International Society for Traumatic Stress Studies

Using Design Thinking to Apply Trauma Principles to New Realms of Public Policy

Posted 31 March 2015 in StressPoints by Shoshana Akins, BS and Caitlin O’Brien, BA

Both poverty and trauma are highly prevalent in Philadelphia; approximately 25 percent of citizens live in poverty and 40 percent have experienced four or more adverse childhood experiences (ACEs).1,2 Although the City of Philadelphia has developed a number of public assistance programs to alleviate the stresses of poverty (e.g., housing and utility assistance programs), the design of these initiatives do not take into account the high prevalence of trauma among the populations they serve. Modifying these programs to consider the linkages between poverty and trauma could allow them to function more effectively and cultivate protective factors for continued trauma exposure, toxic stress, and negative health outcomes.

In order to more effectively address the linkages between poverty and trauma, the Thomas Scattergood Behavioral Health Foundation—a philanthropic organization focused on innovation in behavioral health—has proposed that the City of Philadelphia employ trauma-informed principles to redesign its public assistance programs. The City of Philadelphia’s initiative to reform six public assistance programs through a recently awarded City Accelerator Grant3 presents an opportunity to make these programs trauma-informed.

We applied the principles of design thinking, which look to include new stakeholders to bring a fresh perspective to solving longstanding problems, to create a tool to discuss trauma-informed public policy at the Scattergood Foundation’s Annual Innovation Conference. This led to the development of a Policy Hack—a crowdsourcing event that gathers individuals from a number of fields to generate relevant and revolutionary policy.

To begin the conference’s Policy Hack, we gave a 20-minute presentation about the principles of design thinking and trauma-informed care. We then described the six public assistance programs that are targeted for reform as a part of City of Philadelphia’s City Accelerator Grant, which include the Homestead Real Estate Tax Exemption, Senior Real Estate Tax Freeze, Longtime Owner Occupant Program (LOOP), Owner-Occupied Payment Agreement, Senior Water Bill Discount and the Water Revenue Assistance Program (WRAP). The group of over 180 conference attendees were then split into teams of 10-12 individuals and facilitated by Drexel University public health students and Scattergood Foundation Board Members to generate recommendations. Following this activity, participants had the opportunity to report back to the larger group.

We then developed recommendations for reform, drawing from the Policy Hack responses as well as our research on trauma-informed policy. These recommendations fell into two categories: 1) specific ways to apply trauma-informed principles to these programs, and 2) solutions that support a trauma-informed environment and system. We found this to be an important distinction for conceptualizing trauma-informed public policy. Understanding the concrete actions that embody trauma-informed principles and the environment needed to fortify these actions can anchor these concepts more explicitly and ultimately create a sustainable structure for these changes within the City government.

The specific trauma-informed recommendations were structured by the four areas of building a trauma-informed organization that were identified Harris and Fallot.4 These consist of:
  • Administrative Commitment: Leadership from all involved agencies should be trained in trauma-informed care and be involved in the development of new policies and practices so they can best fit the needs of that department. Managerial support systems with seminars and trainings should be developed so this leadership outlook trickles down through entire departments.
  • Training: All staff members who interact with consumers should be trained in trauma-informed care and Mental Health First Aid. This will create a positive environment between customer service staff and leadership as they are all operating under the same goals.
  • Hiring and Human Resource Practices: Experiential diversity is necessary in these departments to create an empathetic, mindful, and active staff that can thrive in a trauma-informed environment. Human Resources Departments should seek to hire individuals who have had their own experiences interacting with these programs.
  • Policies and Service Delivery Practices: Standard operating procedures should be revised to reflect trauma-informed principles and to ensure institutional memory. For instance, the greeting for Revenue Department’s call center is, “What property are you calling about?” This should be revised to make the caller feel more comfortable when inquiring about tax issues.

The second category of recommendations included a number of environment and system techniques to support the application of trauma-informed principles in the City’s assistance programs. These included, but were not limited to:
  •     Involve consumers in the process of reforming these enrollment processes through town hall meetings, focus groups, and online forums.
  •     Develop a streamlined, online application for all of these programs to reduce the burden on the applicant.
  •     For programs with fewer eligibility requirements, institute automatic enrollment.
  •     Remove language that emphasizes “low-income,” “poverty,” and “assistance program” as these words are often associated with negative stigma of handouts and charity.
  •     Change the language on the applications to reflect a 5th grade reading level. The literacy level of applicants should be considered when designing applications.

Trauma-informed practice has been embraced in Philadelphia in the worlds of behavioral health, school systems, fire service, and police. In applying a trauma-informed lens to the development of public policy, Philadelphia will be utilizing a Health in All Policies approach, which can enhance health in all communities. For more information on trauma-informed public policy and this project, please see our report of the same name, Using Design Thinking to Apply Trauma Informed Principles to New Realms of Public Policy.


About the Authors

Shoshana Akins, BS and Caitlin O’Brien, BA, are both MPH candidates in the Health Management and Policy Department at the Drexel University School of Public Health and current project managers at the Thomas Scattergood Behavioral Health Foundation.


References

Pew Charitable Trusts. (2014). Philadelphia: The State of the City. Retrieved from http://www.pewtrusts.org/~/media/Assets/2014/04/05/PhiladelphiaStateofCityreport2014.pdf
Institute for Safe Families. (2013). Findings from the Philadelphia Urban ACE Study. Philadelphia, PA: Public Health Management Corporation.
The City of Philadelphia. (2014). Harnessing Innovation fro Low-Income Communities in Philadelphia. City Accelerator. Retrieved from http://www.governing.com/cityaccelerator/videos/Harnessing-innovation-for-low-income-communities-in-Philadelphia.html  
Harris, M. and Fallot, R. (Eds,). (2001). Using trauma theory to design service systems. New Directions for Mental Health Services, 89.  
Pew Charitable Trusts. (2014). Philadelphia: The State of the City. Retrieved from http://www.pewtrusts.org/~/media/Assets/2014/04/05/PhiladelphiaStateofCityreport2014.pdf
Institute for Safe Families. (2013). Findings from the Philadelphia Urban ACE Study. Philadelphia, PA: Public Health Management Corporation.   
The City of Philadelphia. (2014). Harnessing Innovation fro Low-Income Communities in Philadelphia. City Accelerator. Retrieved from http://www.governing.com/cityaccelerator/videos/Harnessing-innovation-for-low-income-communities-in-Philadelphia.html
Harris, M. and Fallot, R. (Eds,). (2001). Using trauma theory to design service systems. New Directions for Mental Health Services, 89.