CR4HC Case Study: Sacred Oaks Healing Center

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Sacred Oaks Healing Center: Infrastructure Resilience to Deliver Culturally Responsive Care

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In 2013, the California Indian Health Service (IHS) acquired 12 acres of land in Davis, California, to develop the Sacred Oaks Healing Center (Sacred Oaks) Youth Regional Treatment Center (YRTC) (Indian Health Service, n.d.-a). The location was selected for its proximity to healthcare professionals at the University of California Davis School of Medicine and its accessibility to local Tribal patient populations. IHS YRTC facilities provide residential care for American Indian and Alaska Native youth aged 12-17 who are struggling with substance use and co-occurring disorders (Indian Health Service, n.d.-b). Patients receive therapy, substance use counseling, access to cultural practices relevant to specific Tribes, and continuation of primary and secondary education throughout the duration of their stay, with additional assistance from ongoing care specialists who help discharged patients navigate outpatient services. Initially scheduled to open in 2020, the facility experienced construction and design setbacks affecting the building schedule, including storm-related floods in 2019 and the declaration of the COVID-19 Public Health Emergency in 2020 (Sacred Oaks Healing Center, 2022).

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Flood Mitigation and Energy Resilience 

Davis, California, is largely considered a low-risk area for storm-related flooding (City of Davis, CA, 2024). However, during its construction in January 2019, Sacred Oaks experienced significant flooding following heavy rains that resulted in damage to its foundation and large swathes of deep mud that needed to be excavated before construction could continue.

After the flood, CWE, a civil engineering firm, was hired to perform a floodplain analysis of Sacred Oaks’ property (CWE, n.d.). The analysis incorporated data from Federal Emergency Management Agency floodplain maps, the U.S. Army Corps of Engineers, the National Oceanic and Atmospheric Administration, Yolo County drainage standards, and other hydrological sources to identify both short- and long-term recommendations to address flood risks at Sacred Oaks. Based on the recommendations, Sacred Oaks installed 

• perimeter berms to mitigate flood damage during storms; 
• landscaping improvements, such as flood channels and culverts, to direct excess floodwaters to a large detention pond; and, 
• a stormwater lift station to displace the detention pond’s stormwater to adjacent properties (Romtech Utilities, 2021). 

California Area IHS, which oversees Sacred Oaks, worked with national IHS to secure funding to incorporate these flood mitigation elements in the project. Although the mitigation elements cost nearly $3 million, cost savings analyses indicate that the facility could save more than $10 million in damages from future floods by reducing expenses incurred by patient and staff evacuations, structural damage, and equipment loss. Sacred Oaks intends to further increase its flood resiliency by constructing underground water retention chambers to collect rainfall (Indian Health Service, 2022). The use of collected rainwater for landscape irrigation is being studied as an option for ongoing stormwater chambers project.  

Sacred Oaks incorporates additional features of climate change resilience, beyond flood mitigation. The facility was initially designed and built with insulated structural panels to reduce energy costs related to cooling during hot summers and heating during cold winters, as well as American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) 135 energy efficient heating, ventilating, and air-conditioning units. Following the flood, Sacred Oaks incorporated additional flood-resistance design measures, including 

• incorporation of permeable walkways, driveways, and patio structures to reduce flood risk; and, 
• planting native flora across the property to reduce irrigation requirements and benefit native wildlife. 
• These resilience measures have reduced operating costs and mitigated structural damage during extreme weather events that have occurred post-occupancy.  

The best time to identify high-risk weather hazards such as the flood experienced by Sacred Oaks is during the initial planning phase of a capital project, so that resiliency can be considered early in the design and development process. Although IHS maintains a library of up-to-date guidance documents, such as the IHS Architect/Engineer Design Guide, many of these best practice documents rely on historical data sets (Indian Health Service, n.d.-c). As global weather patterns continue to evolve in the setting of climate change, prospective risk assessments using climate models will likely become a foundational tool for future-proofing new construction/renovation projects and facility upgrades. In response to lessons learned from the Sacred Oaks flood, California Area IHS updated its land acquisition and building design procedures to include elements of prospective risk assessment, such as 

• requiring an analysis of estimated changes to the 100- and 500-year floodplain under climate change scenarios, 
• Climate Impacts Research Consortium (CIRC) toolkit,(Climate Tools, 2016) 
• Federal Emergency Management Agency (FEMA) National Risk Index,(Federal Emergency Management Agency, 2024) and 
• U.S. Climate Vulnerability Index.(Environmental Defense Fund, 2024) 

Culture as a Cornerstone of Health Care

Sacred Oaks is an example of a residential facility that incorporates weather hazard resiliency and environmental sustainability, as well as uplifting cultural practices, into its design and operations.

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Treatment provided at Sacred Oaks connects patients to their culture with traditional and native healing services. Feedback provided by Tribal advisory groups and other stakeholders informed the building’s architecture and landscape design, weaving in cultural and community practices throughout the healthcare facility. The landscape incorporates native plants, water and fire features, and outdoor areas to provide therapeutic environments. The facility’s interior decor and artwork highlight traditional Tribal patterns and flow, and a Cultural Room enables patients to further focus on interacting with their cultural and Tribal histories. Furthermore, cultural specialists assist patients and healthcare providers in navigating cultural differences among different Tribes and weaving those elements into patient treatment plans (California Area Indian Health Service, n.d.).

As Sacred Oaks demonstrates, designing for climate resilience can be intertwined with cultural and historical practices while addressing health equity.