The No Place to Play exhibition focuses on specific findings about gender taken from a large research study with the same name. The larger study was conducted by Dr. Lyndsey Deaton, a Professor of Architecture in the Architecture + Health program at Clemson University. The project links economic development policies to social inequality in gentrifying communities in South and East Asia by highlighting how spatial changes affect teenagers’ mobility and access to public space. The forthcoming book (2024) is written for concerned parents, policymakers, designers, and community advocates. In it, Dr. Deaton describes five years of living alongside seven dispossessed communities and builds a case for contextualized, community-driven design.
Dr. Lyndsey Deaton Opening the show
The exhibition was designed and constructed by a group of Clemson University students from a variety of majors including architecture, psychology, women’s leadership, and sociology led by Dr. Deaton. It is an artistic demonstration of the influence gender has on teenagers’ access to public space in post-displacement communities. The exhibition highlights 50 teens from seven communities in India and the Philippines. Walking through this exhibition, visitors will hear recorded conversations with teens and see maps and photographs they created to better understand how displacement affects teen socialization. Finally, join our team of Clemson students in considering the similarities between the teens’ experiences in this study and the urban public spaces around South Carolina.
Exhibition Window PlacementWhere the Third Place is
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.
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.
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.
