Safety in Adolescent Behavioral Health Crisis Units: A Qualitative Analysis of Clinicians Versus Designers Perspectives

Safety is a foundational concern in adolescent behavioral health crisis units (BHCUs), where therapeutic care must be delivered in complex, rapidly evolving environments. However, limited research has explored how key personnel involved in shaping the environment of care in such units, such as clinicians and healthcare designers, understand and prioritize safety. To address this gap, one-hour, online semi-structured interviews were conducted with a panel of experts (N = 13) at a national level in the U.S., comprising of eight designers (healthcare designers and medical planners) and five clinicians (psychologists and psychiatric nurses) actively involved in designing or construction of BHCUs or providing care in these units for adolescent patients in the past five years. The interviews were recorded, transcribed verbatim, and analyzed via MAXQDA (2024) for qualitative content analysis. Analysis of interviews revealed 592 codes forming four preliminary categories related to safety in adolescent BHCUs: 1) Barriers and facilitators to patient safety and comfort (f = 52%), 2) Care processes and clinical workflows (f = 21%), 3) Care outcomes (f = 19%), and 4) Laws, regulations, and guidelines (f = 7%). Findings highlighted several points of divergence in clinicians versus designers perception of safety related to environmental features, such as nursing station designs, patients access and control over unit features, and furniture type or layout in the unit. Results also showed differences in understanding care processes and outcomes related to safety among the two groups. Addressing such discrepancies can contribute to the development of safer BHCUs that support adolescents healing.