ELGIN, Ill. — Illinois inmates with serious mental illness will receive hospital-quality psychiatric care now that the Illinois Department of Corrections (IDOC) is renovating and expanding the Elgin Mental Health Center (EHMC), making it the first facility to offer such care to state inmates who have been formerly treated inside prison walls.

The IDOC reached a two-year agreement with the state-owned EMHC after an extensive search for a location to deliver hospital-level care. The gap in treatment for inmates whose condition goes beyond what can be managed by correctional staff was the last issue to be resolved in a nine-year federal lawsuit, initially filed by inmate Ashoor Rasho, following allegations of mentally ill inmates being left in solitary confinement and without access to proper care, according to The Pantagraph, a local news outlet.

The correctional overhaul will include a renovation of the 44-bed EMHC, designed by Chicago-based Primera, and an additional 244-bed residential treatment unit in Joliet for both male and female inmates. The first patients are expected at Elgin before the end of the year after about 100 employees are hired.

According to the National Alliance on Mental Illness (NAMI), 1.2 million individuals living with mental illness reside in jail and prison each year, and often their involvement with the criminal justice system begins with low-level offenses including jaywalking, disorderly conduct and trespassing.

The EHMC warden, Dr. Catherine Larry, believes that designating the inmates as “patients” indicates the shift of focus to provide substantial treatment. IDOC hopes to ultimately deliver improved rehabilitation, consequently reducing the return of mentally ill inmates.

“Patients will receive a treatment plan that will follow them when they leave here. All is not lost when they are released,” Larry said.

The remodeling of the EHMC will come with new security updates, suicide-resistant furnishing, i.e., beds with round modeled corners and brightly painted walls encouraging a “more healing” environment. Dr. Melvin Hinton, the IDOC chief of mental health and additional services, explained that “they are not rebuilding a system, but building one” for the 43,000-inmate correctional system, according to a statement.

“The Joliet Treatment Center (JTC) will provide a Residential Treatment Unit (RTU) level of care to its population,” Hinton said. “This level of care applies to offenders whom, based on clear clinical evidence, have a serious mental illness associated with significant functional impairments rendering the offender unable to successfully reside in a non-specialized general population housing unit.”

According to Hinton, an RTU level of care provides enhanced mental health treatment, with the JTC featuring a new security officer classification called correctional treatment officer (CTO). The CTO position requires an earned four-year degree in a relevant helping field and requires the CTO to be integrated into the offender’s multidisciplinary treatment team. This is the first facility within the department to have this position.

Last year, NAMI Illinois trained and certified 150 IDOC staff that then trained the entire DOC staff of more than 11,500 in the NAMI Illinois mental illness awareness curriculum, according to NAMI’S website. Joliet will employ 60 mental health staff and 296 security staff, with employee training being provided through community partnerships and an internal, evidenced-based or informed training curriculum presented by IDOC’s professional staff. This will help the facility bring qualified mental health workers to the team.

“JTC’s level of care is an RTU, which is a lower level of care compared to an inpatient level of care. The IDOC is in the process of opening an inpatient level of care so that it is appropriately able to provide an inpatient level of care,” Hinton said. “JTC’s environment will be structured around the treatment needs of its residents, again with an enhanced treatment schedule and increased professional staff presence, including psychologist, social workers and psychiatric providers.”

Hinton explained that IDOC looked at several other states, sister agencies, professional standard organizations and community partners during the developmental phase of JTC. JTC will become a part of a larger level-of-care system so that every offender within the IDOC system has appropriate and adequate access to care and treatment needed to assist in raising their overall level of functioning.

The total cost of staffing and construction is projected to reach approximately $90 million over several years while four more residential treatment centers are completed at the Pontiac, Logan and Dixon facilities, and a former youth center at Joliet. Therefore, inmates won’t be limited to one location for access to treatment.

Alan Mills, one of the attorneys who represented inmates in the federal lawsuit prompting this renovation, said a recent tour of the Elgin facility left him feeling encouraged, according to The Pantagraph.

“Hospital care is what’s been needed for a long time,” Mills said in the article. “The two facilities that offer the option for inmates to transition from the hospital to lower-level care at Joliet before returning to prison will absolutely make a difference.”

At the Joliet unit, patients with what Hinton refers to as “tall time,” which has kept them behind bars for years, will be given the chance to attend classes tailored toward helping patients properly cope with their illness, as well as providing educational courses. They will also be required to make visits to the library, and a gym will be open for those who have earned recreational time.

Andrea Tack, a clinical social worker who worked as superintendent of the Winnebago County jail before she was hired as warden at Joliet, said helping residents make the transition to life in correctional facilities is part of the treatment plan. In some cases, improved behaviors may result in a reclassification to a lower security facility.

Two Behavioral Management Units will hold approximately 100 patients with significant mental health requirements. The secured rooms that house new arrivals will come with some privileges, while patients with improved behavior will have the chance to move within the self-contained unit, creating positive reinforcement.

“You move down the hall with the goal to move out to a less restrictive housing area,” Hinton said.

Units located across the campus will provide housing to an additional 322 patients who also will receive less intensive care.

The EMHC and JTU will also be recording data, which will ultimately become valuable to the state in determining the results and efficiency of their new model in mental health care for inmates. In the case of Elgin, the state will be seeking a permanent solution to its need for hospital-level care when its agreement to use the 44 beds at the mental health center expires.

Ultimately, by investing in real diversion programs and services and ensuring continuity of care, NAMI believes that projects such as these can establish the first step in the right direction toward reducing the recidivism and incarceration rates of mentally ill individuals in our country.

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The new nine-story, 169-bed acute-care tower will house intensive-care patients, medical/surgical beds, labor, delivery, neonatal intensive care, and other diagnostic, treatment and support functions, which are currently located in the existing acute tower, according to Bethesda, Md.-based, Clark Construction Group, the construction manager on the project. The current departments will be demolished in the third stage of construction. During construction, the hospital will remain fully operational to continue providing quality care to the community. The tower as well as the other two phases has been designed with an emphasis on sustainability and energy efficiency.

The Alameda County Board of Supervisors put into place a green building ordinance that requires all new buildings in the county to be built to achieve, at a minimum, LEED Silver certification. To meet these requirements, the hospital has created an energy-efficient plan that includes installing high-efficiency mechanical equipment, low-emissivity glazing, smart air-conditioning zones and long-life lighting that uses less electricity and minimizes replacement costs, according to Highland Hospital. The hospital will also install a high-efficiency water system that will reduce water consumption. While building the facility, the construction team will use green building materials whenever possible and will work to recycle materials from the hospital’s demolished buildings to minimize the amount of materials that will go to a landfill.

The conservation efforts of the construction team and Highland Hospital will allow the hospital to focus its extra resources on providing patient care and quality services to the Alameda County residents, now and in the future. The project will also include thermal storage that will lower energy costs by operating chillers at night to cool and store water, according to Clark Construction Group. Exterior green screens will provide transitions for patients and visitors, while cooling the interiors.

The three-stage project includes the Highland Care Pavilion, a three-story pavilion with underground parking that was finished in 2013; the acute tower (currently underway); and the demolition of the existing acute tower as well as construction of the Link building and a new courtyard. When the project is complete, the facilities will unify the hospital’s 14-acre campus, both functionally and architecturally, according to Highland Hospital. To unify the historical aspects of the hospital campus, the exterior façade that was original to the facility since it opened in 1927 will remain the same, while the facility will still focus on the needs of the future.

National construction company Clark Construction Group LLC is working with national architecture firm SmithGroup JJR and locally based Ratcliff Architects and Shah Kawasaki Architects to complete the project.
 

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The 500,000-square-foot multilevel hospital is set on 70 acres on Camp Pendleton in Southern California. It is the Navy’s largest American Recovery and Reinvestment Act (ARRA) project. It will provide medical services for surgery, patient overnight stays, dental care, intensive care, and general medical and emergency care. It will include a central utilities plant, a 1,500-space multilevel parking structure (with an additional 1,000 spaces outside the structure) and site development. The contract requires that the project achieve LEED Gold certification.

The new facility will replace the existing naval hospital on Camp Pendleton. The main goal of this project was to provide a facility that meets all of the latest seismic requirements, said Commander Dude Underwood, resident officer in charge of construction for the project.

The project team consists of HKS Inc. as the architect and a joint venture between Clark Construction Group and McCarthy Building Companies as the construction manager. All three companies have offices in San Diego nearby Camp Pendleton.

The $446 million design-build contract, awarded to the Clark-McCarthy team, required an aggressive timeline from conception to final commissioning of the hospital because the delivery method allowed the project team to start construction without having every detail of the design completed, said Carlos Gonzalez, project director for the Clark-McCarthy joint venture project. The contract also included planned modifications for furnishings, fixtures and equipment. Gonzalez said it is rare to have the same entity complete both for a project of this kind.

While the design-build delivery method allowed for efficiencies, the time limit on the project also served as a challenge. Because the project was funded by the ARRA, the project’s funding came with an expiration, so the project team had a specific window of time to get the project done.

“We needed to organize our design so that we could start construction as early as possible,” Gonzalez said. “What we did was create six separate packages and organize them in terms of a time and research standpoint.”

Another challenge was the project requirement to benefit the local economy. That meant that 45 percent of the subcontracts had to be awarded to small businesses. The project met and exceeded that goal, delivering more than 75 percent of small business participation, Gonzalez said.

Underwood said the northwest corner of the building stands out the most in terms of design. “The building was essentially opened up by taking this portion of the building and pulling it away from the rest, creating a crown above it with a reflecting metal surface.”

Gonzalez added that he agrees this section will become iconic for the hospital. He also said that the location of the facility, situated along Interstate 5, gives the building a prominent display.

Both Underwood and Gonzalez also agreed that the safety record on the project has been significant for the team. Gonzalez said that so far the team has completed 2.6 million hours with zero lost-time incidents.

The connection between the project team and the mission of the project was another key factor for all of the workers involved. “It’s inescapable to all of us — the connection of what we’re doing in building a health care facility to treat the men and women in uniform, including wounded warriors, and their dependents,” Underwood said. “As I make my way around the site, I talk to those involved in construction, and they all are immediately aware of the reason and benefit of doing it well.”

Gonzalez added that the mission allowed for them to have better success in terms of meeting the safety, quality and schedule goals. “When you can look at the workers in the eye and say, ‘The sooner you finish, the sooner wounded warriors can be treated and every dollar you saved is a tax dollar that doesn’t have to be spent,’ it actually makes a difference and allows us to engage them on a much more personal level,” he said.

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The $2 billion hospital is being designed by New York-based Rafael Viñoly Architects in association with Lee, Burkhart, Liu Inc., with offices in San Francisco, and will connect to the existing hospital via bridge and tunnel. It is part of the SUMC Renewal Project, which also includes the expansion of Lucile Packard Children’s Hospital, the renovation of Hoover Pavilion, the Welch Road Utility Project and the replacement of School of Medicine facilities. Scheduled for completion in 2017, the hospital is expected to open for patient care in early 2018 but remains operational.

Greg Schoonover, vice president and project executive for McCarthy, said that a large part of the project’s success thus far is a result of collocation. The project team consolidated offices in Palo Alto, Calif., in the latter part of 2012 and will be mobilizing to an office across the street from the job site in August. “This project made me realize the importance of collocation,” he said. “If we had a coordination problem, we could just walk down the hallway to get it resolved by the [design team].”

The facility will include a flexible pavilion design with oversized windows allowing for natural light and views from the 368 patient rooms, which will total 600 patient beds on site after the addition. The project also features a new Level 1 Trauma Center — three times the size of the current emergency department — with 58 treatment bays; surgical, diagnostic and treatment rooms; a central courtyard; and rooftop gardens. It will also be built to withhold the effects of and remain functional after an 8.0 magnitude earthquake.

Schoonover described the project as unique because it is base isolated and has a duel-glazed curtain wall system. Plus, it has a displacement ventilation system. Another standout feature is that the patient towers are being built in four separate pods that connect to a podium level, which makes up the first four levels of the building. “When you look at the project after completion, these pods will look independent buildings with a central atrium area as the focal point,” he said.

Compared to other projects he completed in the past, Schoonover said that the project team enhanced the level of modeling for the job, and McCarthy’s use of BIM as a whole continues to advance with each project the company completes.

“We are setting out to not have any deferred approvals at all,” Schoonover said. “Constructability reviews and coordination are incorporated into the drawings already. That allows us to have a more successful time in the field as we’re proceeding to go ahead with construction. Much of that is due to collocation and all the technology we’re using, which helps streamline the process and will make the job run much more smoothly.”

McCarthy earned a Celebration of Engineering & Technology Innovation (CETI) Award earlier this year specifically, for using BIManywhere software on the Kaiser Permanente Oakland Medical Center replacement project, which is currently in Phase III of construction. Schoonover said that the Stanford construction team plans to use the same software as they move further along in the construction process.

Because of McCarthy’s expertise and innovative approach to construction for the health care sector, HC+O News interviewed Jim Mynott, vice president of design management for McCarthy’s Newport Beach-based Southern California office, and Chris Pechacek, director of virtual design and construction for the company’s Northern Pacific division, based in its San Francisco office. In this second part of the two-part interview, Mynott and Pechacek discuss how BIM software can help the operation of a facility.

To listen to the first part of the interview, click here.

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HGA, with offices in Sacramento, Calif., is the architect collaborating with the general contractor, Clark Construction Group with offices in Oakland, Calif., on the project.

“When we’re talking about multiphase design, we have to figure out what the final outcome needs to be and we have to work backwards, keeping the facility 100 percent operational while we’re building,” said HGA Architect Richard Tannahill, AIA. “We built on four sides of the existing hospital; we built the expansion around the hospital so we could build new services before shutting down the existing services. The trick here was providing access to the public while we’re building completely around the facility. They had to maintain the existing hospital and full operation as we’re building around the perimeter.”

The first phase of construction took about 2.5 years and was completed in November 2012. It included the now noteworthy five-story, 113,000-square-foot bed tower, which features 120 private patient rooms and a 24-bed Intensive Care Unit. The expansion of the diagnosis and treatment area included a surgical department, an emergency department and surgery-imaging department.

Since the bed tower and expansion opened, the hospital moved existing services into the new spaces, while the construction team began converting the original bed tower into a Women’s Pavilion, which provides services for women and children’s needs. According to Tannahill, the team is also currently renovating the pharmacy and cath lab, and is putting in a new PACU.

In terms of green building elements, the construction project includes replacing all existing mechanical systems with more efficient ones and adding steam boilers to the facility, which is a huge savings on the energy loads. Other elements include recycled building materials, lighting control systems and diversion of construction waste from landfills.

The biggest challenge, according to Tannahill, has been simply constructing the building while continuing hospital services. “I have never been on a project where you basically enveloped the existing building and kept it operational while building around it,” he said.

One challenge, for instance, was keeping access to the emergency department open. The construction team had to build tunnels in order to accomplish that. “We worked [with the hospital] to provide access as they needed it. We had to make sure it was 100 percent code compliant and legal along the way; it doesn’t matter if it’s temporary,” Tannahill said.

With a multiphase design as extensive as this one, there are several key points to consider, Tannahill suggested:

• Hospital Layout. The current layout will determine how and in what order to build, as the existing location of services will likely move throughout the process.
• Points of Access. In order to accommodate emergencies in a hospital setting, entrances and evacuation routes are still imperative to keep a building operational. If construction occurs on the emergency entrance, for example, other temporary access points must be built.
 
• Utility Routing. Any new utility routes need to be built first before removing existing ones in order to keep hospital services up and running. Tannahill suggested overhead routing as an alternative to temporary services.
 
• Preconstruction Services. Tannahill stressed the importance of having the general contractor’s involvement early on in the design of a multiphase project. “Having it designed before eliminates headaches,” he said.
 
Since the completion of the new bed tower, it has become somewhat of an icon for the community, as it is one of the taller buildings in the city, said Tannahill. “It’s a building that they can be proud of as a community, and it’s very functional,” he said. “The layout is a triangle shape, and a lot of work went into the design to make sure there is a smooth flow for patients and minimal disruption to the facility.”

The completion of the last phase of the project is scheduled for January 2014.
 

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