DesignTO presentation on January 28, 2020. Special thanks to the Service Design Lab team at the Office of Design & Delivery for all the hard work we all did together. Special thanks to Alba Villamil, Annalise Huynh, Mark Janchar and Taylor Cook for providing me feedback

1. Co-Creating Trauma-
Informed Services

2. Hello world! I am Andrew (he/him/his).
● I am a Service Designer and Design
Researcher where I have worked on a
variety of teams and structures in a variety
of roles.
● This cartoon of me was made by my friend
and former colleague of mine Annalise
Huynh that I’ve grown attached to.
● I have never been wrong about anything
in my life.

3. I have a lot of people to acknowledge and thank.
● To my old team at ODD, specifically Mark, Kelsey, Taylor, Kristin, Manlin, Anu,
Chris, Stephanie, Sam and Garrett. Already missing y’all.
● To my current colleagues at the Design Institute for Health, specifically to
Stephanie, Lauren and Jacob (go Design Research team!) who have
provided lots of insights.
● To Sarah Fathallah, a design researcher whose own work and thinking
inspired me to make a career pivot. Many of her thoughts and framing are
reflected here and it helped crystallize for me many of my own emergent
design practice. I shamelessly am referring to many of her ideas here.
● Many thanks to Rachael Dietkus’ ideas, founder of Social Workers who
Design, who has shared a lot of wisdom on trauma-responsive design.

4. What’s going on in Austin?
1

9. What is trauma-informed?
2

10. trauma
Trau·ma
troumə
noun
______________________________________________________________________________________________________________________________
_
There are many different definitions of trauma.

11. “So trauma is not just a wound, but it’s a wound that’s not healed….They become separated
from their own feelings, sometimes from their own gut feelings….it doesn’t take horrific events
to traumatize people. That’s what the big misunderstanding is.”
-Dr. Gabor Mate

12. “Contrary to what many people believe, trauma is not primarily an emotional response. Trauma
always happens in the body. It is a spontaneous protective mechanism used by the body to
stop or thwart further (or future) potential damage.
Trauma is not a flaw or a weakness. It is a highly effective tool of safety and survival.
Trauma is also not an event. Trauma is the body’s protective response to an event — or a
series of events — that it perceives as potentially dangerous.”
-Reesma Manakem, White Supremacy as a Trauma Response

13. “The brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one
another is matched by our capacity to heal one another. Restoring relationships and
community is central to restoring well-being; (2) language gives us the power to change
ourselves and others by communicating our experiences, helping us to define what we know,
and finding a common sense of meaning; (3) we have the ability to regulate our own
physiology, including some of the so-called involuntary functions of the body and brain,
through such basic activities as breathing, moving, and touching; and (4) we can change social
conditions to create environments in which children and adults can feel safe and where they
can thrive.
When we ignore these quintessential dimensions of humanity, we deprive people of ways to
heal from trauma and restore their autonomy. Being a patient, rather than a participant in one’s
healing process, separates suffering people from their community and alienates them from an
inner sense of self.”
-Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Trauma

14. trauma-informed
Trau·ma - in·formed troumə - inˈfôrmd
adjective
______________________________________________________________________________________________________________________________
_
There are a few working definitions of trauma-informed.

15. “A strengths-based service delivery approach that is grounded in an
understanding of and responsiveness to the impact of trauma, that
emphasizes physical, psychological, and emotional safety for both
providers and survivors, and that creates opportunities for survivors
to rebuild a sense of control and empowerment.”
-Substance Abuse and Mental Health Service Administration
“Trauma-informed care refers to therapeutic approaches that validate and are tailored to the
unique experience of a person coping with PTSD. It understands the symptoms of trauma to
be coping strategies that have developed in reaction to a traumatic experience. Non-
judgmentally, it recognizes that a person with PTSD may have behavioural, emotional or
physical adaptations that have developed in specific response to overwhelming stressors.”
-Centre for Addiction and Mental Health

16. The path to empathy should come from an intrinsic motivation...it is a relational
empathy and not a transactional empathy -- what we can do is manipulate or
exploit individuals to get source material so we can better design…
how can we evolve a transactional process to be more relational...one of the ways
to do it is to slow down the process.
-Rachael Dietkus

18. Everyone responds to traumatic events in
different ways.
Just because someone goes through a traumatic
event does not meat they are traumatized.
What triggers a traumatic response for one
person may not for another.

19. How might we translate trauma-informed
practices into our design processes given
institutional constraints?
3

20. HMW develop a design approach…
HMW identify participants ...
HMW incentivize participants…
HMW conduct design research…
HMW manage participant data…
HMW invite participants to co-create…
HMW recognize past design decisions to change the future…
HMW practice self-reflexivity...

21. How might we use the most respectful and
appropriate approach to understand problem
at hand, for the audience in the present
context?
3.a
Developing a research approach

22. In theory…
● Long detailed structured
interviews with participants in
context (workplace, home, etc.)
● Access to sites for observations.
● Ability to follow-up with research
participants.
● Governance mechanisms in
talking to human research
participants (i.e.Research Ethics
Boards/Institutional Review
Boards)

23. In theory…
● Long detailed structured
interviews with participants in
context (workplace, home, etc.)
● Access to sites for observations.
● Ability to follow-up with research
participants.
● Governance mechanisms in
talking to human research
participants (i.e.Research Ethics
Boards/Institutional Review
Boards)
But in practice…
● Time constraints where typical
research methods may have to
be significantly modified.
● Sites might not be available.
● Limited ability to follow-up with
research participants.
● Potential for re-traumatization.
● Design research typically does
not have governance
mechanisms

27. How might we appropriately recruit
participants?
3.b
Identifying research participants

28. In theory…
● Recruiting and screening
participants according to
participant profile that satisfies
research criteria.

29. In theory…
● Recruiting and screening
participants according to
participant profile that satisfies
research criteria.
But in practice…
● Participants may not want to go
through a screener.
● Participants already feel
overburdened by screeners to
receive service.

31. How might we compensate our neighbours
fairly as research participants?
3.c
Incentivizing research participants

32. In theory…
● Compensation guidelines and
policies in place.
● Offering individual incentives for
their research participants at
market-rate.

33. In theory…
● Compensation guidelines and
policies in place.
● Offering individual incentives for
their research participants at
market-rate.
But in practice…
● Lack of business case and
compensation policies in place
for research participants.
● Restrictive types of incentives
due to managing stakeholder
sensitivities
● Incentives offered at
significantly lower market rate

37. How might we have conversations and gather
data in a trauma-informed way where
participants have informed consent?
3.d
Conducting Research

38. In theory…
● Having documentation to obtain
informed consent.
● Thanking participants for their
participation.
● Participants reveal information
that is within the bounds of what
they consent to.

39. In theory…
● Having documentation to obtain
informed consent.
● Thanking participants for their
participation.
● Participants reveal information
that is within the bounds of what
they consent to.
But in practice…
● Consent can be withdrawn
throughout course of the
research, with issues that arise
that we may not be equipped to
deal with.
● Consent can be ambiguous
with divergent expectations.
● Participants may reveal more
sensitive information than they
intend to beyond what they
initially consent to.

41. TL;DR
We are not mental health professionals.
Let’s stay in our lane.
Refer to appropriate help if necessary.

42. How might we manage participant’s data by
ensuring that their personally identifiable
information is not traceable to them and/or
does not compromise their safety?
3.e
Manage research data

43. In theory…
● “Minimum necessary”
● Scrubbing participants’
identifiable information.
● Use of appropriate tools and
equipments.
● Aggregating the data and
selecting compelling anecdotes
and photos to use to share back.
● Getting actionable feedback on
prototypes.

44. In theory…
● “Minimum necessary”
● Scrubbing participants’
identifiable information.
● Use of appropriate tools and
equipments.
● Aggregating the data and
selecting compelling anecdotes
and photos to use to share back.
● Represent data as shareable
“artefacts”
But in practice…
● Sometimes using personal
devices to store participant data.
● Making assumptions on how
participant data and photographs
ought to be used without
providing agency to participants.

46. We are more
than our data
but our data
is us.

47. ┏┓
┃┃╱╲ in
┃╱╱╲╲ this
╱╱╭╮╲╲house
▔▏┗┛▕▔ we
╱▔▔▔▔▔▔▔▔▔▔╲
WE DO NOT FORCE A STORY
╱╱┏┳┓╭╮┏┳┓ ╲╲
▔▏┗┻┛┃┃┗┻┛▕▔

48. How might we ensure that the people most
impacted by the outcome of our design work
are the ones in charge of influencing them in a
manner that prioritizes their safety?
3.f
Inviting participants to co-create

49. In theory…
● “User groups” and/or “lived
experience groups” as a
governance mechanism with
equal partnership in design
decisions.
● Participants on the design team,
enthusiastically playing a “product
owner” role.

50. In theory…
● “User groups” and/or “lived
experience groups” as a
governance mechanism with
equal partnership in design
decisions.
● Participants on the design team,
enthusiastically playing a “product
owner” role.
But in practice…
● Participants may feel like they
are unable to meaningfully
contribute and feeling jaded.
● Uneven and unclear terms of
engagements.
● Intentional or not,
reinforcement of power
imbalances, especially when
input not used.
● “Consultation theatre”

51. Without pausing to understand a
designer’s relationship to power, one
could unintentionally remind a
community that they have little power
to stop a project from happening.
-George Aye

52. ...the technical nature of jargon create
a gulf between designers and those
they should be co-designing with, it’s
also important to fight against any
impulse to regard it as universal.
-Sarah Fathallah

56. How might we reconcile the historic and
present harms that we have intentionally
designed to co-design a future with those that
we have harmed that promotes collective
healing?
3.g
Recognizing past design decisions to change the future

57. In theory…
● We all have a shared
understanding of how we get
here and acknowledge it.

58. In theory…
● We all have a shared
understanding of how we got
here and acknowledge it.
But in practice…
● We don’t.

61. How might we embed the necessary critical
self-reflexiveness in our design practices to
challenge our assumptions and invite
openness to change?
3.g
Practicing self-reflexivity

62. In theory…
● We are the professionals that can
maintain composure and bring
our best selves.
● We enter into spaces from a
posture of “spectator in a play,”
with the impact of our work
professionally divorced from us.

63. In theory…
● We are the professionals that can
maintain composure and bring
our best selves.
● We enter into spaces from a
posture of “spectator in a play,”
with the impact of our work
professionally divorced from us.
But in practice…
● We bring a lot of biases.
● We can impacted by vicarious
trauma.
● We are “actors in a play.” The
impact of our work cannot be
divorced from us for we too are
the work.

66. We sought to change things but the
things change us too. This work will
require us to be transformed by it.
Take care of yourselves.

67. THANK YOU!
(Might I suggest y’all to support
the Encampment Support
Network?)
https://linktr.ee/ESN_TO