The Case for Trauma-Informed Youth Centered Health Design (TIYCHD)
By Laiah Idelson, MSPH & Stephanie Guinosso, PhD, MPH | February 2, 2021
While designing a digital product in Kigali, Rwanda, I (Laiah) sat in a room full of young women who worked as domestic workers, some of the most vulnerable women in Rwandan society. The goal of the interview, rooted in the Youth-Centered Health Design (YCHD) methodology, was to seek their input on developing a suite of digital sexual health tools.
We asked the women how they used their phones for their health, and if they would consider using an app/service like ours. The women quickly began to describe how, when their employer forgets to pay them, they have no money to get home from work, and have to beg a moto taxi driver to take them home for free, putting them at risk for sexual assault. They asked us, would our service provide support for situations like these?
We answered no. The women asked us if our service would provide information to police on sexual health and try to change their behavior around taking reports of sexual assault seriously. We again answered no. The women became frustrated and shared they would likely not find use for the service.
I left the interview feeling deeply concerned. I wasn’t disappointed about the fact these women weren’t thrilled about our product - that’s part of the job. But the stories they’d shared with me were serious, and I hadn’t felt like my team and I were prepared to appropriately acknowledge and care for these women in the retelling of some of their most difficult moments. In that moment I recognized a major flaw with the YCHD methodology: it was not designed to properly address and account for trauma of participants.
The YTH Initiative at ETR has led the field in YCHD for the past decade. YCHD employs principles of positive youth development and human-centered design to position young people as experts in solving the challenges affecting their lives. By utilizing human-centered design methodology in meaningful partnership with young people, we can create solutions that have the ability to truly make an impact and transform lives.
However, after utilizing this approach with young people in Rwanda and elsewhere, we recognized that something was missing and so ETR engaged with colleagues in the broader community to create Trauma-Informed Youth Centered Health Design (TIYCHD), an approach that interweaves trauma-principles into the YCHD approach.
Our TIYCHD framework was designed in collaboration with experts in design, trauma and mental health, youth engagement, and public health through a community consultation with twelve participants and expert interviews with forty others.
TIYCHD has seven main principles:
Youth at the Center: We believe in meaningfully partnering with young people at every step of the design process.
Safety: When we co-create safe environments, we can focus our energy on thinking, learning and creativity
Equity: When we approach cultural differences with humility and empathy and promote fair access to resources and opportunities, design solutions better reflect the desired needs of the community
Relationships: When we cultivate supportive and trustworthy relationships, we foster well-being and growth
Empowerment: When we are given meaningful opportunities to have voice and choice and our strengths are acknowledged and built upon, we develop agency to take action on issues that impact our lives
Resilience: When we build our capacity to be with, respond to, and transform individual and collective adversity, we dream beyond adverse conditions
Competence and Contribution: When we work in partnership with young people to build their design skills, they develop solutions for the health challenges that most impact their lives
Applying these principles to YCHD requires a shift from a traditional design mindset. For example, YCHD principles encourage practitioners to move fast and welcome failure as a learning opportunity while a trauma-informed approach strongly encourages taking time to cultivate safety and trustworthy relationships, particularly when working with communities impacted by trauma. Through our trauma-informed design process, we have created a framework that will guide public health practitioners using human- and youth-centered design in their work. We hope that the process of meaningfully engaging young people in design facilitates their resilience and well-being in addition to better design solutions.
TIYCHD is currently being piloted in Fresno County through the INSPIRE+ project funded by Elevate Youth California. INSPIRE+ is working with 18 Design Fellows (16-18 years old) to design solutions that address community influences on youth substance use. Given the constraints of COVID, the program spans 12 weeks, and youth meet once a week in a virtual format.
What did we do differently to integrate a trauma-informed approach into the process?
All staff received training on how stress and trauma impact individuals, relationships, and systems and universal practices for fostering resilience and well-being.
Before the program began, we worked with a local community partner to develop safety protocols for how and when to refer youth to mental health or other social services if a Design Fellow disclosed information that may cause harm. We introduced Design Fellows to this community partner and explained our safety protocols in the first session.
In our first few sessions, before we got into any design strategies, we:
- Conducted a listening session with Design Fellows to learn more about their views of their community, the topic of substance use, how they were navigating the challenges of COVID and what they needed to feel supported by the facilitators and their peers throughout the program
- Co-created community agreements and strategies for holding the group accountable to those agreements
- Started each session with a self-regulation practice like mindful breathing or movement
- Conducted community building activities like “I love my neighbor” and “Pecha Kucha” to build trust and relationships among the Design Fellows and facilitators
- Reflected on our individual identities that shape how we show up with each other and our relation to the health challenge
- Examined the oppressive historical and institutional structures that can maintain and even promote unhealthy social conditions that lead to internalized oppression and negative coping strategies
As we moved into design research, we discussed ways that research can be oppressive or transformative and described how to approach research in partnership with communities. For ideation and prototyping, we integrated question prompts for Design Fellows to reflect on whether their ideas advanced our trauma-informed principles. We are also evaluating the extent to which Design Fellows feel these principles were applied throughout program.
What comes next for TIYCHD?
ETR will continue to refine the TIYCHD with two more youth cohorts in Sacramento, Alameda, and/or Los Angeles counties through the INSPIRE+ project. In June 2021, we will also train two youth-serving organizations to facilitate TIYCHD with cohorts of youth through ETR’s Youth Engagement Network (YEN) funded by the Office of Population Affairs. The YEN will implement TIYCHD to develop youth-driven interventions that engage young people in sexual and reproductive health programs, services and systems change efforts.
Stephanie Guinosso, PhD, MPH, (she/her/hers) is a Senior Research Associate at ETR. She specializes in school-based trauma-informed approaches.
Laiah Idelson, MSPH, (she/her/hers) was the Strategic Partnerships & Innovation Lead for the YTH Initiative at ETR until April 2021. She has worked in the U.S. and internationally in the areas of mobile health, health education and youth empowerment.
