As healthcare institutions grapple with the opioid crisis, one increasingly important focus of their efforts to improve addiction treatment is applying innovative design concepts to both new and renovated treatment facilities.
One recent project in New York exemplifies these new approaches required for planning and designing rehabilitation and treatment facilities. Designed by Environments for Health (E4H) Architecture and completed in 2014, a new substance abuse treatment program outpatient clinic building includes:
- A methadone-dispensing clinic, maintenance program and therapy;
- An ambulatory primary-care clinic;
- A program for former users, as well as continuing-care therapy and treatment programs for neighborhood clients; and
- Staff and administrative offices.
Adjacent to a street with an elevated train line, the building has been designed to fit comfortably within the low-rise commercial streetscape. It is made of durable contemporary materials, including polished and rough masonry block, corrugated and smooth steel panels, glass curtain wall, and aluminum storefront components. Concrete Masonry Unit (CMU) rough-face finished block material was specifically chosen along the front façade at street level to aid in preventing graffiti. Its west-facing location open to the extra wide avenue and elevated train across the way, provides greater visibility to the outside and natural light to the interior spaces.
The front entry has a covered roof canopy that welcomes patients and protects them from inclement weather. A glazed finish at the stair tower on the north end provides color and highlights the building, from the street view. On upper portions of the street façade, corrugated metal panels alternate with triple-glazed strip windows whose sound insulation mitigates elevated train noise. A secure and lighted east facing façade and alarmed monitoring system control access to the building from the rear yard. The rear façade is unit masonry with punched windows to allow natural light into the offices and consult areas.
The program space is open-concept and designed to be welcoming and inclusive, with smooth traffic flow to service areas. Most of the ground level space consists of the treatment clinic and primary-care clinic. With direct access to a supervised main entry lobby, the clinic comprises a waiting room, dispensing area with bays, and security station. Windows where patients collect medication are designed to be secure yet approachable. Instead of bars or grills, unbreakable polycarbonate with clear glazing is used, with a four-by-six-inch pass-through slot. Staff wear pendants embedded with panic buttons for added security.
Also on the ground floor, for the added convenience of addiction-treatment patients, is a primary-care clinic. It is located in a separate but interconnected suite with its own waiting room. Primary care spaces include exam rooms, group therapy and counseling rooms, and staff offices.
The second floor is comprised of more consultation rooms, conference rooms, and group therapy spaces. Because patients often come with multiple family members, the clinic provides a children’s play area and additional family-member waiting facilities. The third floor is comprised of administrative offices and additional consult rooms. Both upper floors have a satellite security desk station and are monitored by cameras. Guards make regular rounds through the corridors to ensure staff and visitor safety.
The interior of the building is finished with modest, practical and durable materials, such as vinyl composition tile flooring and vinyl base in most spaces and ceramic tile floors and base in bathrooms. Administrative offices have carpeting for both warmth and sound management. Elevator lobbies and reception areas use porcelain tile for more durable flooring as well as protective wall finishes. The clinic uses a bright, cheery color palette for accents, with different colors on each floor. These pops of paint color are used as a tool for wayfinding and allow for easy and economical updates.
Natural light has been shown to aid healing, so all upstairs consult rooms are located along the exterior and have windows. Vision panels along the building’s perimeter rooms bring natural light into the center’s corridors and make spaces less gloomy and institutional. Aluminum and glass storefronts allow natural daylight to penetrate the space, including waiting rooms. All offices have clear glass sidelights next to their doors to invite ambient natural light from both the front and back of the building. This creates a sense of openness between offices and corridors allowing the natural light to brighten the area as well as staff morale. The sidelights also assist with security by allowing for visibility into each office as guards regularly walk and observe the floors.
Hospitals that incorporate these design considerations underscore their commitment to serving local communities in need by finding the funding to preserve and upgrade older buildings, as well as constructing new state-of-the-art healing facilities from the ground up. Throughout the design process, the guiding principle was putting patients first – no matter their illness or treatment – and supporting their journey to recovery. Likewise, there was a clear objective to make sure clinic staff also benefitted from the design, to best support the important work they are doing in the community.
Susan Romano, AIA, is an associate partner at E4H Environments for Health Architecture.