No Place to Go: The Relationship Between Care Partner Inclusion Practices and the Hospital Environment.

OBJECTIVE: The objective of this was to explore how the physical environment in a hospital contributes to care partner inclusion practices. BACKGROUND: Despite their vital efforts in caring for people living with dementia (PLWD), care partners of PLWD often report feeling not included in their loved ones' hospitalizations. This phenomenon goes against research, policy initiatives, and hospital design frameworks that underscore the importance of including care partners in hospital care. To ensure that care partners are systematically included in hospital care, health systems must create an environment that prioritizes care partners' presence. METHODS: This descriptive qualitative design employs a multimethod approach to data collection. Our team conducted direct observations in a large academic hospital and interviewed 23 clinicians/administrators and 15 care partners of PLWD to understand the relationship between hospital environments and care partner inclusion. Observational data were analyzed using a framework analysis, and interview data were analyzed through thematic analysis. RESULTS: Direct observations revealed an underutilization of environmental resources such as family-centered spaces and environmental communication tools. Interview data revealed that adequate space for care partners, the layout of patient rooms, parking accessibility, room personalization, and comfort level of the hospital space all impact care partner inclusion. CONCLUSION: Our findings highlight opportunities for health systems to create hospital environments that support PLWD and their care partners. In pursuit of systematic care partner inclusion, health systems can make adequate space for care partners, allocate dementia-friendly parking spaces, increase utilization of environmental communication tools, and increase comfort level of the environment.

Design Considerations for Virtual Reality Intervention for People with Intellectual and Developmental Disabilities: A Systematic Review.

OBJECTIVES: This systematic review aims to explore virtual reality (VR) applications for rehabilitation purposes among people with intellectual and developmental disabilities (IDD), identify their effects on rehabilitation outcomes, explore themes to consider in VR intervention design, and provide guidance for designers and researchers in creating therapeutic environments using VR technology. BACKGROUND: VR has gained increasing attention in healthcare settings to assist in achieving rehabilitation goals for people with IDD. VR is particularly advantageous since it simulates the real world while providing controllable, safe, and versatile environments. It is necessary to expand the current body of knowledge on VR intervention's outcomes by synthesizing further information on VR application characteristics as well as identifying design considerations regarding feasibility, usability, safety, and other aspects that will benefit future VR intervention design and research. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framed the current review. Multiple databases were searched to identify studies published between 2001 and 2023. The review qualitatively organized VR environment design considerations according to three themes: feasibility, usability, and safety. RESULTS: This review included 27 articles and included 868 participants. The overall findings indicated that VR interventions are promising in enhancing rehabilitation outcomes among people with IDD, such as physical, cognitive, emotional, and functional independence domains. CONCLUSION: This review provides design recommendations to create effective, usable, and safe VR interventions for individuals with IDD. The suggested design implications should be applied with the awareness that VR is a relatively emerging technology with rapidly evolving features.

The Design of Health Promoting Outdoor Environments for People with Young-Onset Dementia-A Study from a Rehabilitation Garden.

Health-promoting outdoor environments designed for people living with dementia (PLwD) has proved to be an effective non-pharmacological intervention for treatment of symptoms and improved well-being. However, for individuals with Young-Onset Dementia (YOD), who have particular symptoms and needs, the content and design of these environments are underexplored. This study aimed to explore the needs of individuals with YOD in a garden setting, to generate design-related knowledge for 'dementia-friendly' outdoor environments, while contributing to the field of Evidence-Based Design (EBD). An 8-week long nature-based program was carried out in Alnarp's rehabilitation garden, a specifically developed garden based on research from e.g., landscape architecture, environmental psychology and medical science. The study used a triangulation of qualitative methods including six participants with YOD and a multidisciplinary team of five staff members. Content analysis was used for all gathered data, including 17 semi-structured interviews with participants with YOD and with staff. Data collection and analysis was performed based on the evidence-based Quality Evaluation Tool (QET). The study led to a target group adapted version of the QET for people with YOD containing 20 developed environmental qualities for designers to pursue in therapeutic gardens, including the additional quality of Calmness. A progression was noted, as a result of perceived positive effects during the intervention, indicating possible change and development of the group's needs and preferences in the outdoors.

Nature-Based Design in Stroke Rehabilitation Environments: A Scoping Review.

OBJECTIVE: To identify, examine, and map the characteristics of knowledge of nature-based design in stroke rehabilitation facilities, examine how research in this field has been conducted and identify gaps in knowledge. BACKGROUND: Many stroke survivors have wide ranging impacts, resulting in long hospital stays to undertake rehabilitation. The physical environment can influence brain recovery; however, there is limited evidence to support the design of effective rehabilitation environments. Conversely, the health benefits available from connection with nature are well established. A nature-based design approach may have benefits and implications for the physical environment of inpatient stroke rehabilitation facilities; however, it is unclear what evidence exists in this field. METHOD: This scoping review followed the JBI methodological guidance for the conduct of scoping reviews, with systematic searches of six databases. RESULTS: Twenty-eight studies were included in the review. Aims and research methods varied widely. Investigations in 19 studies related to gardens and other designed outdoor nature-based environments. Other studies explored natural analogues, nature inside, inside/outside connections, and the natural environment. Findings from the studies were spread across the fields of design, use, exposure to, and engagement in nature-based environments. CONCLUSION: The characteristics of knowledge underpinning nature-based design in stroke rehabilitation environments are highly diverse, and significant gaps exist in the evidence base. A framework developed during this review for mapping knowledge on the intentions and impacts for spaces and services in this field assisted to identify these gaps and may be applied to other areas of healthcare design research.

A Structured Literature Review on the Research and Design of Rehabilitation Environments.

AIM: This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. BACKGROUND: Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. METHOD: We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. RESULT AND CONCLUSION: Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.

A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings.

OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021). METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe. RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research. CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

Ecocebo: How the interaction between environment and drug effects may improve pharmacotherapy outcomes.

This narrative review describes the research on the effects of the association between environmental context and medications, suggesting the benefit of specific design interventions in adjunction to pharmacotherapy. The literature on Evidence-Based Design (EBD) studies and Neuro-Architecture show how contact with light, nature, and specific physical features of urban and interior architecture may enhance the effects of analgesic, anxiolytics, and antidepressant drugs. This interaction mirrors those already known between psychedelics, drugs of abuse, and setting. Considering that the physical feature of space is a component of the complex placebo configuration, the aim is to highlight those elements of built or natural space that may help to improve drug response in terms of efficacy, tolerability, safety, and compliance. Ecocebo, the integration of design approaches such as EBD and Neuro-Architecture may thus contribute to a more efficient, cost-sensitive, and sustainable pharmacotherapy.

The Impact of Design Factors on User Behavior in a Virtual Hospital Room to Explore Fall Prevention Strategies.

OBJECTIVES: Falls in hospitals pose a significant safety risk, leading to injuries, prolonged hospitalization, and lasting complications. This study explores the potential of augmented reality (AR) technology in healthcare facility design to mitigate fall risk. BACKGROUND: Few studies have investigated the impact of hospital room layouts on falls due to the high cost of building physical prototypes. This study introduces an innovative approach using AR technology to advance methods for healthcare facility design efficiently. METHODS: Ten healthy participants enrolled in this study to examine different hospital room designs in AR. Factors of interest included room configuration, door type, exit side of the bed, toilet placement, and the presence of IV equipment. AR trackers captured trajectories of the body as participants navigated through these AR hospital layouts, providing insights into user behavior and preferences. RESULTS: Door type influenced the degree of backward and sideways movement, with the presence of an IV pole intensifying the interaction between door and room type, leading to increased sideways and backward motion. Participants displayed varying patterns of backward and sideways travel depending on the specific room configurations they encountered. CONCLUSIONS: AR can be an efficient and cost-effective method to modify room configurations to identify important design factors before conducting physical testing. The results of this study provide valuable insights into the effect of environmental factors on movement patterns in simulated hospital rooms. These results highlight the importance of considering environmental factors, such as the type of door and bathroom location, when designing healthcare facilities.

Improving the Mental Health of Surgical Teams Through Operating Room Design.

OBJECTIVE: In this study, we aim to develop and propose an evaluation method for analyzing the design of operating rooms (ORs) from the perspective of surgical teams' reported experiences and stress levels. BACKGROUND: Stress and burnout of surgical team members can lead to diminished performance and medical errors, which endangers the safety of both the patients and team members. The design and layout of the OR play a critical role in managing such stress. METHODS: To understand surgical teams' spatial needs related to their experiences and stress, we administered a survey and in-depth focus group discussions to three surgical teams from the same organization. The identified spatial needs were translated into functional scenarios and spatial metrics, essentially viewing the OR through the perspective of users. RESULTS: Our analysis revealed four integral sections-patient flow, room organization, access to facilities/medical equipment/support staff/team members, and staff well-being-identified as critical design factors associated with the experiences and stress levels of the surgical teams in the ORs. CONCLUSIONS: We expect this method to serve as a tool for evaluating the effect of the design of OR layouts on stress, thereby supporting the well-being and resiliency of surgical teams.

The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review.

OBJECTIVES: This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. BACKGROUND: There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. METHODS: Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. RESULTS: Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. CONCLUSION: This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.

Evidence-based XAI: An empirical approach to design more effective and explainable decision support systems.

This paper proposes a user study aimed at evaluating the impact of Class Activation Maps (CAMs) as an eXplainable AI (XAI) method in a radiological diagnostic task, the detection of thoracolumbar (TL) fractures from vertebral X-rays. In particular, we focus on two oft-neglected features of CAMs, that is granularity and coloring, in terms of what features, lower-level vs higher-level, should the maps highlight and adopting which coloring scheme, to bring better impact to the decision-making process, both in terms of diagnostic accuracy (that is effectiveness) and of user-centered dimensions, such as perceived confidence and utility (that is satisfaction), depending on case complexity, AI accuracy, and user expertise. Our findings show that lower-level features CAMs, which highlight more focused anatomical landmarks, are associated with higher diagnostic accuracy than higher-level features CAMs, particularly among experienced physicians. Moreover, despite the intuitive appeal of semantic CAMs, traditionally colored CAMs consistently yielded higher diagnostic accuracy across all groups. Our results challenge some prevalent assumptions in the XAI field and emphasize the importance of adopting an evidence-based and human-centered approach to design and evaluate AI- and XAI-assisted diagnostic tools. To this aim, the paper also proposes a hierarchy of evidence framework to help designers and practitioners choose the XAI solutions that optimize performance and satisfaction on the basis of the strongest evidence available or to focus on the gaps in the literature that need to be filled to move from opinionated and eminence-based research to one more based on empirical evidence and end-user work and preferences.

Design of Pediatric Outpatient Procedure Environments: A Pilot Study to Understand the Perceptions of Patients and Their Parents.

OBJECTIVE: To understand parent and child perception of spaces experienced during outpatient procedures and to measure their anxiety in these spaces. BACKGROUND: Same-day procedures are becoming prevalent among children in the United States. While studies conducted in different types of healthcare settings show that the physical environment influences healthcare experiences of patients, there is a lack of research on patient and family perceptions of the physical environment of the outpatient centers where such procedures are conducted. METHODS: This study used ecological momentary assessment to collect patient experience and anxiety data at different points during the patient's journey through an ambulatory surgical center where pediatric gastrointestinal (GI) procedures were performed. Objective and subjective measures of anxiety were collected. A Qualtrics survey asked participants' perceptions about four spaces-waiting, preprocedure, procedure, and recovery. RESULTS: Child participants reported liking murals, double chairs, patient beds, wall color, and access to a television. They disliked medical equipment and lack of child-friendly furniture. Most parents liked the murals, access to a television, and nature photos, while disliking the lack of privacy, lack of toys in waiting areas, and lack of child-friendly furniture. On average, both children and parents experienced the highest anxiety levels before and during the procedure and the lowest during recovery. Between the four spaces, no significant differences were observed in the heart rate variability and skin conductance responses for both groups. CONCLUSIONS: Despite the outpatient nature of the procedures, participants experienced anxiety before the GI procedure. Comfortable design features that provide distractions are preferred by children and their parents.

Are We Speaking the Same Language? Terminology Consistency in EBD.

OBJECTIVE: The aim of this study is to analyze the consistency, variability, and potential standardization of terminology used to describe architectural variables (AVs) and health outcomes in evidence-based design (EBD) studies. BACKGROUND: In EBD research, consistent terminology is crucial for studying the effects of AVs on health outcomes. However, there is a possibility that diverse terms have been used by researchers, which could lead to potential confusion and inconsistencies. METHODS: Three recent large systematic reviews were used as a source of publications, and 105 were extracted. The analysis aimed to extract a list of the terms used to refer to the unique concepts of AVs and health outcomes, with a specific focus on people with dementia. Each term's frequency was calculated, and statistical tests, including the χ2 and the post hoc test, were employed to compare their distributions. RESULTS: The study identified representative terms for AVs and health outcomes, revealing the variability in terminology usage within EBD field for dementia-friendly design. The comparative analysis of the identified terms highlighted patterns of frequency and distribution, shedding light on potential areas for standardization. CONCLUSIONS: The findings emphasize the need for standardized terminologies in EBD to improve communication, collaboration, and knowledge synthesis. Standardization of terminology can facilitate research comparability, enhance the generalizability of findings by creating a common language across studies and practitioners, and support the development of EBD guidelines. The study contributes to the ongoing discourse on standardizing terminologies in the field and provides insights into strategies for achieving consensus among researchers, practitioners, and stakeholders in health environmental research.

Architectural design, facilities and family participation in neonatal units in Spain: A multicentre study.

AIM: The architecture of neonatal units plays a key role in developmental strategies and preterm outcomes. The aim was to evaluate the design of Spanish neonatal units and its impact on the participation of parents in neonatal care. METHODS: A web-based survey was sent to all level III Spanish neonatal units, including questions about hospital data, architectural design, facilities and family participation. RESULTS: The study included 63 units. Most units (87%) had part or all the intensive care patients located in open bay units, while 54% had at least one individual patient cubicle. Single family rooms, defined as those including enough space and furniture for family members to stay with the infant without restrictions, were available in 8 units (13%). Eighteen units (29%) had a structured programme of family education. Units with single family rooms were more likely to have parental participation in rounds (p < 0.01), safety protocols (p = 0.02), oxygen management (p < 0.01) and nasogastric tube feeding (p = 0.02), as well as to allow siblings to participate in kangaroo care (p < 0.01). CONCLUSION: Widely variable architectural designs and policies were found in Spanish neonatal units. The presence of single family rooms may have impacted the participation of parents in neonatal care.

Development and initial validation of the staff perception of residential care environments (SPORE) instrument.

BACKGROUND: The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people. OBJECTIVES: To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE). DESIGN: An instrument development and psychometric evaluation study. METHODS: Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level. RESULTS: The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment. CONCLUSION: The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care. IMPLICATIONS FOR PRACTICE: The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

The influence of physical environment on health care-associated infections: A literature review.

BACKGROUND: Health care-associated infections (HAIs) are a common issue in health care settings, caused by environmental microorganisms, leading to health risks and financial strain. Despite efforts to reduce HAIs, the role of the physical environment in reducing HAIs is not fully understood. This literature review aimed to identify physical environment variables contributing to HAIs. METHODS: A literature search was conducted in scientific databases between 2016 and 2022 using keywords associated with infections and physical environment variables. After screening retrieved articles for eligibility, the articles were analyzed for relevant environmental and infection variables. RESULTS: Out of 145, 27 articles were identified. The findings were grouped into 8 categories, including layout design, surfaces, behavior, lighting, Internet of Things, materials, airflow, and air quality, with sub-themes in each group. CONCLUSIONS: The physical environment in health care facilities plays a crucial role in reducing and preventing the spread of HAIs. Proper design and construction of health care buildings, including ventilation and air conditioning systems, help prevent infection spread between functional areas. Antimicrobial materials, cleaning and disinfection protocols, and personal hygiene practices, such as hand hygiene, are key factors in infection control. The positioning of hand hygiene stations is also essential to improve compliance among health care professionals.

Anesthesia Workspaces for Safe Medication Practices: Design Guidelines.

BACKGROUND: Studies show that workspace for the anesthesia providers is prone to interruptions and distractions. Anesthesia providers experience difficulties while performing critical medication tasks such as medication preparation and administration due to poor ergonomics and configurations of workspace, equipment clutter, and limited space which ultimately may impact patient safety, length of surgery, and cost of care delivery. Therefore, improving design of anesthesia workspace for supporting safe and efficient medication practices is paramount. OBJECTIVES: The objective of this study was to develop a set of evidence-based design guidelines focusing on design of anesthesia workspace to support safer anesthesia medication tasks in operating rooms (ORs). METHODS: Data collection was based on literature review, observation, and coding of more than 30 prerecorded videos of outpatient surgical procedures to identify challenges experienced by anesthesia providers while performing medication tasks. Guidelines were then reviewed and validated using short survey. RESULTS: Findings are summarized into seven evidence-based design guidelines, including (1) locate critical tasks within a primary field of vision, (2) eliminate travel into and through the anesthesia zone (for other staff), (3) identify and demarcate a distinct anesthesia zone with adequate space for the anesthesia provider, (4) optimize the ability to reposition/reconfigure the anesthesia workspace, (5) minimize clutter from equipment, (6) provide adequate and appropriately positioned surfaces for medication preparation and administration, and (7) optimize task and surface lighting. CONCLUSION: This study finds many areas for improving design of ORs. Improvements of anesthesia work area will call for contribution and cooperation of entire surgical team.

A Systematic Approach to Evidence-Based Design for Measurable Health and Wellness Outcomes: Curating and Translating Evidence to Practice.

OBJECTIVES: Evaluating evidence from peer-review literature for use in evidence-based design is often challenging for the design disciplines, requiring access to the peer-reviewed literature, expertise in evaluating methods and findings, and translating the results into actionable design and operational recommendations. PURPOSE: The purpose of this methods paper is to elucidate the process for systematic evaluation of research to translate evidence into practical application to improve design for occupant health and wellness. BACKGROUND: Researchers have found strong connections in environmental design influence on health and wellness that have proven to be substantiative in the effort to improve health and well-being. Design has the capacity to encourage healthy choices and decisions within the built environment. Translation of evidence into applied design solutions may improve public health. METHODS: A protocol is presented that culminates in the translation of evidence into design recommendations focused on improving occupant health. The protocol includes preparation for the literature search and review, search strategy, study selection, data analysis, and development of the literature review. RESULTS: After evaluation of the evidence is completed, there were several positive findings in the example that stakeholders could utilize to improve the health of building occupants with programs and design to support nutrition, physical activity, and circadian entrainment. CONCLUSIONS: There are a variety of software tools and processes to utilize in the curation of evidence to improve the built environment with relevant design recommendations and operational considerations affecting the personal, social, and economic health of our society.

Application of the Childbirth Supporter Study to Advance the Birth Unit Design Spatial Evaluation Tool.

OBJECTIVE: Translational research to advance design criteria and apply the Childbirth Supporter Study (CSS) findings to practice. BACKGROUND: The physical design of birth environments has not undergone substantial improvements in layout or ambiance since the initial move to hospitals. Cooperative, continuously present childbirth supporters are beneficial and are an expectation for most modern birth practices, yet the built environment does not offer support for the supporter. METHODS: To advance design criteria, we use a comparative case study approach to create translational findings. Specifically, CSS findings were used as indicators to advance the Birth Unit Design Spatial Evaluation Tool (BUDSET) design characteristics in pursuit of better support for childbirth supporters in the built hospital birth environment. RESULTS: This comparative case study provides eight new BUDSET design domain suggestions to benefit the supporter-woman dyad, and subsequently the baby and care providers. CONCLUSIONS: Research-informed design imperatives are needed to guide the inclusion of childbirth supporters as both a supporter and as an individual in the birth space. Increased understanding of relationships between specific design features and childbirth supporters' experiences and reactions are provided. Suggestions to enhance the applicability of the BUDSET for birth unit design facility development are made, specifically ones that will better accommodate childbirth supporters.

Applying Trauma-Informed Design Principles to Therapeutic Residential Care Facilities to Reduce Retraumatization and Promote Resiliency Among Youth in Care.

Purpose: This conceptual paper connects the literature on the experiences and needs of youth in therapeutic residential care, trauma-informed frameworks utilized in these settings, and early research on trauma-informed design to facilitate an understanding of these connections and move towards developing a blueprint for trauma-informed design in residential settings for traumatized youth. Methods: A critical literature review drawing on trauma theory, trauma-informed care, evidence-based design, and trauma-informed design was conducted to inform the argument presented in this conceptual paper. Results: While many therapeutic residential care models engage trauma-informed care approaches to support staff in promoting healing environments for youth who have histories of complex trauma, the focus has remained on the psychosocial environment of care, and has yet to be systematically applied to the design of the built environment in which these programs are implemented. By applying the principles of trauma-informed care to the built environment, trauma-informed design has the potential to reduce retraumatization and promote resiliency among youth in care. Conclusions: Ultimately, this conceptual paper illustrates the value of further developing trauma-informed design principles to apply to settings that serve traumatized youth, such as therapeutic residential care facilities.