SEEKING ANSWERS FOR AUTISM
Awareness of autism has grown rapidly in recent years, as the rate of diagnosis increases and high-profile celebrities—NFL quarterback Doug Flutie and popular novelist Nick Hornby, for example—openly discuss their children's cases. A focal point of today's research on the disorder is the M.I.N.D. Institute (standing for the Medical Investigation of Neurodevelopmental Disorders), on a 10-acre campus-within-a-campus at the University of California—Davis. Three buildings of a planned five-building project were completed in 2003, and they encompass a number of unique design features intended to accommodate children and their families, both as patients and as research subjects.
Recently, two key players in the development of the center and the design—Robert Hendren, DO, the institute's executive di-rector and chief of child psychiatry, and Bill Blanski, a design principal for Minneapolis-based Hammel, Green & Abrahamson (HGA)—responded to questions from HEALTHCARE DESIGN Editor Richard L. Peck on the challenges involved.
Where did the idea of creating a specially designed environment for autism treatment and research originate?
Dr. Hendren: There were lots of thoughts and ideas from parents based on their experiences with other places that manage autism. These tended to be located in small, dark basement areas with flickering ceiling lights; they were quite claustrophobic. The M.I.N.D. Institute, as designed, seems protective but not constraining. It differs from children's hospitals, too; while their toys and bright colors excite children, they overstimulate children with autism.
Blanski: Research has shown that these children are overstimulated by bright primary colors. Earth tones, however, such as browns and taupe, they find soothing. We were assisted in developing this design by a color consultant, A.J. Peron-Wildes, who is also the mother of an autistic child. She was attuned to designing for the special needs of autistic children and their families.
Also, based on the mission statement that the M.I.N.D. Institute was to be “a haven,” we made decisions that created a more homelike and welcoming environment. For example, with the guidance of HGA interior designer Chris Vickery, we divided the waiting area into two smaller Great Rooms (to use home-based terminology), with comfortable living room furniture. The TVs in these areas run videos that appeal to autistic children; for some reason still not understood, they tend to find Disney movies quite soothing. The waiting areas also have aquariums, although you can't allow the children to touch the water or they start losing behavioral control. We also incorporated furniture fabrics without patterns, because these children tend to fixate on patterns and start counting until, again, you've lost them.
Dr. Hendren: We've tried to make entering the building a welcoming experience. The colors around the entrance are basically warm earth tones, and Bill Blanski managed to save a stand of old oaks nearby that helps to frame it. Once inside the entrance—which is, by the way, the only one to the building and is used by everyone, including children, parents, and researchers—one finds that the building is very open, with large corridors and stairways where everyone can mingle and can see and be seen.
How has this open design worked operationally?
Dr. Hendren: The kids seem much calmer; there's not as much yelling and running around. Even though they can hear a lot of noise from other kids, some of which might be upsetting, with this design the building seems to absorb the sound. The researchers have expressed appreciation that they are actually able to see and visit with the people for whom they are working so hard. The families involved in developing this design actually insisted on this open approach, and we're seeing the reasons why.
Blanski: One of the key requests from the families was for a learning resource center because, as anyone with an autistic child knows, family members devour all the information they can get. So, about 20 steps inside the front door, there is a welcoming, easy-to-use family resource center. As you move farther into the building, the examination/interview rooms have been specifically designed to look like home, with overstuffed living room furniture, homelike lighting fixtures, and even a residential-style kitchen to assist in replicating a homelike environment. These spaces contribute to the perception of the M.I.N.D. Institute as a haven.
How are the research areas designed?
Dr. Hendren:We have two good-sized examina-tion/observation rooms, with unobstructed vision lines so that kids can't hide from view, and with lots of hidden observational technology around them.
Blanski: Designing this space was a challenge and a delight to figure out. The word was that the kids lost control when they walked into a clinic setting, and we obviously wanted to avoid that. We did probably 15 iterations of how the physician and the parents and children should be positioned vis-à-vis each other during the interview. The assessment tables are made of natural wood, have rounded edges, and are positioned low so that children are comfortable sitting at them. The examination tables are quite unique in that they are also made of wood, covered with furniture-quality padding, and they blend in with the finishes of the room. Outside the room, on the other side of one-way glass, the technology is amazing—computer screens, CD and DVD players, and video cameras, to record and play back sessions from every angle.
Dr. Hendren: We have also constructed a “wet lab” for brain studies. We built this first because we thought it might be the most difficult of the research areas to fund. In our future development—the final of the planned buildings on the campus—we will construct a dry lab for patient/family interviews and neuroimaging studies, as well as a school aimed at teaching the teachers and counselors who manage these children in the educational environment.
Blanski: In reviewing this project, project principal Bill O'Malley and I agree that one of the primary objectives we accomplished with the M.I.N.D. Institute was creating an overall comfortable atmosphere. This is of highest importance to the families and children who come to visit, as well as to the physicians and researchers who interact in the facility on a daily basis. We thought it was critical to create a setting that facilitates collaboration in a multidisciplinary work environment, and creating a comfortable place was an important first step. HD