Introduce Trauma-Informed Design to Your Organization - CSUN ATC 2024
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Historically, accessibility specialists focused on a narrow set of disabilities. We focused on the senses, such as sight, sound, and touch. We focused on abilities, like hearing, movement, and seeing. We expanded to include cognitive, mental health, and neurodiversity. This is significant. We now have tools to build inclusive products and services for an estimated 25% of the population. What about the other 75%? As accessibility professionals, we understand unique experiences and needs. We are best equipped to expand customer research and design at our companies. Universal design was described as a one size fits all solution. Inclusive design is one size fits one. Intersectional design is one size fits one, but also accounts for price, texture, availability, cultural appropriateness, and more. This presentation introduces the next layer of inclusive design; one that recognizes trauma. Trauma-Informed Design (TID) started in education, health, and community spaces. It focuses on the person’s experiences, recognizing trauma’s impact, anxiety, and restoring personal control. Architects embraced TID to develop spaces that are comfortable instead of confrontive. While the earlier stages of TID focused on individualized experiences, we can still take the principles and apply them to web and mobile application design. This is especially critical for emerging AI powered experiences where transparency and collective understanding are rarely considered.
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Introduce Trauma-Informed Design to Your Organization - CSUN ATC 2024
- 1. Trauma Informed Design Pam Bingham Ted Drake CSUN ATC 2024
- 2. Pam Bingham Senior Program Manager, DEI Center of Expertise Introductions Ted Drake Accessibility and Inclusive Design Leader, Intuit Design System *Melissa Eggleston Trauma-Informed Design Leader
- 3. Establishing Consensus Confidentiality - What’s shared here stays here. Be present - Engage fully with us and with each other. Engage with empathy and curiosity - Listen with the intent to learn more. Accept lived experiences - Believe and support each other. Address problems, not people - Create space for disclosure. Speak - With “I statements” Don’t feel pressured - Allow yourself space to think and then share Be open to feedback - We all have room to learn and grow.
- 4. Today’s Expectations ● Trauma 101 ● Design’s impact ● Respecting our customers ● Preparing for customer interactions ● Do no harm
- 5. This is Hard
- 6. Expanding Inclusive Design Inclusive Design = Design with diverse individuals Intersectionality = Incorporate the person’s whole identity Spoon Theory = Design for minimal cognitive load Trauma Informed Design = Design for trust, reduce harm, clarity
- 7. Key Principles for Trauma-Informed Approach 1. Safety 2. Trustworthiness and Transparency 3. Peer Support 4. Collaboration and Mutuality 5. Empowerment, Voice, and Choice 6. Cultural, Historical, and Gender Issues
- 8. Challenge: Human Trafficking Report How would you design an app for reporting human trafficking?
- 9. Challenge: Human Trafficking Report How would you design an app for reporting human trafficking? ● Mobile web page that loads quickly
- 10. Challenge: Human Trafficking Report ● Mobile web page that loads quickly ● Accept reports via SMS, WhatsApp, Telegram… ● Mimic other applications, like food ordering ● Acknowledge receipt ● Temporary state (Snap Chat) ● Form should load, fill out, and send within 30 seconds ● No sound or vibrations ● Work offline ● GPS shared by default ● Archived for future use (ACLU)
- 11. What is Trauma
- 12. About 60% of men and 50% of women in America will experience trauma at least once in their lives, with 12 million US adults suffering from PTSD during any given year. Given its prevalence, it’s important to understand what trauma is, what effects it has, and—crucially—where help can be found.
- 13. The American Psychological Association (APA) defines trauma as “an emotional response to a terrible event like an accident, rape, or natural disaster.” Short-term responses are typically shock and denial, while long-term responses can include “unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.” These are normal responses to abnormal experiences. Although individuals can experience trauma in unique ways, there are nonetheless common threads that allow for some categorization. Psychologists have identified three main types of trauma: acute, chronic, and complex. ● Acute trauma results from a single incident. ● Chronic trauma is repeated and prolonged, such as domestic violence or abuse. ● Complex trauma is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature.
- 14. Little T vs Big T
- 15. We can break traumas into little “t’s” and big “T’s” Little”t’s” are events that cause distress because we do not have the ability to cope with the event or experience. These events are not going to be life threatening nor lead to bodily injury, nonetheless, it can cause hopelessness and create a disruption in emotional functioning. Big “T’s” are traumatic events that most people envision when one says the word trauma. This is a significant event that leaves one feeling powerless and often lead to a fear for their lives or another’s life.
- 16. Community Trauma
- 17. What’s traumatic to me, may not be to you
- 20. Toxic Stress 3 Kinds of Stress 1. Positive stress response is a part of healthy development. We experience it in new situations, like starting a new school or job. Our bodies react by increasing our heart rates and our hormone levels are elevated. 2. Tolerable stress response is when our body reacts to a major difficulty: loss of a loved one, natural disaster, or injury. If it is a limited event and we are surrounded by caring adults and healthy relationships, the brain and body recover from the effects of this type of stress. 3. Toxic stress response is when someone experiences ongoing adversity like physical or emotional abuse, neglect, caregiver substance abuse, violence, or economic hardship and they don’t have adequate support from the adults in their lives. Their bodies and brains are in “fight or flight” mode so often that their development can be impaired, even as they grow up.
- 21. Near Science Neuroscience - is about understanding the nervous system, the spine, and the brain, which can help us determine how to intervene and support resilience and recovery, including: Epigenetics - demonstrates that the body is always adapting down to the cellular level. Our DNA is not our destiny, and just as the ability to transfer trauma across generations is clear, so too is our ability to heal from generation to generation with the right intervention and support. Adverse Childhood Experiences (ACES) - can have a lasting impact that unfolds over the lifespan Resilience Research - is the capacity/ability to adapt to, prevent, or mitigate the impacts of an adverse event or trauma. Resilience is a capacity that can be developed and exercised.
- 22. Things to avoid
- 23. Questions?
- 24. AI + TID
- 25. Learn More
Editor's Notes
- LinkedIn: Pam - https://www.linkedin.com/in/pambingham/ Ted - https://www.linkedin.com/in/draket/ Melissa Eggleston - https://www.melissaegg.com/about
- Part of trauma informed design is establishing consensus with your participants Pam will be leading the majority of today’s session and we encourage people to contribute. We ask everyone to agree with the following guidelines. Confidentiality - What’s shared here stays here. Be present - Engage fully with us and with each other. Engage with empathy and curiosity - Listen with the intent to learn more. Accept lived experiences - Believe and support each other. Address problems, not people - Create space for disclosure. Speak - With “I statements” Don’t feel pressured - Allow yourself space to think and then share Be open to feedback - We all have room to learn and grow. Developing Community Agreements — National Equity Project
- Here’s what we hope you will gain from today’s hour. This is not in any particular order. Trauma 101 - what is Trauma? Design’s impact Respecting our customers Preparing for customer interactions - If you ask an open question, be prepared for difficult answers Do no harm
- Pam and I have worked together on several projects to understand how inclusive design impacts those who are not always included in design discussions. We met with Hertz Nazaire, a sickle cell warrior, to understand how chronic pain, illness, and discrimination impact usability. We explored long-term Covid, with Pam’s lived experiences, to better understand the importance of clarity and cognitive load. This also led Intuit to change internal policies for accommodations and well being. Pam was promoted to be a leader in Diversity, Equity, and Inclusion at Inuit with an emphasis on incorporating Accessibility. Congratulations Pam. With this we also worked together to incorporate intersectionality. All of these were much easier than Trauma-Informed Design. Because those projects led us to understand barriers that affected particular traits. Design for one, solve for many. But Trauma-Informed Design is different. It’s not about solving barriers and making enabling people to be more independent. Trauma informed design is about recognizing people have experienced trauma at some point in their lives and our job is to do no harm. How can we ensure our designs are not causing unintended pain, confusion, and risk. You may leave this session with more questions than you have right now. That’s ok. We’ve been studying this for a year and we still don’t have concrete answers and best practices. We spoke with Melissa Eggleston, who described trauma informed design as a universal safety precaution. She made the analogy of doctors wearing clean gloves for every patient, not just those who might be infectious.
- Trauma-informed design expands on the concepts of inclusive design, intersectionality, and designing for cognitive load. It appreciates the build for one, extend for many concept. We are recognizing the impact of trauma and designing to reduce/eliminate harm and confusion. This ultimately leads to products that have more clarity and satisfaction. Trauma informed design is a universal precaution. It’s the design equivalent of wearing gloves in a hospital.
- Key Inclusive Design Guidelines Similarities with design ethics Being trauma-informed means having an awareness of trauma survivors and avoiding marginalizing people through design. These are the original principles for a trauma informed approach. They were created by the Substance Abuse and Mental Health Services Administration 10 years ago. User Research and design It's not just an audit, but could also include loss of control, trust issues, As a product team, we may have a simplistic idea of a trauma experience, but there’s much more that can build to the response. In research, be prepared for the worst possible response. There should be a potential answer. SAMHSA’s 6 key principles of a trauma-informed approach Safety Trustworthiness and Transparency Peer Support Collaboration and Mutuality Empowerment, Voice, and Choice Cultural, Historical, and Gender Issues Source: Substance Abuse and Mental Health Services Administration, 2014.
- Let’s design an app that let’s people report human trafficking. This app may be used by the person being trafficked. It could also be used by someone working in the hospitality industry. Let’s consider the perspective of someone being trafficked. How could we design an application that would reduce potential harm.
- For example, we would want to prioritize a fast loading page that could be used on a mobile device with limited connections. We’re recognizing a person may be in a difficult situation and having to wait for a page to load would be terrifying and could cause harm if the trafficker returns and catches them using the page.
- User Research and design It's not just an audit, but could also include loss of control, trust issues, As a product team, we may have a simplistic idea of a trauma experience, but there’s much more that can build to the response. In research, be prepared for the worst possible response. There should be a potential answer.
- What is Trauma Community trauma Acute traumatic events Traditional ideas of experiences that cause trauma include physical violence, sexual abuse, natural disasters, life-threatening child neglect, and war (Substance Abuse and Mental Health Services Administration, 2014), as well as the loss of a loved one, divorce, and witnessing another’s trauma (Felitti et al., 1998; Nijenhuis et al., 2002). Newer definitions of trauma include institutional racism, cultural and historical trauma, and refugee experiences, among other systemic issues (Ringel & Brandell, 2019). In this article, we adopt the broader definition of trauma that includes the result of events, systems, and situations experienced as harmful by people―including online digital experiences. Eggleston, M., & Noel L.-A. (2024). Repairing the Harm of Digital Design Using a Trauma-informed Approach. Diseña, (24), Article.7. https://doi.org/10.7764/disena.24.Article.7 Most people will not know trauma-informed or trauma People tend to visualize the giant traumatic events instead of smaller Moving from a medical to a community system approach This is relevant to all people at some time in their life People will have individualized responses, based on their history Some people can be affected for years, and others for a short period of time
- https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=Going%20through%20trauma%20is%20not,assault%20and%20child%20sexual%20abuse.
- https://www.apa.org/topics/trauma
- Divorce Infidelity Starting a new job Having a child Legal problems Financial problems Expensive and unplanned home or car repairs Conflict with spouse, children, co Loss of a loved one-workers, supervisor, etc. Combat/war zones Plane/car/train crashes Sexual assault Natural disaster Terrorist attack Domestic violence Animal attacks Physical abuse
- https://www.smartstart.org/resilience-intro/resilience-home/ Adverse Childhood Experiences: Impact individual & interpersonal conditions. Examples include parental mental illness, substance abuse, interpersonal violence, homelessness, incarceration, divorce, death, emotional, physical, and sexual abuse, caregiver separation, and medical crisis. Adverse Community Experiences: Impact population conditions. Examples include poverty, structural racism, community disinvestment, police violence, lack of affordable housing, lack of opportunity and economic mobility, discrimination, disconnected relationships, unemployment, and deteriorating built environments. Adverse Climate Experiences: Impact community conditions. Examples include COVID-19, climate change, wildfires, droughts, hurricanes, earthquakes, floods, environmental injustice, and pollution. Atrocious Cultural Experiences: Impact macro and socio-historical conditions. Examples include slavery, genocide, colonization, segregation, forced family separation, removal of property, and other harmful social norms such as low sense of political and social efficacy and mistrust.
- Trauma is individualized Some indicators of past experiences, environmental, that add to the levels of trauma response.
- Not everyone responds to trauma in exactly the same way, but here are some common signs: Cognitive Changes: Intrusive thoughts, nightmares, and flashbacks of the event, confusion, difficulty with memory and concentration, and mood swings.
- https://www.wavetrust.org/adverse-childhood-experiences-infographics https://www.wavetrust.org/7030
- Harvard University’s Center on the Developing Child divides stress into three main categories: positive, tolerable, and toxic. The types of trauma that cause toxic stress are called adverse childhood experiences (ACEs). The more ACEs a young person experiences, the harder it is to reverse the damage done to developing brains and bodies. https://blog.womensconsortium.org/what-is-toxic-stress?utm_term=staff%20trauma%20training&utm_source=adwords&utm_medium=ppc&hsa_acc=8652799729&hsa_cam=18930332859&hsa_grp=142976811105&hsa_ad=635250777037&hsa_src=g&hsa_tgt=kwd-1954941109197&hsa_kw=staff%20trauma%20training&hsa_mt=b&hsa_net=adwords&hsa_ver=3&gad_source=1&gclid=Cj0KCQjwqdqvBhCPARIsANrmZhMpegsUClsk6fRkz_ixchyoTLOIbEimcc7kwWUDG0WM6mgZOjz3D1YaAvCWEALw_wcB
- This body of science — Neuroscience, Epigenetics, Adverse Childhood Experiences (ACEs), and Resilience research (NEAR) — is one of the most significant public health discoveries of our time. Each area of the science provides clues for how to address trauma across the lifespan:
- Things to avoid Gathering as much data as possible without explaining it Researchers ask open ended questions and sort through it later, this should be re-examined When you don’t have a choice and you feel forced into it. I have to give you my email to get information I have to use a chat bot and cannot get a human agent Give people multiple ways to get things done I don’t want to think about the accuracy, due to a fear of an udit. I want to give you all of the information and be confident the work will be done correctly
- AI and TID Transparency is a problem with AI The information is being built without a traumatic informed design The principles could be applied to VR, safety has been incorporated, like surprise, walking into barriers. TID is almost like over-sharing, to make sure the process is transparent. Artificial intelligence and machine learning systems can be more trauma-in-formed and increase end user’s trust by explaining why a particular recommenda-tion feature that suggests new services or products is offered (Chen et al., 2022).
- Resources for learning more about trauma TID Resources Spend more time learning about trauma and trauma informed Design for Real Life by Eric Meyer, 2016 Learning resources — Trauma-Informed Technology
- This is a guide of how our attendees may feel during different parts of the presentation. Some people may have it all figured out, but we should be prepared for a low point as Pam starts to talk.