On architecture and challenging behavior

On architecture and challenging behavior

Recently I was asked to comment on some architectural drawings of a school to be built in a municipality in Skåne. The school has students from preschool to sixth grade. The five youngest classes would have their classrooms on the ground floor and the sixth-graders a small, secluded area on the second floor that rose over the otherwise one-storey school. In the middle of the sixth-graders’ department the architects had designed a gallery around a five metre wide opening down to a central hall just inside the entrance doors. All the young ones would pass through the hall on their way to the canteen (they have school meals in Sweden). This meant that all the young pupils would pass under the opening where sixth-graders could stand and watch and not least spit on them. It is my experience that the school would have problems with sixth-graders spitting at the small children on their way to the canteen as long as the gallery was there. They would be adding a behavioural problem if they retained the design. Similarly, the architects had drawn small toilets with entrances directly from the school corridors. Many students in school will avoid going to the toilet if they have to go directly from the corridor; it is better to have a small hallway with perhaps two toilets instead. That creates a sense of security.

Building design is of vital importance to human behaviour. Environmental psychology is even a science of its own. Environmental psychologists work with design of public spaces, housing and in rare cases with educational frameworks, but also with colours and materials. This article is about architecture and furnishings of group homes based on the knowledge we have gradually gained from experience and the little, little research there is on the matter. It is possible to transfer most of it to individual accommodations, daily life therapy and school, but I will not specifically discuss these types of housing.

This means that physical frameworks affect everyone, but that the degree of influence increases with the disability. The greater the difficulties, the better physical environment we should be able to offer the person. And not least: The greater effort we should make when designing the physical environment.

There are a few different ways that the physical environment affects the behaviour:

  • Direct emotional impact
  • Pure behaviour reinforcement
  • Security for the person with the disability
  • Security for the staff
  • Socially supportive and habilitating architecture

Direct emotional impact is easiest to work with and basically is about reducing the stress of being overwhelmed by impressions. Stress creates more irritation and testiness and contributes to both acting out behaviour and self-injury. By reducing the physical stress factors, we can therefore reduce challenging behaviour.

A large percentage of the people who live in group homes has quite large emotional deviations. The deviations can be of different nature: You can for example be hypersensitive to light or sound; you can be hyposensitive to for example temperatures and you can have difficulties filtering and getting used to impressions. It is the hypersensitivity and difficulties to filter and getting used to impressions that are important to relate to:

  • Many people are very sensitive to light. They often prefer dim lighting and the curtains drawn. I often meet staff full of energy who draw the curtains apart and say: “You should have a little light so you don’t sit here and become depressed.” It is much better to adjust the light, for example, by having many small light sources. Preferably there should be windows on two sides (not directly facing each other) of the room the person spends most time in, perhaps with the help of indirect skylights. Then shadows are softened and stress is reduced. Often it is also a good idea to be able to reduce the daylight, perhaps not with curtains, but with slightly translucent blinds or similar.
  • Sensitivity to colours. The London-based architectural firm GA Architects has been experimenting with colour in group homes for people with autism and has found that soft pastels and earth tones provide the calmest environment. We do not know why, but perhaps they are colours that do not require much of us.
  • Sound sensitivity is often a huge stress factor. Therefore, we should invest properly for sound insulation. If it is done right from the start when building it is cheap. At least compared to what it costs to have extra staff because of a poor acoustic environment. Example: A group home had to man up from one sleeping night staff to two waking due to one of the residents making noise at night. Not because the person was loud, but because the others were disturbed and reacted. By building a detached small house next to the main building for the person who made noises SEK 75,000 per month could be saved in staff costs. This meant that the small house paid off only by two years of savings. To soundproof is simply much cheaper than not in most cases.
  • Affect sensitivity should also be taken into account. Many people with developmental disabilities react strongly to other people’s emotional expressions. The sound environment should therefore be completely dead, not least to dull chatter, screams and other verbal expressions. For 40 years research on the concept expressed emotion has been made and it has been found that strong emotions can double aggressive behaviour, self-harm and even PRN medication both in people with psychiatric diseases, developmental disabilities and those with brain injuries. Therefore, a combination of soundproofing and acoustic attenuation is a good idea that immediately shows on behaviour and thus on staff costs.
  • Sensitivity to changing impressions. Many people with developmental disabilities are sensitive to flashing. They often even see blinking that we cannot perceive. Light in the form of fluorescent tubes and CFLs should be avoided. The reason is that the light source is a gas that is lit on and off 50 times per second, which in some people is perceived as 50 flashes. In a traditional light bulb the lamp glows 50 times per second, but not in the form of quick flashes but the flashes coalesce into a coherent light. To some extent it also applies to halogen lamps and LED lamps.
  • Difficulties with filtering impressions. Traditional adjustment is about removing unnecessary visual impressions. This is for example done by:
    • Plain, solid coloured walls with no embellishment like pictures, photos, staff lists etc. Photos are preferably kept in an album that can be brought out and put away.
    • Solid coloured doors on closets and shelves. A cabinet or a shelf without a door is like a person standing and screaming all the time for a person sensitive to sensory impressions.
    • No trinkets or knick-knacks. Clean surfaces.
    • Blinds instead of usual curtains. Solid coloured of course.
    • Sparse with furniture and absolutely no unnecessary furniture. A table with a few chairs, a bed and a couch are enough for a full life for a person with major disabilities.
    • A good ceiling height. Not too high and not too low. My experience is that it is better if the ceilings are ten cm higher than ten cm lower than normal.
    • Space to move without having to navigate around furniture. This means that there should not be too little space, but also that there should be free walking routes between doors and to and from the couch, bed and table.

Pure behaviour reinforcement is about us humans having a tendency to act directly on the physical environment we are in. For example, 10-year-old children run in the hallway if it is five metres wide, five metres high and 100 metres long. No matter what the school staff says. Just as we find it more difficult to drive slowly on a wide road than on a narrow road. It is that factor that is in play when the sixth-graders spit at the little ones in the introduction of the article. Some actions simply are the most logical to perform in certain environments.

  • In care it is complicating that people with developmental disabilities respond differently than the rest of us to the physical environment. For example there is plenty of other self-stimulation based on sensory sensitivity:
    • We see this in particular in that we can reduce some people making noises by softening the acoustics. If you are sensitive to sounds, it can be stimulating to make loud noises if there is an echo. By removing the echo, we remove the sounds. It is also good to build walls that are not perfectly parallel, this reduces echoing, but you can of course also use acoustic panels and the like.
    • In the same way, we can reduce slamming of doors by installing so-called door closers. Then the door does not close with a bang when slamming it.
  • In confined spaces some people with developmental disabilities act violently to create distance. This means that a hallway that is less than two metres wide may cause the person to headbutt you when passing in the corridor. Likewise, an entrance should stretch at least two metres in every direction. In a small entrance the risk of violence increases in dressing situations, especially if the person needs help putting on clothes and shoes.
  • Running in hallways is normal behaviour. But having walls that are not straight and parallel can reduce it. Perhaps there is one straight wall and a zigzag wall where the zigzags are at least one metre deep. The zigzag actually makes it look as if the hallway becomes narrower and narrower and then you do not run.
  • People would rather go through a door in a light than dark colour. So use bright colours for the doors to be used often and dark colours on the doors to the storeroom, staff room and similar spaces we want to keep away from people with special needs.
  • Avoid patterns. Some people with autism can be completely drawn into a pattern and find it difficult to free themselves.

The feeling of security is central when discussing challenging behaviour. Partly because it is stressful not to feel safe, and partly because people may act violently if they do not feel safe. It is also important to provide security both for the people with the disabilities and for the staff. An insecure person radiates his or her uncertainty to the environment so that others will also feel insecure. This means that staff feeling insecure actually are at greater risk of violence than others who are secure in the same situation.

We can incorporate security in the physical environment in several ways:

  • Avoid niches. Partly because some people with psychiatric disabilities react negatively to the uncertainty involved in not knowing what may be hiding in the niche, and partly because as staff you do not wish to find yourself in a corner in a violent situation.
  • Have several doors in every room, preferably also in bathrooms. To always know that there is another way out if somebody is standing in your way creates security both for the person with the disability and the staff. It does not matter that there are many doors out into the open.
  • Build kitchens that are open at both ends so that you can never be pushed into a corner in a place where we keep knives.
  • Avoid placing the doors to different flats directly opposite each other. Many people with psychiatric disabilities become insecure if they open their door right out in an unpredictable environment. A plain wall several metres in each direction in front of the front door is much safer. At the same time, it means that people walking past your door passes pretty quickly. It is good if you are unsure of what others are doing and want.
  • Some people with great pedagogical needs enjoy having their front door directly to the outside and not into a common room, a hallway or similar. It makes the situation more predictable and easier to understand. It also makes clear which area is one’s own. The boundary between one’s own flat and the common areas can be difficult for some people to understand and relate to, and it can cause a lot of conflict and violence.
  • Again: Build wide corridors and large halls and bathrooms. If you have some air around you violence is generally reduced. It is of course important in any context, but especially important in those rooms we traditionally build rather small. In pedagogical contexts, we are often several people in those rooms you are otherwise alone in, like bathrooms and in dressing situations. Therefore the rooms should of course be larger than usual.
  • If you work with violent people you should avoid furnishing in ways that can lead to difficult situations:
    • Avoid coffee tables. If you sit on a couch and get angry, the coffee table is in the way and might fly through the room.
    • Avoid couches that stand freely in the room. You should not sit on a couch with your back facing the room if you do not want to risk getting your hair pulled. So, the back of the couch up against a wall.
    • Position the dining table so that you sit with your side and not the back facing the room.
    • Avoid loose TV sets and other electronics. Rather fasten them on the wall so they do not fly through the room in a chaos situation. In some cases we also place the TV set behind plexiglas and fasten a remote with very few buttons on the armrest of the couch.
    • For some very violent people, we have fastened the bed, table and couch to the floor. This can be complemented with armchairs that can withstand being tossed.

The last point, socially supportive and habilitating architecture and interior design is probably the most difficult. We can build environments that open up for social interaction, for example that everybody can see the common room from their flats. But it is also a major stress factor for many to have to keep up with what is happening in the common environment. Moreover, we have conflicting agendas in many situations: We both wish to help the person become independent and live like everyone else as well as we want to create a community of neighbours in a way that we would never demand of ourselves where we live. We should therefore think carefully about how to decorate the common areas and how to use them.

Generally, it is easiest to be with other people in a planned and structured situation. In care we have traditionally dealt with this by having clearly defined areas for different activities. You sit on the couch while watching television, sit at the table when eating or drinking coffee and sit at the desk when making beads or other crafts. It removes some uncertainty from the situation and structures the world. Therefore, we should also have a specific room where we take care of the laundry, not a washing machine in the bathroom.

In everyday life, we add a temporal structure on top of the physical structure so that it is clear when you sit on the couch, at the table or at your desk. Through the combination of temporal and spatial (or geographical) structure the world is predictable and easy to navigate.

It also means that staff should not contaminate the physical structure. The staff of night shift do not sit on the couch and watch television, but have their own space. Staff do not bring a cup of coffee to the couch if it is normal to drink coffee at the dining table.

If it is possible to have a small terrace to each flat, the part that is private should be clearly defined from the common part of the patio. Traditionally, we do this with coating materials, which can also work well in group homes. If we also want a common terrace for joint activities it should be reserved solely for this purpose. People who to and from can manage to choose social activities themselves can have the satisfaction of seeing the common terrace from their own, but for people who cannot, we should shield it off.

Some of the measures included in the various headings of this article are quite general. A measure that creates security can simultaneously reduce sensory impact. A solid coloured wall reduces the sensory impact and does not invite to getting stuck in patterns. Plenty of space reduces impressions, creates security and reduces the risk that furniture will fly through the air.

However, often a good adjustment of the physical environment leads to a quite barren environment. Some people think it looks awful when they first see a special educational environment. There can be very few cosy elements to it. You can, however, lighten it up with soft pastel colours and earth tones and fine furnishings with few pieces of furniture and acoustic panels. But it is likely that you should let a professional do the job. As amateurs with experience from ordinary homes most of us create comfort with pillows, curtains and light, just such interior fittings that might not be so relevant in an adjusted environment. Architects work with space and structure. So let them come to!

And keep in mind that people with major disabilities are affected much more, both positively and negatively by the physical surroundings. So we must ensure that we all work hard!