Author: skenne4

By: Anthony D. Asher, PMP, EDAC

The National Research council states Autistic Spectrum Disorders (ASD) are present from birth or in the child’s early development. ASD affects core human traits and behaviors such as social interactions, the ability to communicate, share feelings, express imagination, and create relationships with others. These behaviors are typically with the individual throughout their lifetime and affect how they learn, interact socially and with the environment, and participate within a community. Symptoms vary from child to child and even with the same individual over time.

When autismspeaks.org was founded in February of 2005, the estimated prevalence rate of children diagnosed with Autism Spectrum Disorder was one in 166 as reported by the CDC at the time. Over the next 15 years, the number of individuals with ASD increased at an alarming rate. In 2020, the CDC reported approximately 1 in 54 children in the U.S. had been diagnosed with Autism Spectrum Disorders.

There is no cure for Autism. There is only treatment through education; however, there are no uniformly accepted and recognized guidelines for the built environment of early education and intervention environments for children with Autism. Tola et al., 2008 conducted a scoping review of the built environment and its relation to autism and states that the built environment is an influential factor in the quality of life of people with ASD and that they often have a problematic relationship with the surrounding environment.

Those with ASD are susceptible to their environment and may have abnormal responses due to sensory processing deficits to noise, light, and textures. This deficit in the sensory process places individuals into two categories that aids in treatment and mitigation options within the environment’s design: hypo-sensitive and hypersensitive. Table 1 illustrates the senses in relation to the hyper and hypo-sensitive reactions to the environment. Children with ASD tend to cope with their stressors in a manner that often appears as an “inappropriate tantrum” to those unfamiliar with ASD. However, these “tantrums” are typically triggered by an “imbalance between the environment and the individual’s ability to adapt to it”. This becomes a challenge when “tantrums” or problem behaviors create a non-conducive learning environment.

The complexity and special considerations related to ASD drive built environment requirements such as specialized school settings. The needs of those with ASD are excluded entirely from all building codes and design guidelines. There is a huge need to understand how physical environments need to be designed to support the needs of children and adults with ASD.

Early intervention through education is vital to ASD treatment and growth. Problem behaviors in the classroom and educational environment become distractors and barriers to effective social and educational development. The design of classrooms often creates sensory challenges for children with ASD and exacerbates social and behavioral issues. Creating an environment that considers sensory issues of children with ASD through a well-designed classroom will help teachers and caregivers support each student in reaching their goals. The environment, modified through architecture and interior spaces, can constructively influence the problem behaviors exhibited by children with ASD. Design modifications might include color, texture, sense of closure, orientation, acoustics, and ventilation. The few guidelines that exist for designing better and less sensory-stimulating environment for persons with ASD provide recommendations around lighting, auditory, and tactile sensory mitigation.

Sight

Lighting greatly influences how space is perceived and can potentially create stress and discomfort. In some cases, fluorescent lighting tends to be an irritant, whereas natural lighting has been shown to improve attitude and academic performance in schools. Fluorescent light tends to flicker and be noticed by children with ASD.

Auditory

Studies have pinpointed auditory processing difficulties as the most common sensory trigger for children with ASD. Noise control should be addressed early during the planning phase of construction. This can be done with flooring material choices such as rubber flooring, sound-absorbing insulation between thicker walls, and sound damping panels that line the walls. The most common cause of unwanted sound in a classroom often comes from the Heating, Ventilation, and Air Conditioning (HVAC) equipment, which can be reduced by locating the air handlers away from classrooms and using large round and heavier gauge ductwork.

Touch

Hypersensitivity to touch is another sensory dysfunction in children with ASD. As a result, in order to learn how to engage with different materials, the engagement of the tactile sense is needed. Sensory integration therapy is a critical element of treatment and intervention. This provides an opportunity to implement design interventions through therapy rooms with different material applications and textures, craft rooms, and playgrounds.

Designing an environment for the Spectrum

Due to the challenges of designing mitigations into the environment for the children across the spectrum, designers and architects need to create universal solutions. Clause states “the goal of a designer or architect should not be to remove all sensory stimuli from the built environment but instead to provide flexible solutions that meet people with ASD, where they are to enable individuals with ASD to build a tolerance so that they can interact more independently within society in different environments.” This will require identification of environmental triggers for problem behaviors and to create design solutions that reduce these events. The less sensory-stimulating an environment is, the greater the opportunity to foster successful and productive interactions without added distraction, for teachers, caregivers, and students.

The Autism ASPECTSS Design Index establishes an evidence-based design guideline to be used in designing spaces for individuals with ASD. The ASPECTSS design index addresses many of the hidden needs of people challenged by ASD. An abridged version of the index is illustrated in Table 2.

Future Directions and Opportunities

Early intervention emphasizing education can improve learning, communication, social skills, and underlying brain development for children with ASD. It is important that learning environments for children with ASD must be clear of distractions for this education to have a meaningful and effective impact. Classroom design can influence learning and positively affect the child in terms of sense of providing comfort, security, and a sense of well-being. Researchers and architects’ have the responsibility to determine which built environment characteristics create negative sensory experiences for children with ASD and to address those through conducive design features that enable distraction-free learning and growth opportunities.

By: Brooke A. Karlsen, MSN, BSN, RN, NEA-BC

Maternal care was an early clinical interest for me and this interest inspired me to pursue nursing so many years ago. As a student in the certificate program in Leadership and Innovation in Health + Design at Clemson University, I am enjoying studying the connections between healthcare policy, nursing and the design of the built environment. Last semester, I had the opportunity to undertake research on an area of public health policy and explore its connection to the built environment. I chose to study maternal mortality and morbidity and its relationship to the design of the built environment. In conducting the research, I was saddened to see the trends in the U.S. and feel called to do what I can in my new career, blending my extensive experience in healthcare with planning, design and construction to make a difference through the built environment.

I learned that the maternal mortality rate in the U.S. has risen consistently since data collection began from 7.2 deaths per 100,000 in 1987 to 17.3 in 2017. The maternal death rate exceeds that of 40 other countries and the U.S. is one of only eight countries worldwide and the only developed nation where maternal mortality has actually increased over the past three decades. Additionally, for every maternal death there are estimated to be 70 cases of severe morbidity, and many more near misses that are not quantified. With up to 60% of maternal deaths being categorized as preventable, there has been heightened interest in the clinician, patient and institutional factors that contribute to poor maternal outcomes, and to identify potential areas for intervention.

While there is a large body of literature outside of obstetrics linking care environment with patient outcomes, there is limited research on the impact of the physical environment of obstetric care on maternal morbidity and mortality. What I did learn from the limited research found on birth environments, is that there are three important built environment themes which promote normal physiological birth processes, influence the need for medical interventions, and effect cesarean section rates. The three areas that architects, clinicians and healthcare administrators should consider for design and research in birth settings are the overall aesthetics of maternal care environments, the design of the birth room as well as unit layout and design. These influences, in turn, impact maternal mortality and morbidity, both directly and indirectly.

Aesthetics

The overall aesthetics of the birth experience are important in helping to avoid triggering a fear cascade in the laboring woman, which is known to affect the birth processes by disrupting the normal physiological hormonal response in labor. The aesthetics of the space are extremely important and include all the areas the woman will encounter throughout hospitalization, and should be designed to promote relaxation. Included are the use of warm colors, textured surfaces, a homelike look for furnishings and fabrics as well as the use of soft lighting, natural light, and views of nature. Artwork, posters or symbols using the female archetype, located in strategic places in birth rooms or the unit where the laboring woman might walk, have been shown to be calming and helping to decrease stress.

Birth Room

The birth room contributes to the normal physiological processes of labor. Labor progressing naturally on its own lessens the need for medical interventions. In addition to the birth room aesthetics, birth rooms must have the essential technical equipment such as fetal monitoring capabilities and neonatal care equipment immediately available. However, for some, its’ presence might trigger anxiety or fear, so housing it in concealed cabinetry unless needed is recommended. Similarly, access to emergency supplies in the room is essential to prevent delays in necessary care, but like other technical equipment, should be concealed whenever possible. Another aspect that can trigger the fear cascade is lack of privacy. The spatial filter, which is the interface between the public corridor and the room itself, is a design element to consider. Privacy curtains, half walls, or doors angled in a way that protects the inside of the room from view from the hallway can be utilized to enhance the sense of privacy.

Features of the birth room layout contribute to the normal physical mechanisms of labor. The room’s size, shape and layout configuration should allow for flexibility to change the room for the different phases of labor and to facilitate the woman utilizing the space in a way most comfortable for her. The laboring woman needs to be able to move around and assume varied positions, so having space for optimal equipment such as birthing stools, bean bags, gym mats, wall bars, along with accessible bathrooms with showers and birthing tub is necessary. The amount of time the woman spends lying in bed impacts the progression of labor (less being better), therefore, the ability to easily move the bed out of the way should be factored into the design. Because continuous labor support is linked to successful outcomes of labor, having sufficient space in the labor room for the supporter and their belongings should be prioritized. Lighting and temperature of the rooms should be capable of being controlled by the woman and or her supporter.

Unit Layout/Design

Beyond the spaces that the laboring woman encounters during the birth process, the overall unit layout has important implications for minimizing morbidity. Because obstetric hemorrhage is a leading cause of maternal death and morbidity, managing hemorrhage requires ready access to life-saving equipment, medications and blood products. In particular, birth units should regularly reassess current practices, logistics, and locations of blood products relative to where they might be needed. At “baseline” blood storage be in the same building as the labor unit, but a “better” practice would be storage on the same floor, and “best” practice would be storage of blood product right outside the cesarean section operating room.

Additional insight into the importance of unit layout emerged from the Ariadne Lab and Mass Design Group’s exploratory study linking facility design with cesarean section rates. High cesarean rates having been identified as a key factor in the increasing maternal morbidity and mortality rates. They concluded that more deliveries per labor room, fewer labor rooms per operating room, higher ratio of overflow beds to labor rooms, longer distances between spaces, proximity of on-call rooms, and lower percent of support areas designated as collaborative spaces, were all associated with higher cesarean delivery rates. Limited unit or facility capacity, high workload, and limited accountability for decision–making all contribute to the clinical decision to perform a cesarean section. Normal vaginal delivery is both space and clinical resource-intensive, whereas a cesarean delivery requires only a few hours of clinical attention. When under pressure to make more space for incoming patients, or in times of staffing shortages, a decision point of whether to continue to attempt vaginal delivery or expedite things by performing a cesarean birth is reached. Thus, design elements can play a significant role in that decision.

Conclusion

Despite the limited number of robust studies on the built environment for labor and delivery, the research that exists supports the essential role of the built environment in promoting physiologic labor processes and reducing maternal morbidity and mortality. These initial studies provide some direction for healthcare planners and designers. However, further research is much needed! Looking to the practices and processes from other countries who have succeeded in reducing the alarming mortality and morbidity rates should also be pursued.

By Anjali Joseph

The Environmental Design Research Association came into being in the 1960s, led by a group of forward-thinking activists and environmental design researchers who believed that architects and designers held a social responsibility to create environments that supported human behavior and intentions, well-being and performance for everyone. This highly multi-disciplinary and inclusive community includes psychologists, social science researchers, architects, landscape architects, interior designers, design researchers and students with a range of interests and focus areas. EDRA members represent many different countries and are leaders in the field of environment and behavior studies, evidence-based design, facility evaluation methods, sustainability, active living, participation, community planning, universal design, diversity in design, workplace design and informatics, design education, and digital technologies. Anyone interested in engaging in conversation around the design of the physical environment and its impacts on human behavior and performance has a home in the EDRA community.

I first attended EDRA in 2003 as a doctoral student at Georgia Tech. I vividly recall standing nervously in front of my poster during a session at EDRA. I remember the many friendly EDRA members who stopped by to provide words of encouragement and advice. At another EDRA conference, at the urging of my advisor Craig Zimring, I organized a workshop session on active living for environments for aging. With Craig’s support, I was able to recruit many leading EDRA researchers including Habib Chaudhury, Atiya Mahmood, Benyamin Schwarz and Gerald Weisman. As I found then and it continues to be the case, the EDRA community is generous in sharing their knowledge and willing to mentor and support young students and early career professionals. These interactions and countless others at EDRA helped me gain confidence as a speaker and researcher and helped me make connections that have served me well during my career.

EDRA creates so many opportunities for students and professionals to enrich their careers and expand their knowledge about environmental design, just like it did for me as a student. The values and philosophy of EDRA resonates with so much of what we do at the Clemson School of Architecture and the Center for Health Facilities Design and Testing. For all these reasons and many more, Clemson University and EDRA 53 co-chairs (Dina Battisto, B.D. Wortham- Galvin and I) are deeply honored and excited to be hosting the 53rd Environmental Design Research Association (EDRA) Annual Conference in 2022 in Greenville, SC!

The theme of the 2022 conference is Health in all Design: Promoting health, equity, sustainability and resilience through environmental design. As we emerge from a global pandemic, it has become imperative that environmental designers and researchers consider health – a state of complete physical, social and mental well-being over time – as a critical goal for all design projects. The pandemic has highlighted the importance of the built environment in promoting safe and healthy lifestyles by providing access to outdoors and green areas for physical activity, good air quality and building layouts that support hygienic practices indoors, and ergonomic design that promotes wellness in workplaces. The pandemic has also highlighted stark inequalities – black, indigenous and people of color (BIPOC) communities have been disproportionately impacted in terms of mortality, illness and unemployment. Providing access to safe and affordable housing, healthcare and health-promoting resources has never been more critical for these communities. Greenhouse gas emissions resulting from human activity including transportation, building construction and operation are contributing to climate change, and future designs should not only impact individual and community health but also help improve planetary health. Inclusive of sustainability and cities’ abilities to help sustain diverse environments, cultures, and economies locally and globally, resiliency which implies the ability of a community to anticipate and recover from challenges is needed now more than ever before. Through ‘Health in all Design’, EDRA 53 will bring together a multidisciplinary community of practitioners and researchers to engage in a conversation about the role of built environment in promoting health, equity, sustainability and resilience as we move beyond the pandemic.

Greenville is a prime example of our proposed theme: Health in all Design. Through an engaged public private partnership, the city of Greenville was revitalized to include a range of health-promoting community resources including walking and biking trails and parks such that it is listed among the 10 most livable cities in the US. Further, the city plans to implement smart city concepts in the near future to support health and well-being of its residents. Clemson University’s College of Architecture, Arts and Humanities (CAAH) and its allied programs that are encompassed by EDRA – landscape architecture, city planning, historic preservation, architecture and health, and resilient urban design – are deeply engaged in conversations locally and globally around health, equity, sustainability and resilience. The Interdisciplinary Ph.D. program in Planning, Design and the Built Environment (PDBE) in CAAH also includes a concentration in Built Environment and Health. The graduate program in Architecture + Health at Clemson focuses on studying how architectural environments impact health and how to create architectural settings that support the health and well-being of individuals and larger populations. The Master’s program in Resilient Urban Design (MRUD) prepares individuals to engage complex cultural, market, and government policy forces through sustainable and resilient urban form. Further, we integrate professional degree programs and research programs to foster lively discussions around blending design, theory and practice. The focus of these programs as well as the broader mission of the landscape architecture and architecture programs at Clemson align well with the goals of EDRA and the theme of this conference.

This proposed theme invites abstracts that focus on research, projects, methods, and designs that envision a safer and healthier post-pandemic world. Thus, the theme will manifest in various session tracks that might include:

Health, Equity, Resilience and Sustainability: How are we generating knowledge to address the great challenges of the time, like: public health issues, an increasingly digital society, climate change, social inequities, overpopulation, stewarding tangible and intangible heritage, an increase in both waste and pollution (soil, air, noise, water), natural resource depletion, access to affordable housing, access to food and water, loss of biodiversity, loss of cultural diversity, urban sprawl, etc.? How do we rely upon simultaneity and adjustability to manage these challenges both locally and globally?

Designing for Diverse Populations: How are we considering the needs of post-pandemic? What impacts did our buildings, communities and natural environments have on vulnerable populations including children, ethnic minorities, young adults, the elderly, people with mental disorders, people with physical disabilities during the pandemic? How will the lessons learned during the pandemic shape the design of future environments for diverse populations?

Designing for Health: How do design and planning professionals approach and define health and well-being as a core part of their practice? How does it affect their methods? What are the emerging design tools (data, simulation, virtual) and how are they being deployed in design projects?

Activism & Advocacy: What are the methods, conversations, and outcomes for those researching and designing under the auspices of design activism, action research, public service, and public education? We encourage not only success stories but also critical discussions of pitfalls and “failures” that serve as learning opportunities for this work.

Trans-disciplinary: How are professionals and academics crossing boundaries to address emerging issues of health, equity, sustainability and resilience in a post-pandemic world? What are the means for doing this? What critiques emerge when blurring and/or borrowing from multiple disciplines?

Pedagogies/Methods: What are the ways in which teaching promotes design and research excellence, innovation, and/or activism? What methodologies are being embraced by environmental design faculty in order to innovate and stimulate their research? How are emerging design tools (data, simulation, virtual, etc.) being used in the classroom and/or in research?

Join us June 1-4, 2022 to discover more about ‘Health in all Design’ and what we can learn from experts in environmental design. EDRA holds a special place in my heart and I am very excited to bring EDRA to Greenville and Clemson. To get involved with EDRA events, explore publications, and expand networking opportunities click here.

By Swati Goel

Approximately 187,000 students enroll in a Ph.D. program each year in the United States. My journey is specific to Clemson University’s Planning Design and Built Environment cohort of 2023, with a concentration in Architecture + health during COVID-19 times. I would say that makes it quite unique.

I am an international student from India. I am trained as an architect. My research interest brought me to the United States in 2017 to get a master’s degree in design and health from the University of Michigan. I started my Ph.D. program at Clemson in the fall of 2020 after working as an architect for two years (to ensure I was making the correct decision for my career). I am passionate about architecture and mental health and was looking to combine design and research. That is when I stumbled upon Clemson’s Architecture + Health program.

COVID-19 hit the United States hard a year ago in March of 2020 and slowly took away all sense of community and peer support. Initially, I thought it would allow me to focus better. Still, as time went by, physical distancing began to feel exhausting, and there was no one to share the good and the bad. I had moved to South Carolina from Indiana after quitting my job as an architect and leaving behind all my friends and support system. COVID-19 made it hard to establish new connections at the onset, a crucial ingredient of graduate school.

The first semester at Clemson University was a significant change and called for adjustment. I had moved multiple times before, but this time was different with no previous acquaintances. Besides, shifting my mindset from an Architectural Designer to a full-time researcher was exceptionally challenging. It required a complete rehauling of my approach towards work. While designing, architects constantly improvise a set of drawings or writing guidelines, which can be reused and do not need a systematic process. However, research is very organized and novel. The process is unique and requires constant reading and insight. The first two months went into decorating my new apartment, but once that was done, all I had left was my studies and an endless series of ZOOM calls. Three months into it, I realized there was a term for it- ZOOM fatigue! (Fauville et al., 2021)

All the classes were online, research assistantship work was online, and all my friends and family were online. I could not meet people and make many new friends in Clemson. A few months into the program, my advisor suggested that the research assistants work in the Ph.D. student offices while practicing social distancing. It was nice to leave my house and be around my research team once or twice a week. I was beginning to see the importance of peer support while pursuing a Ph.D. We could talk through ways of doing research activities and brainstorm ideas. It is tempting to stay home and sit in front of the computer and plan and read. However, once I started going to school, I realized the importance of in-person interaction, taking breaks, and investing in myself; instead of just being a Ph.D. student. In a study assessing the effects of the COVID-19 pandemic on college students’ mental health conducted at a large university in Texas, 86% (n=195) of the participants reported decreased social interactions due to physical distancing, while 89% reported difficulty in concentrating (Son et al., 2020).

I grew more and more grateful for the support system I found in the other Ph.D. students who I had the opportunity to meet and work with in person. Earlier I used to think that a Ph.D. is a feat to be accomplished alone, but it is the opposite. The more we alienate ourselves, the harder it gets. It needs to be shared and celebrated, at least the first two years! That’s how we grow as individuals and researchers. It gets better. In the Fall of 2020, the Center for Health and Facilities Design Testing (CHFDT) team organized multiple (physically distant) events such as pumpkin carving on Halloween and hikes in nature to enforce peer connection. Clemson University held socially distant football games at the memorial stadium with reduced seating. And finally, in my winter break, I celebrated Christmas with my fabulous new friends in Clemson and later saw my friends in Indiana. These activities reinforced the importance of combining work and play and the power of community and peer support.

I am in my second (spring) semester right now. The expectations are higher, but I feel more at home with myself. I have a nice routine. I am more organized. I am more in sync with my role as a researcher. I have a great support system within my research community and outside. I reach out to my friends and mentors whenever I need them. I am more productive and yet carve time to be myself.

All research papers end with a conclusion! A year later, and COVID-19 hasn’t left our lives; in fact, it has been a unique experience for everyone. Students and professionals are suffering due to more than usual hours spent at home. Clemson’s dining halls are open this spring, and I think the line between sweatpants and jeans is blurred. Screen time has increased, and exposure to sunlight and physical activities plummeted, leading to a rise in mental health issues. In the research at a Texas University, only 76% (105/136) of students utilized any coping mechanisms to handle the stress due to the outbreak (Son et al., 2020). Out of these 105 students, only 30% of students mentioned using physical exercise to manage stress. Another 21% used streaming and social media as a means of self-management. 44% of the students experienced some depressive thoughts due to loneliness and uncertainty. These outcomes worry me, and I wonder how an architect + researcher would respond to that? I do not have a perfect answer, but I am looking.

Personally, COVID-19 taught me to be grateful for my peers and colleagues. I am thankful for a supportive and encouraging team at the Center for Health and Facilities Design Testing. I am thankful to my advisor for thinking ahead of time and encouraging us to return to our offices while being safe. These experiences made me humble and appreciative of little things that I would not have if I were not forced to spend so much time alone. Maybe there is a lesson for all of us here!

Sources:

1.  https://www.statista.com/statistics/185167/number-of-doctoral-degrees-by-gender-since-1950/
2. https://news.stanford.edu/2021/02/23/four-causes-zoom-fatigue-solutions/
3. https://cookchildrens.org/coronavirus/action/Pages/Safe-Reopening.aspx
4. Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. Journal of Medical Internet Research, 22(9). https://doi.org/10.2196/21279
5. Fauville, G., Luo, M., Muller Queiroz, A. C., Bailenson, J. N., & Hancock, J. (2021). Nonverbal Mechanisms Predict Zoom Fatigue and Explain Why Women Experience Higher Levels than Men (SSRN Scholarly Paper ID 3820035). Social Science Research Network. https://doi.org/10.2139/ssrn.3820035