Oakwood: An intervention in design Dr Raja Mukherjee

Why Move In 2009 decision made to sell Oakland house site as part of trust Acute redevelopment strategy All services on the old site had to move or close Those in the old Grandview and Holly Tree were not so easy to move Options appraisal concluded that move to new unit best. Pre Winterbourne

Process Group of clinicians met with Architect and implementation team Manger Matron Consultant Care worker Presented the needs of ASD generally Then specific needs of those currently in residence

Visits to where they had done it before Sunfield school Visit made and discussion with their architect Very few other evaluated building in the scientific literature Lots of wider info on needs of people with ASD that was added in.

Areas considered Lighting Noise Temperature Transition Circulation Activity and engagement Security Privacy One problem was the change in specification

Lighting and space Lots of natural light high level windows High ceilings Wide corridors Light neutral non stimulating walls Sound absorption

Circulation and transition Lots of open areas Limited barriers Space away from main area Central area that makes space feel large Feeling not being enclosed and diminishing effect of proximity Security and safety without formal barriers

What we ended up with Limitations on space Not possible or practical to do everything A building in three parts Originally planned as transition through building Now set to meet different needs Areas considered were addressed in the design

Engagement through process Project management groups set up Management Clinicians Families (not individuals in all parts as not able to but they did input where they could) Clinical need always at centre of decision making Not everyone could be involved but attempts made to keep people up to speed

Evaluation Decision made to evaluate the move Pre and post analysis made Kept a series of different measurements Qualitative interviews staff and families Direct time sampling Family and staff questionnaires

So what does it look like

So What does it look like 2

Technology Sensory room Smart Table Paro seal Temperature control

So what did people say before: staff The building isn’t built for the clients, it doesn’t suit their needs, they’re not thinking about the clients at all. There is only one bathroom. There isn’t much for the clients to do. The activities are not age appropriate. The building is built just for show, not taking in consideration the clients. Doesn’t feel like it will change much, these guys they don’t like changes, it will be hard for them. Very excited about the move, feel like it will be very good for the service users. Hopefully there will be a lot more for them to do. They should interact more, there should be more options.

So what did people say before: Families Not happy that the move has to happen in the first place as xx doesn’t like changes. X has always been encouraged to see XX as his home and now he has to move, so not happy about that. Most of his life was on that site and he did everything there so his life has changed completely. It’s not just the move; it’s the whole package where everything has slowly been taken away from X as it has been ongoing for a few years. He lost his job there, unable to ride his bike – most of his life went. The whole situation has changed his life completely

After the move: Staff The new building is great, very spacious. Finding it a lot easier to work, there are fewer disturbances for JH, not so many staffs coming in and out of his flat. Thinks that the individual has settled in very well. The garden allows more activities to do, providing more opportunities. Think it’s good, really nice and bright. Much better place to live. It’s brilliant, there’s a lot more things to do even if they don’t do it the opportunity is there. Able to help make lunch, the open plan is very good and they’re doing a lot more, doing a lot more activities, using the interactive board a lot. This is great, to see them interacting and taking themselves off to do things in different places and enjoy the environment – it is a nice place for staff as well to interact with the service users It has helped to reduce rush as you can see things happen and then respond quickly before it becomes a bigger problem

After the move: Family (same as initial feedback) Very pleased about it. It’s a nice place, a lot better than before.

Quantitative analysis Most significant difference currently is engagement scores. P<0.05 on areas of engagement including spending time with client and spending time with other residents. Not presenting other data as numbers too small or time point limited to see difference Mean( Pre) Mean(P ost) S.D (pre) S.D (Post) Z scor e Sig. Clear Social Act * Neutral contact by staff or visitors Assistance given by staff or visitors *

Individualisation Criticisms were that is was not individual Opposite true Evidence that benefitting people Own space also designed in

How could it be improved The change in remit did not help Some features designed for inpatient unit More homely bathrooms Some more individual choice in room design not generic with need to move on

Final say: case Study 42 year old man Fraxile x and previous Challenging behaviour and Bipolar and ASD Did not go out of old building for several years Lived in the corridor High levels of arousal and anxiety Now going out into community More relaxed and coming into communal area as no transition Smiles at people when he sees them More engaged with staff Joined and sat next to peers at BBQ in summer Expressed view to researcher “ I am happy”

Questions