1800RESPECTMarch|2018

Trauma-Informed Digital Design: Applying the Practice Guidelines for Trauma-Informed Care

and Service Delivery to the Digital Space

Presenters: Dr Cathy Kezelman AM and Kim Preston

The information presented in this webinar is of a general nature and is not a substitute for legal or other professional advice.The views expressed in this presentation do not necessarily represent the views of the Australian Government, or Medibank

Health Solutions. While all reasonable care has been taken in the preparation of this presentation, no liability is assumed for any errors or omissions.

Dr Cathy Kezelman AM – President, Blue Knot FoundationDr Kezelman will provide an overview of Blue Knot Foundation’s internationally acclaimed Practice Guidelines for Treatment of Complex Trauma and Trauma-Informed Care and Service Delivery. The webinar will focus on the trauma-informed guidelines for services and their workforces, the philosophy and vision behind them, their core principles and the process of mapping them for services and systems.

Kim Preston - Design Director, TigerspikeThe Blue Knot Foundation’s trauma-informed guidelines were recently adopted with a digital lens to guide the 1800RESPECT website re-development. Kim Preston will present the approach to applying these guidelines to a digital setting and the key learnings from the process.

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Introduction

Dr Cathy Kezelman AMBlue Knot Foundation’s Nationally and Internationally Acclaimed

Practice Guidelines for Treatment of Complex Trauma and Trauma-informed Care and Service Delivery

• Informed by 20 years of research -substantive evidence base around trauma

• Filled a gap in knowledge, understanding and practice

• Two sets of guidelines:

- ‘Practice Guidelines for Treatment of Complex Trauma’

- `Practice Guidelines for Trauma-Informed Care and Service Delivery’

• > 20,000 downloads

• blueknot.org.au/guidelines

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Blue Knot foundation practice guidelines

These guidelines reflect the diversity of information relevant to trauma-informed service delivery and the diversity of organisational and servicesettings to which it can be applied.

Blue Knot Foundation is delighted 1800RESPECT has applied these guidelines to the digital space. We present them in two main sections:

1. `Philosophy and Vision’ outlines the core principles which underlie and infuse service delivery which is trauma-informed.

2. `Mapping to Practice’ considers implementation at systems’ and service levels.

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Practice guidelines for trauma informed care and service delivery

• Establish service-charters of trauma-informed care.

• Emphasise a recovery orientation and establish five foundational principles – `safety’, `trustworthiness’, `choice’, `collaboration’ and `empowerment’ (Fallot & Harris, 2009).

• Promote understanding of the impacts of trauma and the importance ofco-ordinated care.

• Commit to survivor-driven systems.

• Commit to all forms of diversity.

• Incorporate a message of optimism and hope into all interactions between service providers and clients.

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1. Philosophy and vision

• Establish service-charters of trauma-informed care:

Articulate guiding principles for service design, development, delivery Formally acknowledge reality, prevalence, impacts of trauma; need for

services to adapt to mitigate risks of re-traumatisation/promote healing Emphasise need to comprehensively modify services at all levels and in all

aspects

• Emphasise trauma-informed recovery orientation - need for major shift in approach

From caretaking to collaborative From illness/symptom-based to skills acquisition and strengths-based From pathologising to asking question: what happened to you? From ‘doing to’ -> ‘working with’

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1. Philosophy and vision

In implementing philosophy and vision of trauma-informed care:

• Whatever affects one part of the system will affect other parts of the system because of interrelatedness of human problems and efforts to resolve them (Bloom and Farragher, 2011)

• Attributes of system as a whole significantly affect implementation and effectiveness of any services (Fallot and Harris, 2009)

In mapping to practice the guidelines distinguish between system level and service level, with some areas of overlap

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2. Mapping to practice

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2. Mapping to practice

Systems Level Service Level

• Promote co-ordination between and among systems of care and incorporate a life-span perspective.

• Revise all policies and procedures to incorporate trauma-informed principles.

• Involve service users in all systems; articulate and uphold trauma-informed rights.

• Review education and training to incorporate trauma-informed principles.

• Identify funding requirements.• Promote education in trauma.• Promote respect for diversity.

Step 1: Identify key formal and informal activities and settings

Step 2: Ask key questions about each of the activities and settings

Step 3: Prioritise goals for change

Step 4: Identify specific objectives and responsible persons

(Fallot and Harris, 2009)

We consider five domains:

Safety: Ensure physical and emotional safetyTrustworthiness: Maximise trustworthiness through task clarity, consistency,and interpersonal boundariesChoice: Maximise client choice and controlCollaboration: Maximise collaboration and sharing of powerEmpowerment: Prioritise empowerment and skill-building

Service Policies: Ensure formal policies are based on the above principles and are consistently implemented and monitored

Screening for trauma: Ensure a mechanism for screening for underlying trauma is implemented for a service/organisational context to be fully trauma-informed

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2. Mapping to practice

Kim Preston:Tigerspike’s Approach to Digital

Product DesignDesigning inclusive digital products and services

to meet the needs of all users

Undertake trainingEncourage the product team to undertake training in trauma informed design through the Blue Knot Foundation.

Define your approach With the product team, workshop features that might align to the trauma-informed principles of Safety, Trustworthiness, Choice, Collaboration & Empowerment.

Engage usersIncorporate user interviews into your process to ensure you are designing a product for, and with, your users.

Test, Learn & IterateValidate your approach with users of the system to test out the features outlined above. You may need to adjust your approach depending on the service provided or the type of trauma being experienced.

Trauma informed design

Getting started

Allow the participant to choose where they want to sit in relation to the door

Avoid sitting or standing behind the participant

Where possible, conduct interviews in a calm, friendly but uncluttered environment. Avoid overly corporate or institutional rooms

Ensure the participant knows they can stop the session at any time.

Considerations for user interviews and user testing with participants who may be experiencing, or have experienced trauma

Provide ample water and tissues within arms reach.

Schedule more time than average to allow for breaks or other disruptions

Be aware that retelling trauma stories may be therapeutic for some, but traumatising for others, including the interviewer. Avoid unless absolutely necessary.

User engagement

Explain the nature of the research, how and why it will be conducted and how the participants responses will be used

Allow the participant to choose the type of recordings they are comfortable with; screen interactions, audio, video, photography etc, and be prepared if they are uncomfortable with any form

Considerations for user interviews and user testing with participants who may be experiencing, or have experienced trauma

Avoid making any assumptions about, or on behalf of, the participant

Be present, listen, and ensure the participant feels heard.

Don’t be afraid to show sympathy towards the participant.

User engagement

Our solutions are built to meet the needs of the widest number of users by following the design

principles of accessibility, universal design and trauma-

informed design. Tigerspike’s Commitment to Inclusivity

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Integrating trauma informed principles into our practice

Accessible

Universal Trauma Informed

BestPracticedesign

• Most content was rewritten to the reading level of a 12yo

• The content shifted towards an unassuming tone, and aimed to be more inclusive. i.e gender pronouns

• Visual clutter was decreased by keeping content within a single column, and increasing whitespace –all with the aim of reducing cognitive load

• Brand colours were updated towards a more calming palette, that also complied to WCAG AA+ accessibility guidelines

• Photographic imagery in particular was updated to consider triggers and lend a warm supportive tone to the site, while also trying to represent the diversity of the audience

Application of trauma informed design principles

Safety

• Areas of the site that previously required a user’s email address were updated to allow users to preserve their anonymity

• Quick exit functionality was improved.

• Ensured we disabled auto play on videos and audio files.

Trustworthiness

• Government and institutional logos were removed.

• Fonts were updated to improve legibility and appear less institutional, and font sizes increasedto provide greater readability, and improve scan ability

Application of trauma informed design principles

Choice

• Provide options for support,including live chat, calling or further browsing the site.

• Avoided asking questions of users

• We simplified the process of downloading content for offline viewing

• We sought to limit the number of navigation options in order to reduce complexity and cognitive load.

Application of trauma informed design principles

Collaboration

• Designed and tested with users

• We ensured we were not pushing users towards any action they may not be comfortable with

• Feedback forms where provided for users to comment on the service.

Application of trauma informed design principles

Empowerment

• We used ‘next steps’ to provide users with more information when they are ready

• The site IA and content was restructured to align with the journey from contemplation to establishing safety and reconnection.

Any questions?

Medibank Health Solutions ABN 99 078 934 791 is contracted to deliver 1800RESPECT for the Department of Social Services

Thank you for your time today