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Introduction
I wanted to share a little bit about trauma-informed design with you. And I'm really speaking about design as it relates to websites and apps because that's my expertise. That's what I've been doing. I'm a UX designer and I've been doing design for ten+ years now.
I've been exploring this idea of trauma-informed design for, let's see, since about 2015 when I first learned about it. I just want to share what I learned, what's been helpful to me. And this is just my perspective, my experience, there are various ones out there and I encourage you to seek them out as well. But this is what I learned and I'm hoping that it will be helpful to you.
Talking About Trauma May Be Triggering
I also wanted to say that talking about trauma can bring up our own stuff sometimes. I want you to be aware of that because that's certainly happened to me. Take care of yourself while you're watching/reading this. Certainly, if you need to talk to somebody afterward, I encourage you to seek a friend out or a therapist. Or you're free to reach out to me if you just want to touch base and talk about any of the ideas we've discussed in this presentation.
How I First Heard About Trauma-Informed Design
I first learned about trauma-informed design on this playground. This is in Durham, North Carolina, in the United States where I live. And this is the playground where my daughter went to preschool. She spent a lot of time here, and she got to play with this other wonderful little girl.
And her mom was there, too, of course. And so I got to know this other mom, whose name is Elizabeth Johnson. She's a wonderful, I call her an educator, really, in Durham, North Carolina. She had been doing a lot of education and helping nurses and doctors, other types of clinicians, be more trauma-informed in their practices.
And she kept using this word "trauma-informed" when she discussed what she did. And like a good UXer, I asked her what she meant by that, because that's what we do. We ask questions when we're not sure. What is, you keep saying this word trauma-informed. What does that mean? And she explained really by giving me examples.
For example, she talked about the police officer who might come up on a crime scene. And maybe there are a few kids who are nearby and he or she would perhaps get down on the floor to talk with them or at least kneel down. So they were at the same level. So it wasn't kind of a conversation from a commanding authority down at a small child.
Other times she talked about a nurse could be trauma-informed if the nurse was asking questions at a medical appointment. Maybe asking about past sexual history or abuse or anything like that. That nurse would be would be explaining why she was asking those things. She would also be informing the patient whether items shared were going into the medical records or not. That would be trauma-informed.
So she gave me these interesting examples. I thought, "Wow this seems really important. This is really interesting to me." So it really made me think about this book that I love. And this is by Ginny Redish. She is, Ginny is a contemporary of Steve Krug. If you've ever read, "Don't Make Me Think!" It's a great book. And this is another great book that came out around the same time frame in general. And I really like it. And one of the things that Ginny just talks about in this book is that a good website is like a good conversation.
A Website Should Be A Good Conversation
And so I always have that in my mind. That a website is somebody initiating a conversation with you. What are you going to say with your website to them? And as I was listening to my friend Elizabeth talk about being trauma-informed, about about how people were talking to other folks. I thought, "Gosh, well, it seems that websites also should be trauma-informed." We should be making sure that people are having a good conversation and a good experience when they're coming to websites. So I started to learn more about trauma in general. I ended up on a project where I helped the North Carolina Coalition Against Domestic Violence help make their website more trauma-informed. And it's been quite an adventure.
So I started by learning more about trauma. And so if that's kind of where you are, if this word trauma-informed is new to you, just start by learning a little bit more about trauma. And I'll just give you some highlights here and certainly give me more resources at the end. Trauma, this definition that I'm using is it's an emotional response to a terrible event. And this is from the APA. There are different definitions of trauma.
So it's not just one agreed-upon definition. Some tend to focus more on the event itself, like an event being traumatic. And they're probably events we could definitely agree seem to be traumatic. But it's interesting because this is really focusing on the reaction people have to whatever kind of terrible events occur.
The Tricky Thing About Trauma
So here is the tricky thing about trauma. And I think this is why sometimes people don't understand it well or don't understand other people very well. Trauma can show up in different ways at different times with different people.
So in 2014, we were, it was Christmas Day and we were waiting for grandparents to come. And on the screen you can see that's my husband, that middle picture of me with brown hair. And that's was my daughter back then. She's older now. And we were waiting for our grandparents and we just had to take a walk on Christmas Day around like 11 or 12pm. We decided to just walk down the street and I think my daughter just didn't want to go. She was too lagging behind by about 20 or 30 feet.
And we were walking our dog and we hadn't gotten very far at all, just a few houses down. And all of a sudden we saw this really big dog jump its fence and it was big and brown barking and it was scary. But it paused for a moment. We thought, oh, maybe it'll be friendly. And nope, that was not what happened.
There was a dog attack. And I want to let you know, everybody is fine. But, you know, it did mean like that our dog got attacked. My husband ended up, you know, having to go to the hospital, too. And, you know, there's blood, the screaming. It was not good. It was bad enough that the insurance company was trying to just give us money to not sue. So that was a really strange thing we didn't expect to happen on Christmas Day.
And you would think that maybe from that experience, you know, my daughter Parker would be petrified of dogs, from now on. Well, that is understandable and that sort of thing. But that isn't actually what happened. You know she seemed to process the event with grandparents who were there later that day. She talked about it with different people and family. And she's fine around dogs today. I think about this probably more. Every Christmas Day I think about it. So this is just like one event that happened that we all had different reactions to.
You know, my husband, honestly, I think he forgot about it. And he was kind of like the main person who was able to get the dog by its collar and get it back into its yard. He handled the situation. But it was a scary day.
And that is one of the weird things about trauma is that we could all have the same event happen. We could all have different reactions to it. And some people may be affected for a very long time to a traumatic event and other people just not so much. It may just be a terrible event that happened, but that just becomes a bad memory and not something that triggers what's often called a trauma response.
And whether somebody is a trauma response or not can vary on so many different factors. I mean, I was reading research recently and there were eight different factors, but there's probably tons more too.
So we can't really predict like who's going to have trauma response, who's not necessarily. But even something small can trigger somebody to kind of think about the trauma, the experience. And they may start to go into thinking that is like negative and not helpful.
Adverse Childhood Experiences (ACEs)
So when we talk about trauma, there's really no way to talk about it without talking about these things called ACEs. These are adverse childhood experiences, and this is from the CDC. And thank you to the Robert Wood Johnson Foundation, which does a lot of good work and put together this graphic here.
And these are some of the various experiences that people may have in childhood. The things can affect them in the future and can have serious long-term effects. And as you look at some of these, you might think, gosh, I've got some of those.
And we do know that something like 70 percent of adults in the United States will experience some kind of trauma in their life. And that's I think research was mostly done with a mostly white population. So it's even more in minority populations. For example, people may experience multiple kinds of trauma. And if these happen, especially in childhood with where our brains are developing, that can be really problematic.
So over time, the community-level ACES have come up. We've realized that in those lists I just showed you of ACES that we weren't covering some other things that are a really big deal, right? So if you feel these things like discrimination or bullying, or if you witness violence, you know that things are happening in your community, that can also have a significant effect on your well-being.
And that the reason we care about these sorts of things is if you look at this pyramid. You see how the conditions that we experience as children, the social conditions, as well as whatever's happening in our own household, can start to really affect us early. It affects us early, and it can continue and even cause early death.
So that is a problem. And that is something that public health officials, we all, need to try to work toward - making sure that it's a safe place for everybody to live. And they're not experiencing this kind of trauma, whether it's in a neighborhood or a household.
Cognitive Consequences
And as designers, this is the area that really jumps out to me as an area we can focus on, right? So we know that somebody who has experienced trauma, could have long-term cognitive effects from that trauma. That might affect how they come to our website.
You know, Steve Krug has a great part in his book Don't Make Me Think about how people come to your site with some kind of reservoir of goodwill. And it's going to be really dependent on what just happened. And if what just happened was a bad experience at another site, then that's going to affect their experience on your site. And it's not just the goodwill, but the state of mind they're in, how they're doing, what kind of capacity they have.
We know that trauma has long-term effects — depression, insomnia, all kinds of things that relate to cognition. And that can affect, whether somebody is able to navigate a website really well or can get overwhelmed easily.
And it's interesting that it's not just happening the year after a trauma occurred. We also know there are things like complex trauma, where it's not one big event. It's a series of events over time. So trauma is the thing is something we need to all be aware of.
We can see that the hallmark symptoms of PTSD have to do with memory, attention, planning and problem-solving. Please know that someone doesn't have to have PTSD diagnosed to have some of these issues. It's a spectrum.
So there's a lot of us who may be affected by these long-term effects of psychological trauma. So to be trauma-informed or at least like begin to be trauma-informed. We're all just trying to get there. It's this recognizing that people can have different types of trauma in their life.
It could be interpersonal violence or the kind that we talked about as ACEs or people have other kinds of trauma. When a big hurricane hits the United States, we tend to have huge hurricanes and they are devastating. And that can have a huge effect on somebody's life, right. Or there's just a lot of terrible events. I'm sure you can think of many of them.
Being more Trauma Informed
So trauma-informed is also about being careful in our interactions. We don't want to re-traumatize people accidentally as we are conducting research or testing out an app or something like that. Even if we are well-intentioned, we can still cause problems. So it's being sensitive to this. We would call it being survivor-sensitive, trauma-informed in the way we go about our design.
The great thing is that SAMSHA, which is part of the United States government, the Substance Abuse and Mental Health Services Administration, created these principles of trauma-informed care. And these are great because these are things we can think about. How do these principles apply to design? Well, there is a ton of overlap with UX design in these.
Trauma-informed Principles from SAMSHA Overlap with UX Principles
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment, voice, and choice
Cultural, historical, and gender issues
We are often trying to think about being trustworthy with websites and apps, and hopefully, we're giving people choices. We have a user experience principle about user control and freedom that is very much in line with trauma-informed care. Even ones like peer support, collaboration and mutuality. Those are things that we need to kind of keep in mind and think about. When we do something like participatory design, we are thinking about collaboration, mutuality. So I think the one, two, five and six are principles that we can cover pretty well in user experience and we can work more on three and four.
We can also be really careful about whenever we're conducting any kind of interview. Make sure that it is trauma-informed. People have choices and feel safe and really trying to give people what they need in order to not be retraumatized in any way or triggered.
Trauma Affects Everyone
You may think, "Well, I don't work with a population that has a lot of trauma. I'm not a social worker. I'm not a blah blah blah." But, you know, I worked at a sports startup, and I interviewed elite athletes. And I can't tell you the number of times that sexual assault will come up in our conversations or other kinds of like traumatic experiences with coaches or just sudden changes and that sort of thing. People have a lot of things going on in their lives.
An elite athlete is somebody we might look at and think, “Oh, they have it all.” but they may have struggled with an eating disorder or things that happen in their life. And when we talk about their life story, they often go, "Wow, that was cathartic!" And I think, "OK good," you know, because I didn't want them to feel on the spot. Or that I was soliciting stuff from them that they didn't feel comfortable sharing. So all of us have trauma in some form. Not everybody is going to have a trauma response by any means.
But we just need to be really mindful of how we are going about doing our design work.
Takeaway #1 Reduce Cognitive Load
So I have a few takeaways for you. If you don't really remember anything else, I would really think a lot about cognitive load. The great thing is that when you're working in UX design, you want to be reducing the cognitive load and making things so easy for people anyway. And that is only going to help anybody who has dealt with trauma in the past.
I once interviewed a guy who was in charge of four different e-commerce websites. He was really funny. And he just would say, "I just want people to, like, shake their butt and like buy products. I want it to be frictionless, an easy experience, as easy as you accidentally pocket dial somebody." It was just that simple to buy a product. We want it to be that simple for somebody who wants to get help, reducing barriers as much as possible.
It's keeping forms short, right, only asking what's absolutely necessary. Don't give somebody like twenty-five choices on the homepage, which I still see sometimes. Give them a few items, your website visitors.
Takeaway #2 Prioritize Mobile
The other thing I want you to think about is mobile. Mobile is really important. Not everybody has access to a desktop or laptop computer, especially when we're talking about lower-income folks.
The mobile phone they have may be the only way they access the Internet. And so we need to make sure our websites that are serving the general public are really working well on mobile. And somebody can do something, any kind of task there that they can do what somebody else can do on desktop.
Mobile is also important if you ever do design for anybody who's in some kind of crisis situation. They maybe don't have a lot of privacy. Maybe the only time they can maybe look up information to get help is if they have their phone in their bathroom by themselves. They've got 90 seconds to themselves to look up some phone numbers or that sort of thing. Well, then, gosh, I hope your phone number is like one click to call and they can at least, you know, maybe make contact. Or get quickly get from your website what they could do, what would the next step be, that sort of thing. So definitely keep mobile in mind. We want to continue to work on being more and more mobile-friendly, because that will be more trauma-informed too.
Takeaway #3 One MaKES A Difference
If you're watching or reading this, then I assume you have some kind of interest in being more trauma-informed. Maybe you're on a team of six people. I have like these six little figures on my screen. If one person is paying more attention to being more trauma-informed, you're probably going to be asking better questions. You'll be thinking more holistically about the experience you're providing people.
When you start asking questions and using the word trauma-informed and you help other people learn. You're going to help your whole team think more carefully about how we are working with our research participants, how we are building our websites and apps. So I encourage you to keep learning.
We have a trauma-informed design monthly call. Contact me if you'd like to be added to that Google group list and then you'll get that information. I also keep a list of resources on my Birdcall blog. I will make sure to keep that updated with more as I find them — there's new information coming in all the time. This topic has grown in the last few years. Everybody seems to be talking in health care, certainly, and in other areas as well, about how can we make things more trauma-informed.
So I hope that you will join me on this journey. Let's make sure we are being trauma-informed designers and helping everyone.