Applying trauma-informed principles to user-centred design

Image credit: Patrick Tomasso via Unsplash.

A few weeks ago I wrote about the importance of approaching research and design with a trauma-informed mindset. This work takes continual practice. It is not a step which you can add to the design thinking process, or slot into the double diamond. As with accessibility and inclusive design, we need to be thinking about it throughout the research and design lifecycle. We need to bring this lens to each new project, and think about how we can apply trauma-informed principles in that specific context.

As part of the workshop I ran at UX Scotland, the group came up with a whole range of ideas for how we could bring trauma-informed thinking into our work. This list is not exhaustive, but can be used as a jumping off point to think about the sorts of things you could try in your own work. People discussed this in relation to their own roles and organisations which spanned private and public sectors, small and large organisations. They used a range of lenses to inform their ideation, thinking about:

• Macro approaches (e.g. systems, policies and processes) and micro approaches (e.g. individual research encounters)
• Things they already do in their work (like asking for consent before a research session) and things they’ve never done but could try in future
• How things might be different in a physical setting to in a virtual or online setting
• What learnings they might bring in from outside work to inform their thinking. For example approaches they might use when volunteering, or as part of a hobby*

*Quick sidebar from me: I wanted people to think about this because it took me a while (too long) to realise the training and experience I had as a Rape Crisis helpline volunteer was incredibly relevant to approaching research in a human-centred and trauma-informed way. I was bringing some of the skills I learnt in that environment into my work for a while before I made the connection in my brain. I had compartmentalised these two parts of my life. Heldiney Pereira also gave an impactful talk at the conference about how his experience volunteering at Samaritans has had a profound impact on his work as a Product Designer and in leading a team.

Refresher on the principles

Before we jump into the ideas, a quick refresher on trauma-informed principles. In my last blog, I talked about how the SAMHSA framework (and others like it) can help us to bring a trauma-informed approach to our work. The principles are interrelated and build upon each other. They should be considered holistically — you can’t pick and choose, they’re all crucial.

In the workshop, we used the SAMSHA framework to help structure our ideation. Each group had a different principle, and came up with ideas for how they could apply it in practice. I want to say a huge thank you to the workshop group who came up with so many great ideas. I’ve also mixed in some things I’ve tried in my own work, and examples from other practitioners. Where I have shared an idea that wasn’t generated as part of the workshop, I have cited it at the end so you can go and find out more from the people who originated it.

These are the six SAMHSA principles:

• Safety: Prioritising the physical, psychological and emotional safety of users and staff (and anyone else involved)
• Trustworthiness and transparency: Transparency exists in an organisation’s policies and processes, with the objective of building trust among staff, users and the wider community
• Peer support: Throughout the process, it’s critical to think about how participants can support each other, as well as how researchers can support one another
• Collaboration and mutuality: Recognising the value of collaboration between and amongst staff and users in overcoming challenges and improving the system as a whole, creating a safe and supportive environment for collaborative working
• Empowerment, voice and choice: Making efforts to share power and give users and staff a strong voice in decision-making, at both individual and organisational level
• Cultural, historical and gender issues: Taking into account people’s intersecting identities, and having awareness of the ways cultural stereotypes and biases could impact people differently

Synthesising the ideas

Because the principles are interrelated and holistic, lots of ideas spanned multiple principles. For example,

having a collaborative conversation with participants where you empower them to make choices about how the research session is run, can foster a greater sense of safety, and improve trust between participant and researcher

One idea, (at least) four principles.

For this reason, I’ve decided not to just list the ideas under each principle, which would lead to a lot of repetition. When I was analysing the thoughts, common themes began to emerge across principles. I will use these themes to structure the list of ideas.

From here on out — this is going to be a big, long list post. I don’t expect you to read through it all in a linear way! Please use it as a reference point to spark ideas for your own projects. Some of the themes had so many ideas, I’ve had to further divide them into sub-themes.

Jump to a particular section to read ideas related to a specific theme:

• Theme 1: Clarity of communication
  Be clear and open in your communication: with participants, with team members and with other stakeholders. Take care with language, and collaborate to set appropriate boundaries for the conversation or engagement.
• Theme 2: Proactive planning and policy-making
  Proactively design policies, processes and protocols that support your team to engage in trauma-informed research and design work. Use these policies and processes when planning specific research or design activities.
• Theme 3: Training and ongoing learning
  Train your team in trauma-informed principles and approaches. Engage in continuous learning and discussion. This is an ever-evolving field and we are always learning and refining approaches. (Shout out to the wonderful Trauma-Informed Design community group that meets monthly online for discussion and learning).
• Theme 4: Lean on experts and networks, especially for aftercare
  Lean on support from subject matter experts, charities, professionals from other disciplines, informal networks, and community groups. Where you don’t know enough about a topic or a particular cultural group, reach out to professionals and learn more. Signpost to professionals and professional resources if participants need additional support.
• Theme 5: Make practical adjustments in your research and design encounters
  Consider practicalities related to the environment (physical or virtual), compensation, communication and timing.
• Theme 6: Organisational advocacy for trauma-informed approaches
  Advocate for these approaches within your organisations. Share information with senior stakeholders. Share power with your participants by bringing them into conversations with decision-makers.
• Theme 7: Mindset and culture shift
  This is a big one, and perhaps it is an outworking of engaging in the other themes above. But ideas came out that relate to shifts we need to make in our own mindsets, that will eventually form part of the cultural mindset. This crucially involves changing our mindsets around pace and time.

Up next: what stops us from working in a trauma-informed way?

Some of the ideas below could be implemented in your next research or design session. Others will take more effort. We might be constrained by our current working practices and organisational pressures. To give us a better chance to be able to embed these ideas, I’d like to dig deeper into the constraints we face. If we understand our constraints better, we can be better prepared to work within or around them.

My next post will look at some of the barriers to implementing trauma-informed approaches and discuss how we can start to shift them out of the way.

Ideas for applying trauma-informed principles in practice

Theme 1: Clarity of communication

Establish boundaries and consent through open, honest communication:

• Agree clear definition of roles and responsibilities at the start of every interview
• Include content warning in interviews and establish consent to discuss particular events or subjects
• Be really clear on why we’re doing the research, how data will be used, how it will be collected and stored
• Outline at the start of the session which topics will be covered, the support available, and the limits of the researcher
• Give [participants] an overview of topics in advance and allow them to push back on topics they’re not keen to discuss
• Provide nudges when sensitive topics are discussed*
• Give people the space to leave, and to say no
• Informed, dynamic consent
• Make content as clear as possible and in multiple formats, participants can’t truly consent if they don’t understand what they’re agreeing to. Usie plain english, and read it out or provide it in other languages/mediums if necessary. Think about if they can sign digitally so they don’t have to print and return a document

Create shared understanding around the language being used, defaulting to the language of the person you are researching or designing with:

• Agree shared common phrases, language and definitions
• Do your research to learn how to pronounce unfamiliar names, or to find out the correct pronouns for somebody
• Be super aware of language and the connotations of words: observer, interview, collecting data — all of these could be difficult for people
• Rethink or reword questions based on the participant
• User-friendly ‘Terms of Service’ which summarises legal language simply*
• Give people choice about the language you use, follow their lead, reflect the language they choose to use

‘Close the loop’ i.e. share your insights with the people who gave their time to come to research:

• Give them an update before final outputs to see if they’re comfortable with how their data is being represented
• Share synthesised final findings back with your participants, and tell them what is going to be done on the back of this research

Be transparent about the future of the product or service:

• Make sure the roadmap is up-to-date
• Create better communications about the product or service
• Be honest about feedback we won’t be taking onboard, and why
• Publish the methodology you are using and share your resources with the team and other stakeholders, and ask others to share what they are doing

Use good listening skills:

• Put participants at ease — don’t go straight into questioning or treat it like a clinical research setting, acknowledge each other’s shared humanity
• Verbally summarise what you think you heard, to ensure you’ve understood them correctly and have not misrepresented what they’ve said through your own lens or bias
• Provide simple ways for people to give feedback outside the research setting for example via surveys or suggestion boxes

Theme 2: Proactive planning and policy-making

Implement policies that allow you (and your team) to push back if doing primary research is likely to trigger trauma

• If there is risk, ask whether the research is necessary or whether it’s been done elsewhere. Can you get the insight via secondary research and analysis?
• Choose to not research
• Brief the team on subject matter before you get started, and give them the option to opt out
• Ensure only team members who are okay to participate do so
• Ask: are you the right person to be the UR on this piece of work — keep your biases in check

Plan what you would do if somebody is triggered during a research or design encounter:

• Conduct a ‘safety audit’ to think through questions: “how might participating in this research cause or fuel more harm to a participant” and “what steps can be taken to mitigate or minimise that harm?” — done collaboratively
• Anticipate and plan in advance for potential concerns
• Create a mitigation plan for if something goes wrong including how and when to end an interview

Create processes for internal peer support and debriefing:

• Provide opportunity for team debriefing
• Guidance on good self-care practices
• Follow up and check in with them to see how they’re doing

Have policies on compensation, and ensure that compensation is not contingent on completing the session:

• Compensating at the start so they can leave whenever they want to
• Rethinking compensation or incentives: financial, assisting participant in finding solutions to pain points e.g. putting them in touch with customer support, or vouchers — depending on what the individual needs

Bring in processes to identify gaps in your research and identify which voices you haven’t heard from:

• Look for gaps in your research
• Put measures in place to reach groups that you know less about — even if it’s more difficult to recruit
• Consider barriers to research and look into how you can mitigate against them
• Bringing awareness of differences between groups e.g. gender differences in addiction based of real data
• Be sensitive to attitudes towards your organisation from certain groups, and put mitigations in place

Have robust policies and processes around data and privacy:

• Giving choice to users — to be anonymous, to be private, to share lived experience through different mediums
• Transparent about what user data is collected, why, and what will be done with it*
• Improve the safety of data collection and storage*
• Opt-in not opt-out policies*
• People don’t have to use real names when joining calls*
• Ensuring participants are aware of how their data is used and that their information is secure
• Allowing participants to be in control of the experience — where is it? When is it? Who is present? How is the data used? Related to informed consent.
• Notify users of data breaches*

Bring inclusive, participatory evidence-based processes into your work:

• Write down your assumptions
• Base hypotheses on evidence
• Involve community members in the design of the research, not just as participants who answer the questions
• Offer different avenues for contributing and facilitating, taking into account different communication styles, and encourage people to participate in ways they are comfortable with

Theme 3: Training and ongoing learning

• Training on signs of traumatisation, and vicarious or secondary trauma
• Create a safe space for colleagues to share, learn and reflect
• Work with other professions to understand how to do this better, for example social workers or charity support workers
• Be aware of perception gaps when interacting with someone from a different background
• Embed trauma-informed practice guidelines and training within the organisation
• Communities of practice to share experiences more generally
• Train clients on parts of the process so they can replicate it themselves
• Train staff regarding inclusion and accessibility
• Ensure there are named colleague(s) with training (for example mental health first aiders)
• Create a repository of support materials
• Understand more about protected characteristics

Theme 4: Lean on experts and networks, especially for aftercare

• Have relevant organisations to signpost to so the participant can get further support
• Go via trusted community or charity groups, working with them to reach the participants and involving them in the process to act as an intermediary
• Get feedback from SMEs from charities or industry professionals on wording of questions and framing of language
• Create a network, support group, or regular discussion space or signpost to existing groups and networks
• Know your boundaries — if you are not a trained mental health professional, know when to step back and end the interview and signpost to the professionals
• Provide referrals to other services*
• Leave participants with some pointers [resources] on how to decompress after a user research session
• Do UR with experts or support workers
• Collaborate with SME organisations to recruit
• Ensure there’s support for participants in known vulnerable groups
• Participatory design: participants may be able to form their own informal networks for peer support
• Debrief with colleagues or other professionals
• Work with other professions to understand how to do this better, for example social workers or charity support workers
• Follow-through ensures continued support*

Theme 5: Make practical adjustments in your research and design encounters

• Meeting online means tech needs to be exemplar of how it should be set up — good microphone/camera/software can help participants be put at ease and reduce delays and complications
• Have experienced support on hand
• Pre-interview with participants to determine needs and requirements ensuring that you are prepared and have the right team in place
• When meeting in person consider the environment: e.g. temperature lower than normal, ease of access and exit, spacious etc
• Ensure there is a person and process in place to get help
• Consider locations of research sessions and services
• Enable choice from participants — venue, time, option to withdraw
• Relaxing wall colour and lighting*
• Arrange chairs to not block the exit door*
• Allowing people to leave, move around, take a break, choose how to situate themselves
• Give them something to do with their hands like a fidget toy**
• Unique privacy considerations for people with rare diseases who seek support online*
• Be aware of cultural considerations e.g. not doing UR on certain days, taking shoes off
• Hospitality practices: paying immediately via electronic apps; providing transport and refreshments; on-site childcare
• Think carefully about appropriate incentives for the group you’re working with
• Getting all observers to come on camera and introduce themselves, not just lurk in the background with camera off
• Touch base a day or two before***
• Check prototype for triggering content / boilerplate***
• Make the environment safe, accessible and comfortable
• Have a mix of in person and online research
• Asking for and using user’s name and pronouns*
• Use relaxing colours in online spaces*
• Using accessible and collaborative tools so clients and users can contribute to the process
• Enable user-identified filters that block or hide triggering content*
• Best place to hold the interview for that participant — would they be more comfortable/able virtually or in person? Do they have the funds to attend a research session in person, or the data to do it virtually? Do we have a budget to support getting them to the research?
• Provide different ways to engage: call, video, text chat, in person, written submissions, voice note
• Provide food (or a budget for food of their choice if it’s virtual) to signal that it’s an informal and low stakes interview**

Theme 6: Organisational advocacy for trauma-informed approaches

• Advocate for trauma-informed principles when supporting design teams
• Invite users to decision-making with leaders, perhaps rotating representatives. If they can’t be there, being the voice of the user when they’re not there to advocate for themselves using what you’ve learned in research
• Have open communication about trauma-informed practices in team meetings e.g. design review, user research preparation sessions
• Model trauma-informed approaches for others in your team
• Enable the wider team to input, and be transparent with your process and decisions
• Share out what you’ve heard from users in a public forum. If you can’t make changes, acknowledge this
• Escalation paths where someone is uncomfortable or wants to challenge a process
• Co-design with those with trauma histories*
• Ensure decisions are informed by user research
• Bring designers along on the strategy journey
• Create confidence around trauma-informed practices in the team
• Have a facilitator role to help identify areas where a decision is required, and ask questions in order to build a balanced view
• Raise the risk in not working with people
• Define safe spaces as a team
• Policy teams should be included in the design process
• Asking questions when things are not shared
• Involve users at discovery to better understand user needs
• Clarity to your researchers on why the research is being conducted, and the autonomy you (as a team) have to act on the findings, as well as constraints
• Understand the team you work with and the environment in your organisation — you need to be safe before you can think of the safety of others
• Involve users in redesigning policies*

Theme 7: Mindset and culture shift

• Don’t force stories**
• Invite feedback
• Call out and recognise when safety is being compromised
• Be okay with not knowing the answer and be okay with not being okay
• Acknowledge and be responsive to potential algorithmic bias (e.g. racial)*
• Take accountability for peer support and building trust
• Understand each other’s needs when working together
• Awareness of the power dynamics between researcher and participant especially when incentives are involved, look for opportunities to shift the power dynamic
• Creating more of a routine around support e.g. checking in with each other after visits or UR sessions
• Acknowledging people feel different day-to-day and that you may need to adjust accordingly
• Cross-team, cross-organisation, cross-stakeholder working — representation and visibility reduces likelihood of bias
• Peers share their stories and journey, normalising shared experiences*
• Keep principles front and centre in your initial desk research
• Build the trust through actions — a welcoming and safe space
• Create a culture of open and honest communication among design and research teams where people can talk about vicarious trauma (KE note: I would add, modelling this for the rest of your team yourself, particularly if you are in a leadership position)
• Break open silos
• Being attentive to signs of discomfort*
• Make it part of the culture and incorporate in company values

Mindsets around pace and time

• Build in the right amount of prep time
• Create more space for listening (to staff and to users)
• Take the time and space to understand who you are working with
• Allow more time for sessions and in between
• Allow people thinking and breathing space
• Slowing down if you need to, going at the participant’s pace or building trust over multiple sessions
• Plan for more time, take time to plan, allow time to process
• Be flexible with taking breaks. Allow more time just in case, and don’t schedule interviews back to back***

References

The majority of these ideas came from the UX Scotland workshop group. I have edited some for clarity and flow, but have not changed the meaning.

Any ideas marked with * came from a presentation in a community session with the Trauma-informed design community group led by Carol F. Scott. You can find more on this by Carol and co-authors here: Trauma-Informed Social Media: Towards Solutions for Reducing and Healing Online Harm.

Ideas marked ** come from the brilliant discussion of Trauma-Informed Design from the Restorative Design Conference 2020 between Rachael Dietkus, Sarah Fathallah and moderated by Sara Cantor Aye [requires login]. “Don’t Force Stories” is referenced to YLabs in the discussion.

Some other great resources for applying trauma-informed and inclusive principles in practice:

• Chayn’s User Researcher Jenny Winfield wrote a brilliant and thorough series about applying different principles: Safety; Accountability; Equity & plurality; Agency & power-sharing; Hope
• Trauma-informed design research — Jax Wechsler
• When user testing sessions bring up trauma***— Ally Tutkaluk
• Anticipate and Adjust: Cultivating Access in Human-Centered Methods — Kelly Mack

Do you have other ideas for applying trauma-informed principles or examples of where you have applied them in your work? Or links to resources? Please share them in the comments or over on LinkedIn.