Environmental quality in psychosocial treatment units: a post-occupancy evaluation in CAPS AD III units

Abstract

The Psychosocial Care Centers - Alcohol and Drugs (CAPS-AD) are strategic health units for the treatment of people with mental suffering due to the use of alcohol and other drugs. These Centers promote "care in freedom", that is, a humanized service that respects the autonomy, freedom and integrity of patients, offering individualized, open and community-based assistance to people with mental disorders. Because it is a specialized service, they have particularities regarding their spatial organization. Given the enormous proportion of evasion in the treatment of chemically dependents, the impression that the patient acquires upon entering a CAPS-AD for the first time can be understood as decisive for the continuance in treatment. It is important that the environments of the unit express comfort, hospitality and care, signaling to all who use them that this space is a place of healing, where freedom and autonomy of patients are respected. The existing literature emphasizes that the composition of a physical space becomes categorical in the evocation of our sensations and the formation of our behaviors. The environment is perceived according to the individual characteristics of those who experience it, and research has indicated that health professionals and people in treatment are susceptible to the environmental quality of spaces, which impacts on the ease with which various functions are performed and influences the relations between doctors, nurses and patients. This work proposes a better understanding of the needs of users / occupants of these Centers, using Post-Occupancy Evaluation (POE) methods and techniques applied in CAPS-AD III units. The main objective is to perform the POE in CAPS-AD III units in São Paulo, assessing the constructive, functional, environmental and behavioral characteristics of the buildings, focusing on the detection of architectural elements that indicate perception of control, reception and social interaction. Employees and people undergoing treatment will participate in the survey, the latter being indicated by the reference technician of each unit. Firstly, the selected units will be submitted to expert evaluation. Then users / occupants will respond to questionnaires about their perception on the environment. The questionnaire used will feature the adapted version of PHEQI - Scale of Percieved Quality of Hospital Environment, which evaluates in 36 items physical-spatial, and socio-functional aspects of the environment. Their issues measure the dimensions "Comfort", "Orientation", "View and Lighting", "Tranquility" and "Air temperature and quality." The impact that the spatial configuration exerts on the quality of treatments will be discussed in interviews with key-users. The final quantitative data will be submitted to statistical analysis and a content analysis will categorize the information collected in the interviews. Finally, users will be invited to suggest, through the application of other instruments, with use of semantic scale, improvements that make the CAPS environment more comfortable and welcoming. The cross-comparison of data obtained will clarify which environmental characteristics can optimize the activities performed in CAPS-AD, aiming, above all, to contribute to the increase of technical subsidies, so that future units of CAPS-AD are designed in order to adapt to the needs of users. The aim is to establish a set of design parameters that are in line with the guidelines and objectives of Brazil´s Psychosocial Care Network, characterized by humanized attention, community-based treatment (replacing the asylum model), and respect for human rights, specially people´s autonomy and freedom. (AU)