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Physician Update - Brick and mortar "placebo"

Physician Update Spring 2012

Brick and mortar "placebo"

Date: April 1, 2012

Brick and Mortar
“Even the new waiting room is night-and-day different,” says psychiatrist Marco Grados.

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 now that Child and Adolescent Psychiatry (CAP) has moved its clinical services there.

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 are astonished, in a word, by this setting,” says Nurse Manager Nancy Praglowski.

All patient rooms are now singles. Some have added technology for patients with asthma or other medical conditions. New one-way observation rooms enhance training. The area is 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 is, for now, circumspect. The present number of inpatient beds is staying at 12 for a time, even with a new 20-patient capacity.

“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 changes are 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 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.”

410-955-5335 to refer a patient.

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