Integrating Behavioral, Primary Care At Centerstone
Opening its doors on Feb. 4, behavioral health not-for-profit Centerstone of Tennessee celebrated its new 18,090-square-foot outpatient facility on the six-acre Dede Wallace Campus in Nashville, Tenn. With the goal of improving its coordination of care and enhancing patient outcomes, the $6 million facility combines primary and behavioral healthcare services for children, adolescents, and adults—all under one roof.
Centerstone’s goal is to serve the local community with convenient access to a continuum of health services with a fully integrated facility, in partnership with Unity Medical Clinic.
Traditionally, primary care and mental health services are delivered separately, but Centerstone CEO Bob Vero says that integration comes with great benefit. “We want to treat the whole person by coordinating patient care and addressing those critical healthcare gaps that all too often result in premature death,” he says.
The new facility, designed by InForm Smallwood + Nickle LLC (Nashville, Tenn.) and built by Orion Building Corp. (Brentwood, Tenn.), was several years in the making. After the team was chosen in 2007, the programming phase was immediately underway, with InForm collaborating with Centerstone staff on how best to support the operations and workflow, as well as the warm, welcoming patient experience it aspired to achieve.
Redefining behavioral health
Centerstone’s new facility is fully integrated to make physical and behavioral healthcare accessible and approachable. With 37 clinicians’ offices, three exam rooms, a physicians’ workspace, group therapy and play therapy areas, a community room, and staff touchdown space, the focus is on healing both the minds and bodies of its patients.
There’s no physical separation between the behavioral and primary care spaces. Primary care is located in the right wing of the building, but primary care services are provided in behavioral care spaces, as well. For example, clusters of clinicians’ offices are adjacent to an exam room, while group therapy and meeting rooms are interspersed throughout. This type of flow allows a patient to walk from a therapy room for behavioral care right to an exam room for primary care. Likewise, a behavioral care specialist can join a primary care physician during an exam. Additionally, a physician may choose to move a conversation with a patient or patient’s family down the hall to one of the therapy rooms.
Since patients will oftentimes go to their primary care doctor with mental health issues, while other behavioral care patients may not want to discuss their physical health problems with a therapist, the layout strives to remove barriers that might traditionally prevent a patient from seeking either type of treatment and help ensure that needs are addressed.
Another design goal is to decrease any discomfort patients might feel in seeking behavioral care. For example, the facility uses one common reception area. “No one would know whether you’re there to see someone on the behavioral health side or the physical health side,” Vero says.
Many of the existing buildings Centerstone used for its behavioral health services were dark and institutional in feel. Creating the open and inviting environment the organization was an effort to make patients and visitors more comfortable.
“We spent a lot of time trying to develop a solution that integrated a level of wayfinding that was extremely straightforward to reduce confusion as well as develop a way to bring light into the building so that every office had the opportunity to have natural daylight,” says Brian Smallwood, the InForm partner in charge of the project.
The new layout is easy to navigate with extra-wide corridors in a figure-eight configuration. Making right turns from anywhere in the building will ultimately lead a patient back to the lobby area that’s located at the center of the eight.
And with 17.5-foot-tall ceilings and 4-foot-tall windows on all sides, the building receives plenty of daylighting. All interior offices have clerestory windows to take advantage of the natural light and provide privacy. A palette of warm wood finishes, metal accents, and bright colors throughout add to an overall sense of calm and well-being.
Therapy rooms were designed to put patients at ease and are filled with comfortable furnishings, such as loveseats, oversized chairs, and children’s-sized tables and chairs. To encourage interaction, there are no desks between the patient and therapist. Instead, a portable laptop cart allows the therapist to make notations while engaging in conversation with the patient. “It feels very much like a private practice environment,” Vero says.
Technology as part of the solution
Modern technology brings Centerstone into the 21st century, while also enhancing the patient and visitor experience. When guests first walk into the lobby, they’re greeted by the warm voice of professional actors in a video playing on a flat-screen monitor, explaining what to expect on their visit and the care coordination process.
Technology solutions were integrated into the therapy rooms, as well, to become part of the care process. Each therapy room has a wall-mounted flat-screen TV, where educational information on the patient’s physical or behavioral health condition might be displayed for the patient. The provider can also use it to walk a patient through a relevant health website or app, to show them how it should be used, part of an effort by Centerstone to improve patient follow-through on post-appointment activities.
“As we went through this process,” Smallwood says, “Dr. Vero was critical in a real forward-thinking vision. He saw that the paradigm of how they were providing healthcare was changing and that they needed to re-imagine how this works, and some of the ways in which [we accomplished that] was this integration of technology.”
Preserving the past
Established in 1923 by the Junior League of Nashville (JLN) as the Home for Crippled Children, the former structure, a brick-front house, had been used by JLN as a nine-bed facility to house and treat children with polio since 1930. Over the decades, it evolved into behavioral health provider Centerstone, while the building eventually fell into disrepair. An analysis performed by InForm determined the building’s many issues, from lead paint and lead pipes to asbestos, made it unsalvageable, but the firm chose to incorporate several details that pay tribute to the site’s heritage.
Limestone pavers were placed throughout the new building’s landscape to delineate the footprint of the former building, along with markers made of granite, limestone, and brick that tell the story of the site. “The bases of these markers are made out of bricks salvaged from when we demolished the building,” says InForm project manager Kyle McKiness. “We thought that was the perfect opportunity to use them in a respectful manner.”
It was also important to the local neighbors to preserve a large, old oak tree that’s been on the site at least as long as the original facility. Not only was the tree spared from demolition, it’s now a prominent feature in the new healing garden, which is visible through the windows in the rear of the building.
Outlook for the future
With its newly integrated facility offering a continuum of health services, Centerstone hopes to be the primary care provider of choice for the surrounding co
mmunity. “When a child or adolescent first walks through our doors in search of treatment for a behavioral health disorder, we want to become their family’s primary care provider as well,” Vero says.
The idea is already starting to catch on with patients and their families. “We have clients coming in asking whether they’ll get dental services with us. Soon, we may have to add physical therapy, a pharmacy, or other physical healthcare specialty services to be more of a whole-person provider,” he says. “We’ll watch it develop in the near future, as we witness more and more integration of physical and behavioral healthcare.”
Margie Monin Dombrowski is a writer based in Southern California. She can be reached at firstname.lastname@example.org.