Trauma Informed Design for Behavioral Health – part 3

Inclusive Designers Podcast
Trauma Informed Design for Behavioral Health - part 3
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  • By: Janet Roche & Carolyn Robbins
  • Co-Hosted By: Janet Roche & Dr. J. Davis Harte
  • Edited by: Andrew Parrella
  • Guest: Meredith Banasiak
  • Photo Credit: Caleb Tkach AIAP

This just in… new changes are coming for those who create spaces for Behavioral Health. Combining the scientific knowledge from Neuroscience and the research evidence from Trauma-Informed Design is opening up new ways to optimize health, performance and access.

IDP is excited to share this 3-part series with Meredith Banasiak that explores the transformational shift in design towards an evidence-based, person-centered culture. She shares her insights for designing for behavioral health projects, from family clinics to eating disorder facilities.

Part 1- Meredith’s story; sensory issues; and the concept of a ‘Shared Experience’

Part 2- The stigma of mental health; Solutions using Trauma-Informed Design for Behavioral Health Facilities.

• Part 3- Social Determinants of Health; improving access to healthcare; designing for eating disorders facilities; and a new way to look at Post Occupancy Evaluations (POE)

Guest: Meredith Banasiak, EDAC, Dir. of Research, Boulder Associates; LinkedIn; Twitter

– References:

Academy of Neuroscience for Architecture, ANFA

American Institute of Architects, AIA

Basic Science of Light / Color

Boulder Associates

Boulder Community Health- Della Cava

Boulder Community Health- Tunable Lighting

BeWell

Biophilia

“Bridging the Gap” (Healthcare Design Magazine article)

Clinica Family Health

Eating Recovery Center

 Colin Ellard – Cognitive Neuroscientist

Evidence Based Design, EBD

Flexsim Simulations

GoInvo-Social Determinants model

HIPAA: Health Insurance Portablitiy and Accountability Act 

Lifting the Gaze – How to focus to Change Your Brain

Nationwide Children’s Hospital, Big Lots Behavioral Health Pavilion

Adverse Risk in Playgrounds

SAMHSA: Substance Abuse and Mental Health Administration

Seattle Children’s Hospital, Psychiatry and Behavioral Medicine Unit

Mardelle McCuskey Shepley, BA, M.Arch, MA, D.Arch, EDAC

Trauma-informed Design, TiD

• Roger Ulrich Study

USC Santa Barbara ‘Dormzilla’ (Construction Dive article)

 

Transcript:

Trauma Informed Design for Behavioral Health- part 3
Guests: Meredith Banasiak / J. Davis Harte

(Music – open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(music up, then lower)

Intro

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: And I am your moderator, Carolyn Robbins.

Janet: We have a really great show for you today, we are taking a look at how to improve the standard of care in behavioral health using a trauma-informed design approach. And for this important discussion, we are talking to the amazing Meredith Banasiak.

Carolyn: Let me tell you a little bit more about Meredith… she is a Fellow with the Centre for Conscious Design; maintains an advisory role with the Academy of Neuroscience for Architecture. She has published in psychology, medicine, and architectural research journals and books. And now she is here to share her passion for research and evidence-based design with us today.

Janet: And to make it even more special we have asked Davis Harte, or as I refer to her as Dr Harte, to be my co-host. Together we have co-founded the Trauma Informed Design Society and will be adding our insight from that to this discussion.

Meredith has done some incredible work on sensory issues and designing for human health along with Trauma-informed Design, to foster inclusivity and a healthier environment.

Carolyn: There is so much to explore here, that we’ve decided to make this a 3-part series. You can listen straight-through or choose to hear each section separately, let’s call it ala carte.

Janet: In this section, we will look at how nuanced or specialty behavioral health facilities are emerging to treat specific behavioral health conditions. The question becomes: How do we design for these new models of care?

Meredith will walk us through the research and how new technologies were used in the design of a dedicated eating disorders facility that she personally worked on. I really find that story so fascinating, I think you will too.

Carolyn: And of course, if you want to know more about any of the places or studies mentioned, we’ll have a really rich list of resources for you on our website: InclusiveDesigners.com.

Janet: Carolyn, I think we’ve covered all that needs to be said here up front, so I guess we should just start the show now, don’t you?

Carolyn: Agreed. Without further ado, here is our thought-provoking look at combining neuroscience with evidence-based design, with insights from Janet, Meredith Banasiak and Davis Harte …

(music)

Interview- Overview

Janet: Hi, and welcome to Inclusive Designers. I am your host, Janet Roche. And today, we’ve got a special guest host. You’ve seen her before on this show, Davis Harte. And today we’re going to be interviewing Meredith Banasiak. Welcome Meredith. Welcome Davis. How’s everybody doing today?

Davis: Great. Thanks Janet. It’s wonderful to be here…

Meredith: yeah, it’s great to be here.

Janet: Thank you for coming.

Interview- Section 3

Janet: So Meredith, how is behavioral health being integrated into healthcare?

Meredith: Okay. So we’re seeing kind of a move from healthcare systems, changing their care practices. And then in turn, we’re kind of changing the design of clinics and facilities to better support those models of care. So the move to include behavioral health in healthcare generally really comes from healthcare systems who recognize the totality of factors impacting health beyond just medical care or clinical care.

And here I’m really talking about the social determinants of health kind of model here which just includes all the non-medical factors that influence health outcomes. So, addressing those other factors is really fundamental for improving health; reducing inequities in health; and even increasing access to medical care, which is kind of what we consider when we think about healthcare, we only consider that realm.

But if you look at one of the models by ‘Go Invo Boston’, they have a social determinants of health model and their data suggests that only 11-percent of health is attributed to medical care. And the other 89-percent is these other things, like your social circumstances, your individual behaviors. And those are usually not very separate from each other. (J: hmm).

So, for example, your income or your employment status or unemployment status can very much influence your individual behaviors— your sleep patterns; your stress levels; your substance use. And those in turn will manifest in health outcomes and, you know, diabetes or what are considered deaths of despair, which include like suicide or substance related deaths. And those are largely preventable deaths. So, we have to kind of address all those other 89-percent of health factors if we’re really interested in working for a more healthy population.

So, the more innovative healthcare systems— and these tend to be, like community health centers who are working with populations that have more inequities and disparities and health inequities— they’re able to sort of see that totality of factors influencing health and really connect the dots between the way they’re delivering medical care. and then also, providing opportunities for nutrition, or housing, or behavioral health. (J: right).

And one of our clients that we’ve done some community health centers for is ‘Clinica Family Health’. They’re in Colorado. And they were one of the pioneers to sort of introduce integrated or team-based care into their practice. So, team-based care includes your traditional kind of family doc or primary care provider, but then also on the team are a behavioral health provider; a dietician; someone from dental, like a dental hygienist; a case manager. And they all work together in the same shared clinic team space. So they can support the range of patient needs.

In these community health centers, they also have co-located services that can provide housing assistance or nutrition assistance like WIC. So these co-located services, this team-based care model, can really increase access to care for patients who have these diverse needs. So, they’re also really innovative in thinking how to design for supporting this new model of care. They introduced group visits to create support systems for like diabetes management and that sort of thing.

They, before the pandemic, were doing car care. So they were administering flu shots. So kind of the whole family gets in the car. These often happen on weekends or after hours, you know, because that’s another problem with access to care. And sort of drive up and everyone gets their flu shot. It’s really easy. It’s also easier for children, so, right. I don’t know if you’ve had the experience of taking a young one— yes, okay Davis, yes— for their vaccine recently or a flu shot, but transitioning from the car into, for me, we had to go into this clinic, into the basement. It just was an opportunity for anxiety to build up and fears to build up.

So, there’s lots of innovative things that they’ve introduced, and they’re very nimble. They’re quick to change. So, they don’t have that kind of risk aversion, like a lot of other kind of healthcare organizations have. They’re very nimble in order to support the needs of the community and deliver the best care and get healthy outcomes.

Janet: Right. Yeah, I talked to somebody who has a child who has autism and she uses the parking spots. They’re labeled for handicap, and lot of people have yelled at her (M: oh), because she’s not in a wheelchair. How dare she use the handicap placard or handicap parking spot.

And I bring this up because it takes heaven and earth to move her non-verbal kid who has autism from the car, just to the, you know, go into the supermarket just to pick up whatever it is that they need to pick up. (M: yeah). And so, yeah, the thought of like, maybe you’re getting a shot, like people have aversions to getting shots and they get freaked out by all this, and then it’s just another layer.

So to be that kind of nimble and to be able to make things easy, go figure, right. To make them a little bit easier to make them a little bit more accessible, a little less stressful. Pretty great.

Meredith: Yeah. So, in that example where behavioral health and medical care and those other services I mentioned are coming together. We’re also seeing campuses specific to addressing behavioral health come about. There’s a great group in California called ‘Be Well’, that we’ve designed two projects for and so they’re bringing together behavioral health services to address again, the continuity of care from crisis, all the way to management and prevention.

They also include transitional housing. In this case, it’s in the same building. In another project it’s on the same campus, so that they can support patients and clients at every step of the journey. And that’s, that’s usually not a linear journey. It’s a lot of, kind of back and forth, but they can support them at any stage that they’re at. (J: Right).

One of the design challenges with those campuses— so it’s, it’s great to have all these things co-located to support access and continuity of care— but I think one of the things we learned is that you have to have these strategic separations. So for someone who’s coming in in crisis or in need of detox services, you know, how do you support their transition into the center in a way that supports dignity and offers privacy and anonymity, and also doesn’t sort of frighten people who are coming in for just an outpatient. (J: Right). Yeah.

Janet:  It’s, it’s interesting. I was just going to say what were your challenges? Because you know, you’re bringing a lot of different services. I’m sure when you do all the initial interviews and stuff like that, I’m sure you have a list that’s at least an arm’s length of wishes and needs and have to’s. And, do you spend a lot of time trying to connect the dots? Or do things fit together somehow naturally? What’s your process? I guess.

Meredith: (Laughs). Oh…

Janet: How long do we have?

Meredith: laughs.

Janet: (Laughs). Is it one of those, okay. It was a loaded question, but if you can break it down. I mean, because as designers, right, even in the best circumstances, you usually get like a wish list, right? (M: sure). I mean, you get some sort of something like, this is what we would really like to have, and some of the things they might not have even thought of. (M: yeah).

But when you’re dealing with so many different components, yet although trying to provide the same service for the same individual, (M: yeah). How does that work? Like any tips or I guess maybe that’s a better way to look at it at the moment… (M: yeah). We can have Meredith come back for a whole new series just on her methodology.

Meredith: Absolutely. I’d love to, um, so. Oh, gosh.

So first I’ll just say like, these projects are my favorite because they’re new models of care. And so they’re new building typologies. We don’t have precedents that we can turn to. And so we get to be really innovative, which is fun. And so kind of to your point of like, well, where do you start?

So sort of from the human factors perspective, we embrace evidence-based design processes, but we also include experience-based design. And this goes back to a point Davis was making about that lived experience and the importance of lived experience and cultivating empathy.

So I don’t have a prescriptive approach, but I do like to sort of start with the experience which recognizes, you know, that every person’s experience is a very valuable data point. Which is different than evidence-based design, which is like, you know, we need robust evidence and large sample sizes in order to sort of show this as true. And experienced design is like, no, every person’s experience is, is a very valuable data point that we need to consider.

So I like to start with that. I like to sort of start with the stories. And for behavioral health, this can be challenging because their behavioral health patients are considered a protected class. They’re a vulnerable population. And if you’re working with, you know, pediatric behavioral health, they’re kind of twice protected, so it can be really, really challenging.

So some of the ways we’ve sort of gathered their experience is by, accessing family advisory groups that are attached to the organization. So if we can’t go to the children, we can ask their parents and their caregivers to share their experience. Or if they’re adults, we can ask past former patient volunteers who give their time and share their experience in these advisory groups to participate.

I like to do whenever possible sort of walking interviews where you’re walking, and talking because there’s, I don’t know if this is the right use of the word, but there’s like this artifactual memory, or sort of like seeing different artifacts that triggers like ‘oh, you know…’

Janet: ‘oh, that’s right, oh by the way, can you do something with this?’ Right, exactly.

Meredith: Yeah. So we do a lot of that with staff, kind of these walking interviews with staff to talk about what’s working or what’s challenging in certain environments.

So I like to start with kind of that experience. And right away, I think we kind of learn, you know, what’s important, such as, you know: dignity; or reducing stigma; protecting privacy; giving control. Those things kind of bubble up right away and help create targets or goals.

And then we can issue things like surveys to get kind of that larger sample size. But now at least we know the questions to ask from kind of having those stories and learned those experiences.

Janet: Right, yeah. Davis?

Davis: I love talking methods to an ethic approval. Ah, yes, it’s a tricky, it’s a tricky thing to get access to people who are so-called vulnerable, because they’re the ones that we need to study the most. (M: Yeah).

And I love hearing about the walking interviews. It reminded me right away of a different time frame, but a similar approach perhaps, is video reflexive ethnography. (M: hmm). So that’s the work that I was involved with, videotaping an experience, something occurring, and then watching that video with the participants themselves.

And while they’re watching their own selves, they’re recognizing all that was going on, on a subconscious level that they’re now aware of now that they’re sitting and viewing it and having a chance to pause it, and interview and ask what’s coming to the surface for them.

Meredith: Oh, wow. I love that.

Davis: it’s so interesting.

Janet: That’s a great example Davis, right, because that might be something that could, you know it’s technology.

Davis: But another thought I had around getting somebody who you don’t have access to. So we want to design for particular folks and they’re not, we can’t approach them, we can’t talk to them because of privacy concerns and their vulnerable status. (J: Right). So this is where being creative and imaginative and knowing how to be, you know, like having more actors and actresses come into the design world would be amazing because they can become and personify other people role playing.

I did a lot of work when I worked at— and there’s a podcast episode from early on of me speaking about the ABC House— where I worked with folks to design an abuse intervention center. And I wasn’t, I had no intention to talk to any of the people who would be coming to that space, aside from the staff and the clients.

And there, we didn’t have advisory groups like Meredith does, but that would be fruitful. And we, I think we were doing it ad hoc. We were pulling that together and I was finding my nearest children and saying, would you mind coming with me and just giving me your opinion about how this is going to look, because I needed it from your perspective and your angle. And I would put myself on my knees and get to that height so I could see what people are seeing. (M: hmm). So, it’s just fascinating, fascinating work. (J: Yeah).

Meredith: Yeah. What you just described, it, we call those empathetic observations. So the scenario I’m thinking of, we were designing this eating recovery center. It was what they call their spa bath. So it’s the space where patients with eating disorders get ready in the morning. So they shower, they brush their teeth, they get ready, but it’s also where they have weight check-ins and vital check-ins in the morning. So, they’re in a very vulnerable state and it would never be appropriate for us to kind of go and observe this in real life.

So I played the role of a patient, just so we could document the processes in the spaces and really get an understanding— not to say that I would ever understand what it’s like to be a person with an eating disorder or to sort of be in this inpatient eating recovery center— but reenacting the processes they were going through in the morning. And then there was another researcher with me who was kind of writing everything down and doing spaghetti diagrams and that sort of thing, really helped us with some process improvement for the space and then ultimately the design of the space as well.

Janet: Yeah. I think that this is a really fascinating part that you did in your methodology for this particular type of a vulnerable group. And it’s probably one of the more challenging populations to design for and your methodology to go through all of that. And to Davis’ point, you’re putting in sort of an actor into that role, because you’re also trying to have some sort of privacy for those that go through it.

At some point I have gone and taken my students around and I have them in wheelchairs or I have them sort of blindfolded. There’s definitely like you even said, I’m not trying to pretend to know what it’s like to go through it, but, but there’s certain things that I think you can get out of that.

And I guess my, my question is… Did you have an ‘aha’ moment when you were walking through and you were doing your own acting role within this? Did you think it was a good thing to do it that way, I mean obviously we would like to have those that go through it but is there something else that you would have preferred? Did it work?

I guess I have a hundred questions, so I don’t know which ones to ask first, (M: laughs). I think that that’s what it comes down to. So if you want to expand a little bit more on, on your experience with that, that would be great…

Meredith: Sure, sure, sure. So, there’s not like a prescriptive sort of methods I roll out for every project, it’s really kind of matching the right tools and techniques to whatever it is we’re trying to address. For that particular space, there was an issue of sort of, of waiting in line in order to have weight and vitals checked. And these patients are in a really vulnerable state they’re sort of in a gown, besides just the ‘waiting is waste’ sort of thing.

And so our objective was, you know, how do we get rid of that waiting experience, and then also just create sort of more dignity around what’s happening during their morning routine. So the empathetic observation was one piece to really capture the processes. And there were some also, some things that I experienced just, different proximity to other people, that felt very uncomfortable, again, when I was in that vulnerable state and I did put on the gown and all of that.

Janet: Wow. So you really are a method actor, as they would say. So it’s sort of like what we do with my students. Right.

Meredith: Yeah. So right, even though I don’t have that eating disorder, there were still environmental elements that I was very hyper aware of, that I would imagine sort of would translate. So we can check our assumptions on that by issuing a patient survey, which we did to former patients. They have a whole alumni group of volunteers who took the survey and did respond to some of the assumptions that I had so that those were validated in the survey.

The other thing we did is we did some simulation testing using a digital software program called ‘FlexSim’, which you can set up the architecture, you know, floor plan or a 3d model. And then if you have the processes correct, and sort of timestamped, you can actually run these fake patients through and understand sort of where the bottlenecks are.

And then, you know, you can figure out, do I need to add another staff member? Is this an operational thing? Do I need to cut out one of the process steps? Or is it a design thing? Do I need to add another shower? Do I need to add another exam room? And so you can quickly change these different variables and then run patients through as a simulation and see if wait time is reduced, if sort of the bottlenecks go away.

I think that testing during design is really, really important, so we’re not waiting until the project’s built, and we can’t do anything about it. (J: about it, Right). Yeah.

Janet: Yeah. That’s an important piece. So, yeah, but I just think it was such an interesting project that you did and I think there was probably more challenges than other projects. Did I understand that correctly?

Meredith: So again, this is kind of one of those new ways of delivering care, so kind of specific to an eating disorder population. Even though anorexia is the most— gosh, I feel like I need to get my words correct— but I want to say anorexia is the most fatal psychiatric disorder. There’s not a lot of funding to support treatment. It’s getting better, like they’re passing legislation to recognize it as a disorder and then sort of provide insurance treatment. But historically it’s been really difficult. (J: right). So without the insurance to sort of fund treatment, there haven’t been facilities to have the treatment, which is, I mean, it’s sort of mind-blowing.

Sometimes these patients go into traditional behavioral health care settings, but eating disorders are really different. And the what the patients are experiencing and their treatment programs are very, very different from sort of, (J: just like, alcoholism…) sure, yeah. Any of those sorts of things. (J: right) And so, again, this is an opportunity with the rise of these eating recovery centers, which are now all over the country to say, well, what is the right design to support the care that they’re giving.

One of the things that came up was proxemics, comfortable proxemics. So sort of part of eating disorders diagnosis is a misperception of your body, the kind of the space your body is taking up. And related to that, sort of a misjudgment of maybe body to body distances; or body to wall distance; or body to furniture distance. That perception is off, that judgment is sort of off.

So like in the dining area, which is a really stressful part of treatment, you know, we heard from the patients that they felt cramped or crowded. And so we created smaller dining cafes, so there weren’t as many patients in the dining space together. And then we created— and I forget what sort of the recommendation is between, diner to diner— but we almost doubled that to give them more space and more comfortable proxemics there.

Janet: I mean, I find that fascinating you know, that there’s some sort of body dysmorphic anyways, but that they are also reading the built environment incorrectly in terms of their body. Am I understanding that correctly? (M: yeah).

And then I start to wonder who, those others, like psychological issues that I think would probably also have that same sort of thought processes— like maybe people who have schizophrenia— in terms of themselves versus the built environment. (M: hmm). But in terms of eating disorders, I mean that’s pretty incredible. And I’ve got to think that there’s, I mean, we talk about it anyways, right, to a certain degree, but this is, I feel like it’s more tangible and more understandable.

Davis:  It might even be more or, or even less than the thought process, because that’s putting it on the individual that they’re thinking or not thinking correctly, but really what we’re talking about is it is a circuitry… (J: misfire), you know, neural connection (J: right), that, uh that can be altered. And once the chemistry of the body is, is shifting. And in addition to the thinking training along with the, you know, the spaces is therapeutically supporting that process. Right?

Meredith: Yeah, absolutely. Right. And another thing with persons with eating disorder is they have dis-regulated circadian rhythms because eating and regular meals is a regulator of our circadian system.

So, you know, I think that’s where daylight becomes really, really important in their recovery process as we’re, you know, trying to retrain the circadian systems. And that’s hard for behavioral health because by code you’re required to have patient rooms have windows and that’s a code requirement. But often patients aren’t using their rooms during the day. So all of the spaces that could have daylight are often kind of moved to the core. and that’s just, that’s not good for their, their recovery process.

Janet: You learn something new every day, Meredith. (M: laughs). That’s an interesting point, but it’s, it’s a really good point, right? I mean, you don’t spend all that time and if you do it’s mostly at night.

Well, there’s that, ah I’m not going to remember the name. They just did a whole thing. Some very wealthy donor gave a lot of money. It was for a dormitory….

Meredith:  oh yes, at “USC” Santa Barbara.

Janet: Yes. So just for our listeners, in case you don’t know, they put all the dorm rooms on the interior, right? And they put all of the public spaces on the outside. And there’s been a lot of outcry from the design and architecture community that this is probably not a good thing. And they are sticking to their guns. They are sticking to their guns. Any thoughts on, on that…

Davis: Well doesn’t it bring up that we need more good science and good evidence because, well, you know, you’re manipulating the experiences of thousands and thousands of people without necessarily the logical evidence that can create that… you know, tossing hypotheses at a construction plan that will become an actual building and a place where a person will live for long time, not the length of a cruise. You know, but what is it when you get back to the evidence part of it?

Well, is it the photons of light coming through the window that are helping people feel better, or is it the gaze of the eye that’s connecting to the brain that’s helping people feel better? We just don’t know, do we. (J: right). I mean, it’s bringing to the front a complex matter that needs a lot of good smart people coming together and talking to each other, just like we’re doing.

Janet: I was going to say just like Meredith and Davis… it’s all good…

Meredith: (laugh). It certainly is a move that does not seem supported by any evidence that I’m aware of. (J: Right). And, when we did a project for Boulder Community Health. This was an adult inpatient behavioral health unit. And the design team included tune-able lighting throughout the whole unit. And it’s the first that we’re aware of that the inpatient behavioral health that had tune-ables throughout the whole units, even in the patient bathrooms, for example.

So the tune-able changes over 24-hours to mimic changes in, in natural daylight. And, you know, you have higher intensity blue light in the morning to suppress your melatonin and keep you awake and alert, and then kind of eliminating that blue light spectrum in the evening to allow melatonin and support sleep.

Now, because this had never been done, our lighting designer really struggled with: “what time do I make the shifts?” “What should be the light intensity at four o’clock versus nine o’clock?” “What should be the color spectrum at, you know, 11 o’clock at night versus 8:00 AM in the morning?”

So she made use the best use of the evidence, but I remember having many conversations with her about, ‘we don’t know what if we are doing harm here, because we don’t know.’ And, but certainly, you know, we made really the best decisions we possibly could make using the evidence we had available. (J: right).

The great thing about tune-able is you can change it and, and we’ve collected data and we have gone back and changed it. So, that’s great. It’s not sort of like a traditional lighting system where you got to change out all the fixtures in order to make a difference.

But this question of designing when you don’t have the evidence, it does become sort of a little bit of an ethical responsibility to consider. (J: right). But UCSB, I don’t see any evidence supporting what they’re doing at all. (laughs).

Janet: No. Well, I think that’s why it made the news. (M: yeah). I think that’s why everybody was sort of up in arms about it. I kind of didn’t mean to go off topic, but again, it was, you know, again, it goes back to this sort of like what kind of evidence that we have, and, you know, in much like the lighting that you’re talking about, we will always have to kind of keep tuning those pieces of evidence because things will come out and things will change. And who knows, even with some of the stuff that we’re dealing with the pandemic will change sort of how we also live, and how we, maybe inherently biologically like it’s still, a lot of this stuff is still the same, but maybe things will change just a little bit that again, just need to be finely tuned.

Meredith: Yeah, I think this is a really interesting time we’re in, because evidence-based processes are great when we’re in stable systems. And when I think about the pandemic, we’re in this time of great disruption. And the evidence keeps changing, and policy keeps changing every single day, right?

Janet: And we’re getting used to the uncertainty…

Meredith: We’re getting used to the uncertainty and those who have relied on evidence-based medicine or evidence-based processes to make decisions, I think they’re really struggling right now. sort of what is best practice. Even for our designs, you know, they’re supposed to last at least 40 years. And we don’t quite understand ‘what is best practice now’ considering this pandemic and transmission and all of those things. So…

Janet: Right. Going back to what you were talking about in terms of the neuroscience of it. (M: yeah). Is any of this, you know, again, back to trauma, is some of this trauma also changing some of the wiring in our brains? Is that going to be some sort of factor? Is the 40-year time span really relevant?

I find this kind of stuff fascinating. I think it’s going to, you’re right, this is a destructor, right. So, but we get an opportunity to kind of maybe look at things (M: yeah) and, maybe it is that we will have things that we have already known to be true, but maybe we will also pivot.

I know Davis and I have both talked about how a lot of people are like, ‘oh, I haven’t done anything by make bread for the last two years.’ (M: laughs). Davis and I both though, have— I don’t know about you— have found that this is a very busy time for us. It’s been very, very busy. And because I think people were trying to figure things out and, and we’re trying to all kind of, I think, maybe help each other.

Meredith: Yeah, I think, you know, Davis made a point about healthcare, well specifically to healthcare being risk averse. And absolutely, we see most healthcare organizations being risk averse. But because of the pandemic, I think there’s a real opportunity rather than just using evidence to inform design— they like to use evidence that can validate this model that’s been used 50 times is the best nurse station or patient program or that sort of thing— now we can use evidence to transform design. So to me that’s really exciting because we weren’t able to sort of take those innovative leaps with a lot of healthcare clients today. And, because we have this great disruptor, now we can…

Janet: We have an opportunity for change, right? I agree with you, mentioned it to my students recently as well. (M: Yeah.). That’s great. Meredith. So what do you think about going forward? What do you think about the future about methodology? What do you think about, in terms of some of the things that we might be seeing? Because we’re now just talked about the pandemic and how things are disruptors. Like, so what do you see as our future? What are your hopes and what are your thoughts about that?

Meredith: Okay. So from the research perspective, I see sort of this move into data. I’ve heard others kind of describe that data, not drawings, is our new currency. I think it’s probably data in drawings, because drawings are the way that we communicate. So how do we infuse data into the drawings? So I’ve been— even as Director of Research— I’m increasingly uncomfortable with kind of this post-occupancy evaluation, which is sort of what we’re trained as design researchers is the gold standard.

Janet: You might not be able to see me, but my eyes just went “what?” …

Meredith: (Laughs). Don’t throw rotten fruit at me, please, please. They’re going to take away my title as researcher. But hear me out first for a second. Because post-occupancy— so here’s my issues is that— it looks at a facility at one point in time. And I think that we need to realize that certainly people are dynamic. We get that. We change. And also groups of people and, uh, sort of staffs can have turnovers or different cultures. And those change too.

I don’t know that we think enough about how dynamic environments are. And I’m not just talking about sort of longitudinal change that happens over a building’s life cycle. Like, okay, now this storage closet becomes a break room. I mean, that is important to consider as well, but I’m thinking of just the short-term dynamic changes that happen in our environment.

So if you’re in an environment with windows, you’re exposed to different light levels and color spectrums of light throughout, you know, almost minute by minute. If you’re in a room with a lot of people, you have different noise levels and those can change, again within a day. Your air quality. Again, if you have a room full of people, you might have higher CO2 levels, which can really affect your cognition and your alertness. So those kind of environmental variables are constantly changing and affect our performance in those environments. (J: right).

So I think that we need to think about continuous monitoring of both the environmental and humane parts of that ecosystem. Going back to the ecosystem model, in order to sort of understand this as a complex interacting system. So, our methods, instead of post-occupancy, I might offer, you know, can we move into continuous occupancy evaluation? Instead of looking at just one project, can we look at portfolios of projects?

So we’re really lucky because we have repeat clients who, like ‘Eating Recovery Center’ who I mentioned earlier, who have multiple facilities and sites that offer the same programs.

So, when I’m doing a study, I never just look at one project. I always look at sort of their whole portfolio. Right now, we’re looking at eight different programs sites for them in order to sort of understand what’s best moving forward.

So it’s sort of this big data approach and taking multiple streams of data. And then, you know, maybe looking for outliers of, ‘oh, this facility is really doing something great, what can we learn from them on this dimension’ versus ‘this facility isn’t working at all’.

So in terms of technology, we’re starting to introduce sensors and wearables. Like a ring measuring stress. We have not used it in a healthcare setting yet. We’ve sort of just set up a system using volunteers from our own staff to do sort of an office worker study, just so we can kind of get the components in the system set up.

We have done a study where we had inpatient behavioral health staff wear light sensors to understand their lighting exposures. This was under the tune-able system which was really important.

But any time you have a sensor— whether it’s an environmental sensor or a biometric sensor— that’s timestamped, you can bring all of this data into the same spreadsheet and then look at interactions between them and really start to understand the system as this ecosystem

Davis: That is so fascinating. Being a lifelong, um, sensor wearer due to— which I’m also forthright about sharing my lived experience— of having type one diabetes. It was only recently that they’ve developed a continuous glucose monitor sensor. So to know that information for me on an ongoing constant evaluation is fruitful and helpful, and I can see patterns and trends.

And one moment in time with a blood sugar test is useless. (M: yes). So having something that’s responsive to the immediate needs is much, much more helpful. So I really love your evolution of post-occupancy evaluation. In fact, I was just speaking with Mardelle Shepley yesterday, because she said that also— something she was hedging in that direction I believe, I might be putting words in her mouth— but it’s a little too broad. The POE, it’s, it’s a broad ‘here let’s just plunk it into the building and take advantage of this’, not knowing what the actual specific typology is; what the actual population needs are. It’s not able to be nuanced and fine-grained enough. So the ‘Continuous Occupancy Evaluation’ – Meredith Banasiak, C-O-E. I’ve got a termed here now, it’s a thing. (laughs).

Meredith: Sweet! Yeah, I love, I love the analogy you shared Davis about your monitoring your diabetes. That’s, I might have to borrow that one as well. I think that makes a strong case. And I also think it’s setting us up as designers for creating kind of feedback loops. So not just the monitoring of this human environment system, but adaptive environments. And that sounds really sci-fi, but it’s really possible with the tune-able lighting. I mean, we’re almost there. We don’t have the AI built into the tune-able system, but we’re not that far away that it could respond to different occupant measures and automatically adapt.

Davis: Right. And once we get sleep under control individually and as a collective community, we’re all going to just start feeling much, much better. And getting a handle on our lighting needs, will feed, it’s that feedback loop, its, it’s just perfect. And the sensors and the lighting and the battery life is just eclipsing each other, the competition is amazing. I wear my aura ring here and can track my sleep measures quite well. So, I’m excited to hear about the future of technology and how we can integrate and incorporate these new streams of data. (M: hmm). It’s Fantastic. (M: Yes).

Janet: “Right, so, before we go, any last thoughts from your perspective, meaning like what do you want designers to take away or know on neuroscience and designing for behavioral facilities? Is there anything else we should know?

Meredith: So, when the Academy of Neuroscience for Architecture was just emerging, it aimed to bring together neuroscientists and architects, because that’s all we had as our starting point. But, you know, fast forward almost two decades later, we have bridges. We have, like you, like Davis, like Janet. We have bridges in this field who are bilingual in the sciences or in evidence-based and in design. And those bridges are really critical to help making the translation between the evidence. And also for conducting practice-based research which is absolutely a necessary part of this research spectrum.

We absolutely want to make use of the findings coming out of the lab, but we also need to do research in naturalistic settings which is very different from the way they do research in the lab and the findings they’re getting in the lab. So, I would just say, we need more bridges in this field in order to advance the field.

Davis: Well, thank you so much. This is such a treat and, I love the emergence of a new job description, the design bridges of the world. So, I look forward to speaking with you more personally, but I also would invite you to share how folks who are listening, who would like to hear more about your work or learn more about what you’re up to, how they can be in touch with you.

Meredith: Oh, I’m happy to share anything. It’s great, I love connecting with people who are interested in this stuff. So I’ll provide a link to our site at BA Science. And I can also be found on Twitter and LinkedIn and look forward to connecting.

Janet: Meredith, thank you so much for this time. This has been a fantastic episode and there is so much more to discuss. Maybe we can continue this conversation in a future episode…

Meredith: Yeah, absolutely. Thank you so much for the opportunity to be a guest on your show. I have such respect for the work you’re doing and the resources that you’re sharing with our design community so we can help move the culture forward.

Janet: Yeah, I know I’m excited about it too.

Davis:  and I look forward to more conversations with you Meredith, thank you.

Janet: Thank you Meredith, Thank you Davis.

Outtro- Section 3

Janet: Boy, Meredith really knows her stuff. I am so impressed with her and the work that she is doing in this area of behavioral health facilities. One thing that really stayed with me was the use of Tune-able lighting. Although Carolyn I got to tell you, my cat was just a little disappointed, she thought it was tuna-able lighting. Get it?

Carolyn: (laughs) I do get it… I think my sense of humor is rubbing off on you.

Janet: But in all seriousness, daylight is so important to recovery, and to be able to adjust the lighting is huge. I also love how Meredith stresses the use of research evidence and scientific knowledge together to inform real projects. This optimizes the design for health, performance and access.

Carolyn: From what she said and the examples she gave, these methods have proven to help the staff at the facilities, as well as the patients and their families. Meredith is very forward thinking and to quote from her own bio, she ‘supports a transformational shift in design towards an evidence-based, and person-centered culture.’

Janet: With that we’d like to thank both her and Dr. Harte for this inspiring, empathetic and scientifically considered talk today. I cannot thank them enough. As Dr. Harte said, this was a gift for us to have this type of conversation with Meredith.

Carolyn: And I can see us bringing Meredith back to dig into these topics even more in the future.

Janet: I’m nodding my head, absolutely, but getting back to this episode… we will also share the links for Meredith; Davis; Trauma Informed Design; and of course, the many more things mentioned during this discussion… all on our website at: inclusivedesigners.com…

Carolyn: That’s: inclusivedesigners.com…

Janet: Thank you to Meredith & Davis. And thank you all as well for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page.

Janet: And as we say around here: ’Stay Well…and, Stay Well Informed’.

Thank you as always for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again.

Music up

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