Children and adolescents are experiencing mental and behavioral health issues in significantly rising numbers. A U.S. Department of Health and Human Services study of recent trends in children’s health revealed that between 2016 and 2020, the number of children aged 3-17 diagnosed with anxiety rose 29 percent and the number of those with depression increased 27 percent.

The Covid-19 pandemic further exacerbated the mental health crisis among children and adolescents. According to the U.S. Centers for Disease Control and Prevention, emergency department pediatric visits related to mental health conditions increased in January 2022 compared to 2019.

Teen girls are especially at risk. In February, the CDC reported that between 2011 and 2021, the percentage of teenage boys who persistently felt sad or hopeless rose from 21 percent to 29 percent, while the percentage of teenage girls who persistently felt sad or hopeless rose from 36 percent to 57 percent – a nearly 60 percent increase. The findings reveal nearly 30 percent of teen girls have seriously considered suicide.

In addition, more than half (52 percent) of teens who identify as lesbian, gay, bisexual or questioning reported they have recently experienced poor mental health and 22 percent of LGBTQ+ teens attempted suicide in the past year.

As the CDC noted in its report, “These data make it clear that young people in the U.S. are collectively experiencing a level of distress that calls on us to act.”

The design world is responding with research into how design can support pediatric mental and behavioral health. During my 2021-2022 Health Fellowship at HKS, I explored evidence-based design for pediatric mental and behavioral health environments. There are several key factors driving design for this patient population:

Increasing Number of Pediatric Mental and Behavioral Health Patients

The rising utilization of mental health care for children and adolescents has paved the way for an increase in demand, access and government investments in pediatric mental and behavioral health care.

Focus on Family-centered Care for Improved Long-term Outcomes

Children’s emotional well-being greatly depends on their parents’ well-being, so it is imperative to actively include family in the treatment journey.

Flexibility

Due to the wide age range within the pediatric inpatient population, there is an increasing emphasis for unit adaptability in health facilities to provide appropriate treatment and care for all young age groups.

Growing Emphasis on Therapeutic Design to Support Improved Outcomes

There is a focus on child-centered care to improve long-term outcomes and reduce re-admittance rates. Improvements in therapeutic interventions (sensory rooms, meditation/quiet rooms, outdoor activity spaces, etc.) have resulted in treatment occurring away from the patient room. There is a pressing need to provide a variety of spaces to accommodate children and adolescents’ need for play and respite.

Welcoming Spaces for Children, Adolescents and Families

HKS strives to create environments that support improved mental and behavioral health outcomes for children and adolescents and ease their families’ stress and anxiety.

For example, Baylor Scott & White All Saints Medical Center’s Adolescent and Young Adult (AYA) Cancer Unit in Fort Worth, Texas is designed to meet the unique biological, medical and psychosocial needs of AYA cancer patients, which differ from those of adult patients.

Six patient rooms are centered on a shared work core that encourages collaboration between nurses and physicians and fosters a sense of community on the unit. Murphy beds make overnight stays comfortable for family and encourage family involvement in patient care. Each room has a unique color scheme to accommodate varying patient preferences. Patients can further individualize the walls of their rooms with colorful vinyl images of rocks that can be rearranged and stacked into cairns to mark patients’ progress along their treatment journey.

The design of the College Hill Behavioral Residential Building at Cincinnati Children’s Hospital Medical Center (CCHMC) reinforces CCHMC’s support and commitment to children, teens and families dealing with behavioral or mental health challenges. The space is bright, welcoming and designed to aid visitor wayfinding and access. Accommodations for family members enable families to relax and interact with their loved ones and CCHMC staff.

The Sensory Well-being Hub at Lane Tech College Prep High School in Chicago services special education students who struggle with sensory equilibrium. The hub’s modular design enables each student to create an experience that allows them to refocus and calm down on their own terms. The demountable framing structure resembles a high-tech playset, providing places for activities ranging from quiet to stimulating. Audio, visual, kinesthetic and tactile features help students “reset.” A media wall system houses a touchscreen monitor, color changing lights and a sound system — all sensory elements that are controlled and customized per the user’s preferences.

The Garth Brooks Foundation chose UCLA Mattel Children’s Hospital for its first West Coast Teammates for Kids installation. This was the initial project of this type and complexity to be built in an acute care hospital regulated by California’s Department of Health Care Access and Information, which requires adherence to strict structural and architectural regulations. Kids of all ages can access a variety of age-appropriate therapeutic play and learning spaces that are custom-designed and centered on the theme, “Exploring Los Angeles.” The space enhances the efforts of Child Life practitioners who work with the hospital’s entire multi-disciplinary team to promote coping, create meaningful memories of play and enhance the overall health care experience for young patients and their families.

In addition to providing a warm healing environment for its young patients, Our Lady of the Lake Children’s Hospital in Baton Rouge serves the larger community as a gathering place for education and recreation. The hospital is surrounded by gardens with bird houses and an entertainment pavilion.

The main lobby of Kay Jewelers Pavilion at Akron Children’s Hospital acts as an extension of the adjacent park and features a Backyard theme, complete with a floor-to-ceiling white fiberglass tree and a bright blue “fence” wall with peek-a-boo cutouts and interactive animal elements. Bright colors and distinctive shapes capture a sense of favorite childhood places to play – rain puddles and the backyard sandbox. The “garden” on the Obstetrics floor features cool colors and artwork inspired by nature. Silhouettes and leaf patterning in the Neonatal Intensive Care Unit create the cozy sense of being in a treehouse.