Applying trauma-informed design to improve government services

In a recent InnovateUS workshop, Rachael Dietkus, founder of Social Workers Who Design, led public sector participants in a training session discussing the inclusion of trauma-informed design to improve public services. 

Dietkus is a social worker-designer who integrates trauma-responsive principles with care-focused design research methods. In September 2022, she joined the U.S. Digital Service, where her focus has been on trauma-informed design, research, and practice across several White House and agency projects. She has also served as an AmeriCorps member with the American Red Cross, an NGO delegate to the United Nations Commission on Human Rights and Human Rights Council, a Mayor-appointed member of the City of Urbana Human Relations Commission, and a Governor-appointed member of Serve Illinois. 

Dietkus began the workshop by acknowledging the importance of hope and care. From her perspective, hope strengthens our work as public professionals in unimaginable ways. Hope means meeting people where they are, growing interpersonally, maintaining resilience, and healing oneself and others. She asked participants to reflect on how this concept can be incorporated into their daily work. 

She defined cultures of care as the many seemingly small moments in daily life. Care is often multifaceted and can be viewed both from the receivers’ and the givers' points of view. She then asked participants to consider where more care is needed in their work and how they might cultivate a culture of care. 

Dietkus explained to participants why learning about trauma is important when working locally and nationally in the public sector and with constituents. Given the range of services the government provides, it is essential to be mindful of how people navigate these emotional and important situations. 

“Many people interact with our different levels of government during some of the most stressful and vulnerable times in their lives,” she said, listing examples such as experiencing a natural disaster, applying for healthcare, or seeking asylum.

Understanding trauma (social model)

Trauma can be understood in three parts, Dietkus said. This is known as the three Es: the event, the experience, and the effect. Dietkus expanded on this by sharing: 

1. The event: Trauma is a response to anything that’s overwhelming and happens too much, too fast, too soon, and/or for too long.

2. The experience: It is coupled with a lack of protection or support. It lives in the body, stored as a sensation: pain or tension - or a lack of sensation, like numbness.

3. The effect: Context is critical to both acknowledge and understand that what may impact one person may not impact another in the same way.

Trauma is pervasive. In 2014, according to the National Council for Mental Wellbeing, about 70% of adults in the U.S. had experienced some type of traumatic event at least once in their lives, equivalent to about 233 million people. Around the world, trauma is estimated to impact 60 to 70% of individuals. There are several common, normal reactions to trauma that people can experience, including manifestations that are emotional, behavioral, physical, and cognitive.

Trauma can also show up in our work through a lack of support and resources, institutional betrayal, burnout and compassion fatigue, intergenerational and historical trauma, ethical dilemmas, moral injury, secondary and vicarious trauma, and much more.

“Sometimes many of these things are happening together,” Dietkus said. “Trauma can have this compounding effect on other things that we either have or might be experiencing in our lives as well.”

Trauma-informed principles

One of the more hopeful approaches in response to the prevalence of trauma is Trauma-Informed Care Principles. This approach, led by the Substance Abuse and Mental Health Services Administration (SAMHSA), includes:

1. Safety

2. Trustworthiness and transparency

3. Peer support

4. Collaboration and mutuality

5. Empowerment, voice, and choice

6. Cultural, historical, and gender issues

SAMHSA’s principles have since been adapted and expanded by Dietkus and her colleague Kevin Shaw to incorporate other elements such as listening and equity, as well as adapting the other principles to apply to a public interest design context. 

Using these principles, Dietkus defines trauma-informed design as an approach that recognizes the persistence of trauma and further commits to not repeat or cause additional trauma through any government service experience.

“By integrating trauma-informed care principles, government practitioners support the mission and help people restore a sense of safety, dignity, and self-worth in all aspects of the delivery of government services,” she said. 

Trauma responsive practices

Finally, Dietkus highlighted promising tools and tactics to integrate trauma-informed care into government work. This included Ways of Working exercises and integrating the Model of Care for Co-Design Cards. She also advised participants to consider the following tactics immediately:

1. Open up your calendar: Just like you, your calendar needs some breathing room. Reduce by 50% or cancel the scheduled meetings that could be a Slack message, an audio message, or an email.

2. Resist the false urgencies: Pay attention to where urgency culture creeps in your workplaces. It used to be much more overt, but it’s nuanced now. Define for yourself, your team, and your organization the differences between false urgencies and a true crisis.

3. Debrief with a trusted peer: If you’ve recently had a difficult research session or know that a particular government project will be emotionally challenging for you, talk about this openly with a trusted peer.

4. Map out a scope of practice: A scope of practice is the professional boundary you work within that clearly communicates where you begin and where you end (Katie Kurtz, KA McKercher). What are you trained in? What do you still need to learn? What are you willing and unwilling to do or choose not to do?

5. Create a code of care: We sometimes call this a code of conduct, but a code of care is a fundamental shift. As Joan Tronto said, “Care is both a practice and a disposition.”

6. Explore design supervision: Supervision practice is familiar to licensed professionals but may be unfamiliar in design. Design supervision would allow you to explore and manage ethical dilemmas, your role and responsibilities, and accountability. It can also allow you to learn from experiences, develop your intuition, peer-to-peer critique, develop your career, and notice and name your skills, values, and strengths.

7. Seek consultation: We cannot be experts in everything all the time (or maybe any of the time). Is there a topic your team is about to dive into that you need to learn about? No amount of quick ‘studying up’ will prepare you for the pitfalls that lie ahead. Seek out consultation and guidance from subject-matter practitioners.

8. Give yourself margin: This is a sewing maxim (shared by the author and creative Stacie Bloomfield) about leaving enough excess fabric to account for potential mistakes. Give yourself the space – the mental margin – to reconnect with your values, purpose, and integrity. This will help keep you in alignment with your true self.

9. Commit to a daily practice: Another gem from Stacie (noted above) is that ‘practice makes pattern.’ When you make small changes daily you will soon notice the differences in how you are able to show up for the work, your friends, your family, your communities, and – most importantly – yourself. 

10. Rest: Taking time off, slowing down, and doing nothing (the kind of nothing that allows you to zone out, stare at the ceiling, sit in the sun, etc.), to quiet your brain and nervous system is essential for a sustainable practice.

11. Start with accessibility: The most promising trauma-informed design practices start with accessible, inclusive practices that are not afterthoughts or done at the end. Always start with intentional accessibility.

12. Expansion is good: Often, individual designers start to lead a shift by deepening their trauma awareness in their own practice. When we expand out to the team, department, or agency level, we are not necessarily scaling up trauma-informed ways of working but instead scaling deep. 

Want to keep learning? Feel free to connect with Rachael on LinkedIn. To watch the workshop recording, click here. Remember to sign up for upcoming InnovateUS workshops here and follow us on LinkedIn for information on upcoming workshops.