When you first arrive at Fora Health’s new treatment and recovery facility, you’re greeted by pavers engraved with motivational messages, just like the one above. These pavers, featuring quotes from iconic figures like Martin Luther King Jr, Albert Einstein, Charlotte Bronte and even Willie Nelson, are sprinkled throughout all of Fora’s outdoor spaces, each offering a piece of advice, motivation or inspiration. But they also serve as a hint of what’s awaiting you on the other side of the door: a warm, welcoming environment that encourages hope, recovery and well-being.

Fora Health is one of Oregon’s largest providers of substance abuse disorder treatment for adults. Previously known as De Paul Treatment Centers, the organization has served more than 50,000 people since its founding in 1977. Fora Health’s new facility, located in SE Portland, continues providing care for adults and housing their administrative services under one roof but in a dramatically different and purpose-built space. The two-story, 53,000 s.f. building serves as a comprehensive wellness center and offers multipurpose spaces for counseling, group meetings and making connections, in addition to medical and administrative offices, conference spaces and residential rooms.

Fora Health’s new building more than triples their capacity to serve Oregonians in need. The new facility also adds impact through its use of thoughtful trauma-informed design and community spaces that allow patients the space and resources to learn, heal and recover. Now, Fora is home to 24 beds for medical withdrawal management, 70 inpatient residential beds, an intensive day treatment program with an 80-person capacity and an outpatient service program with the ability to serve nearly 1,000 patients at a time. At peak capacity, Fora will be able to provide services to nearly 10,000 outpatient patients annually. With a strategic location near Adventist Health and convenient to public transportation, Fora Health’s new building sets them up to serve those in need for decades to come. Fora Health was awarded Portland Design Commission’s 2019-2020 Design Excellence Award, which recognizes a project that best exemplifies the tenets of design: context, public realm, quality, and resilience.

Designed with Patients and Community in Mind

While Fora Health’s new headquarters is visually striking from the outside, the vision extends far beyond the front doors. Designed by Holst Architecture, the goal was to create a building that expanded Fora’s program, a building that patients could be healed and respected in, and a building that neighbors would be proud to have as a part of their community. Fora’s mission has always been to destigmatize addiction—treating it as a disease rather than a moral failing. Their program provides a continuum of care, from withdrawal management to outpatient counseling, so the building needed to reflect this full spectrum of treatment while maintaining aesthetic appeal.

A Mountain-Inspired Roofline

The first thing you notice when you see Fora Health is the unique roofline. While a flat roof can often feel institutional, the sloped roof feels more residential or reminiscent of hospitality spaces like hotels or spas. This helps to give Fora Health a warm and welcoming feeling. The roofline was designed to mimic a Northwest mountain range with its varied peaks and valleys. Each peak is slightly different and directly reflects the variability in a natural mountain range.

The roofline gives the building a natural beauty that can be seen by residents, staff, patients and community members alike. Fora Health is a community-focused organization and it’s only natural that the building appeal to the community as well as its end users.

The roofline was accomplished with over 300 trusses, each one unique from the other. The roofline required several coordination meetings with Holst, R&H, Catena Consulting Engineers and the truss designer—it was a labor of love in order to get it right, both aesthetically and practically for appropriate drainage. The truss design was so unique that the city required two weeks to review the entirety in the field.

Fora Health Front Entry. Fora’s mountain-inspired roofline is visually stunning and gives this medical facility a warm and welcoming hospitality-like feel. Photos by Christian Columbres.

Trauma-Informed Design

Fora Health uses trauma-informed care practices to shape their treatment programs. The Trauma-Informed Care Implementation Resource Center states that trauma-informed care seeks to:

1. Realize the widespread impact of trauma and understand paths for recovery
2. Recognize signs and symptoms of trauma in patients, families and staff
3. Integrate knowledge about trauma into policies, procedures and practices; and
4. Actively avoid re-traumatization

Holst carefully adapted the tenets of trauma-informed care practices and integrated them into trauma-informed design to, which as a practice, integrates tenets of trauma-informed care with the goal of creating environments that promote healing and recovery. Holst’s research into designing for individuals coping with trauma suggests the following six strategies: safety, nature, comfort, coherency, de-escalation and empowerment. These principles can be recognized within Fora Health’s new building in the following ways:

1.  Safety

Patient safety is always at the top of mind. Fora Health’s design balances patients’ privacy needs against the staff’s need to maintain sight lines for monitoring. The selective use of glass helps to balance these needs. Patients’ perceived safety is also considered by using large open spaces and eliminating dead ends or blind corners that can feel unsafe for patients experiencing trauma.

2.  Nature

Fora’s connection to nature is evident from the first time one visits their facilities. The roofline, as discussed above, is designed to mirror a mountain range with varying peaks and valleys. The building is designed around, and literally wraps around, a central courtyard to provide as much visual exposure to nature as possible. The punch metal fencing seen in the courtyard and along the interior stairs and balcony is made of punched metal steel panels with a tree and forest design. Vinyl graphics, like the one found in Fora’s dining room, feature nature-inspired photography from Pacific Northwest locations like the Columbia River gorge. The building also uses cedar siding on the exterior and wood paneling on the interior. In addition to providing a connection to nature, wood is known to have a relaxing effect on people, providing a sense of calm that is especially beneficial in an environment like this one.

3.  Comfort

To create comfort within Fora’s space, Holst’s design avoids overly warm or bold colors and instead uses tones of blue and the natural warmth of wood. Rather than having all seating options be face-to-face, comfort is created by having many options of seating, each facing in different directions to help create a stress free space. Finally, when you enter Fora Health, the reception desk is located subtly off to the side and you’re instead greeted by a beautiful open entry way, fireplace and lobby filled with cozy seating options, complete with a large hearth and fire. The lobby feels more similar to a spa or high-end medical center rather than a treatment and recovery facility. Other design decisions like indirect lighting, open furniture arrangements and natural imagery help to create comfort within the space.

4.  Coherency

Coherency in trauma-informed design means creating coherent spaces that help patients develop a sense of trust in the environment. At Fora, the repetition of finishes gives the spaces a sense of predictability. While there are several ways of getting from room-to-room within the building, all of the paths (marked with clear wayfinding signage) lead back to the central lobby, which gives patients and residents a clear sense of direction.

5.  De-escalation

Fora’s design allows several spaces for de-escalation including quiet rooms and lounges so patients can de-stress away from others. Fora’s design has several alternate spaces for groups to convene when challenging situations arise with patients, including break rooms, community rooms, the courtyard, and amenity spaces.

6.  Empowerment

Finally, Holst’s design creates opportunity to empower patients and residents to make decisions for themselves throughout the day. The location of the front desk (off to the side rather than directly in front) lets visitors choose to visit the reception desk rather than being confronted with it immediately upon entry. Lights in meeting and therapy rooms have options for dimming so patients can choose their preferred levels of light. Each space, from the lobby to the dining spaces, provide multiple styles of seating so residents can make the selection that feels right for them. Finally, having several amenity spaces—from an art studio and fitness center to casual café seating and a basketball court—allows patients and residents to choose recreational activities that most interest them.

The Lobby. Accented by warm wood tones and forrest-inspired punch metal guardrails, the lobby opens up to Fora’s courtyard and serves as a central gathering space within the treatment and recover facility. The lobby is home to several seating options and a cozy fireplace.

Amenities and Finishes

Beyond providing an increase in space and capacity, Fora Health’s new building offers several new amenities that their previous home, located in downtown Portland, couldn’t offer.

Fora is committed to “caring for the whole person.” This includes providing patients and residents with access to a variety of impactful activities that help patients express themselves, develop healthy habits, and build resilience. Inside, an art studio, fitness center, library and commercial kitchen provide recreational activities to help patients build healthy habits and practice self-expression. With these spaces, Fora can offer yoga workshops, cooking classes, space for art projects, as well as other activities that encourage holistic wellness and recovery. There are also community spaces that can be used for peer or family counseling services or be rented out to community members.

Outside, a lushly planted courtyard, sport court, walking paths, seating options, and a therapy garden, provide residents with access to fresh air and nature. Plans are in the works for garden beds designed and grown by patients and led by one of Fora’s physicians. The courtyard becomes increasingly infused with nature the further you move from the building. Beyond the courtyard, up Fora’s walking path, you’ll find a council ring—a traditional circular gathering space made of concrete, with low benches and a small opening on two sides. Stone pavers are engraved with words including “transform,” “healing” and “courage”. The council ring holds space for thoughtful contemplation and reflection, to mark important achievement or transitions, as well as providing a place to enjoy a moment of peace or solitude.

The finishes throughout the space were selected with patient care in mind. Anytime a building serves a population that isn’t responsible for a space, such as a school, hotel or medical facility, you can expect that some visitors might be tough on materials. To mitigate this, Holst did investigations into impact-resistant gypboard and other resilient building materials. Finishes were selected based on their ability to be cleaned, wiped or hosed down depending on the room’s function. Easily cleanable concrete floors can be found in the withdrawal management rooms while a durable LVT flooring can be found in other patient-focused areas. Many of the fabric and furniture selections are stain resistant and easy to clean.

A New Home for a New Future. With this new facility, patients, residents, and staff have more space, additional medical treatment facilities, amenities that nurture self-expression and access to nature – all in a building that is calming, inspiring and empowering for patients and residents.

Overcoming Obstacles

Understanding the Programming

One of the biggest challenges early in the project was understanding Fora’s programming and goals, then subsequently making sure that the building and building materials aligned with those goals. Early on, R&H worked with Holst and Fora to gain a deeper understanding of project goals and Fora’s programming.

Although Fora is a treatment and recovery center, their model of treating addiction as a medical condition means that they also treat patients’ co-occurring medical or psychiatric needs. For this reason, Fora employs a team of doctors, nurses and other care providers and the new building needed to work for them as well. Fora has many spaces similar to that of a medical facility including exam rooms, nurse stations, as well as pharmaceutical storage and distribution space.

While the building itself primarily houses residential, medical, and office space, the goal was to make the building feel more like a hotel, spa or other hospitality space. So, while finishes needed to be durable and fit medical needs, they also needed to feel warm, calming, and comforting.

The R&H/Holst team utilized multiple methods before and during construction to ensure the building and its materials fit Fora’s goals. First, Holst developed a digital model of the building that allowed Fora to visualize the project before there were boots on the ground. Then, throughout construction, R&H used a mock-up to ensure Fora was happy with the form and function of their selections.

COVID-19 and Weather

The COVID-19 pandemic has created one of the most difficult building environments in construction history. From unprecedented material shortages and cost escalations to labor shortages and plant closures, the Fora Health project, like many others in our industry, had to overcome some major hurdles presented by the pandemic.

Fora Health was slated to begin in April 2020, just one short month after the initial COVID shutdowns. R&H pivoted quickly to change to the adapting environment. Early in the pandemic, R&H was an early industry leader who developed a Plan, Prepare, Respond strategy to safely operate our project well ahead of local AGC or OR-OSHA guidance. Our response to COVID-19 included forming a COVID-19 Task Force, creating a COVID-19 Response Plan, enhancing both internal and external communications, as well as launching a COVID-19 resource page where team members, clients and subcontractors can find our plan, documents and signage needed to ensure safety on all projects.

R&H navigated material shortages and delays by practicing early procurement and ordering materials long before they were needed onsite. Thankfully, the Fora Health site was large and was able to accommodate increased material storage. As an example, R&H purchased and procured all of the wood for the wood-framed building before we finished site prep and were able to store it onsite while completing early scopes.

Another challenge during the Fora Health project was the February 2021 snow and ice storms. In just three days, Portland accumulated 10” of snow and 1” of ice, essentially bringing the city to a halt. This snowstorm hit Portland right as the project was topping out, causing construction to pause for nearly a week.

R&H prepared for this event by wrapping the entirety of the roof with roof underlayment in order to dry in the building and allow the trades inside to begin working on MEPF rough in. The decision to wrap the whole roof, led to an entire resequencing of the project, which initially intended to build out the building in halves the East and the West, but once the snow even occurred R&H elected to combined the spaces and operate them in four parts.

Thoughtful design. Fora’s outdoor space offers patients access to nature, activities that promote well-being and locations for reflection and meditation.

Meeting DMWESB Goals

The Fora Health project had a goal of achieving 30% DMWESB participation. To achieve that goal, R&H sought out qualified and certified subcontracting partners to work with onsite. As a result of a busy market, many of the trade partners we brought to the project were new partners for R&H. During preconstruction and construction, we took several steps to ensure the success of these subcontractors:

1. R&H held several detailed preconstruction meetings with all trade partners where we set expectations of quality, time and budget.
2. We had large onsite team to answer questions or mitigate any potential issues quickly.
3. Our team worked through detail plans with the subcontractors to ensure a deeper level of understanding of Fora’s aesthetic and programming goals.

With the help of talented subcontractors, R&H was able to meet that goal and achieved 30% DMWESB participation on the project.

Complex Design & Mock-up Donation

Fora Health’s complex design created a fun and challenging project the R&H/Holst teams. From the intricate peaks and valleys of the roofline to the combination of wood and steel needed to create Fora’s beautiful lobby and wide-open spaces, the building required extensive pre-planning and teamwork to lead the project to success.

To ensure that the final building and building materials matched Holst’s design and model, as well as fit Fora’s vision, we utilized a mock-up. Due to the complexities of the design, the project donated an additional $20,000 in labor and materials to complete the mockup and ensure the building and building materials aligned with the project goals.

In the end, we were able to donate the building mock-up to Portland State University’s Center for Public Interest Design (PSU CIPD) Useful Waste Initiative which aims to divert material and reduce landfill waste by converting construction mock-ups into tiny homes for those in need. Their program takes construction mock-ups and gives them new purpose, therefore increasing the positive impact this project has on our community. The Fora Health mock-up now lives in Gresham and is a part of the C3PO BIPOC Village. You can learn more about our mock-up, the PSU CIPD program and the C3PO BIPOC Village by visiting the linked websites.

https://www.usefulwaste.org/p/-(in-process)—depaul-

https://www.usefulwaste.org/about

https://ahomeforeveryone.net/c3po

Progress at Fora Health. Construction of Fora Health began in April 2020, just one month after the initial COVID-19 shutdowns. Crews battled material delays, labor shortages, cost escalation and an ever-changing pandemic to bring the project to a safe completion in November 2021. Photos by R&H Construction.

Alignment with Budget and Schedule Goals

Fora Health is a nonprofit organization and raises funds to help create new opportunities, build new facilities and help patients experiencing poverty to access the treatment they need to succeed. Fora Health’s new building was funded through a combination of Fora’s equity, tax credits and donations. For this reason, it was important that we as building partners, be stewards of their funds and ensure best value for our client. With these funds, Holst produced a stunning yet cost-effective design to help meet Fora’s needs.

Value Engineering

During the preconstruction phase, R&H led a value engineering process that resulted in a savings of over $1,200,000. Some of the most significant value engineering efforts are detailed below.

Emergency power: Through a careful analysis of electrical loads and emergency power requirements, we were able to reduce the back-up generator size from 750 kw to 80kw. This resulted in over $100,000 in construction savings as well as reducing long-term operational costs.

Building envelope: Through evaluation of exterior wall assemblies and required energy performance, the team selected an alternative weather-resistant barrier system and was able to eliminate continuous exterior insultation. This resulted in a cost savings of $140,000.

Building infrastructure: We identified an alternative wiring method for branch wiring that reduced the amount of conduit required. This resulted in a cost savings of nearly $75,000.

Schedule Considerations

As previously mentioned, construction of Fora Health began shortly after the onset of the COVID-19 pandemic, which created one of the most challenging times in the history of construction. R&H, Holst and our hard-working project and trade partners overcame extraordinary material and labor shortages as well as unprecedented weather delays to complete the project. Despite inevitable delays, we were able to meet the client’s deadline of relocating by the end of November 2021 to meet the lease term of their previous building.

“No one who achieves success does so without the help of others” -Alfred North Whitehead

This quote is one of the dozens found around Fora Health’s new facility and directly emulates Fora’s mission. Through their new facility, Fora will be able to help more patients, increase their impact and help people find hope while recovering from addiction. Their new building reflects their program goals and their mission to treat the whole person with compassion and care throughout each stage of their recovery. With this new facility, patients, residents and staff have more space, amenities that nurture self-expression and access to nature – all in a building that is calming, inspiring and empowering for patients and residents. The resulting project is one that is truly at the heart of the Portland community and one most deserving of recognition.

Awards

• Top Projects – 1st Place Health & Life Sciences, Daily Journal of Commerce