safe inpatient therapeutic environments · particular substance abuse treatment centers in nh that...

Friday, August 21, 2015

Safe Inpatient Therapeutic Environments Round-table Discussion Recap

2 LAVALLEE BRENSINGER ARCHITECTS

Thank You to Our Sponsors!Thank You to Our Sponsors!

t Attendees hard at work


Safe Inpatient Therapeutic EnvironmentsRound-table Discussion Recap

Summary of Objectives• Explore the programmatic and physical plant

environmental challenges faced by behavioral healthcare facilities in reference to providing a safe, therapeutic environment

• Highlight what works and what doesn’t• Identify common opportunities• Create a path to make meaningful change

In attendance: clinicians, administrators, designers, contractors and industry product experts. Event chairwoman: Joan Eagleson, Senior Associate at Lavallee Brensinger Architects, Event moderator: Melissa Bruneau, Director of Marketing and Business Development at Lavallee Brensinger Architects

Speakers • Tym Rourke (NH Charitable Foundation), Chair of NH

Governor’s Commission on Substance Abuse• Kevin Gorman (Britplas), Better Bedrooms Initiative• Daniel Horan (Cavanaugh Tocci), Impact of Acoustics on

Human Behavior• Marilyn Collins (ASSA ABLOY), Solutions to Life Safety,

Security and Access Control• Tim Van Curen (Sherwin-Williams), Healthcare Colors,

Design, Trends and more

t What makes you feel happy? Safe & Secure? Anxious?

u Richard Pizzi, AIA, CEO at Lavallee Brensinger Architects leading round-table discussions


Table Captains • Table 1 — Richard Pizzi, AIA, CEO and Brittany Page, both

of Lavallee Brensinger Architects• Table 2 — Nico Flannery-Pitcher, IIDA, NCIDQ, Senior

Interior Designer at Lavallee Brensinger Architects• Table 3 — Christina Mellor, IIDA, NCIDQ, LEED AP, Interior

Designer at Lavallee Brensinger Architects• Table 4 — Scott Timmons, RA, Project Architect at Lavallee

Brensinger Architects

Attendees arrive with images they feel represent the following categories:

• Happy• Safe & Secure• Anxious

Images are placed on boards and displayed throughout the day. Attendees were also asked to bring their Top 5 facility or program challenges affecting their built environment.

p Tym Rourke, NH Charitable Foundation addressing attendees

p Kevin Gorman, Britplas discussing problem-solving designs featured in the Better Bedroom Initiative (BBI) in the UK


IntroductionsLavallee Brensinger Architects CEO, Rich Pizzi (also a former Board Member, Chair of Mental Health Center of Greater Manchester) made introductions and thanked sponsors. Lavallee Brensinger Architects’ Joan Eagleson welcomed attendees who represented 12 campuses across 4 states: NH, MA, ME, VT. Joan’s experience working on projects for Brattleboro Retreat included a touching story about the transformation of their children’s unit.

SpeakersTym Rourke, NH Charitable Foundation, shared a personal story about his son Dylan’s rare pediatric cancer and their excellent experience at Dana-Farber Cancer Institute. He addressed:

• Stigma of patients with addiction/behavioral health• Rise in heroin overdoses• Correlation between number of drug and alcohol related

deaths and the lack of treatment• Wait-list for care, poor facilities, lack of funding• Dana-Farber Center is healing, well-lit, home-like vs. a

particular substance abuse treatment centers in NH that are dilapidated, lack natural light, basement-like

• NH 4th highest state with children suffering from addiction, 2nd highest use of alcohol in adults

• Only 12 beds (Dublin, NH) for inpatient treatment for adolescents in NH

• Creating a state plan for addiction, visit www.nhtreatment.org

Kevin Gorman (Britplas) helped initiate the “Better Bedroom Initiative” (BBI) in the UK. Through his company Britplas, he has designed safe, secure windows for behavioral health facilities that bring in natural light, add ventilation and are virtually indestructible. He discussed problem-solving designs featured in the BBI that are simple, safe and secure:

• Slanted bed base for older behavioral health patients, assists in standing from a sitting position

• Silent observation panel for patient’s door. Key card activated, doesn’t wake the patient, can record observation time, can trigger an in-room red light for added visibility

• Patient room door that opens in or out. Programmable, alarm triggered by weight or lack thereof

• Safevent Security Fencing a/k/a “cloaking.” Offers patient privacy, can be retrofitted, displays any digital image, prevents unauthorized items to be passed through, provides a calming environment, eliminates the “prison look”

• Patient in-room monitor. Overseen/controlled by staff, gives patients options for: soothing images, temperature control, light control, window control, communication with staff and family

t Tables discuss Top 5 facility or program challenges that affect their built environment


Round-table Discussions – Session ITables 1-4 include a representative from: policy, clinical, facilities, operations, engineering, consulting and architecture. Attendees worked with their table captains to categorize their Top 5 facility or program challenges that affect their built environment, into the following (represented by a bullseye chart at each table):

• Finance• Safety• Maintenance• Programs/therapy• Staff support

Challenges listed include:• Changing population• Budget process• Aging infrastructure• Space• Access to natural light• Technology - interjecting and updating• Liability• Wrongly specified materials for the environment - “sharp

edges”• Multi-level living• Institutional look• Maintenance lifts• Acoustics• Furniture• Codes lag behind design• ADA accessible• Access to music (patient’s music on their own device)• Staff safety and protection

p Tables list their challenges

u Panel discussion lead by: Daniel Horan, Cavanaugh Tocci; Tim Van Curen, Sherwin-Williams; and Marilyn Collins, ASSA ABLOY


Table 3 spoke about regulatory impacts, the disconnection between regulatory agencies and manufacturers, and the importance of patient/family/staff feedback.

Tables then prioritized challenges by indicating the most pressing at the center of the bullseye chart, working their way outward.

Speakers Daniel Horan (Cavanaugh Tocci), shared his personal experience and the impact of acoustics on human behavior. He discussed:

• Quiet does not always equal good. Most therapeutic sounds: nature, water, birds

• Acoustical challenges include: traffic noise, corridor noise, HVAC noise, alarms, vibration

• Visit www.fgiguidelines.org to submit ideas/concerns for the Facility Guidelines Institute (FGI) Acoustics in Healthcare Buildings 2018 Guidelines. Deadline to submit 10/15/15

• Reviewed a Harvard & Cavanaugh Tocci test program, sleep study and the effects of acoustics. Sleep was most interrupted by telephone and IV alarm noise. Jet and helicopter noise were the least – sounds that build in the background

t Mary Collins (ASSA ABLOY) and Nico Flannery-Pitcher (Lavallee Brensinger Architects) lead their groups’ discussion


Tim Van Curen (Sherwin-Williams), spoke about his experience working with hospitals and other healthcare environments. Concerns he encounters include:

• Hospital-acquired infections• Aging facilities• Renovating existing facilities

Sherwin-Williams’ product line:• Designed for active, working facilities• Reduce paint odors• Improve indoor air quality (reduced formaldehyde) • Offer colors for senior living, memory care, assisted living

– designed for the eye’s change in viewing colors

Marilyn Collins (ASSA ABLOY), discussed her experience in the door and hardware industry and that ASSA ABLOY has a product line that is designed specifically for use in behavioral health settings. They continue to develop product lines in response to the changing challenges faced by the behavioral health industry.

Interactive Panel DiscussionJoan Eagleson (Lavallee Brensinger Architects) asks speakers to name the Top Challenge(s) in their field as it relates to behavioral health:

• Daniel Horan (Cavanaugh Tocci): Budget, Space addressing acoustic issues is always a challenge due to budget and space

• Tim Van Curen (Sherwin-Williams): Durability in finishes• Marilyn Collins (ASSA ABLOY): door and its lock (2% of a

project’s budget, but 35% of the headache after-the-fact)• Kevin Gorman (Britplas): Budget – finding the true cost

(penny pinching at the start, costs more in the end)

A hospital attendee said staff retention is a top challenge.


Round-table Discussions – Session IITables 1 – 4 are assigned a specific patient type:

• Table 1 – Adolescent• Table 2 – Geropsychiatric• Table 3 – Child • Table 4 – High Acuity/Forensic

Tables review their original challenges and priorities represented on their bullseye chart, and make adjustments as it pertains to their newly assigned patient type. Speakers rotated between tables engaging in the discussion and challenging participants with questions.

Group Share/Discussions/Next StepsA representative from each table shared their top challenges based on their patient type:

Table 1 – Adolescent• Design for Mixed-Population• Activity Program (Indoor/Outdoor)• Connection to the Outside World (Technology+Physically)• Education Opportunities• Staff & Patient Safety

Table 2 – Geropsychiatric• Safety (ADA)• Space/Aesthetics• Staff• Planning/Finance• Medical Program (medications)


Table 3 – Child• Multiple Buildings/Spaces• Access to Outdoors• Family Space(s)• Flexible/Multi-purpose Space(s)• Meet Diversity Across Age Spectrum (5-12 years) from

Faculty/Space Perspective

Table 4 – High Acuity/Forensic • Safety vs. Dignity• Regulatory Constraints/Work-flow Efficiencies• Staffing Shortages• Flexibility of Plan• Access to Exterior Space

Top 5 common challenges identified, regardless of patient type• Outdoors• Flexibility• Staff• Regulatory Constraints• Budget

Next steps• Volunteers identified from the event will meet and address

these issues, formulate goals and devise an action plan. Next meeting scheduled for Thursday, November 5, 2015 at Lavallee Brensinger Architects in Manchester, NH.

• A survey was sent out to 42 attendees from the Safe Inpatient Therapeutic Environments Round-table Discussion. Overall guests enjoyed the speakers, the format and are excited for future meetings.

• Joan Eagleson (Lavallee Brensinger Architects) and a small group are meeting with Tym Rourke (NH Charitable Foundation) who’s connecting them with members of the state’s regulatory and financing agencies.

Thank you to our sponsorsHP Cummings, Cavanaugh Tocci Associates, ASSA ABLOY, Britplas, Sherwin-Williams, and the New Hampshire Charitable Foundation.


Several participants heeded our call to action and agreed to be core team members or to serve as a resource. We welcome the support of the following individuals:

Meghan Baston, Director of Behavioral Health, Elliot HospitalJennifer Conley, Director, Cypress Center MHCGMGerri Cote, Vice President of Operations, Brattleboro RetreatDaniel Horan, Senior Consultant, Cavanaugh TocciRick Levesque, Director of Support Services, Riverview Psychiatric CenterAmy Lynch, Rehabilitation Manager, Cambridge Health AllianceSarah Preston, Interior Designer, VA Manchester Healthcare SystemBill Rider, President & Ceo, The Mental Health Center Of Greater ManchesterJudy Rosenstreich, Senior Policy Advisor, Dept of Mental Health State of VTJasper Tolarba, Nursing Director, Tufts Medical Center

If you too want to join us in being part of the change please contact Joan Eagleson or Melissa Bruneau of Lavallee Brensinger Architects.

Thank you to all participants!

safe inpatient therapeutic environments · particular substance abuse treatment centers in nh that...

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