By Hao Duong and Ashlee Washington
About 70% of Americans have experienced some sort of trauma in adulthood. This high number has led to an expanded approach to improving a patient’s health — trauma-informed care. With greater awareness of trauma-induced patients, there was a demand for action to treat patients more holistically, beyond the limits of a specific illness. Treatment facilities can make significant progress toward supporting these practices by creating environments that mitigate the adverse effects of these traumas. By adopting trauma-informed practices, patient and staff well-being is significantly improved, from patient engagement to treatment adherence, and health outcomes.
Today, people want more than a diagnosis and treatment. They are seeking quality care with respect and dignity while visiting healthcare facilities. The better their experience is while at a treatment center, the faster and smoother their road to recovery will be. If people are surrounded by environments that create anxiety, feel foreign and sterile, or deprive them of a dignified experience, they will be less motivated to work on their recovery. However, when the spaces are filled with rich engagement, stimulating activities, and positive surroundings, there is more of an inclination to get better. The foundation for creating an atmosphere that understands the impact of trauma and patients’ treatment process lies within the architecture and design of these facilities.
What is Trauma and Trauma Informed Design?
To understand the mechanics of trauma-informed design and how it can be implemented in healthcare facilities, it’s first necessary to recognize what trauma is. Trauma is the exposure to incidents or events that have lasting effects on one’s mental, physical, social, and/or emotional well-being. These stress responses can be barriers to care, causing patients to be less likely to trust the healthcare institutions — further alienating them and resulting in diminished treatment adherence or desire to seek care.
The trauma-informed design approach acknowledges the built environment’s role in creating or minimizing perceived threats, and it also takes the role of design to support and dismantle disempowering care models. The design tactics acknowledge the core tenets of trauma-informed care models, including realizing impact, recognizing the experience, responding effectively, and resisting re-traumatization.
Trauma-informed design solutions and interventions remain unique to each community and require a deep understanding of their needs, wants, and values. A predominantly upper-class, suburban community may need environments that recognize the trauma around the stigma of additions whereas an urban, BIPOC community may require facilities that deal with inequity or struggles with basic needs. Understanding each community is a necessary first step.
How To Design A Trauma-Informed Care Facility
Designers build trust and allow an honest exchange of ideas with clients by building an outline strategy for including a diverse set of users and building occupants through a series of meeting types. It is imperative to create a “safe zone” to have honest discussions to address the root causes of trauma.
Projects begin with three process meetings: listing professions, visioning, and workshops. Listing professions is important because staff can be just as likely to have trauma themselves. Designers need to ensure that staff and patients feel comfortable within a space to share their experiences and stories to define the community at hand and connect with those within the community. Visioning involves understanding the community’s hopes and dreams and what can help them grow and develop. Lastly, workshops are a way to invite the population in and put pen to paper on the ideas. Doing so allows patients and staff to define specific language representing their needs and provide tools and support without architects driving the process for them.
What Do Trauma-Informed Spaces Look Like?
There is no one-size-fits-all approach to incorporating trauma-informed design into healthcare facilities. The initial 60 seconds when patients step into a healthcare setting should be a primary focus. It’s of utmost importance that the design of the space provides patients with clarity, comfort, and belonging upon entering. To achieve inclusive design for all patient types, it’s essential to understand that every individual who walks into a facility comes with a unique upbringing, story, and personal traumas.
Every building’s design layout is different, so how can architects design spaces that promote trust by maximizing transparency? One of Ankrom Moisan’s recent projects, Compass Health, positions inpatient floors around a central care team station, giving care teams and patients views between all patient spaces, including the outdoor patient areas. Access and wayfinding are also key in creating easily fluid and comfortable spaces for patients and staff. Better wayfinding, predictability, and communication reduce stress from confusion that patients may experience in traditional healthcare settings.
Additionally, by considering all senses, designers can create livable spaces that provide users with options to avoid harm to a patient’s journey to recovery. For instance, some lighting might be dim to mitigate those sensitive to light, but other spaces might have brighter lighting for those who cannot see well in darker-lit settings. Adding quiet spaces is also a great solution to reduce a patient’s stress or anxiety and be a place of comfort in escalated situations where people might need to take a breather or relax. It is also important to consider the use of color throughout the space. Muted earthy tones may be calming for some patients, but they may be triggers for others. On the contrary, bright colors may be joyful and cheery to some, but they may be jarring to others. It’s all about understanding the community’s triggers and what can encourage positivity.
Furthermore, biophilia and nature are fantastic ways to immerse patients in the outdoors and bring a sense of home to the facility. Whether it is an outdoor courtyard, a rooftop garden, large windows for natural light, or plants throughout the interiors, there are many ways to take staff and patients’ minds off of their current setting and put their mental state in a place of relaxation and tranquility. They can also be designed as treatment spaces for patients who are triggered by indoor environments.
While it can be a challenge finding ways to design spaces for such unique, individual experiences, trauma-informed design is about reigniting people’s dignity and allowing people to see themselves as a whole person. This approach expands beyond the silos of traditional medical care and allows for opportunities for transformational design. Trauma-informed design creates spaces that build bridges of trust between patients and staff, leaving patients with a positive memory of their recovery.
Hao Duong is a Principal, and Ashlee Washington serves as a Senior Associate, both with Ankrom Moisan.