Frank Castello

Rx for Kids: Design Matters

Letter to the Editor

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

reserved.

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

Children’s

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

invaluable

resource for families of children, from infants to young adults up

to age 21, with injuries, developmental delays, chronic medical

conditions,

learning or behavioral problems, and congenital disabilities.

"We are here to evaluate and treat children’s rehabilitation

needs,

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

17.

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

neurodevelopmental

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

Pennsylvania

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

blocks

of color. Parents and physical therapists work with children on blue

mats that cover much of the floor. Kid-height parallel bars help

children

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

abilities.

The sensory motor room with its beanbag mats and padded climbing wall

is where children’s gross motor skills are evaluated. There are

occupational

therapy rooms where therapists work with children to develop

handwriting

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

children

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

audiology

booth for hearing testing — and the Hamilton center plans to do

outreach, Foley explains, with speech and hearing testing in local

schools.

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

rehabilitation

physician specialists, pediatric orthopedists for evaluations, and

neurodevelopmental pediatricians.

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 specialty.

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,

benefited

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

affiliated

partner in the Robert Wood Johnson Health System, CSH and its network

of different facilities continue to evolve to meet children’s changing

medical needs.

"There is now a huge concern about children being diagnosed with

both autism and ADD, with many more children being evaluated and

treated,"

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

autistic

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

conditions,

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

ADD."

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

children

affected by two other growing epidemics: diabetes and asthma,

conditions

that are particularly difficult to manage in adolescents.

While many pediatric diagnoses are on the rise, the fact is that

relatively

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

pediatric

facility."

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

geographic

restrictions, and allowing them to bill at hospital rates.

Many aspects of providing pediatric rehabilitation,

however, remain fiscally challenging, Castello points out: Most

children

enrolled in Medicaid are now in Medicaid HMOs. Their care gets

reimbursed

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

University

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

should

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.

Top Of Page
Frank Castello

The 47-year old Castello, a pediatric intensivist, was formerly

director

of the RWJUH’s pediatric intensive care unit. His wife, Carol

Novinson,

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

children

who wouldn’t be classified as "special needs" will be able

to get assistance here, especially in cooperation with different

school

districts.

"A lot of children have needs that can be met at this

facility,"

says Stephenson. "This is a much needed resource for many more

than just a small subset of the pediatric population."

Children’s Specialized Hospital Outpatient Center

at Hamilton, 3575 Quakerbridge Road, Hamilton 08619-1205. Patricia

D. Foley, site director. 609-631-2800; fax, 609-631-2897. Home

page: www.childrens-specialized.org

Top Of Page
Rx for Kids: Design Matters

Many physicians are starting to realize that their

offices

need to lose their traditional air of cold sterility. That’s

particularly

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

sitting

and getting examined, but you’re actually going to be physically

working

there when you’re a patient," says Brick in a phone interview

from his office in Medford (609-654-6951, E-mail:

jwball@comcast.net.

"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

Philadelphia,

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

Delaware.

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.

"They

realize that the old HMO doctor’s office just doesn’t make it

anymore,"

Brick says. "It’s as much of an esthetic issue as a marketing

one."

— Phyllis Maguire

Top Of Page
Letter to the Editor

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

US1:

The article says Dr. Frank Castello is "formerly Medical Director."

He actually has the dual role of Medical Director and acting

President/CEO.

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

parents directly.

Please understand that we do appreciate the coverage in your

publication, but would like these errors addressed.

Fred Feiner

Public Relations Manager

Children’s Specialized Hospital


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