Corrections or additions?
This article by Phyllis Maguire was prepared for the May 21, 2003
edition of U.S. 1 Newspaper, with an addition on May 23. All rights
Re-Sizing Rehab at Children’s Hospital
When you walk into the lobby of the new Children’s
Specialized Hospital Outpatient Center at Hamilton, you are surrounded
by color: A huge fish swims across the big blue mural that fills the
back wall, while broad swatches of different colored linoleum form
waves across the floor.
Chairs with iridescent eggplant-colored upholstery — some in kid
sizes, with adorable wooden "duck" feet — fill the waiting
areas, along with wavy funhouse mirrors, wall-mounted gear panels
that clatter when you crank them, and a round wooden maze — the
size of a truck tire — that you spin with knobs. Like the lobby,
the entire new 12,000-square foot facility at 3575 Quakerbridge Road
is a bright, sun-flooded space filled with color, warmth, and whimsy.
But all this fun serves a very serious purpose. Hamilton’s new
Specialized Hospital outpatient center — the first CSH facility
on this side of the state — is Mercer County’s only comprehensive
pediatric rehabilitation center. Its opening here in January brings
the expertise of CSH, the largest pediatric rehabilitation hospital
and facility network in the country, headquartered in Mountainside,
to pediatric patients in western New Jersey. That makes it an
resource for families of children, from infants to young adults up
to age 21, with injuries, developmental delays, chronic medical
learning or behavioral problems, and congenital disabilities.
"We are here to evaluate and treat children’s rehabilitation
for everything from simple speech delays to cerebral palsy," says
Patricia DiGiovanni Foley, a former physical therapist. Foley spent
13 years at CSH’s Mountainside facility and is now site director for
the Hamilton site, where she oversees a staff of
Before the outpatient facility opened here, she points out, parents
of special needs children used to have to drive at least an hour each
way — or even take off a day of work — to take their child
to Philadelphia or to another CSH facility on the other side of the
state. Multiply that hardship by five — which is how many times
a week some children injured in accidents or playing sports may need
physical therapy — and you get a sense of the grueling access
problems many families face.
Even more chilling, parents referred by their pediatrician to a
pediatric specialist — to evaluate their child for autism, for
instance, or for attention deficit disorder (ADD) — often had
to wait up to nine months to get an appointment.
"This puts services that families desperately need much closer
to the children who need them," says Foley. While the Hamilton
Township public school system strongly endorsed opening the center,
Foley says the facility is also drawing many families from
and Monmouth County.
A tour of the center points out the many services it
offers — and the range of children’s rehab needs. The huge open
space for physical therapy is lined with mirrors and filled with
of color. Parents and physical therapists work with children on blue
mats that cover much of the floor. Kid-height parallel bars help
practice walking, while all the brightly colored balls and padded
inclines are used to help young patients improve their strength and
coordination. Even the colored hopscotch squares on the floor have
a therapeutic purpose, allowing therapists to test patients’ balancing
The sensory motor room with its beanbag mats and padded climbing wall
is where children’s gross motor skills are evaluated. There are
therapy rooms where therapists work with children to develop
and fine motor skills. There is a casting and splinting room, as well
as suites where children get fitted for customized wheelchairs and
augmentative sounding "keyboards" that wheelchair-bound
with speech problems can use to communicate.
Teens have their own space in an adolescent fitness room, with windows
that open up onto the trees surrounding the building. Here teenagers
recovering from sports injuries or being evaluated for scoliosis —
curvature of the spine — can work on a treadmill, stairmaster,
or stationary bicycle.
There are eight — eventually, there will be 10 — individual
speech evaluation and therapy rooms, as well as rooms where children
with feeding and swallowing problems can be treated. There is an
booth for hearing testing — and the Hamilton center plans to do
outreach, Foley explains, with speech and hearing testing in local
There are four rooms for psychology sessions — at least one is
outfitted with a gorgeous dollhouse-sized wooden stable — for
children and their families. And there are several medical exam rooms
where children can meet with pediatric physical medicine and
physician specialists, pediatric orthopedists for evaluations, and
The network’s neurodevelopmental pediatric staff is a major strength
of the CSH system, says Princeton resident and CSH interim president
and chief executive officer, Frank Castello MD, speaking by phone
from his office in Mountainside. (Formerly CSH’s medical director,
Castello was thrust into his interim role by the sudden death this
March of CEO Charles "Rex" Riley.)
The Hamilton facility already has one full-time neurodevelopmental
pediatrician, with a second slated to begin in September. That will
bring the number of CSH’s neurodevelopmental pediatricians throughout
the state to nine, making it by far New Jersey’s best resource for
The Hamilton site occupies one-fifth of a building owned by Frances
Neuman, who is represented by Bob Burke (Maguire Burke) and Gerald
Fennelly (NAI Fennelly). Stan Kurzweil of Colliers Houston represented
the hospital. The build-out, which cost more than $1 million,
from donations from Johnson & Johnson, the John Ben Snow Memorial
Trust, the George A. Ohl Jr. Trust, and State Street Corporation,
a financial services company. It is one of five outpatient facilities
that CSH maintains throughout the state, in addition to pediatric
primary care practices for children with special needs as well as
their siblings in Newark and Union, and inpatient facilities that
provide burn, spinal dysfunction, and long term care.
First established more than 100 years ago to give medical help to
inner-city children, CSH evolved into a polio-only facility in the
1940s and ’50s during the height of the polio epidemic. Now an
partner in the Robert Wood Johnson Health System, CSH and its network
of different facilities continue to evolve to meet children’s changing
"There is now a huge concern about children being diagnosed with
both autism and ADD, with many more children being evaluated and
Castello says. It is unclear, he adds, whether the actual number of
children affected by these disorders is on the rise — or if cases
of autism and ADD are only now being more effectively recognized and
treated. (Here in Princeton, both the Eden Family of Services and
the Princeton Child Development Institute provide education for
children, while Eden also does extensive vocational training.)
Two other factors are driving the need for pediatric
treatment and rehabilitation, Castello continues. Number one is the
sharp rise in the number of children who have chronic medical
particularly related to being born prematurely.
Babies born as many as four months before term now have a good chance
of surviving, he says, "but surviving with more medical problems.
Many children born prematurely can have cognitive problems, cerebral
palsy, or chronic lung disease — and be at higher risk for
But often, many children outgrow those problems and go on to lead
healthy, productive lives, Castello adds. "That’s one very big
plus of the work we do."
Number two, many children born with congenital anomalies — such
as cardiac or neurologic conditions — "are now surviving and
doing well, but they have health problems," says Castello. And
at other CSH facilities in the state, physicians and allied personnel
have designed disease management and intervention programs for
affected by two other growing epidemics: diabetes and asthma,
that are particularly difficult to manage in adolescents.
While many pediatric diagnoses are on the rise, the fact is that
few children are affected by medical problems — making it hard
for local community hospitals to develop comprehensive, well-staffed
programs for children with special needs.
"Given the relatively low volume of problems with kids, the only
way to provide really effective care is to specialize and regionalize
it," Castello says. And children with medical problems or rehab
needs should have their own institutions and facilities. "They’re
not little adults," he explains. "Not only is their physiology
not the same, but the differences in psychological and other factors
between adults and children are significant."
At the same time, he says, "the mindset in a pediatric facility
is very different from an adult one, in terms of visitations [for
inpatient care], openness, and education, and addressing psychological
issues that both the child and the family may have. Whenever possible,
I think it’s preferable to treat children and young adults in a
The business model that makes it possible to open outpatient rehab
centers was ushered in by recent pediatric rehabilitation hospital
legislation that made it possible to provide services to children
in outpatient centers, exempting satellite centers from certain
restrictions, and allowing them to bill at hospital rates.
Many aspects of providing pediatric rehabilitation,
however, remain fiscally challenging, Castello points out: Most
enrolled in Medicaid are now in Medicaid HMOs. Their care gets
according to a fee-for-service schedule — one that frequently
doesn’t cover the cost of care.
That’s a major factor for CSH’s pediatric primary care practices for
special needs children and their siblings in Newark and elsewhere.
"These are critically important programs," Castello says,
"so we continue to provide and subsidize them."
At the same time, CSH intends to expand. The organization now plans
to grow its number of New Jersey outpatient facilities from five to
between seven and ten by 2007. At the same time, CSH is drafting plans
for a new inpatient rehab facility on the Robert Wood Johnson
Hospital (RWJUH) campus in New Brunswick. In addition to the existing
Bristol-Myers Squibb Children’s Hospital, the university is building
a pediatric research center — and a new CSH inpatient center
be opened within three years. The center will care for patients with
conditions such as traumatic brain and spinal cord injuries, as well
as orthopedic injuries requiring rehabilitation.
The 47-year old Castello, a pediatric intensivist, was formerly
of the RWJUH’s pediatric intensive care unit. His wife, Carol
maintains a matrimonial law practice in Research Park, while their
two children attend Princeton public schools.
In the meantime, word is getting out to grateful parents in about
Hamilton’s new facility. "This was a real need identified in our
community, and we moved forward aggressively to meet it," says
Christy Stephenson, CEO of the Robert Wood Johnson University Hospital
in Hamilton, a CSH partner. While the center will have a real impact
on the families of special needs children, she says, many more
who wouldn’t be classified as "special needs" will be able
to get assistance here, especially in cooperation with different
"A lot of children have needs that can be met at this
says Stephenson. "This is a much needed resource for many more
than just a small subset of the pediatric population."
at Hamilton, 3575 Quakerbridge Road, Hamilton 08619-1205. Patricia
D. Foley, site director. 609-631-2800; fax, 609-631-2897. Home
Many physicians are starting to realize that their
need to lose their traditional air of cold sterility. That’s
true when you are providing medical care for children, says architect
James W. Brick, who designed the new Children’s Specialized Hospital
Outpatient Center at Hamilton, which opened earlier this year.
And creating the right environment is even more critical when you
are designing a space for physical therapy. "You’re not only
and getting examined, but you’re actually going to be physically
there when you’re a patient," says Brick in a phone interview
from his office in Medford (609-654-6951, E-mail:
"We wanted to lighten it up, get a lot of color involved, and
truly make it the least stressful environment as possible."
Brick succeeded handsomely with the Hamilton facility, working with
project manager and interior designer Granary Associates of
with general contracting done by Michael Riesz and Co., of Fords.
But then Brick, a 1980 Clemson graduate, has had a lot of practice:
He specializes in health care architecture, having designed ambulatory
surgery centers in Florida and Arizona, for instance, although 95
percent of his work has been in New Jersey, Pennsylvania, and
For the past five years, he has worked solo, following 13 years spent
with Granary Associates.
He says that part of the impetus now to spend more effort with color
and design in health care settings comes from the trend of physicians
owning their own facilities, such as ambulatory surgery centers.
realize that the old HMO doctor’s office just doesn’t make it
Brick says. "It’s as much of an esthetic issue as a marketing
— Phyllis Maguire
The following letter was received on Monday, May 23.
Please consider the following corrections to the electronic version on
your Web site as well as a printed correction in your next issue of
The article says Dr. Frank Castello is "formerly Medical Director."
He actually has the dual role of Medical Director and acting
Patricia Foley did not say the "Hamilton Township public school
system strongly endorsed opening the center." Rather that Robert Wood
Johnson Hospital at Hamilton (an affiliate of CSH through the Robert
Wood Johnson Health System) strongly supported our new center. The
same paragraph mentions referrals. Patty had explained that referrals
come from local pediatricians, community groups, schools and often
Please understand that we do appreciate the coverage in your
publication, but would like these errors addressed.
Public Relations Manager
Children’s Specialized Hospital
Corrections or additions?
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