HCS 446 Week 1 The Facility Design Process Example

Somewhere to Go at Two in the Morning: The Design Process and Planning Team for a County's First Behavioral Health Crisis Receiving Center

[Student Name]

University of Phoenix

HCS/446: Facility Planning

Week 1 Assignment

[Instructor Name]

[Date]

The county, the provider and the project figures are composites written for a model paper; guidance and research findings come from the sources listed.

In a composite county of 410,000 people, adults whose mental illness or drug use reaches a crisis point have two places to go at two in the morning: a hospital emergency department or, if police are involved, jail. Last year, adults waiting for a psychiatric bed spent a median of 19 hours in the county's emergency departments. The county, its largest nonprofit behavioral health provider and two hospitals agreed to build a crisis receiving center, a place where anyone in crisis can walk in or be brought by police or a mobile team at any hour. This paper describes the design process that will take the project from that agreement to its first patient.

Why the Facility Exists

Federal crisis care guidance (Substance Abuse and Mental Health Services Administration, 2020) describes three essential elements of a crisis system: someone to call, someone to respond and somewhere to go. The county has a crisis line and two mobile teams but no place built for crisis stabilization. The center will accept everyone who arrives, including people brought by police, and offer up to 23 hours of observation in a recliner area and short-term stays of several days.

Stage One: Needs Assessment

The process begins by measuring need. Planners counted emergency visits for psychiatric crises, police transports and crisis line calls that ended without a place to send the caller. They estimated demand at about 8,500 visits a year in the first full year. This number drives every later decision about size and staffing.

Stage Two: Functional Program

The functional program translates need into spaces. It lists every room, its size, its occupants and its relationships: two separate entrances, one for walk-ins and one for police and ambulances; an intake and triage area; 16 recliners for observation; 16 short-term beds; calming rooms; a medical exam room; staff work areas and support spaces. It also states staffing and hours. A building designed before its program is written ends up telling the program what to be.

Stages Three to Five: Design

Schematic design produces rough plans showing how the spaces fit together and how people move. Design development adds detail: materials, doors, lighting, heating and ventilation, furniture and security systems. Construction documents are the final drawings and specifications that contractors will price and build from. Each stage narrows choices, and each change becomes more expensive as design moves forward.

Stage Six: Bidding and Contracting

The owner selects a contractor through competitive bids or a negotiated process in which the contractor joins the team during design to advise on cost and schedule. For this project, the county chose the second approach because crisis center features, such as tamper-resistant fixtures, carry long lead times.

Stage Seven: Construction

Construction takes the drawings into steel, walls and systems. The owner's representative attends weekly meetings, reviews changes and checks that work matches the drawings, especially for safety features.

Stage Eight: Activation

Activation, sometimes called transition planning, is the three to six months of preparation before opening: hiring and training staff, testing equipment and alarms, running mock patient scenarios, obtaining licenses and inspections and moving in. Many projects underestimate this stage.

The Planning Team

The owner, the nonprofit provider, leads through a project director and a steering committee that includes county and hospital representatives. The architect, chosen for experience with behavioral health buildings, leads design, supported by engineers. The contractor advises on cost and builds. Clinical users, nurses, peer specialists, psychiatrists and security staff, define workflow and safety needs. People with lived experience of crisis, recruited through a peer advocacy group, review plans for dignity and comfort. Police and mobile team leaders advise on the entrance for transports. Infection prevention, information technology and facilities staff join early. State licensing staff are consulted before design is final.

Evidence-Based Design

Ulrich et al. (2008) reviewed research linking hospital design to outcomes and found evidence that single rooms, noise reduction, daylight, views of nature and better layouts improve safety, reduce stress and support staff effectiveness. The team adopted evidence-based design as a principle: every major choice, from window placement to room size, must be supported by research or by the experience of comparable centers.

Design Guidelines

National design guidelines published by the Facility Guidelines Institute (2022) for outpatient facilities, which many states adopt into their licensing rules, set minimum sizes, clearances and features for spaces such as exam rooms and behavioral health areas. Meeting them is a floor, not a goal.

What Goes Wrong When Stages Are Skipped

The steering committee studied two crisis centers in neighboring states before starting. One had skipped a detailed functional program to save time and opened with a single entrance, so people brought in handcuffs by police passed through the same lobby as families arriving voluntarily; a second entrance was added two years later at nearly three times the cost it would have added during design. The other center compressed activation to five weeks, opened with staff who had never practiced a medical emergency in the building and closed its short-term unit for a month to retrain. Both lessons shaped this project's schedule: the program and activation stages were protected even when the county asked to open sooner.

Timeline

Needs assessment and functional programming take four months, design 10 months, bidding two months, construction 14 months and activation four months, about three years in all.

Guiding Principles

The steering committee adopted four principles: accept everyone who arrives; keep patients and staff safe without making the building feel like a jail; design for dignity and calm; and allow the center to adapt as the county's crisis system grows.

Conclusion

The crisis receiving center begins with a need, adults in crisis with nowhere to go, and a national model for meeting it. The design process moves from needs assessment and functional program through design, contracting and construction to activation, with clinicians, people with lived experience and first responders on the planning team from the start. Evidence-based design and national guidelines set the tests every decision must pass as the project moves into site selection next week.

References

Facility Guidelines Institute. (2022). Guidelines for design and construction of outpatient facilities. Facility Guidelines Institute.

Substance Abuse and Mental Health Services Administration. (2020). National guidelines for behavioral health crisis care: Best practice toolkit. https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf

Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H., Choi, Y., Quan, X., & Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 1(3), 61-125. https://doi.org/10.1177/193758670800100306