CHAPTER 261. VETERANS HEALTH ADMINISTRATION - DAY TREATMENT CENTER CONTENTS PARAGRAPH PAGE 1. Approval of Criteria 261-1 2. Definition 261-1 3. Program Data Required 261-1 4. Space Determinations 261-1 5. Operating Rationale (Basis Of Criteria) 261-4 6. Design Considerations 261-4 Distribution: RPC: 0862 assigned FD CHAPTER 261. VETERANS HEALTH ADMINISTRATION - DAY TREATMENT CENTER 1. APPROVAL OF CRITERIA Criteria approved by the Department of Veterans Affairs (VA)on April 11, 1990. 2. DEFINITION a. Day Treatment Centers provide a supportive learning environment in which patients having chronic difficulties with community adjustment, interpersonal relations and vocational or educational problems may receive help. Such patients often have long periods of hospitalization, and need continuing monitoring of their general health and medication needs. The Day Treatment Center is an outpatient treatment program which can offer a therapeutic experience for a patient who requires clinical assistance and support for as much as six to eight hours per day, five days per week, but does not require hospitalization. The program permits patients to remain within their social and family environments concurrent with their treatment program. 3. PROGRAM DATA REQUIRED a. Staffing projections by category. b. Projected number of annual visits to the Day Treatment Center. c. Is biofeedback Laboratory included in Psychology Service or Mental Health Clinic? d. Is a dedicated Compensated Work Therapy program to be included in the Day Treatment Center? e. Is a dedicated Occupational Therapy Clinic to be included in the Day Treatment Center? f. Is education therapy program to be included in the Day Treatment Center? 4. SPACE DETERMINATIONS a. Administration (Provide offices only if staffed) The offices are for use by the assigned staff involved in the mental health treatment program. Activities include patient and family interviews of an extremely confidential nature, and administrative duties supervising and teaching. The offices should be connected to a corridor, contiguous to and independent of each other. Offices should be reached after passing through a control point (secretary or receptionist). (1) Office, Chief 13.9 NSM (150 NSF) (2) Office, Secretary/Receptionist 11.2 NSM (120 NSF) (3) Office, Clerk 7.4 NSM ( 80 NSF) (4) Office, Counseling Staff 11.2 NSM (120 NSF) (Psychiatrist, Psychologist, Social Workers, Vocational Rehabilitation Specialists, Psychiatric Nurses, and Rehabilitation Technician) b. Waiting Space (Projected annual visits X.003 = seats) 1.9 NSM ( 20 NSF) per seat (Minimum = 7.4 NSM ( 80 NSF)) This area is required to accommodate patients appearing in the Day Treatment Center for the first time, as well as family members or others who pick up and deliver patients to the clinic. Sufficient space must be available to alleviate closeness which can create anxiety in the waiting patients. This area should be adjacent to the entrance corridor. c. Examination-Treatment Room 11.2 NSM (120 NSF) This room is used to complete routine annual physical examinations for each patient as required by the Department of Veterans Affairs (VA) policy. Also, about 50 % of Day Treatment Center patients have complicating medical problems which have to be maintained. These exams and treatments are conducted by both physicians and nurse practitioners. d. Biofeedback Laboratory (To be provided only if not provided in Psychology Service or Mental Health Clinic) (1) Patient Treatment Room 9.3 NSM (100 NSF) (2) Control Room/Office 11.2 NSM (120 NSF) The Biofeedback Laboratory will be used to treat patients with a wide range of disorders such as anxiety, headache, hypertension, irritability, tachycardia, ulcers, insomnia, chronic pain and certain musculoskeletal problems. The Treatment Room will house a large relaxation-inducing lounge recliner as well as the full range of biofeedback equipment, eg., EMG units, temperature units, electrodermal units, automated sphygmomanometer, audio-voltage isolators, printers and supplies, a neuroprocessor and polygraph. The Control Room is equipped with one-way viewing capability and is used as a teaching facility. One-way viewing capability permits observing and monitoring of patients undergoing treatment. This dual purpose treatment/training facility will house a desk and chair or other typewriting surfaces, supplies, and the monitoring portion of the equipment listed above. e. Group Therapy Space Annual Visits No. Rms. NSM NSF Up to 6,000 1 27.9 (300) 6,001 to 21,000 2 27.9 (300) 21,001 to 36,000 3 27.9 (300) 36,001 and above 4 27.9 (300) This area provides space for patient group therapy with the treatment team. Sessions of one or two hours duration require space for physical action such as wandering around or acting out. Freedom of movement during the session is an integral part of the treatment regime. Sounds should be attenuated to allow free verbal expression without disturbing or being overhead by others outside the group. Television is used in training and patient treatment. Normal occupancy is two staff and eight to twelve patients. This space should be located off the corridor with easy access to activity areas and waiting space. It can be on the periphery of the service. Ingress and egress should be at one end of the room(s) to minimize disturbances. One group therapy room should be designated as a "Quiet Area". This room provides space for a quiet, parlor-type atmosphere for patients during the day treatment regimen. In addition, the room can be used as a library and soft music room. Normal occupancy one to ten people. The room should be located contiguous to but independent of other activity areas. (The addition of one group therapy room for these purposes alleviates the need for a designated "Quiet Room".) f. Social Activities/Dining/Multipurpose Space 1.3 NSM ( 14 NSF) per annual visit (Minimum = 46.5 NSM (500 NSF)) This area provides space for resocialization training of patients through participation in planned social activity programs, including dining. Planned activities are geared to assist patients in coping with the skills and interaction required in daily living. (This area is sized to accommodate from 14-60 patients). g. Storage 0.0 NSM (0.02 NSF) per annual visit (Minimum = 9.3 NSM (100 NSF)) This area provides storage of mobile or folding equipment not in use in the social activities area or kitchen. There must be room enough for one or two people to circulate while storing or removing items. h. Kitchen 13.9 NSM (150 NSF) If annual visits exceed 12,500, add 4.7 NSM ( 50 NSF) This area provides space for the preparation of food and drinks used in the social activities program. Activities conducted in this room are prescribed for patients as part of their treatment. Planning and preparing lunch, for example, involves cooperative efforts and patient interaction and also provides training in home food management and self-care. Normally three to six persons will occupy the kitchen. The location should be contiguous with Social Activities/Dining/ Multipurpose and Storage spaces. i. Education Therapy (To be justified on an individual project basis) j. Compensated Work Therapy (The factor will be used only when there is a dedicated CWT program in the DTC) Annual Number of Visits x 0.00128 = No. of Work Stations 6.0 NSM ( 65 NSF) per work station The purpose of a Compensated Work Therapy (CWT) Program is to provide therapeutic work rehabilitation for inpatients and outpatients in order to induce motivation, heighten self-esteem, create new interests and break regressive institutional patterns through the use of remunerative work. The major component is a work regime with monetary incentives derived from contracts with private industry or other sources outside the Departments of Veterans Affairs (VA). Reimbursement to participants in the program are related to their productive capabilities. Every effort is made to create a realistic work environment. Although industrial business practices are utilized to simulated usual working conditions, therapy is the objective. Patients may be involved in activities ranging from simple packaging of buttons to the complex assembly of computer parts. Earnings in the program should be commensurate with wages paid in the community for essentially the same quality and quantity of work. k. Occupational Therapy (To be included only if there will be dedicated O.T. space in the DTC) Basic Clinic 60.5 NSM (650 NSF) Storage 9.3 NSM (100 NSF) 1. Toilet Facilities (Wheelchair Accessible) (1) Male: (a) One water closet and lavatory per 5000 annual visits 4.7 NSM ( 50 NSF) per first fixture 2.0 NSM ( 22 NSF) per fixture for each additional fixture (b) One urinal per 10,000 annual visits 2.0 NSM ( 22 NSF) per fixture 2. Female (One water closet and on lavatory) 4.7 NSM ( 50 NSF) 5. OPERATING RATIONALE (BASIS OF CRITERIA) a. Day Treatment Center criteria were formerly combined with Mental Health (Hygiene) Clinic criteria in one chapter, Outpatient Psychiatric Service. There are several other outpatient mental health programs in addition to these two, such as, Day Hospital, Drug Dependence Treatment Clinic and Alcohol Dependence Treatment. All are individual programs with individual program guides and as such benefit by having separate space planning requirements. b. Information for development of these criteria have come from Day Treatment Centers in the field through Mental Health and Behavioral Sciences Services in Central Office. 6. DESIGN CONSIDERATIONS a. Whenever possible, Day Treatment Centers should be located away from a hospital. b. Day Treatment Centers may be adjacent to other outpatient mental health services such as Mental Health Clinic. c. Design must be in compliance with architectural accessibility standards. Department of Veterans Affairs VA HANDBOOK 7610 (261) Washington, DC 20420 February 5, 1991 261-i VA HANDBOOK 7610 (261) February 5, 1991 February 5, 1991 VA HANDBOOK 7610 (261) 261-4 261-5