Healthcare Design - June/July 2020 - 29

However, the tight urban site and extensive
program would require building up as opposed
to out-but it helped achieve something else, too.
"Its largeness is an attribute that really does demarginalize and destigmatize mental health care
and create a flagship for this kind of care that gives
it the visual prominence on campus that it deserves. Its positioning, its size, and its shape were
a big part of those [site] studies," Hullinger says.
However, that didn't mean the design team
wasn't challenged to make such a large building
work on such a constrained space. Frank Pitts,
principal of Architecture+ (Troy, N.Y.), says that
traditional approaches to mental health-lowrise, residential scale-generally deliver a lot
of small rooms that all have light and views and
don't "pack into small boxes particularly well,"
requiring some creative thinking for this project to achieve the same amount of nature and
daylight. "We were convinced the site was the
right place to put it and collectively worked our
butts off to find a form factor that allowed us to
be there," he says.
The solution was a basic podium building
with a nursing tower built atop it, with an outdoor deck level planned at the middle of the
podium as a void that the inpatient units (built
to house 48 beds) could be wrapped around to
achieve goals for light and views. The top of the
podium allows for two large courtyards, while
an additional rooftop gym and outdoor play
deck as well as screened-in porches on each
inpatient unit together answer needs for access to the outdoors. "All of those things were
really about upending the conventional thinking about the shape and form of mental health
care and doing it in a fundamentally different
way that allowed us to work in this urban environment," Hullinger says.

I N T R I C AT E D E TA I L I N G

Beyond the site itself, an immense amount of research was conducted by Nationwide Children's
on the front end of the project, garnering knowledge of what other providers across the country
were doing and conducting site visits. Additionally, the organization, which had opened its first
behavioral health inpatient unit in 2014, recognized it had a wide range of knowledge available
from its own staff, as well. To ensure that expertise was applied to the new building, the design
team implemented an extensive mock-up process, including three patient room models that
evolved from cardboard to drywall and finishes
to ensure the details were right.
The specifics explored were as intricate as the

This living room and
quiet nook are typical
elements found within
the pavilion's psychiatric inpatient neighborhoods.

joinery on millwork and casework to embed safety in the componentry-
for example, concealing fasteners and hinges and the easing or rounding
of edges and corners were important to the mitigation of self-harm risks,
says Edwin Beltran, principal at NBBJ (Columbus). Durability and maintenance issues were considered, as well. "One example is making sure
that patient beds were durable. To that end, our team studied and eventually specified a stacked plywood finish that, if scratched or dented, helps to
visually camouflage the wear and tear. It is a very resilient solution," Beltran says. Flooring, too, was addressed, with a sheet flooring product chosen that allowed the team to continue the design language found in other
buildings on campus but was installed using a seaming strategy that enables repairs within hours and without shutting down a unit-a priority for
the project. Even the wall base was carefully analyzed to ensure it couldn't
be torn off or create a sharp edge that might physically harm someone.
Another element weighed in the mock-up phase was corridor width.
Simulations that considered the scenario of patients lashing out or potentially hurting themselves found that a traditional 6-foot hallway was
dangerous because someone could be thrown against the wall, whereas an
8-foot width allowed enough clearance to avoid that-even if more costly,
McClimon says. "Adding those two extra feet was really important to staff
safety," she says.
As staff as well as family members, program graduates, and community
members toured the mock-ups to further refine the design, "we quickly realized we had a lot of safety issues dealt with, and the tweaking of the mockups really went to look and feel," says Ed Cheshire, senior project manager
in engineering at Nationwide Children's. "We knew what would impact behavior. So how do you make a space really welcoming, engaging, and comfortable?" One way the design team worked to answer that was by moving
away from corrections-based safety products to achieve a sense of normalcy in furniture and finishes. "I think it's a point of view or a cast of mind,
that you walk into it thinking safety-but with every time you say 'safety'
you also say 'normative, familiar, fun' and you try to have those qualities
also be part of the safety," Pitts says.
Innovative lighting systems were used, as well, including in the inpatient bathrooms. "These bring a touch of supportive normalcy and dignity through flattering lighting helping to boost the self-image of adolescents dealing with self-esteem issues," Beltran says. Additionally, "in the
inpatient rooms, color-changing ambient lighting fixtures provide a therapeutic positive distraction intended to reduce anxiety and de-escalate
aggressive behaviors. Touch-activated reading light sconces add a safe,

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Healthcare Design - June/July 2020

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