Cincinnati Children’s, William K. Schubert, M.D. Mental Health Center, Cincinnati
More than two decades ago, Cincinnati Children’s Hospital Medical Center opened an extended hospitalization treatment program for children and adolescents needing mental health care in Cincinnati’s College Hill neighborhood.
The 94,000-square-foot facility was housed in a repurposed 1970s-era adult psychiatric building, which became a growing challenge over time. Limited space for therapy, outdated semi-private rooms, and insufficient staff resources hindered the behavioral health facility’s ability to meet evolving care delivery models and patient needs.
“The building was an obstacle to delivering care the way we wanted to,” says Dr. Joseph Luria, vice president of mental health operations at Cincinnati Children’s Hospital Medical Center.
Furthermore, the building’s cruciform shape with mechanical and building infrastructure in the middle and patient wings extending out from this central space meant there was little separation between front- and back-of-house services on the inpatient floors.
“The only way to get on and off the unit was through patient care areas,” which would cause distractions for the patients, says Angela Mazzi, principal at GBBN Architects (Cincinnati) and senior medical planner on the project. Furthermore, the small staff break rooms lacked windows and doubled as consult rooms. “They just didn’t have the spaces they needed,” she says.
To help Cincinnati Children’s consider its options on whether to remain in place or build a new facility, the architecture and interior design firm developed nine scenarios, from gutting and renovating single floors to demolishing entire wings and constructing a new addition. However, none fully addressed the existing delivery of care issues or met the organization’s future goals to transition to all private rooms, with expanded milieu and additional resources and amenity spaces for families and staff.
After reviewing its options, Cincinnati Children’s decided the best path forward was to construct a new purpose-built facility. In 2020, the organization received a $30 million donation from the Convalescent Hospital Fund for Children (Cincinnati), which helped push the project forward, putting the pediatric health system’s behavioral health services on a new path.
Cincinnati Children’s rethinks milieu in behavioral health care
As part of its behavioral health program, Cincinnati Children’s assigns patients to an inpatient unit by age, rather than other attributes, such as gender, sex, or disease, which results is a mix of patients and therapy needs in each unit. As planning and design for its new building kicked off, Cincinnati Children’s began taking steps to introduce a new care model that would group patients into smaller, unit-independent treatment cohorts, allowing caregivers to better tailor treatment to specific needs.
In tandem with this shift, the design team focused on increasing the number and diversity of milieu in the new facility where patients would receive therapy. In the previous location, milieu comprised a single day room, limiting program offerings as well as reducing patients’ ability to move and experience changes in scenery throughout the day, which can lead to boredom, frustration, and rises in aggressive behaviors.
At the new building, the design team introduced three tiers of milieu: unit based (day room and group rooms), shared milieu (dining and gross motor areas), and building milieu (gymnasium, outdoor spaces, chapel, and art room).
Cohorts move to these different spaces throughout the day, much like being in school and changing classes, Mazzi explains. Additionally, the variety of space types provides patients with more choice between stimulating and calming areas while helping decrease social density within these spaces, which can help reduce patient aggression.
Mazzi says research from the study “Psychiatric Ward Design Can Reduce Aggressive Behavior,” by Roger S. Ulrich, Lennart Bogren, Stuart K. Gardiner, Stefan Lundin, published in 2018 in the Journal of Environmental Psychology, recommends a unit social density of less than 0.5 patients per room.
“The goal is to have fewer patients than rooms available to those patients,” Mazzi explains. “With the tiers of milieu available to patients, we are much below that 0.5 at College Hill.” The benefits of this new approach, she adds, include a reduction in the use of restraints/seclusion and staff injuries, as well as an increase in program time and decrease in employee turnover.
Expanding care at William K. Schubert, M.D. Mental Health Center
Completed in fall 2023, the 160,000-square-foot William K. Schubert, M.D. Mental Health Center is 68 percent larger than the previous facility. Circulation within the 5-story building is designed to separate different patient types, including outpatient, inpatient (83 private beds), and neurobehavioral, as well as staff and family flows.
Inpatient floors on levels 3-5 comprise two 15-bed units that extend off a central core, which houses a lobby, family respite room, and onstage staff area. An enclosed bridge that connects the two units houses more milieu, increasing access to shared programming space for patients without having to exit to public areas.
Cincinnati Children’s sets the tone for its new care experience from the moment patients arrive on campus. Erin Schmidt, associate at GBBN and lead interior designer on the project, says the project team created the concept of a “cozy blanket” metaphor, expressed through curvilinear forms, building materiality, and architectural features such as rounded corridors and cozy seating nooks built into the walls, which communicates the idea that “this is a place to come where you’re cared for, where you’re protected.”
In the foyer, a large oculus and tall, angled ceiling planes help create a sense of “lift to the arrival,” while guiding visitors into the lobby and entry, says Aaron Anderson, principal and market design leader—healthcare at GBBN and lead project designer. “It’s meant to evoke a sense of shelter and softness that helps lower defenses,” he says. “At the same time, it conjures an imaginative sense of wonder.”
Connecting to the outdoors for better health outcomes
Views to nature was a driver on the project to reduce the sense of isolation, says Project Lead Scott Vidourek, principal at GBBN.
“The building form allows more spaces to be located on the exterior, taking advantage of daylight and views,” he says. For example, patient rooms, milieu, and staff lounges on the inpatient units are situated to take advantage of views and daylight. Those spaces not on exterior walls, such as dining and recreation, incorporate borrowed light through floor-to-ceiling windows to allow a sense of light and time of day while providing privacy to the rooms.
Recognizing that many patients may return multiple times for treatment, the project team was mindful to balance a sense of familiarity with moments of continued discovery.
On the exterior façade, dichroic glass fins are designed to create a feeling of transparency and invite curiosity and interest through a sense of texture and interplay of light throughout the seasons. Inside, dichroic materials and artwork, such as images of a caterpillar becoming a butterfly or a pinecone sprouting into a tree, reinforce a message of “evolution” and “potential.”
“The journey through a mental health crisis is deeply personal, and we wanted to create something that patients wouldn’t feel resistant to returning to—if and when they need to,” Anderson says.
Rethinking intake process in behavioral health design
In addition to approaching the building as a therapy tool, the project team also took the opportunity to elevate behavioral health design, starting with the intake department. In the former facility, patients arriving by transport would enter through a back door and be moved directly to an inpatient unit, where the admission process would be conducted in the dayroom or other semiprivate space.
“It was disruptive to the unit and not a good transition for that new patient coming in,” Mazzi says.
The new facility houses a dedicated intake area on the first floor, which includes an ambulance sally port that protects from elopement as well as a private entrance for parents that includes landscaping and wood materials to create a sense of dignity and respect. Arriving patients are moved to private exam or family consult rooms, giving space and time for patients and families to transition to the setting.
“So when they arrive on the [inpatient] unit, they’re ready to be shown to their room and get situated,” Mazzi says. “And it gives parents the opportunity to come in and get comfortable with how their child is going to be brought through the system and the treatment plan.”
Supporting families, staff in behavioral health care
To further increase parent’s involvement in their child’s treatment planning and therapy, each floor houses dedicated family respite areas and consultation rooms where staff can talk privately with families and patients, while benches in the patient rooms can be used for parents and families to stay overnight.
For patients, the bedrooms are designed to promote autonomy and self-efficacy by incorporating lighting controls, televisions that provide a sense of home and can be used as incentives during therapy, and chalkboard paints within and outside each room, where patients are encouraged to express their individuality.
“We’ve heard feedback from the staff that patients write notes, share inspiring quotes, and draw on the chalkboard,” Mazzi notes.
Building flexibility for future care needs
Since opening, the William K. Schubert, M.D. Mental Health Center has served more than 1,600 unique patients across its program, while the building design is proving to be supportive to evolving care approaches and patient needs. For example, Cincinnati Children’s recently introduced a first-of-its-kind pediatric mental health extended stay program to address a rise in patients experiencing prolonged stays as they await placement in foster care.
“That was not something that was planned during design; it was a pivot they made once they opened,” Mazzi says. “But because all of the units have the private rooms, and there’s such a variety of milieu space, they really can make those kinds of decisions and flex who’s in the units and how they’re used.”
Adds Schmidt, “This is a building for everyone; this is not something that’s necessarily meant to treat one thing. It’s really meant to hopefully shift your perspective on behavioral health.”
William K. Schubert, M.D. Mental Health Center project details
Location: Cincinnati
Completion date: August 2023
Owner: Cincinnati Children’s Hospital Medical Center
Total building area: 160,000 sq. ft.
Total construction cost: Not disclosed
Cost/sq. ft.: Not disclosed
Architect: GBBN
Interior designer: GBBN
General contractor: Messer Construction
Wayfinding, art, signage and graphics: Kolar Design
Architectural support: WA Architects
Engineers: Schaefer & JCA (structural), CMTA (MEP), Bayer Becker (civil), KFI (process controls)
Lighting: AEI & Pivotal
Landscape: The Kleingers Group
Medical equipment: Walsh Consulting Group
Furniture: RCF Group
Ceiling/wall systems: Armstrong Ceilings, USG Ceilings, Sherwin Williams, Mosa USA, Clayhaus Modern Tile, Daltile, Oceanside Glass Tile
Fabric/textiles: Architex, Arc Com, Anzea, C.F. Stinson, Carnegie Fabrics, Designtex, Maharam, Mayer Fabrics
Furniture: Haworth, Krug, Norix, Keilhauer, Leland, Berco, Erg, Integra, Pineapple Contracts, Arcadia, Weiland, Kwalu, Intensa, Stance, Humanscale, Mockett, Versteel, TableEx, Global Industrial Equipment, Market Lab, Silentia, Max Secure, Wilsonart
Surfaces—solid/other: Corian, Wilsonart, 3-Form, Pionite, Silestone, Mecho Shade, Inpro
Project details are provided by the design team and not vetted by Healthcare Design.
Anne DiNardo is editor-in-chief of Healthcare Design and can be reached at [email protected].
