Embarking on a behavioral health construction project can be a complex journey, filled with unique challenges and regulatory hurdles. From ensuring compliance with stringent safety standards to addressing the specific needs of patients and staff, the design review and permitting process requires careful planning and expert navigation. In this blog, we’ll guide you through the design review process, offering insights and practical tips to help you achieve your standard of care and keep your project on schedule. Each recommendation is based on our recent experience building behavioral health units for Inova Mount Vernon Hospital, Inova Fairfax Hospital, Johns Hopkins Medicine’s Howard County Medical Center, Frederick Health Hospital, and the ongoing Virginia Department of General Services Central State Hospital.
Design Review Process for Behavioral Health Construction
Ensuring the project plans are feasible, compliant, and aligned to the needs of your patients and staff is essential during the design review process. Engaging a construction manager with behavioral health construction experience to review the design documents for constructability and identify potential issues that could arise during construction can alleviate headaches down the road. This includes:
- Assessing the practicality of the design
- Understanding the availability of materials
- Ensuring efficient construction methods
Let’s review two examples. At Johns Hopkins Medicine’s Howard County Medical Center’s new behavioral health unit, Gilbane worked through the constructability and availability of multiple elements. Doors, frames, and hardware required a lot of upfront planning. Custom behavioral health systems necessary for patient safety and made-to-order materials meant we had to plan for long lead times. One of the first things we did was build mock-ups in the field to design and fine-tune the door openings with the architect and client. The assemblies, integrated card readers, and complex slider doors had tight tolerances. This process helped us reach a consensus on the overall look and functionality for patients and staff while finalizing the design details like elevations.
At Inova Fairfax Hospital, Gilbane worked with the client and the design team to build one of the first Empath Units in the region. Leveraging our recent experience at Inova Mount Vernon’s Veatch Family Behavioral Health Unit, we worked through the design process early with the architects. This helped them better understand what they should specify for specific areas of the behavioral health unit to ensure patient and staff safety. Millwork, glazing, wall panels, and hardware were key trades. We ensured the project met behavioral health standards by digging early into these specific components, like adding polycarbonate glazing to team stations and double-glazing exterior windows with a layer of polycarbonate.
As we’ve showcased, a construction manager who understands the intricacies of behavioral health standards and their importance to patient safety can help prevent costly changes and delays by providing expertise early in the process. Their involvement is crucial for translating the design into a successful, functional, compliant structure.
Regulatory compliance and permitting process for behavioral health construction
Navigating the regulatory landscape for behavioral health construction projects requires a thorough understanding of state and local standards. For example, Virginia’s Department of Behavioral Health and Developmental Services (DBHDS) sets forth specific guidelines to ensure that facilities are safe, accessible, and conducive to the well-being of patients. These regulations cover many aspects, including building codes, safety protocols, and environmental considerations. Facilities must comply with the Virginia Uniform Statewide Building Code (USBC), which integrates standards for fire safety, structural integrity, and accessibility. Additionally, the DBHDS mandates specific design elements tailored to the needs of behavioral health patients, such as secure environments and spaces that promote therapeutic interactions.
Beyond state-level regulations, local municipalities may have additional requirements that must be met. These include zoning laws, local health department approvals, and community impact assessments. Engaging with local authorities early in the planning process is crucial to identify any unique local standards and ensure all necessary permits are obtained on time. For example, Gilbane worked directly with the inspector on ADA and DBHDS compliance for the showers at Inova Fairfax Hospital to find a resolution that satisfied all parties. ADA showers must have either an adjustable shower head or a shower head at a low elevation. These shower heads typically have a hose attached, which doesn’t meet DBHDS standards because they are not ligature-resistant. To resolve this conflict, Gilbane worked with the design team and plumbing contractor to identify a hand shower head with a quick disconnect. This solution allows the shower to meet both requirements. If the shower is not used for ADA, the hand shower can be removed to eliminate the hose and potential ligature issue.
At Frederick Health Hospital, we worked directly with the hospital and their joint commission survey consultant to ensure compliance and patient safety. Because of our early engagement and due diligence with the client and joint commission survey consultant, we had zero citations from the joint commission, leading to a quick occupancy upon project completion. As we’ve demonstrated, your construction manager must understand these layers of regulatory compliance and, more importantly, how they support a safe and caring environment for your patients and staff.
Maximizing the Design Review Process for Behavioral Health Projects
A structured design review process, guided by an experienced construction manager, ensures all stakeholder needs are met while maintaining project momentum. At the Virginia Department of General Services Central State Hospital, the client asked Gilbane to attend drawing review sessions with the AHJ and assist with drawing coordination. The new behavioral health facility is a complex construction project with strict state requirements in place to ensure patient safety, so we enlisted our Interdisciplinary Document Coordination (IDC) team, who performed a full drawing review to help identify and remove issues that could further delay approvals and permits. Below are two solutions Gilbane developed during the IDC review.
Card Reader Clarification
Security is one of the major components of the Central State Hospital project, which contains both a civil and maximum-security side. Approval of the security design was one area of focus for Virginia’s Division of Engineering and Building (DEB), the authority having jurisdiction (AHJ). During Gilbane’s IDC review, we identified several instances of conflicting door hardware requirements between the door hardware schedule in the project specifications and the security drawings. After we clarified card reader requirements and design intent with the design team, they coordinated security requirements between the design disciplines, ultimately getting approval from the DEB.
Door Ratings
Another focus area for the DEB was life safety and partition/door ratings. As part of our IDC review, we identified several locations where doors leading from rated passageways did not meet the same rating as the passageway they served. There were instances where door schedules would show a 0-hour rated door with glazing specified as 45-minute rated, leading to a one-hour rated passageway. Identifying and resolving these issues led to the approval of the design documents.
Having a construction manager with experience engaging with state agencies for regulatory compliance and who is willing to collaborate is essential to keeping your behavioral health construction project on track to meet your goals.
Importance of Early Engagement in Behavioral Health Projects
The complexity of behavioral health construction projects demands early engagement with an experienced construction manager to successfully navigate the design review and permitting process. As demonstrated by the outcomes at Inova Mount Vernon, Inova Fairfax, Frederick Health Hospital, Howard County Medical Center, and Virginia’s Central State Hospital, this partnership helps identify and mitigate risks associated with patient safety while maintaining budget and schedule integrity.
As the behavioral health construction landscape continues to evolve, the role of the construction manager becomes increasingly critical in guiding projects through complex approval processes while maintaining project objectives. Consider engaging your construction manager at the earliest stages of project planning to maximize value and minimize risks throughout the design review and permitting process.
