Kennedy Krieger Institute is an internationally recognized facility dedicated to improving the lives of children and adolescents with disorders of the brain, spinal cord, and musculoskeletal system. Kennedy Krieger's new Outpatient Center-located in the heart of downtown Baltimore-plays a key role in expanding these services, consolidating many into a central location and dressing them up in an innovative, state-of-the-art facility. The six-story, 115,000-square-foot center located in the new Harry and Jeanette Weinberg Building includes such features as aquatic therapy pools, 7,500 square feet of dedicated rehabilitative therapy gyms, and a spectacular therapy garden that spans the bulk of a city block. HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock spoke with Kimberly Stanley, AIA, of design firm Stanley Beaman & Sears; Chief Operating Officer Jim Anders and Senior Vice-President of Clinical Programs and Inpatient Services Lana Warren, EdD, OT/L, FAOTA, Kennedy Krieger Institute; and Catherine Mahan, president of landscape architecture firm Mahan Rykiel Associates, Inc., about this award-winning project.

Jim Roof Creative
Jim Roof Creative

Origins

Jim Roof Creative
Jim Roof Creative

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Jim Anders: Over the last 20 years, Kennedy Krieger Institute has gone from about 300 employees to about 2,500 and expanded our services significantly. The outpatient programs had expanded to the point that we needed to start thinking about moving them out of the 35-year-old building they were located in and moving toward an uplifting, modern space that matched our high quality of services. This was a dramatic shift.

We started the formal master planning for the Outpatient Center about five or six years ago, but we really began planning it 20 years ago when we started acquiring the land. It felt a bit like a game of Monopoly in a way, gathering up all the pieces over the years to be able to consolidate into the site we have now.

Design principles

Kimberly Stanley, AIA: Stanley Beaman & Sears was contacted by Kennedy Krieger because of our specialty in designing children's facilities. We were really excited about designing this facility because of the real desire to design a building that would allow children with disabilities to overcome stereotypes. The facility is meant to reflect the potential of every child. Every child won't be cured, but every child can be healed to a certain level and can really explore his or her potential. Kennedy Krieger has great people on staff, really fantastic research, and a philosophy of care. That “big idea” got us excited about working together.

Often, places in hospitals or outpatient centers where people with disabilities are cared for are in the basement or tucked in places with no natural light; we wanted the therapy-and these children-to be front and center. Part of the master plan was to deliberately place the therapeutic garden right in the front of the building on the corner. But we are respectful of the privacy issues, so the garden is a bit recessed and there is also a low garden wall around it; there is privacy, but there is also a very public statement of, “This is what we're all about.”

Jim Roof Creative
Jim Roof Creative

Jim Roof Creative

The client wanted to make sure that the new center communicated state-of-the-art medicine and how progressive Kennedy Krieger Institute is in terms of its research and care. They wanted to make sure there was lots of natural light in the facility, as well as lots of things for children to explore, because often kids with disabilities are there for many hours. So the aesthetic is a modern one, predominantly glass and precast.

Jim Roof Creative
Jim Roof Creative

Designing for positivity

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Stanley: Often, children being treated at the Institute will be in cumbersome motorized wheelchairs or other assistive devices, being transported via specialized vans, and the process of being dropped off in front of the building can take up to 20 minutes. The master plan took this into account and accommodated this process by making sure drop-offs could be made outside of the public view of the main street in front of the building. There is a long queuing area under a canopy that facilitates the dignity and privacy of this process. The canopy is extremely long to allow multiple families to take their time to unload. While they're doing that, they're overlooking the therapeutic garden, creating a positive first impression.

Moving inside, the design of the lobby was meant to showcase in a very positive and bold way the exploration of potential. Embedded on the wall is the phrase, “In my mind, I can do anything.” That's meant from an emotional perspective and a physical perspective, and it also gives parents and children hope that they can overcome these sometimes overwhelming problems.

The wall is also meant to highlight the extraordinary research done at Kennedy Krieger, so the importance of the word “mind” in that phrase is subtly highlighted, reinforced by an image of the brain.

Therapy spaces on every floor overlook the large therapeutic garden. The spinal cord injury gym, the physical therapy gym-all these spaces that hope to inspire kids with problems overlook this positive outdoor space.

Interior design

Stanley: In the lobby, there is a lot to see very high on the walls, but there is also a lot to observe if you're in a wheelchair or three feet tall. The design and detailing of even the reception desks, for example, was done so that if you're in a wheelchair, you're not staring at a blank surface-you're looking at a human being. It says, “Welcome, we're expecting you.”

Some of the materials that our interior design team used are passive play elements. We embedded materials at a low level so kids could interact with them.

Often, our clients in children's facilities want a lot of bold color, but in this facility we worked hard to make sure we used a timeless selection of materials that wasn't overly stimulating. Children with autism or some severe behavioral disorders can become overstimulated by too much color, pattern, or texture.

Jim Roof Creative
Jim Roof Creative

Jim Roof Creative
Jim Roof Creative

Aquatic therapy center

Anders: We actually decided to put the aquatic therapy center, complete with two pools, specifically on the top floor of the building. Donors Art and Pat Modell, former owners of the Cleveland Browns and Baltimore Ravens football teams, really thought it would be spectacular to put the pools up there, like a luxury hotel and with lots of natural light and views, providing an uplifting feeling for those undergoing therapy. In addition, privacy issues are nonexistent. It was designed in such a way that it didn't cost us much space on the floor below, which is administrative areas, and the cost differential wasn't significant versus locating the pools on the ground floor, so we went ahead and put them up there.

Jim Roof Creative
Jim Roof Creative

Stanley: The pools are designed so that children in wheelchairs can wheel themselves onto the surface of the pool bed. Once there, rather than being transported via a large lift that would carry them into the pool, the floor recesses down and water rises; the pool comes to them. This is a real plus for the therapists, too, as it reduces the amount of lifting in and out of the water. It also adds a sense of normalcy to the process, a sense that they can do it themselves that is important.

Therapy garden

Jim Roof Creative
Jim Roof Creative

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Catherine Mahan: We were delighted to have the opportunity to develop this outdoor space for children. The garden is the majority of a Baltimore city block, and all of which is permanently devoted to the therapy garden. The lot is long and skinny, which presented us with opportunities to design a variety of spaces. The garden is a series of outdoor “rooms”-spaces devoted to therapeutic mobility activities, and there are areas where children can practice real-life experiences, such as navigating various surfaces or using differently sized steps that the children will encounter in the outside world.

There are other spaces where the kids can do other play activities that are actually very therapeutic, but the children wouldn't realize it was therapy. For instance, there is a long water runnel, which is a channel of water at wheelchair height. Kids can come up and play in the water and follow the water down. Because of its length, it allows many children to be at the water's edge at the same time. This is something you could never do in a smaller space.

We also left a large open space that we deliberately didn't program. We simply present the space and say, “Use your imagination.” This open lawn can be used for things like birthday parties, or bringing animals for the children to interact with-the kinds of activities that really add life to the garden.

Wherever there's a child with a disability, there is an associated family that is also deeply affected by the illness. The family goes through everything together. We wanted to give the caregivers an opportunity to “get away” from the cares and worries of their situation. So we developed the farthest space from the building as a place for parents and caregivers to escape for a moment. There is seating under flowering trees, a water feature in the middle, and also a small labyrinth. To give families and staff a break and to provide a refuge area while their children are in therapy is invaluable. We were pleasantly surprised to see that the kids are also using the labyrinth, which is fun and fulfilling for them, and also utilizes valuable mobility skills.

Conclusions

Jim Roof Creative
Jim Roof Creative

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Courtesy of Kennedy Krieger Institute
Courtesy of Kennedy Krieger Institute

Jim Roof Creative
Jim Roof Creative

Stanley: The design underscores the idea that we wanted the building to be such a model of accessibility that there is a sense of independence and optimism created as part of the therapy experience. We came into this project with our own preconceptions on how to design a children's facility, but we learned it could be so much more from a philosophical perspective. It made us want to do more and more of this type of project, and to think more about what people of all ages that are going through this experience are dealing with. I love that the attention being shown to this project will raise the level of attention being given to people with disabilities and the kind of environment that is possible to support their care.

Mahan: This was one of those projects that just steals your heart. I've been doing this for more than 25 years, but this was really the project of a lifetime. HD

Kennedy Krieger Institute Outpatient Center Baltimore, Maryland

For more information on Kennedy Krieger Institute, please visit http://www.kennedykrieger.org.

Healthcare Design 2010 April;10(4):52-60