Seattle Children’s Targets Neurodiverse Patient Needs In New Clinic Design

Seattle Children’s Autism Center, which serves children, teens, and adults with autism spectrum disorder, had been housed in a commercial building off Seattle Children’s Hospital’s main campus for more than a decade.

However, when a lease on the building expired, it prompted the organization to begin considering other options. Mendy Minjarez, executive director at the Seattle Children’s Autism Center, says the clinic had long outgrown the location. The space wasn’t originally designed for clinical care and had been remodeled several times over the years to better support the clinic’s unique programming.

“It was a generic clinical space,” she says. “We were looking to not just move but tailor a space for this patient population.”

At the same time, Seattle Children’s outpatient psychiatry and behavioral medicine department was outgrowing its space on the main campus, as well. The department treats patients with a range of emotional, behavioral, or neurodevelopmental concerns, including attention deficit hyperactivity disorder (ADHD), depression, bipolar disorder, and mood and eating disorders.

“People started to realize a lot of synergy, innovation, and improvements in patient care would come if we were physically co-located,” Minjarez says, including reducing redundancies and maximizing specialized spaces.

For example, the autism center’s specialized kitchen could be used for feeding programs for families with autistic children as well as patients being treated for eating disorders as part of psychiatry services.

Capitalizing on the timing of both service lines needing new locations as well as recognizing the opportunity to build out collaborative care models, the organization decided to merge the two programs under one roof.

Creating a new home for autism and behavioral health services

In late 2019, Seattle Children’s began working with ZGF (Seattle) to deliver a new 45,000-square-foot facility, which houses autism and behavioral health care, outreach, training, and research. Those services include an early intervention program for kids to learn positive behaviors through therapy and group rooms for therapy, recreation, and family outreach programs.

Mark Gesinger, principal at ZGF, says an existing administrative building near the main campus had a vacant floor, was closer to neighborhoods than the former clinic, and was on a public transportation line and staff shuttle route.

“It checked a lot of boxes as far as location and proximity and staff needs,” he says.

Additionally, the available space had its own entry, which would allow the design team to create a separate entrance for users. This feature would help to break down barriers for behavioral health and autism patients to receive care.

Kari Thorsen, principal at ZGF (Seattle) and lead interior designer on the project, says a lot of families shared how challenging it can be for any kid with any type of behavioral need to walk in the front door as well as navigate multiple departments and elements within a larger facility. “This offered a dedicated place and approach to be able to welcome these patients,” she says.

Gathering family, patient input on needs of neurodiverse patients

The importance of creating a welcoming and accessible front door was just one piece of valuable insight the project team received from a Seattle Children’s family advisory group, which was involved throughout the entirety of the project starting in 2020.

Much of the feedback about autism patients was how they experience anxiety and stress when they don’t know what to expect. So an overriding goal of the project was to use simple, clear layouts with onstage/offstage circulation and visual cues to help define spaces and assist families navigating the clinic.

Wayfinding strategy at Seattle Children’s

Inside, a main corridor runs the length of the entire facility, providing clear sight lines to clinical areas, further helping families and patients get their bearings and understand next steps.

Care team neighborhoods for both service lines are accessed off the main corridor and consist of eight pods with four treatment rooms each.

Visual cues, such as blue and purple colors on the walls, ceiling archways, and signage, are used to help identify which care neighborhood families are going to for their appointment. These cues also help parents guide their child through the space.

“It’s getting their kid ready for what’s next, because that’s so much a part of the unknown for them and what they’re overstimulated by,” Thorsen says.

Providing choice in the clinic environment

When entering the facility, families can select from three options to best meets their needs, from quieter to more engaging settings. For example, a child who needs more time to transition to their appointment can choose a discreet entrance that’s near a quiet waiting room that offers semi-private seating and calming artwork.

Minjarez says the project team also incorporated input from several families. For example, a mom shared that at times her child might be really overstimulated and would need an environment where they could run around or be active without being disruptive to others and told to sit down.

“Those kinds of needs necessitated what we call our sensory waiting room, which is a separate area where kids can go in and they don’t have to be quiet,” Minjarez says.

The room has tactile elements, opportunities for play, and soft furnishings and bean-bag type chairs. “You can drape your body over the furniture, sit upside down with your feet in the air, whatever you might need to do,” she says.

Furthermore, an enclosed garden space is designed with play space for therapy sessions as well as benches to provide an alternative space for clinicians to meet with families or children who don’t want to come in the building altogether.

“There’s something here for everyone, and it doesn’t matter what state you’re in,” Minjarez says.

Small clinic details that make a big impact

Beyond the overall architecture and layout, the design team also sought to create an engaging and interesting experience for its patients that also met their diverse sensory needs.

Again, the project team used input and feedback from parents, resulting in an approach that Thorsen calls “sensory kindness.” Specifically, this meant being conscious about acoustics, noise, and design features to make sure the environment was welcoming to everyone.

For example, after hearing from one family that the sound of a click made their daughter think she was being locked up, the project team worked with hardware consultants to pick door and lock fixtures that minimize triggering noises.

“There are all these things that seem like such a small comment that a family member made, but it had such a big impact into how we thought about the space and having that sensory kindness for everyone who came into the space,” Thorsen says.

Safety considerations for behavioral health settings

It also meant approaching safety considerations through the lens of its specific patient population while ensuring the environment wouldn’t feel institutional. For example, the project team discussed with parents the original design of an enclosed garden to provide access to natural materials and positive distractions. The space would include features such as loose rocks and a water feature.

However, the project team got feedback and concern from families on how their child would interact with those features. Parents worried their children might throw rocks or drink dirty water.

So instead of removing the elements entirely, the project team proposed embedding the rocks into the concrete to deliver a safer and tactile experience.  Also, the water feature was modified to prevent the build-up of stagnant water.

“A lot of thought went into making sure the safety perspective didn’t compromise the design in the sense of making it institutional or taking away those sensory and welcoming elements,” Minjarez says.

The same focus was considered within clinical spaces regarding the location and placement of medical equipment. For example, supplies, sharps containers, soap, and handwashing sinks in the exam rooms are enclosed in a floor-to-ceiling cabinet for safety and to minimize distractions.

Additionally, furnishings such as love seats and chairs are used instead of exam tables in most rooms to create an environment that would feel comfortable and less like a doctor’s office.

“We got a lot of feedback from families that their kid is fearful of the doctor … so those kinds of features during treatment sessions are really important, too,” Minjarez says.

Meeting growing needs of neurodiverse patients

Seattle Children’s expects its new clinic, officially called Seattle Children’s Magnuson and opened in December 2022, to allow the organization to provide family-focused care to 25 percent more children over the next five years.

Additionally, the location features research, outreach, and training spaces to further drive efforts to improve access and outcomes.

Through its tailored environments and intentional design features, the clinic also offers a space where patients and families of children on the autism spectrum can feel that they belong.

“It was heartbreaking to hear the struggles that they had to go through out in the everyday world,” Thorsen says. “So to be able to have spaces that met their needs was such a huge driver.”

“The idea of feeling unwelcome is not a thing here,” adds Minjarez. “Here, we are ready for whatever behavior your child is having.”

Anne DiNardo is executive editor of Healthcare Design. She can be reached at anne.dinardo@emeraldx.com.

 

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