Perspectives February 20, 2024

Trauma-Informed Design: Healthcare Designed to Heal

The Family Tree Clinic in Minneapolis provides respite, hope, and specialized care for the LGBTQ+ community in the Twin Cities and beyond.

What is Trauma-Informed Design?

According to a 2020 study by BMC Public Health, a staggering 57.8% of American adults experienced at least one Adverse Childhood Experience (ACE), with 21.5% experiencing three or more (Zachary Giano, 2020). While these experiences can be nearly any traumatic life event, series of events, or circumstance the most common are: physical, emotional, or sexual abuse; domestic violence; substance abuse; incarceration; war; natural disaster; mental illness; and divorce. With either direct or indirect exposure, The Adverse Childhood Experiences Study showed these patients are often vulnerable to chronic health conditions and health-risk behaviors later in life, such as heart and liver diseases, substance abuse, PTSD, and depression.

The concept of Trauma-Informed Design is quickly gaining momentum as architects and interior designers work to integrate the trauma-informed principles of care into mental healthcare practices. The overarching goal is to create welcoming spaces that demonstrate safety and privacy, while not interfering with the need to assess, diagnose, and monitor clients’ behavior. In Trauma-Informed Design, the physical environment promotes safety through de-escalation for patients and staff. Staff members recognize and address aspects of the physical environment that may be re-traumatizing and work with clients on developing strategies to cope with or avoid potential triggers. The physical environment must provide space that both staff and guests can use to execute treatment and practice self-care.

At Family Tree Clinic, framed views of nature and the city connect the community and staff to the natural world. There are opportunities to gather together or sit in solitude.

11 Principles of Trauma-Informed Design

Ultimately, we need to create environments that emphatically meet guests where they are in their personal healing journey, without triggering trauma. Here are the principles we follow to advise Trauma-Informed Design within the behavioral and mental healthcare environment.

Reduce or remove known adverse stimuli.
Reduce or remove environmental stressors.
Actively engage the individual in a dynamic, multi-sensory environment.
Provide ways for the individual to exhibit their self-reliance.
Provide and promote connectivity to the natural world.
Separate the individual from others who may be in distress.
Reinforce the individual’s sense of personal identity.
Promote the opportunity for choice while balancing program needs, safety, and comfort.
Provide an environment that is safe and secure.
Provide collaborative spaces that are flexible and adaptable.
Provide opportunities for community connection.

Designing with Empathy

In architecture and interior design, we use evidence-based design, the process of weighing decisions about the built environment based on credible studies and research to achieve optimal outcomes. These design guidelines spur the creative thought process in designing for a broad spectrum of trauma. The guidelines also remind us of critical issues impacting traumatic stress, and to critique our preliminary designs to develop more comprehensive solutions. The inclusion of Trauma-Informed Design ideas within the overarching concepts that shape a project ensures a more fully integrated design solution. The physical environment is the program as much as routines, goals, and staff are the program. We must also design environments built for inclusivity and equity, designing with people instead of just for people. The one-size-fits-all approach to healthcare is now leaning to distinct environments that uniquely support specific populations.

Many users of Family Tree have experienced some form of medical trauma. Expansive views outdoors and intentionally framed corridors provide patients and staff with a sense of calm and safety.

Below, we explore specific design guidelines associated with Trauma-Informed Design.

Carefully chosen accent paint colors provide high contrast that helps ease eye strain for the visually impaired and normally sighted clients alike.

Aesthetics and Finishes

Healthcare spaces need to be aesthetically pleasing, not institutionally sparse. Finishes play an important role in the healing environment, affecting patient health outcomes, staff satisfaction, and operational efficiency.

Research has shown that an environment that was perceived as pleasant, beautiful, well-kept, and calming was considered more professional and offered a higher level of care than an environment that was perceived as disorganized and unpleasant.
Consider finishes that are durable, easy to clean, and have biophilic qualities.
Design for equitable environments and select culturally respectful materials, colors, and patterns.

Biophilic Design

Biophilia is defined as the inherent human inclination to affiliate with nature. Biophilic design incorporates natural materials, natural light, vegetation, nature views, and other experiences of the natural world brought into the modern built environment. Biophilia is an evidence-based method of reducing stress and promoting a sense of organic comfort and calm.

Research shows settings that include vegetation reduce stress and promote peace, tranquility, enhanced self-esteem, and a sense of mastery of the environment.
Plants perform an important biophilic function by connecting occupants to the natural world, which has been found to reduce stress and pain while improving mood.
Nature-inspired art, views to the outdoors, exposure to natural light, as well as indoor plants, are all associated with increased positive impact and comfort.

Family Tree Clinic used local artists to create large scale murals to call people into the clinic.

Distraction Imagery

Distraction Imagery is a visual installation that can positively draw focus away from triggering anxiety and fear. This concept can include interesting graphics, engaging artwork, calming colors, and any appealing visual that replaces negative thoughts. Distraction Imagery can create a visual override that alleviates stress, improves mood, comfort, and patient satisfaction.

Landscape paintings are associated with increased positivity and comfort, doubling as natural, biophilic elements in places where natural light and views are not accessible.
Avoid abstract artwork with harsh lines and colors which can evoke strong and varied emotions.
As part of a healing-centered design, art is one way to bring joy inside of the building, but it should not convey meaning or symbolic significance that could generate negativity.

Areas of Refuge

A Trauma-Informed Design approach embraces “layers of space” that enable people to choose the level of engagement they need at any given time – flexibility is key to these spaces.

Feature a “peace corner” where people can take a breath when they need to, use fidget materials, read a book, or just sit for a few moments to gather themselves.
Provide varied, passive, or actively supervised spaces for people to find refuge, like a nook or balcony.
Provide areas of refuge within or adjacent to large gathering areas, along with quiet outdoor spaces within staff sightlines.
Carefully design nooks for retreat or passive observation, providing flexible seating that faces a wall and does not call attention to the need for retreat.

The Family Tree Clinic celebrates the design concept of coziness, incorporating low window alcoves that patients can crawl into and feel protected.

Every environment we enter has a profound impact on our state of well-being, happiness, and mental health. With healthcare interiors and planning, we must continue to promote a sense of well-being and trust that opens the door to mutually beneficial outcomes and healthy client and provider relationships.

Trauma-Informed Design: Healthcare Designed to Heal

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