other thing that can happen on the flip side is you'll be in a room with, you know, myself and a handful of others that I work with and will just say, hey, can you switch those two spaces?

It's important to ask the question, why, why, why do you want to switch those spaces versus them coming back the next week?

And those spaces are switched and then we're like, oh, I guess that doesn't make sense.

So it's not a good use of everyone's time.

You know, I think it's we want to be challenged in terms of how we think about layout and design as well.

So I would just encourage you guys to ask those questions.

Right.

Yeah, absolutely.

I think was there did you have a question to I thought you did.

Sorry.

So okay.

So when you were going through the different phases of did you have any issues with patients being stimulated through construction boys and that sort.

Yeah.

So that's a really good question.

And yes, and every day, particularly once we were on our largest unit on AP because it is such a big unit.

So we were able to let me get back to just point it out.

I think the visuals help.

So we were able to renovate this with no patients.

However, when you're drilling into concrete, it's pretty loud.

So some of our patients on this unit were actually able to hear it.

So we got to a place where we closed off some of this for a while.

So we're cinderblock walls, concrete floors not not real easy if you want to move plumbing.

So doing that it just was really loud projects.

So we ended up closing some of those areas or moving patients.

You know if we could adolescent was really hard because that was our adolescent unit at the time.

And you certainly can't put an adolescent on an adult unit.

So managing that was really important.

And what those parts of the project didn't take an incredibly long time, but might have taken a day or two.

So we really needed to look at the admissions we had those days and how we balance that.

But this unit, I would say, was incredibly challenging.

So we were having our team meeting to escort all of the construction workers, and as they came in with every tool and escort them out every night.

So really finding access for the construction team to get on and off the units without impacting patient care was important.

And again, having to close like this is a community room.

While we were doing some of this work over here.

So having only one community room is impactful for somebody that likes to walk in pace.

So it was really challenging but became the part of every patient's treatment team.

How can we inform the team if we're starting to feel agitated?

What can we do?

We used a lot of gym time when we're on that unit because it's all the way over here, much quieter.

So just getting patients out of those stimulating areas as much as we could.

And we also really set time.

So anything with noise, it was 8 a.m.

to 5 p.m.

period.

Good question.

That was a great discussion.

I have one more question for you regarding the design of nursing stations and or potentially renovation of those designs, since students are currently working on, you know, proposing new designs for this existing facility, I noticed that there were many designs of nursing stations that were imposed.

So I'm wondering, based on your experience with your facility, do you support more open designs for nursing station or semi-enclosed, and how does that work for the staff?

Absolutely.

So actually I can start right where I, where I am so inpatient and our Ed are a little bit different as well as outpatient.

So philosophically each organization is going to have a different perspective.

Do you want enclosed.

Do you want open.

Do you want a care team station or do you want a formal nurse's station?

I am a firm believer in care team stations.

If it's everyone in the same location, the doctor can talk to the therapist and the nurse all at once, and you really get to solve the problem a lot quicker that way.

And everyone knows what's going on on these units.

We have what we are currently call our outer station, and that's me and 24 over seven.

And some of this is because of just the infrastructure.

We aren't able to take down all the concrete walls and everything.

And then we've got our inner nurse's station and these are formal nurses station.

My, when we started this project, my dream was to have them all open.

With the increase in violence that has occurred within psychiatric facilities and really health care overall.

There was a lot of feedback to to make those in close.

So now we have a mix of those.

Even our initial drawings for our site, those were all open.

So that's going to show you get there.

I can show it actually in this one.

So that's our care team station.

You can see one of the types right there.

There were no windows and initial designs on that.

So our team would prefer that those are closed off they can't see in etc.. But the truth is it really improves the patient and care team experience when they can see each other.

So with that we do have all enclosed.

This is our our care team station right here.

All of our therapists are here.

Our providers one on each side, our nurses one on each side.

And then our texts are usually throughout, but they are all in all enclosed.

And that's really just the paper.

And any other questions, especially from the students.

We have more.

I can say I'm trying to figure out the shortest path.

I'm going to take this.

Okay, so I have one more question.

And I know this is like a treatment facility, but what does it look like for visitors or families?

Because some of these patients, they might have problems that are exacerbated by their families or situations that are coming from or that could actually be support, like help them a bit.

And absolutely.

So we have scheduled visiting hours.

We do metal detection for anybody that's coming onto our units and that's really, really important.

We do not allow our patients and visitors to be alone.

And the least we want to keep our visitors close to an exit if needed.

So go back to one of these.

So what we do is we create an easy entrance on the unit for the visitor, and then we're able to bring the patient in.

So let's say this for example, we're able to bring our visitors in this way and our patient in this way.

And then it's almost an off unit visitation.

They get they get some privacy with their loved one.

But there's always a team member there, particularly with adolescents.

Oftentimes they don't have the capacity to verbally express their feelings and not act out physically.

So really creating that safe environment is important.

But we do do a lot of screening before they come, just metal detection and things like that.

Yeah, it can be tricky.

It's a tricky balance for sure.

We also do zoom visits when we have concerns from a community perspective as well.

Thank you.

Great questions.

Thank you so much.

Joining us and also giving this wonderful presentation.

Greatly appreciate it.

Thank you.