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Psychiatry Newsletter - Brick-and-mortar "placebo"
Date: March 2, 2012
In 1913, when Hopkins’ Henry Phipps Psychiatric Clinic opened, patients availed themselves of pipe organ concerts, garden-strolling or plays in its 100-seat theatre. The building’s very architecture was meant to divert minds and ease stress in an age well before SSRIs.
To say that The Johns Hopkins Hospital’s new clinical buildings will do the same for today’s patients may be a stretch. But nobody’s scoffing at a possible brick-and-mortar placebo effect once Child and Adolescent Psychiatry (CAP) moves its clinical services there this April. The airy entryways to the new children’s center spark the same feel of optimism travelers get in a large, modern airport. And each arm of the U-shaped 12th floor—totally dedicated to CAP—is cradled in sunlight at some time of day.
“Institutional doesn’t come to mind. I think the kids and their families will be astonished, in a word, by this setting,” says Nurse Manager Nancy Pragloski.
All patient rooms are now singles. Some have added technology for patients with asthma or other medical conditions. New one-way observation rooms will enhance training. The area promises to be quieter as staff now carry visual pagers and an electronic locator system is built in.
But for all of the new site’s wonders, CAP’s day-to-day operation will at first be circumspect. The present number of inpatient beds will stay at 12 for a time, even with a new 20-patient capacity. Meanwhile, there’s careful planning for the future. “It’s a gentle start,” says Clinical Director Marco Grados, “because that’s in keeping with the nature of psychiatry. Environment can significantly affect our patients, so we need to test the waters first.”
CAP Acting Director Maggie Bruck agrees: “Increasing patient number by even a few can alter dynamics. And since interactions between patients, our staff and the families that visit can vary greatly, a manageable change lets us keep our children and teens safe and in the best position for recovery. This isn’t just a move,” she emphasizes, “it’s a project.”
Still, some preparations have been dramatic. CAP has woven in newer approaches to managing young patients, for example, based on nationwide studies that show high success. “Working with our medical psychology team,” Grados says, “we’ve just begun a new collaborative problem-solving approach with children whose social or cognitive deficits take shape as difficult behavior.” Also, a new school-based system that rewards positive behaviors—Positive Interventional Systems and Supports (PDIS)—will show its worth when kids are in the new, larger space. In PDIS, children earn stamps that can be redeemed for daily rewards for good behavior.
“We’re always seeking ways to deliver the finest clinical care,” says Grados. “We’re determined to keep that constant when we’re ultimately ready to admit more kids.”