The Call for Trauma‐Informed Design Research and Practice

Abstract

Whether we're living through a pandemic or navigating life-changing unravelings across the world, we are rolling through immeasurable discomfort.
Becoming a trauma-informed designer is crucial to finding solutions that respond to the many complex problems we face as a society.

Full text

26 DMI VOL.33, ISSUE 2 | DMI.ORG
FEATURE THE CALL FOR TRAUMA-INFORMED DESIGN RESEARCH AND PRACTICE
Whether we’re living through a pandemic or
navigating life-changing unravelings across the world,
we are rolling through immeasurable discomfort.
By Rachael Dietkus
The Call for Trauma-
Informed Design
Research and Practice
SOCIAL
WORK
VALUES
DESIGN
RESEARCH
METHODS
TRAUMA
INFORMED CARE
PRINCIPLES
TRAUMA
RESPONSIVE
DESIGN
Compassionate
Inquiry &
Participation
Liberatory
Work
Trauma
Knowledge

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FEATURE THE CALL FOR TRAUMA-INFORMED DESIGN RESEARCH AND PRACTICE
HIS ARTICLE FOCUSES ON TRAUMA AND the
many ways the serious phenomenon impacts us
directly and indirectly in design. For some, reading
about trauma can cause moments of physiological
dysregulation that impinge our sympathetic
nervous system. This article reads more like an
overview of trauma and what it might mean if all
designers were more trauma aware in their scopes
of practice. As a design leader, taking steps toward
building your trauma literacy is an important first
one. As you read on, I encourage you to take note
of the following: principles and matters that are
resonating, questions that might be coming up for
you and your team, and considerations of how your
understanding of trauma in the context of design
might be shifting.
Whether we’re living through a pandemic
or navigating life-changing unravelings across
the world, we are rolling through immeasurable
discomfort. And even if day-to-day matters from
the past few years are seemingly beginning to settle
and calm, there is no doubt that we will be living
with the ripple eects of acute and chronic traumas
for decades to come. So, my opening provocation
is this: how will we start to heal and recover from
such massive, lasting traumas?
Defining trauma
Trauma, the late seventeenth century Greek
word for wound, is something I talk, think, and
write about a lot in design. And yet, in design,
it may be the last thing design researchers and
managers bring up in discussions about process
and emerging practices. In examining trauma more
deeply, I’ve seen far more focus on other vital
issues of concern like employee well-being, healthy
organizational cultures, and overcoming the
stigma around depression, anxiety, loneliness, and
stress. These are consequential issues that need
serious attention and a bevy of professional and
community care resources.
Trauma is a more nuanced concept and isn’t
simply a word for something enormously stressful.
It doesn’t always come from short, sharp shocks
like car accidents, conflicts, attacks, or fires. And
trauma isn’t the same thing as post-traumatic stress
disorder, a clinical diagnosis from the Diagnostic and
Statistical Manual of Mental Disorders. Trauma is
about events or experiences and their eect on the
mind (emotional, psychological) and body (physical,
physiological). But what separates it from something
merely stressful is how we relate to these events on a
deep level of belief. Using the pandemic as a glimpse
into the future, the eects of the massive, collective
trauma will linger for many of us for decades. This
makes me wonder how our understanding of trauma
might help us design through and with this?
A psychologist in the United Kingdom, David
Trickey, says that trauma is “a rupture in meaning-
making.”
1
He says that the way you see yourself, the
way you see the world, and the way you see other
people are shocked and overturned by an event.
As a result, a gap arises between one’s “orienting
systems” and that event (or events). What might
have been a more simple, acute stress can cascade
into trauma through sustained and severe feelings
of helplessness and hopelessness.
When talking about trauma and how we can
become trauma-informed in design, I like to share
a simplified definition that resonates with the
kinds of serious and complex work we do. This
is gathered from Karine Bell, Resmaa Menakem,
and Bessel van der Kolk: “Trauma is a response
to anything overwhelming, and that happens
Notes
1. E. Prideaux, “How to heal the
‘mass trauma’ of Covid-19,”
BBC Future, February 3, 2021,
https://www.bbc.com/future/
article/20210203-after-the-covid-
19-pandemic-how-will-we-heal.
FIGURE 1
Model of Change for Trauma
Responsive Design Research,
created by the author and
inspired by social work values,
design research methods, and
trauma-informed care principles.
T

28 DMI VOL.33, ISSUE 2 | DMI.ORG
FEATURE THE CALL FOR TRAUMA-INFORMED DESIGN RESEARCH AND PRACTICE
too much, too fast, too soon, or for too long.”
2
“A primary aspect of a traumatic experience is
that it is also coupled with a psychological or
physiological lack of protection or support.”
3
“And it lives in the body stored as sensation: pain
or tension—or a lack of sensation, like numbness.”
4
Acknowledging that people are swimming in
a sea of overwhelm—a collective overwhelm—is
vital for this work. Even if we are not directly
impacted, we undoubtedly know others are and
may be struggling in ways that we might not
always notice. Life is a plethora of complexities
and stressors. And trauma—much like the
manifestations of stress—lives in and throughout
the body, stored as sensation such as pain or
tension, or is a lack of sensation like numbness.
Trauma is also deeply contextual and does not
impact us all in the same way.
Trauma-informed care principles
Trauma-informed care started in medicine as
an approach to patient care that takes traumatic
events and experiences into account with
diagnosing and treating individuals. It had its
genesis in patient care in the 1970s when the
physical and mental traumas experienced from
the extreme wartime conflicts necessitated a new
way of understanding the experiences and impacts.
What might this mean for designers?
Being trauma-informed means accounting for
the potential presence of trauma within our work
and examining how and why we design could be
more trauma-informed while also acknowledging
that we, too, may have experienced traumatic
events that influence the patterns we design. It’s
important to note that the principles are not meant
to be condensed down to a checklist. Integrating
these principles takes time and requires constant
attention, caring awareness, sensitivity, and often
a culture change. The Centers for Disease Control
(CDC) and Substance Abuse and Mental Health
Services Administration (SAMHSA) provide
a great starting point for ways in which we can
integrate trauma-informed care principles in our
work. Being trauma-informed, or as I often prefer
to put it, trauma responsive, means that we are
accounting for the potential or likely presence
of trauma within our research participants—as
well as in ourselves as we conduct our serious
and complex work. And while there isn’t a
single approach to being trauma informed, most
approaches focus on some combination of the
“6 Guiding Principles to a Trauma-Informed
Approach” laid out by the CDC and SAMHSA:
• Safety
• Trustworthiness & Transparency
• Peer Support
• Collaboration & Mutuality
• Empowerment, Voice, and Choice
• Cultural, Historical & Gender Issues
5
SAMHSA cautions us, though, that adopting
a trauma-informed approach “is not accomplished
through any single particular technique or checklist.
It requires constant attention, caring awareness,
sensitivity, and possibly a cultural change at an
organizational level.”
6
As organizations undergo
ways to assess organizational eectiveness, finding
meaningful ways to embed these principles fully
will shape practices now and in the future.
Karen Treisman, a clinical psychologist based in
London, often illustrates how we might start moving
through trauma-sensitive phases to build awareness
to be better informed in our work. It is not enough
to have pockets of being informed in design. Instead,
to be genuinely trauma-responsive, we need to
examine every aspect of our design organizations—
the environments, the language we use, the values
we profess—and involve all sta on our teams to
create better designs that serve the very people we
are designing with and for. How can this be done, and
where might we find inspiration for achieving this?
Inspiration from social work
As both a social worker and designer, my work sits
squarely at a unique intersection of social work and
design. I study trauma in the context of design, and
I practice being a trauma-responsive designer—a
true integration of social work practice in design.
Much of my approach has come from over twenty
years of clarifying my values, purpose, and practice.
Notes
2. K. Bell, “Trauma Alchemy,” Karine
Bell, Embodied Trauma Education,
accessed March 23, 2022, https://
www.karinebell.com/trauma-
alchemy#:~:text=The%20
best%20definition%20of%20
trauma,our%20bodies%20
and%20subconscious%20
experience.
3. B. van der Kolk, The Body Keeps
the Score: Brain, Mind, and Body in
the Healing of Trauma (New York:
Penguin Books, 2015.
4. R. Menakem, interview by Truth Be
Told Team, “It Is Not in Your Head,”
Truth Be Told podcast by KQED,
August 27, 2020. https://www.
kqed.org/podcasts/602/it-is-not-
in-your-head.
5. “Infographic: 6 Guiding Principles
to a Trauma-Informed Approach,”
Centers for Disease Control and
Prevention, accessed March 22,
2022, https://www.cdc.gov/
cpr/infographics/6_principles_
trauma_info.htm.
6. Ibid.

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FEATURE THE CALL FOR TRAUMA-INFORMED DESIGN RESEARCH AND PRACTICE
Over time, this led me to home in on the core
values of integrity, self-trust, and authenticity.
These values are foundational to what I
call purposeful design, a design practice that is
compassionate, just, and ethically conscious
about both the process and its impacts on people
and their environments. This has all shaped
what I would call years of being a practicing
helper through immersion in systems, policy,
and advocacy on issues like abolition of the
death penalty, ending veteran homelessness, and
addressing the mechanisms of racism in the foster
care and healthcare systems. A lifelong learner
aspect has also been the consistent thread in much
of this work. As a licensed clinical social worker
and as part of maintaining licensure, I adhere to a
professional code of ethics by engaging in reflective
practices, seeking consultation with colleagues,
and taking part in continuing education.
There are two other points worth mentioning
that are deeply connected to this work. The first
is a 2002 article by Victor and Sylvia Margolin.
Victor was a well-known design historian, and many
designers are unaware that his spouse, Sylvia, was
a social worker. In 2020, I learned from Elizabeth
Resnick that Sylvia’s work often influenced Victor
in how he thought about and approached design.
They demonstrated this inspiration and synergy
in their article by sharing the following:
—
We believe that many professionals share the goals
of designers who want to do socially responsible
work… and therefore propose that both designers
and helping professionals [social workers] find
ways to work together.
7
—
The second is an article that I reference nearly
every time I speak about trauma, especially to
a design audience. “Practicing Without a License:
Design Research as Psychotherapy” by Tad Hirsch,
Professor of Design at Northeastern University,
should be required reading for any current and
future design student, educator, and practitioner.
Hirsch emphasizes several things related to
the need to update consent procedures, the call
for revising design education, and the need for
trauma-informed research practices. And he
cautions us with this:
—
A growing number of design research projects
intentionally recruit vulnerable participants…
our ability to entice participants to share their
most personal stories and feelings raises the
potential of using rapport to exploit participants
in order to ‘gain source material.’
8
—
The reality is that social workers cannot do
their jobs without all forms of design. And with
these two points mentioned above, it has been clear
to me that design just might need social work.
An emerging model of change
Another way I can demonstrate how I frame trauma
work in this context of design is like this: I used
to think that I had to shy away from or abandon
my social work values to be a good designer. Yet
I found quickly that the synergy between social
work values, design research methods, and trauma-
informed care principles is where I see a lot of
meaning and purpose. (See Figure 1, p26.)
If we approach our design research with
compassionate inquiry and humility—both
for ourselves and others—we can start to build
knowledge and literacy around trauma. We can
then be moving toward this future state of trauma-
responsive design by practicing and embodying
liberatory practices of trauma work—those that
are not just centered on medicine and diagnoses.
Trauma-informed design
in research and practice
I want to close this article by sharing the design
adaptations for the trauma-informed care
principles that I have been pushing into practice
over the past few years. Let these marinate and
note how these principles can start to shape
your design practice and leadership.
SAFETY
People feel emotionally, psychologically, and
7. V. Margolin and Sylvia Margolin,
“A ‘Social Model’ of Design:
Issues of Practice and Research,”
Design Issues (18(4))(2002):
24-30, https://direct.mit.edu/
desi/article/18/4/24/60066/A-
Social-Model-of-Design-Issues-of-
Practice-and.
8. T. Hirsch, “Practicing Without
a License: Design Research as
Psychotherapy,” (conference
paper, Honolulu, HI, April 2020),
https://www.researchgate.
net/publication/339844239_
Practicing_Without_a_
License_Design_Research_as_
Psychotherapy.

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FEATURE THE CALL FOR TRAUMA-INFORMED DESIGN RESEARCH AND PRACTICE
physiologically protected when participating
in our design processes.
—
As we examine our design teams and consider
people and communities we invite to design with
us, we consider how we can establish safety plans
for everyone before we begin and when conducting
design research. An analogous example of this
done well was when I worked at Veterans Aairs on
behavioral health program accreditation through
the Commission on Accreditation of Rehabilitation
Facilities (CARF). CARF’s mission is to promote the
quality, value, and optimal outcomes of services
through a consultative accreditation process and
continuous improvement services that enhance
the lives of persons served. I sometimes hear
designers say we need to ensure safety and do no
harm. We know we need to do this, but our intent
can occasionally cause significant harm and lasting
damage. CARF focuses on how to assess and act
on risk while ensuring safety. They also state that
the persons served are the primary consumers of
services and call them moral owners of our programs.
Who among us are the moral owners in design?
TRUSTWORTHINESS AND TRANSPARENCY
All design decisions are conducted with integrity
and transparency. This builds and maintains trust
with everyone involved and anyone who might use
our design.
—
The far-reaching impact of civic designers is
relevant here. Their work at the local to the
federal levels, particularly agencies like 18F and
U.S. Digital Service, is consequential and inspiring.
In a recent design talk, the Head of Design for 18F
shared, “We need designers who are dispersed and
savvy and understand the implications of design.
We need integrity designers to be proactive and
minimize the damage of what is going to happen.”
9
Who among us are already integrity designers?
PEER SUPPORT
Any individuals brought into the design process as
participants can involve the people they care about.
This is crucial for building trust, establishing
and maintaining safety, and building power.
—
In their book Beyond Sticky Notes: Doing Co-
design for Real, Kelly Ann (KA) McKercher shares
that the mindsets of co-design are elevating the
lived experience, being in the gray, valuing many
perspectives, curiosity, learning through doing,
and hospitality. This last mindset on hospitality
is directly aligned with a trauma-informed design
principle on peer support. How can our designs
strengthen and change if we allow for flexibility
of care and peer support?
COLLABORATION AND MUTUALITY
Designers recognize that care and healing happen
through connection, compassion, critical consciousness,
and meaningful shared decision-making.
—
As trauma-informed design principles continue to
emerge and evolve with practice, so are the matters
of concern that designers are finding themselves
working on and within. This principle refers to what
the Margolins suggested when those in the helping
professions share similar goals as designers.
We both care deeply about people, yet we come
from dierent scopes of practice. Social workers
often see the impacts of bad design. We are reacting
to circumstances and trying to restore a person’s
dignity and humanity within deeply flawed systems
and structures while reinforcing safety. George Aye,
co-founder and Director of Innovation of Greater
Good Studio, says that good design honors reality,
builds power, and creates ownership.
10
EMPOWERMENT, VOICE, AND CHOICE
We strengthen and empower the experience of the
communities we are inviting in while recognizing that
every experience is unique and may sometimes require
a more personalized approach.
—
Civilla is a Detroit-based, non-profit design studio
reimagining public institutions. I had the pleasure
of working with a team for a few months on the
anticipation of secondary or vicarious trauma.
9. R. Bronson, “The Designer’s Share
of the Problem,” IxDA Oslo meetup
No 142, November 30, 2021,
https://vimeo.com/651801535.
10. G. Aye, “Understanding Power
and Privilege in Design,”
Service Design Network, June
26, 2020, accessed March 23,
2022, https://www.service-
design-network.org/chapters/
new-york/headlines/george-aye-
on-understanding-power-and-
privilege-in-design.

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FEATURE THE CALL FOR TRAUMA-INFORMED DESIGN RESEARCH AND PRACTICE
They were getting ready to launch an intense and
robust round of interviews with people who utilize
a current system in the state of Michigan. Project
leaders knew this was going to be an intense
period of work. One of the things I did with them
was meet as a team and meet 1:1 to debrief and
process what was coming up for them by oering
a dedicated, personalized space of understanding
as a social worker-designer. Each person talked
and processed at their own pace the things that
were rewarding, challenging, and ahead in the next
phase. The care and attention to the anticipation
of trauma among their team members are the kind
of trauma-responsive design work we need much
more in our organizations.
CULTURAL, HISTORICAL, AND GENDER ISSUES
Designers identify and understand their biases and
avoid stereotypes via personas. Truth is centered,
relationships are valued, and trauma’s historical and
generational impacts are acknowledged and addressed.
—
ChiByDesign is a Chicago-based social and civic
impact design firm that is people-centered and
grounds its work in a co-design approach. They
are caring, bold, and dynamic in how they
approach design. In 2020, ChiByDesign started
a research project with the Ohio Department of Job
and Family Services to understand how racism is
embedded into their foster care and child welfare
systems. The design team knew this would be a
complex project and tried to incorporate micro
trauma-informed principles into their research.
However, they realized they had to do better
than simply try because the mission was focused
on co-designing an anti-racist future for youth
and families. Authentically engaging with people
who have been traumatized by racism and other
oppressions means putting forth an abundance
of care. So, they brought me on board to work at
this intersection of trauma-informed, anti-racist
co-design. We approached this work with an
evolving understanding that to be anti-racist, you
must be trauma-informed. And if you’re going to
be trauma-informed or trauma-responsive, you
must commit to anti-racist work in structures and
systems that have been designed.
In conclusion
The ways we can become trauma-informed are vast
and personal. Committing to daily practice matters.
Continue to learn and understand the language of
trauma and what it means to be trauma-informed—
especially in the context of design. There is a
literacy around trauma missing in our organizations,
ourselves, and our design work. Now, more than
ever, we need to be at least trauma-informed so that
we can lead and work within trauma-responsive
teams and organizations. Responding to this need
is one of the reasons why I started a design practice
committed to being trauma-informed and becoming
trauma-responsive in design.
Becoming trauma-informed is a radical act. As
we design with, by, and for, we must continue to do
transformational, relational work—not that which
is transactional and extractive. To engage in this
evolutionary work means we need dramatic shifts in
our education and training, new patterns and ways of
practice, and personifying care principles that allow
us to understand people and their environments
ethically, responsibly, and holistically.
Rachael Dietkus is a design
research strategist, licensed clinical
social worker, and ce rtified trauma
professional dedicated to trauma-
responsive practices in design. She
advocates for social workers in
design and tech, studies and writes
about the impacts of trauma in the
context of design and focuses on
how and why trauma-responsive
methods are needed in design
research and practice. She is the
founder of Social Workers Who
Design and speaks and works with
design teams worldwide.