In order to deeply involve families in the treatment process, each patient room has a parent bed, an integrated element in front of the window that allows for overnight stays. “The [family approach] ranges from rooms on each floor between the two units, to a sibling room on the ground floor, to an information exchange room – it’s really an extension of Nationwide Children commitment to family care as well as child care,” Pitts said. Staff and their families, program graduates, and community members visited the models to refine the design. “We quickly realized that we had solved many of the safety issues and that the development of the models was really going in the direction of look and feel,” says Ed Cheshire, Nationwide Children’s Senior Engineering Project Manager. “We were very happy with the quality of the models and the way they were designed,” says Ed Cheshire. To manage this inherent complexity, the team looked more closely at the differences between outpatient and inpatient care and, in particular, conducted a risk assessment that led to the design of “what, where and how” decisions affecting material consumption in the patient’s environment, Pitts explains. Nationwide Children’s set out to find a solution and recognized the need to optimize both mental and physical health in a holistic way – for example, the kind of response that often occurs in cancer patients who previously lacked mental health,” says McClimon. The nine-story, 386,000-square-foot National Children’s Hospital pavilion opened in March in Columbus, Ohio, as the largest mental health center on a pediatric medical campus in the United States. “In the end, we had a gradient from a lesser emphasis on self-harm in the outpatient setting to a much greater emphasis on the crisis setting, both residential and hospital, but we were always guided by sections that were both safe and non-institutional. “The process also ensured that Nationalwide Children’s could target exactly where money needed to be spent to improve safety,” Cheshire added. “All of these things were really about transforming conventional thinking about the form and design of mental health care and doing it in a fundamentally different way that would allow us to work in this urban environment,” says Hullinger. While a delicate balance had to be struck to meet the desire for safety, sustainability and non-institutional design, Cheshire said that the resulting environment was the result of a mindset that took into account the fact that 90-95 per cent of children treated in the ward would not display aggressive or dangerous behaviour, compared to 5-10 per cent who would. “If you look at buildings from this perspective, how do you care for families who are hurt and in need? It really took them to another place for Nationwide Children’s,” says Cheshire. And while the organization already had a strong outpatient behavioral health program, this new approach led to a much less traditional solution: a large-scale building that would provide a full continuum of care on its urban campus in downtown Columbus. “We agreed from the beginning that “he” needs to feel like a brother or sister in the hospital tower,” Beltran says of the relationship between the behavioral therapy room and the main hospital. To further support efforts and make decisions that work throughout the facility, a set of design tools has been developed to identify a range of complementary furniture that works well overall, while taking into account the different functional needs throughout the building,” explains Beltrán. “If we have a child that we know can be really destructive and harmful to the environment, we may have to think differently about how to care for that child, the staff situation, and not let the worst case determine the process of conception,” “she” says. By 2015, Nationwide Children’s leaders began to see trends, not only in the services their own patients increasingly needed, but also in national statistics: Suicide is one of the leading causes of death among U.S. children; half of all mental health problems in the U.S. are caused by suicide.