Inclusive Designers Podcast

By: Janet Roche & Carolyn Robbins

Inclusive Designers Podcast presents…

What is the Trauma-informed Design Society’s award-winning  TiDEvalK12 Tool and how can it be used to help designers and educators identify ways to make positive changes within their schools?

In this episode, IDP explores just what trauma is, and how it can affect the built environment in schools, and beyond. You’ll meet the team that created this thought-provoking tool that can bridge the gap of language and understanding to ultimately reduce stress through the built environment.

Focusing on 12 key domains, the tool can be used to evaluate schools and identify changes in the physical environment that can lower the stress levels of students and staff. It also assists designers in making pointed recommendations and helps administrators better understand the reasons these can be beneficial to their spaces.

Panel:

Davis Harte, PhD, WELL AP

Other IDP Episodes:

Trauma-informed Educational Design in a Post-Pandemic Environment

Designing for: Trauma-Informed Design

–

Christine Cowart-Trauma-informed Design Consutant

Other IDP Episode:

Trauma-informed Design: Transforming Correctional Design for Justice

–

Molly Pierce- Occuaptional Therapist

–

– References: 

An Award-Winning TiD Tool for Designing Schools (Season 5, Episode 1)

Panel: Janet Roche, J. Davis Harte, Christine Cowart, Molly Pierce

(Music / Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music / Intro)

Janet: Welcome everyone, we have a very special show for you today. I am very excited to be not only hosting this episode, but also participating, as I was one of the researchers. With a great team that you’ll meet shortly, we created the Trauma-informed Design Evaluation tool for Kindergarten thru 12th grade. Otherwise known as the EDRA CORE award-winning TiDEvalk12 tool— if I might toot my own horn.

Carolyn: In my opinion, there’s no need to be humble, this one is definitely worthy of one or two toots of your own .

Janet: I really appreciate that Carolyn. This was a lot of hard work, and we’re getting a lot of really great feedback and it’s being explored literally around the world. So we’re very excited about it, so yes, ‘toot-toot’ for us.

Carolyn: Maybe explain the title…

Janet: I can do that, well, it’s TID- Trauma-informed Design; eval- because it’s an evaluation tool; and it’s for K through 12… so, TID-Eval-K-12 tool.

Carolyn: We’ll talk about the tool shortly, but Janet, before we get into your interview with the team… why don’t you start by telling us a little about Trauma-Informed Design, and how it led to form the Trauma Informed Design society.

Janet: Happy to… first, Trauma-informed Design, or TiD, is about integrating principles of trauma-informed care, as originally established by, the Substance Abuse and Mental Health Services Administration (or SAMHSA) and continually evolving into design. The goal is to create physical spaces that promote safety, well-being, and healing. This requires realizing how the physical environment affects identity, worth, and dignity, and how it promotes empowerment.

The Trauma-informed Design Society was started in early 2018 and is co-founded by myself, along with Davis Harte and Christine Cowart. Our panel today includes Davis Harte, or as we like to call her around here Dr. Harte, who like me is an inclusive design professional, and you might recognize her from other IDP episodes.

Christine Cowart is our in-house Trauma-informed Care professional, who has also joined us for past episodes. Also joining us today is Molly Pierce, who was on board as our Occupational Therapy specialist. All of their LinkedIn profiles are available on our website at: InclusiveDesigners.com

Carolyn:  And I’ll jump back in here to say: This assessment tool was created through research performed by the Trauma-informed Design Society, with assistance from over 100 participating educators and designers. It is intended to be used to evaluate schools and identify changes in the physical environment that can lower the stress levels of students and staff.

It is grounded in SAMHSA’s guidance for a trauma-informed approach, and the Trauma-informed Design Society’s framework. And we should also mention that this project was supported by American Society of Interior Designers, Foundation Research Grant.

Janet: And with that, I think it’s time to let everyone hear from the team about just what the tool is, and how it is already helping in the design of K through 12 schools.

Carolyn: Yes, I agree. And so here is our episode with Janet, Davis, Christine, and Molly… the force behind this award-winning evaluation tool.

(Music / Interview)

Janet: Hello and welcome to ‘Inclusive Designers Podcast’. We’ve got a great show for you today. We are going to be talking to my teammates for the Trauma-informed Design Evaluation Tool. The grant we got, which was through ASID, the American Society of Interior Designers Foundation. And we will go and talk a lot about what is trauma, what is trauma informed design, and what was the tool and some of the things that we did to create the tool and how we see the future of Trauma-informed Design.

So, without any further ado, I’m going to go around the room, and we will start with, well, I’ll start with myself. How about that? I’m not only going to be the host today, but I am also going to be a participant as I was one of the Trauma-informed Design professionals assigned for this particular evaluation tool.

Oh, and I’m here in Boston and I am in my office, so if you hear any background noise, occasionally we try to block it out, but you know, some, it’s not a perfect world, but here we are. With that, I’m going to introduce J. Davis Harte, or as we know her around here as Dr. Harte. So Dr. Harte, would you please introduce yourself?

Davis: Hello everybody. I am J. Davis Harte. I’m known as Davis, and I am happy to come to you today from Oregon in my office. I am the principal investigator for the Trauma-Informed Design K-12 Evaluation Tool. It’s a pleasure to be here.

Janet: Great, thank you Davis. Next up we’ve got Christine Cowart.

Christine: Hi, my name is Christine Cowart. My pronouns are she/her. I was the Trauma-informed Care consultant on the tool, and I’m happy to be here.

Janet: Great. Thanks Christine. Christine’s coming from the great state of Vermont.

Christine: I am indeed. I’m here in my office in Vermont, and if you hear anything, it’s likely to be cows. (laughs).

Janet: Thank you so much Christine for being here. Next up we have Molly Pierce. Hi Molly.

Molly: Hi, yes, I’m Molly Pierce, and I come to you from Oregon, and I come to this team with an extensive background as an Occupational Therapist. So I am just really happy to be here and be a part of this team and this podcast. So thank you.

Janet: Thank you, Molly. So let’s jump right on in. We’ve got a lot to cover today. Obviously, everybody can jump in at any point in time. Christine, we’ll start with you. Why don’t you tell us a little bit about what is trauma and why it is so important for designers to understand.

Christine: Sure. So, when we’re talking about trauma, I like to operate under the definition that is pretty much well understood and perpetuated by the Substance Abuse Mental Health Services Administration. And the way they define trauma… “It’s an event that happens to an individual, that that individual experiences as life-threatening or harmful to their well-being that has lasting negative impact.” And so when you think about that definition, it’s much broader than what we sometimes think of as trauma. It really encompasses a whole lot.

And that definition is grounded in how the person experiences that event. So we can’t come up with a list of things and say, these are traumatic things because it’s about how it impacts that person. (Janet: yeah). And so what we know is from surveys and other studies that have been done that the majority of our population has experienced at least one traumatic event in their lifetime.

Why this is important to know is because when you experience more traumatic events over the course of your life, your long-term impacts can increase. (Janet: mm-hmm). And so what they found is, it has impacts on your health, on your likelihood to have chronic disease (Janet: hmm), and on your ability to make good choices. Really access your full ability to think logically and rationally about situations. Control your reactions to situations, and it impacts your ability to access life opportunities. (Janet: yeah).

So why this is important in design is because what we understand about trauma is that it is really— a person experiences something as traumatic when their stress levels are very high. (Janet: mm-hmm).

And so, we know that the physical environment can shape how a person feels when they’re in that environment. It can impact a person’s stress levels, and if we can lower those stress levels for the individual while they’re in a space, we are eliminating some of the potential things that might be leading to them being re-traumatized or triggered in that environment. (Janet: right).

Janet: So thank you so much, Christine, for that brief overview and why it’s so important for designers to understand what trauma is and not to just kind of brush it off. Davis, do you want to add to that? Is there something that you think is important for our listeners to understand about trauma and what trauma is and why it’s so important?

Davis: Thank you so much Janet, and Christine covers our foundation of this work so, so well, (Janet: she covers a lot). I adore how well she explains it because it is a very complex and nuanced process. And we want to highlight the point about how much trauma might affect somebody’s health long term. And I am the Design for Human Health Director and faculty member, so this topic is near and dear to my heart.

And I just want to spotlight a bit more the influence of traumatic experiences, especially in childhood, on the lifetime of the individual. So the impacts that it can have on folks can be something that stays with them, whereas also they can heal and there can be an opportunity for transformation. And it’s a living organism in my mind. You know, if a person experiences trauma, they may become in a pattern of harm and poor life choices and, and sickness.

And in that same regard, there is a real opportunity with sufficient resources and social support and the built environment to facilitate healing. So people can heal, people can change, and they can come out of the other side of a traumatic experience with new insights and resilience. So it’s just one of those, let’s not make it black and white, it’s much more colorful than that, and a hopeful topic. Although it seems like it’s counter to that. Right.

Janet: Yeah. Thank you, it’s all good and important points. Molly, did you want to jump in here and talk about the experience that you have, and you come at it from an OT perspective, do you want to add something?

Molly: Yeah, sure. Just, it is super complex, and every individual is unique, and they come with their unique circumstances. And currently I do work in schools. so kind of being in the trenches, living that lived experience of watching students and teachers stress levels. I was just thinking of this, this morning, that what is it about design and trauma?

And if you think of the body as a whole, the design piece of the school building is the skeleton. (Janet: hmm) And I think that’s, we have such an incredible opportunity to bridge Trauma-informed Care to inform design, and it’s really bringing in that common understanding and bringing everyone to that table, (Janet: Right), because it is complex.

Janet: It’s a really good point, Molly. Absolutely. And it is complex. In Trauma-informed Design, we talk a lot about understanding the individuals using the spaces and designers like to think that that is part of their programming, but really understanding what trauma is, and then with the lens of Trauma-informed Design and understanding each of the individuals in those particular spaces is so important.

Molly:  Yeah, I just, it was funny, before I came to the podcast this morning, I was actually in a school-wide, welcome back to school. (Janet: oh boy). And the director, actually, she was the Chief of Staff for the Oregon Department of Education, so state level (Janet: wow), came to speak to our school district and I wrote down a quote she said, and I wanted to share that because it just is so beautiful with the work that we’re trying to do.

She said: “Schools are sanctuaries where students feel safe, have a sense of belonging.” (Janet: right). And I think that is, that is exactly what we’re doing through Trauma-informed Care and Trauma-informed Design, is building that bridge so that we do create those school buildings that really are sanctuaries for our students and our staff to decrease those trauma stress levels.

Janet: Right. Thank you so much, Molly. You teed us up a little bit for the next section of what we would like to talk about and that is, that this particular episode of Inclusive Designers is really going to be about the tool, which is for K-through-12. It’s about schools, and trying to reduce those stress levels in schools. And how designers can help make that happen for, not only just students, but also for faculty and additional educators, or people in the education field.

So with that, we want to start talking a little bit more about the tool and what was the impetus for the tool. I know a lot of the answers, but I’m not going to keep talking the entire time. I know, I did one of my favorite things I like to do to any team is like, “Hey, I have an idea.” And the idea in this case was again, the American Society of Interior Designers Foundation was putting out this grant. And I thought we might be able to start moving the needle within Trauma-informed Design with the K-through-12 schools and creating this particular type of tool.

Davis, do you want to jump in and… (Davis: sure). you know, Christine, you can jump– both of you can jump in at any point in time, because I definitely came to the two of you, and I was like, we should do this.

Christine: I do want to jump in because this conversation reminds me of when you first approached me. You did exactly as you said. You came to me, and you said, “I have an idea.” (Janet: laughs).

And I’ll never forget, it was one of the hottest days of the year, and I was lucky enough to be in my pool on the phone with you. And I sat there, and I said, “okay, but I don’t understand what you’re telling me.” And you just kept saying, “well, there’s a grant and we should go for the grant.” And I said, “great, but what’s the idea?” And you kept saying, “we could do something for schools.” I said, “okay, but what?” And we keep mentioning the tool and I just, I feel like we might want to take a step back and tell people what we’re, what is this tool that we’re talking about.

Janet: I totally agree with you. Go ahead Christine. Knock it out of the park.

Christine: Well, I’ll do my best. (Janet: okay). So what we created was an actual tool that schools and designers can use, independently and together, to evaluate the physical structure of their school and their environment, both interior and exterior.

To identify changes that they could make or should make if they want to be able to reduce stress levels of the people who are in that school– so that’s student, staff, visitors. And really kind of give them a rating, like these are areas you should really pay attention to because they might be having an adverse effect on the people who are in your school.

And we embedded within that tool some explanation of different terms that we use and things like that, so that they can understand why we’re making certain recommendations. (Janet: right). And it can help them have conversations that were previously, possibly more challenging, because designers speak one language and educators speak seemingly another from time to time. (Janet: right, laughs). And we’re trying to give them the ability to make sure that they’re not talking past one another, but they’re talking in a way that they’re all on the same page.

Janet: Yeah, and you’re absolutely correct. And I think one of the things that made the tool so successful was the fact that it is a way to bridge the gap between designers and educators so that they’re speaking the same language.

I always find that there are educators who depend on the designers to tell them almost what they want, and designers think to themselves, “well, I know what you need.” And instead of actually having a complete conversation. So it’s a really important point. And yes, Molly, what would you like to say?

Molly: Well, I just wanted to add to that, that what’s really kind of our thought process was building that bridge between the designers who really understand spatial and interior design, exterior design, (Janet: right), with the educator who truly understands how the space is used, (Janet: correct), how students use it, how they use it, what is working and what’s not working.

But then also the administrators who now are the ones that are writing the checks who are really like, we do need a new school. So it’s bringing each of those voices to the table and it’s creating that unity rather than everybody in silos, it’s an opportunity, using the assessment tool as a way to really start having conversations about how do we really truly design and build a school that is Trauma-informed and is looking at all aspects, whether it’s an elementary school, a middle school, or a high school.

Janet: So I don’t know if Davis, do you want to kind of go and start talking a little bit about the impetus for the tool.

Davis: Sure! (Janet: Yeah). Well, there were so many seeds planted for this work before we penned the grant application. (Janet: oh my goodness), there’s so, so much background.

Janet: Well you, Christine, and I have been at this for a very long time. (Davis: yes, absolutely). Right, and so, that’s very much worth mentioning.

Davis: So the question is, you know, at what point did we say, ‘oh, it should be a tool for schools’ or even before, you know, how do we set it? There’s so much lead in time. some of the applied work that we did at the BAC with the middle school that we worked on, I feel like is a real solid seed that was planted (Janet: absolutely), yeah.

Janet: You and I both were working on that particular school in Dorchester, and that really started me down a path of really, I was just so annoyed. And I know it’s a poor section, but and it just bothered me how poorly the school was set up in terms of design.

Davis: Yeah, we just saw that when we toured the school and we got to know the staff, we didn’t have access to work directly with the kids at the time, (Janet: correct), but we saw ways to make design recommendations, but the ones that they did implement actually had a positive effect on those kids’ lives when they needed a moment to recognize that they were in a state of stress and they couldn’t learn and they should go see a counselor in a separate room, that they had a place to go, that they felt welcome, they felt safe, they could relax a little bit, they could, have an outlet to discharge their emotions and then they could return to class.

So that’s, for me, one of the most important origin stories for the TiD. We call it the TiD-Eval-K12 (Janet: mm-hmm). The Trauma-informed Design Evaluation Tool for K through 12. So when we were alerted that ASID Foundation had grants coming up. Yeah. Janet. I mean, you know, it was a bunch of ideas, (Janet: right), this tidal wave of need and (Janet: and passion), passion and what we love to do, and ‘hey, let’s do it.

It’s going to be, it’s, you know, all of it, all of the energy of ‘well, we have a way to help make some bridges here’. So, you know, I’m, I’m just thrilled with how well it’s been received (Janet: yeah), and how much more momentum it’s generating just by existing in the world at this point. And I know Christine’s eager with her passion and righteousness as well. (laughs).

Janet: I know. Well, this is where it does get very passionate. So my, my apologies in advance if we get a little raucous.

Davis: And I can jump in too with a little quick story of when I went to present on the tool at the EDRA Conference in Mexico City this past June. EDRA, which is the Environmental Design Research Association.

So, I was lucky enough to have my teenage daughter with me. And she, at the end of the talk said, “mom, all this time that you’ve been working on the tool,” and she’s sort of doing the shrug of the shoulders, “like, I didn’t really know what that meant, but now I can see that it’s just a bunch of papers, like a couple of papers and some questions” –  you know, she had this light bulb moment of, “oh, it’s, it’s accessible.”

And that was our point when we developed it, we wanted it to be accessible. (Janet: yes). People can have this PDF, 10 pages, something like that, with nice explanations. It simplifies things. In my mind, it’s a little bit of a shortcut to the conversation, but it’s also gives the room for really in-depth and nuanced conversations that really need to happen.

And along those lines, one of the audience members at this talk asked about, you know, have we validated it and checked it, and so forth. And that’s really important for design research (Janet: correct), and for research generally. (Janet: right).

But we really spent a lot of time when we were developing, saying every single school has its own personality (Janet: right). Right. Its own culture, (Janet: its own culture), its own geographic location, (Janet: right), its own history as a town. So we wanted to have the ribs of the work very clear, defining it with a lot of room for personalization by each set of folks working with it.

Janet: Yeah, and I just wanted to let our listeners know a couple of things, that when you went to EDRA, you picked up a CORE Award for the research that we did on this. So, CORE Award is ‘Certification of Research Excellence’ through EDRA. And both Christine and I have just gotten back from Los Angeles where we talked at ASID’s ‘Gather’. And we had a 90-minute conversation of not only about the tool, but the process that we went through to put the tool together.

And then just to let our listeners know that on the IDP— otherwise known as Inclusive Designers Podcast— website, “InclusiveDesigners.com” we will have links to a lot of this, the tool obviously, as well as a whole bunch of other information that gets brought up on this episode,

And then I wanted to also add to Davis’s point about the personalities, and as Molly had pointed out earlier, that it’s very kind of complex and that people are very diverse. But we have just found out that the tool will be used for the Uvalde Rob Elementary rebuild in Texas. And we could not be more humbled nor thrilled that they are using our tool in order to inform the new design building. So, yes, Molly, Molly’s like, “Yay!” And it is a ‘Yay!’ moment for sure. It’s a big deal. Christine, do you have something to add to that?

Christine: It just struck me because we knew that the tool was introduced to that community and that they had some conversations about it. But to have the community that is, you know, in the process of fundraising for the new school, to actually call it out and say, independently of the architect or us, to publicly say that this tool was helpful. (Janet: yeah).

It just really, really blew me away because it felt like what we wanted to come of this, which was a way to help the students who need it most, right? And to help the people who are most affected. (Janet: right). What better way to be able to help than to know that this tool was found useful by that community in particular. So it really, I, I’m getting ‘fer klempt’, I don’t know if you can hear it in my speech…

Janet: I was just going to say, I’m getting, I’m getting a little like, Yeah, it’s, it’s one of those things where we can get a little emotional over it and {we know that the main architectural firm there Huckabee, they’ve been putting in an incredible amount of work for the project itself.

And I know it was very emotional for them as well and obviously for the community.} And if we can just even play a small part in helping to heal that community, I couldn’t be more proud, and I know the rest of the team is as well. (Davis: yeah).

Is there anything else that we want to talk about the actual tool itself, you know, that was more of an overview. Do we want to maybe get into more of some of the nuances about the tool? So Davis, maybe you could tell us a little bit about how we started to design the tool, how did we go about that, besides the tremendous amount of hours. So we’ve gotten the grant. Now what?

Davis: Right. Exactly.

Janet: I remember thinking to myself, “yay, we got a grant. Like somebody wants to give us money for this research”. It was fabulous. And then, all of a sudden, I was like, oh my gosh, now what, what do we do? (Laughs).

Davis: Yeah, yeah. And so we knew kind of a ballpark vision we were aiming towards was, okay, make it accessible and have it be, all sets of people can understand it. (Janet: right). So I think in our minds eye, we had some domains that we were aiming towards, (Janet: yes), but we also knew it needed to be based on solid evidence, (Janet: right), and evidence that is wide reaching.

So I think the way we boiled it down was let’s get a better understanding of all of the frameworks that already are in existence for doing spatial evaluations (Janet: correct). And secondly, all of the frameworks and research that’s been done on Trauma-informed Care. (Janet: right).

And then we synthesized and sifted and merged those together. And then, that was kind of the theoretical foundation of it all, but I’m going to pass it over to one of my teammates to go on more, because there were many steps involved in getting us to our final results.

Janet: Right. But that was just in itself a very arduous process, if that’s my memory of it. I know that Christine and I spent an incredible amount of time. We already talked a little bit about SAMHSA, right? We started really kind of doing a lot of the empirical research that we wanted to do. I kept saying, I just want a very, very solid foundation, because our thinking was that as Trauma-informed Design Society, that we would be very capable at that point with that solid foundation to be able to start working with other communities and creating these other tools.

So, I know, Christine, please feel free to jump in because you and I, you know, it’s sort of where we started to really bond, our late-night hours, and going through hours of empirical research, and like I said, SAMHSA which we mentioned earlier. Go ahead.

Christine: That’s where I was going to jump in. It was really important to me that whatever we came up with fit well within this SAMHSA’s six key principles of a Trauma-informed Approach, because, you know they’ve been doing this work for nigh on 20 years trying to figure out the best way to work with people who’ve experienced .

And what they’ve come up with are that there are 6 key things that you need to weave into your approach. And they’re now just starting to recognize that some of that is literally the built environment. (Janet: yeah). So their 6 key principles are ‘safety’, ‘trustworthiness and transparency’, ‘peer support’, ‘collaboration mutuality’ and ‘empowerment, voice and choice’, all as one.

And then the final one we refer to as ‘having an equity lens’. They developed this before that language was common, and what they called it was ‘cultural, historical, and gender awareness.’ (Janet: right). And so what we literally did is we went through every single design framework that we found and every single, Trauma-informed Assessment for organizations (Janet: tools) And we mapped it to those 6 key principles. And we mapped it to our understanding of what a Trauma-informed Design approach would look like. And then we cross-referenced everything. (Molly: yeah), Molly, go right ahead.

Molly: Yeah, I just want to jump in, because while that was going on, at the same time, there’s a group of us looking at what are those design frames of references? What are those design tools, assessments that are out there? And there really weren’t a lot. So what we did, and then thinking about design terms and actually thinking of schools, that’s then how we kind of came together to look at, trying to figure out what those domains are and creating surveys that we could really understand when we go to talk to schools, their understanding of Trauma-informed Care. (Janet: Right).

And then maybe also those places in a school building that might’ve trigger— I hate to use the word trigger— or cause or increase stress levels, dysregulate students and teachers. So, I just wanted to add on to what Christine said.

Janet: Yeah, we were, and Davis feel free to also to jump in. There was a lot going on at that particular point in time as we were bringing together the tool, which also included getting schools involved. And now you got to remember, so some of these schools that we tried to get involved, they were happy to do it. I should add, they were wonderful. But they’re all trying to deal with the end of the pandemic or the end as we kind of knew it pandemic, and then, getting kids back into the classroom.

And we were up against a time limit, right? So, you know, here was the end of school and now they’re trying to figure out how to get these kids out of school, but also keep them safe from the last part of the big part of the pandemic. And then also trying very hard not to have their own nervous breakdowns about everything. And now we’re like, “Hey, we need a whole bunch of information from you.” So they were really terrific in giving us the information, which really included just a whole bunch of photos. Right? And then at some point we did have them talk to us about the photos and their floor plans that they provided for us. Right, is there anything else that I’m missing?

Christine: Yeah. Molly hit on it. We issued surveys that were two-fold. One was around their care practices. The other one was around the physical design of their school. (Janet: that’s right). And we anticipated and asked specific questions about certain areas of the school, (Janet: right), that we thought kids might be most dis-regulated in (Janet: dis-regulated, yeah).

And what we found out was, we were right about some of them, but there were others that came up to the surface. (Janet: yeah), So it was interesting because those survey results served as the basis for those conversations with the school to get to the bottom of, “well, why are you seeing this here?” and “why are you not seeing it where we thought you might.”

Janet: Right. And with that list, we also added entrances, we thought entrances were really important. It’s like the first portal that you walk through. And it’s also the like, first impressions, right? Does anybody want to add to that? (Davis: yeah). Go ahead.

Davis: That’s exactly right because, a lot of the times when design doesn’t work, people recognize that, and say, “oh man, this doesn’t work.” But a lot of times also just through environmental psychology understanding, they just become acclimatized to it, and they get used to it. And they’re not necessarily going to point it out and say, “oh, this is an issue.”

So this is why design research is so important because we can help make those connections for people (Janet: right), between what they’re experiencing subconsciously at, you know, less than a second, impressions are made. The symbolic communication that occurs from the spaces that we go into can really set the tone for the rest of the experience. (Janet: right). So that’s why we added entrances.

Janet: Yeah. For the listeners, you don’t realize we’re all nodding. And we also want to add, I’m just going to throw that out there as one of the co-founders of Trauma-informed Design Society, if you want to give us money for additional research, we’re always open for that as well. (laughs). So moving along…

Molly: Well I can jump in…

Janet: yeah, go ahead Molly.

Molly: Yeah, just the next phase after that before we even got to developing the assessment tool is, then we collected all this information from the schools, from the staff, the people involved, all the research.

Janet: And I just want to add that we also had an ‘IRB’ as well in place, which is an ‘Institutional Review Board’ approval for the work that we did. This wasn’t just us kind of going out there. We really wanted to make sure that this was a strong foundation that we were going to be researching. So we got an IRB because the research was really important to us and to make sure that it was done properly and well examined. Go ahead Molly.

Molly: Yeah, and now we created a visual because the next phase was to pull in our designers, (Janet: right). So, Christine can talk about this because she really helped develop those pictures and organizing them. And we created them, and we identified the spaces in the school and then we had photos from each school. Christine, you can talk a little more…

Christine: Yeah Molly, so one thing that we were faced with, and kind of outside of our control, was that we entered into this project not realizing that we would be trying to do essentially design assessments of these buildings in the middle of a pandemic when we couldn’t actually physically visit the buildings. (Janet: right). So we…

Janet:  … it was a little oversight on our part (both laugh).

Christine: The schools were just phenomenal. (Janet: they were). They really, they played ball. (Janet: they did). I mean, we had them scour and go into every nook and cranny of their school and take photographic evidence that we then had a massive amount of information from these schools as if we had been there ourselves. (Janet: right). And we realized that we wanted architectural input from people who are actively engaged in design work and familiar with the principles of Trauma-informed Design (Janet: right). And we needed to do this all remotely. And I don’t know who came up with the idea of Miro boards. (Janet: right, that was Molly?) Was it you, Molly?

Molly: Yeah. I think I really, because being an Occupational Therapist, I am such a visual person. I’m kind of this multi-sensory learner and I just realized— I did some coursework at University of Oregon with their Architectural program in Human Design— and architects are really good at using spatial tools. And so I learned a lot, and we weren’t familiar with it. We did have some support of a Boston Architectural student who also was familiar and had some background in Interior Design. And so she was able to say, “oh, well I’ve used this tool, this tool, this tool.” And then that’s kind of how it evolved.

Davis: Yeah, I heard your guy’s idea for let’s do this visually. And I thought, ‘oh, how about Miro board?” so…

Molly: …there you go. That’s it Davis.

Davis: Yeah. pull together the pieces. it’s a great tool (Janet: yeah) Yep.

Christine: So for anyone who’s not familiar, it’s essentially a platform, like a huge whiteboard on the computer that you can stick pictures on and put stickies. (Janet: right). And so it was like having a virtual working space that we could all share. (Janet: right). And what we did is put together a template for each area that we were looking at.

Janet: So we’ve got areas like, entrances as we talked about, hallways, gymnasiums, cafeterias, classrooms, (Molly: bathrooms), bathrooms, (Christine: outdoor spaces), and outdoor spaces. I think that that was pretty much it, right? (yeah).

Christine: And so we had a template for each area, and each school had their own portion of the board all de-identified. And then we had a selection of architects and designers who were going to review these photos for us and provide us feedback. And so each one of them needed their own board.

Janet: Right, Christine, I don’t mean to interrupt, but here I am. So what is I think is important to recognize… one of the things is that we asked those designers because we felt like they understood what trauma is. And we had some idea that they understood what we were looking for and asking for that particular help, that that was an important piece. And, and we got a lot of designers to help us sift through all of this tons of information.

Christine: Yes, absolutely. I did want to put in a plug here though, for the fact that I don’t know that we ever would’ve gotten those boards ready in the timeline we had, if it wasn’t for the help of our friends at Huckabee who stepped in and said, “You know what? We will help you put these boards together” because each one of them needed their own copy of a board. (Janet: yeah). “We will help you put these together and we will step out of the assessment piece, but we’ll help you also when you get all the results, sort through it.”

So, we were so lucky to have their assistance. (Janet: absolutely). And the boards, I would say magically appeared, (laughs). (Janet: they did!). But I know that was a lot of work that was put in. (Janet: right). And what we asked for was the architects and designers to give us up to 3 ideas for each area that might be helpful to lowering student stress levels; 3 things that might be harmful, and any other suggestions or questions that they might have.

Janet: Right, it was helps; hurts; and questions or comments. I think that that was how we put it together. (Molly: yeah). Right.

Christine: And then all of that information from each of those participants got entered into a spreadsheet and we looked for common themes.

Janet: Right. Yeah. And that, like you said, that was a bit of a bear. So to comb through and then also look for those common themes on those Miro boards and then put it all together. Then at that point, we started to create the tool. So, Molly, did you want to talk about the different domains? You want to kick that off?

Molly: Yeah sure. So then the process from taking all that information, so we have spreadsheets and oodles and oodles and oodles of information. And the first part of it was really to define the domains and bridging Trauma-informed Care with design.

And then I think a big important piece that we all agreed on was developing vocabulary. (Janet: right). So not just what the domains are, but really defining what that domain is, to have clear language that now we’re building that bridge through a common language to be able for designers in school and administrators or whoever uses this tool. They can take that, understand what we’re talking about, and come together and understand it together. So with that being said, the domains we came up with, and I’m just going to kind of list them…

Janet: You should rattle them off, right? People could still go to inclusivedesigners.com, it will be at the top, the link for the tool. So go ahead Molly. Thank you.

Molly: Okay, so: “safety, accessibility, biophilia and connection to nature, inclusion, wayfinding, visibility, comfort and aesthetics, lighting, choice and flexibility, acoustics, community and culture, and movement and play.”

Janet: Molly, can you give us an example of one of the questions in one of the domains? (Molly: okay). Let’s go with safety. What are a couple of examples under that particular domain?

Molly: Okay, yes. Well, I kind of just want to read it just to give context then to the questions. (Janet: sure). So safety, “the domain of safety is the highest priority in implementing a Trauma-informed Approach and is typically measured by how students and staff fill within the space. That’s just the first sentence. (Janet: perfect).

A typical question. The first question is: “is there adequate lighting in the parking lot? Are there lights along paths and entrances of the school? Are there security cameras? Does your school have ample storage?”

So what it was is, we took from the information from designers, from teachers, from what safety is, and maybe lighting— we need visibility, we need to see and feel safe as we go into a space, especially at night. So the questions are kind of all developing, whoever’s filling it out to really start thinking about these different areas and how safety could be a piece of that.

Janet: Davis? Do you have anything to add? (Christine: I just wanted…) Go ahead, Christine.

Christine: I just wanted to pipe up and say, and when we’re thinking of safety, it’s important to know that we’re talking about emotional and physical safety. (Janet: yes). So there’ll be questions in there that you might not think are relative to a safe building, but this is more than just the building. It’s how the building makes a person feel. (Janet: correct).

So that could be things like: are there places where you could have private conversations, which you wouldn’t really think of that as safety, but that would be something that we would think of safety under this approach.

Davis: Right. That’s exactly what I was going to add, so well done.

Christine: Oh, sorry Davis, (laughs).

Davis: I’m happy for you to describe and give a good example of what that would look like. Absolutely. I mean, yes, we might think of safety as well, “Let’s have lots of walls and barriers and, and metal detectors and ways to help people feel like they’re psychologically safe when perhaps actually that’s counter (Janet: counterproductive), to having, “look, we know each other, we belong, we’re welcome here, we’re safe to see each other and to know what’s going on, who is expected here and why, you know, if there’s a stranger coming in.

Then those ‘eyes on the street’— that’s the design terminology that shows that being familiar with and caring about your work and caring about coming to your place and having a sense of place. You know, “this is my place. I’m proud of coming here. I like coming here.” That’s deep, deep safety from my point of view and I think from the teams as well. (Janet: yeah).

Christine: I love that you brought up the cameras.

Janet: I was just going to say, I was like, can we talk about the cameras.

Christine: (laughs)

Janet: I was thinking in my head, I’m like, ‘oh, should I bring up the cameras?’ because Christine, we’ve had this conversation quite a bit. Alright. Just as a background, I come from Brooklyn, New York. So for me, a well-lit area with cameras and stuff is not a bad thing. Like you feel like there’s some sort of sense of security knowing that they’re there. But Christine, take it away.

Christine: Yeah, I have a very different feeling. Cameras make me feel like I’m in a place that might not be safe. My experience is built on the fact that I mostly encounter cameras in environments where they’re used for surveillance. You know, I work in prisons, so that’s one example. I also have traveled to countries where it was used to surveil their population.

And so for me, cameras make me feel unsafe. And so we included it in the tool, and we actually had this question when we were presenting in LA at the Gather Conference. If you look at it, it’s on there, but it doesn’t matter if you answer yes or no. The score is a zero because we just want to have that conversation. (Janet: yeah).

Molly: And I, I love that you said to have that conversation, Christine, because I think that’s what’s so important to understand. Everyone coming to the table brings their own perception. (Janet: right). And so what triggers you or what brings up your stress may not with me, but it’s because of our childhood experiences or it’s because of those adverse responses and situations that we have. We come uniquely to that, and that’s what I hope that this tool does, is that it really, it’s an assessment. It’s just assessing, it’s bringing that conversation to the table, so we talk about it before the design of it starts. What are those areas.

And I think teachers, I mean, I’m putting a plug to advocate for teachers and staff because what I’m seeing, being in the experience of brand-new buildings, they’re beautiful. (Janet: right). But they continually don’t meet the needs of teachers and students. And so we continue to have adverse responses to environments. (Janet: right). And what I’m noticing is now in, well, at least in Oregon, it feels cookie cutter. The schools are still these cookie cutter structures, and that’s where Trauma-informed Design can create…

Janet: …can make a difference.

Molly: Can make a huge difference. (Janet: right). And meet elementary kids where they are and you know, they’re not all the same. (Janet: right). So, I just wanted to just say ‘yes, okay’… that about the cameras or any of these other questions, you might be wondering why is that on there? Well, it’s on there because we need to bring those conversations to the table.

Janet: Correct. Yeah.

Christine: Molly, I’d love to highlight something that you said, because you said it and then moved on, but it’s so important that these conversations should happen before design.

Janet: And that’s a really good point. Right.

Christine: … because so often we get brought in after, (Janet: after), right after the plans are already set. And now they’re trying to see, “oh, is it just, you know, colors or finishes or the furnishing we’ve put in?” (Janet: right). And we keep saying “no, it’s so much deeper than that, there’s so many things about the actual design that can be impactful.” So it needs to be at the front end. (J: absolutely).

Davis: And along those same lines, if we think about this with various scales. So for example, my sister-in-law just became a third-grade teacher. And she has intuitive ideas of how she wants to set up her classroom, right? But when we were together and I said, “let’s take a look at this tool I just worked on, it’s got a lot of things you might want to know about. (Janet: right).

So it validates the ideas that she already had and gives her justification for spending the time she wanted to spend to go into her single classroom. She’s not in the position to change her entire school, but yet she can change her own space in her own classroom for her students in a way that when they first walk in, they can feel respect and calm, and they are ready to, you know, be greeted and have a good learning experience for the year. (Janet: right).

So it’s, you know, looking at it from various scales I think helps people understand who this is for and how they can just pick it up and start with where they’re at, right? And build it from there if there’s momentum and capacity, and sure, let’s spread this to the entire district. Right? And you know, beyond, as we’ve seen now with people interested outside of elementary and high So, yeah, there’s that.

Janet: Yeah. (Davis: laughs). Yeah. Davis, you totally teed us up for the, the next part. And where are we going with this? Like we know that, like I said, creating that strong foundation, we can start applying that to other communities, other marginalized communities, and other types of social services. And we even see it as well as for aging populations as well as within the home, within offices. I mean, we see Trauma-informed Design applications for just about anything a designer could possibly touch.

Christine: You’ve mentioned marginalized communities, but we haven’t yet talked about why that’s important. Marginalized communities being more at risk for having increased levels for having experienced trauma. (Janet: yeah, of course, of course).

And like we didn’t at all, and I know why, because of time and relevance right now, but we didn’t talk at all about like the racial disparities or any of that. (Janet: right). Or even that experiencing racism as a form of trauma or, you know, so it all depends on how much we want to get into.

Janet: You know, Christine, we can talk at some point about that. I will assume, that Inclusive Designers Podcast will at some point have additional Trauma-informed Design episodes where we are really kind of also focused on some of the other work that we’re doing, including marginalized communities and the trauma of things like racism. (Christine: mm-hmm),

So it’s definitely on the agenda and we will talk about that. But for the moment, talking about the tool and keeping the tool in mind. And again, all this information will be on ‘inclusivedesigners.com’ for all the listeners to go and get engaged and start looking at and starting to understand Trauma-informed Design better. (Christine: mm-hmm), (Molly: yeah).

We talked about the tool, but I think for right now, talking about the future of what this tool has afforded us, and we’d start talking about what’s next. Maybe we could kind of go around the circle here, or Molly can start. Molly has her hand up. So go ahead Molly.

Molly: Okay, so where do we go next? This is a tool that we’re hoping, it’s an assessment tool, so it could be used as Janet said, for any of these spaces.

Janet: It is true. Davis- Any thoughts?

Davis: Yeah. I’m excited to, to see how the more gathering of feedback from and people using the tool can help us iterate. As designers, we want to iterate and develop more understanding of the kinds of positive impacts that will happen when these assessment design recommendations are put into practice. And they show up in the schools. What are the outcomes? We want to measure some outcomes. I’m really excited to see that part of the work unfold.

Janet: Right. And you bring up a really good point, Davis, that we do want to start talking to schools using the tool— the TiD Evaluation, K-through-12 Tool— because we want to start using that in other forms and also getting that information that speaks to us, that we can then push back out to other designers and say, this is what’s working and this is what’s working well.

And that is an important piece because as we all know, there’s still not a lot of information out there. This is all still relatively new and Trauma-informed Design Society is the leader, a global leader in fact, in this particular area. And our next steps are, we know that universities are coming up. It seemed like a natural progression that we’re now going to start working on creating tools for the universities. And so, it’s just going to really kind of mushroom from there. Christine, did you want to jump in?

Christine: Yeah. I see things all the time where people are saying, well, “that’s fine for schools,” or “that’s fine for this community or that community, but I’m doing just plain old residential design,” or “I’m just doing commercial design and anyone could be in this building. So I don’t really need Trauma-informed Design.” And I keep pointing out the prevalence of trauma in our society is such that (Janet: it’s huge). Just about everyone has probably experienced trauma in their lives, may be impacted by it.

And so why wouldn’t we do it for every design (Janet: correct), right? (Janet: yeah). Absolutely we see it in certain projects more common. You know, we see it in the human services fields. We see it in organizations that provide services to individuals. We see it, asks for it, in residential design for the unhoused. We’re starting to see it in courthouses. (Janet: yes). We’re starting to see requests for it in institutions that treat individuals, whether it be for regular medical care or for mental health. (Janet: right).

And as you and I always like to point out, the last frontier, the place the most marginalized, the place where people usually just don’t feel like they want to spend the money or that people in the community needs it, is really correctional facilities. (Janet: right). And the people where a segment of our society just wants to throw away the key. And yet we’re seeing it there, (Janet: right). It’s starting. So we need to make sure that what we’re doing is actually effective.

Janet: Right, yes Molly…

Molly: And I just want to add that just as we are all different individuals for different parts of life, and we have come together at the table to create this tool, this assessment tool. We all bring our knowledge. It’s almost like we’re one body, we’re uniting, but we all have different parts. And that’s exactly how design is. And I just go back to thinking again from my OT brain, if we think of development, the foundation, what is the foundation of any building? It starts out with the idea, the vision, and then the process of design.

And we want all voices at the table. And I feel like this tool is the beginning of really showing that we’re trying to break down barriers and silos within all the people involved in creating these spaces that support our communities. And that if we come together and we know we want things in, that’s a structure that then can dictate what and how users use it.

Janet: Davis, do you want to add anything?

Davis: I do have one more thing that I’ve been thinking about quite a bit is the use of the word design itself. Because if a person were to say be interested in what is Trauma-informed Design, and they Google searched it, they might find a whole other world of Trauma-informed Design that isn’t specifically talking about physical spatial built environments. (Janet: right).

And that world is our friend. We’re, you know, we’re neighbors with them that we’re in the same room at kind of the same table. But so those folks are doing incredible work as far as how processes are designed, and including the voices of social workers who are right here doing the lived experience work (Janet: right).

You know, this is important to us when we gather evidence as well, it’s really honoring people’s actual experiences and knowing that there’s this beautiful overlay between the different folks and groups of individuals doing this kind of work. (Janet: right).

So I don’t want anyone to feel confused if they’re like, “wait, this is Trauma-informed Design. I’m an Architect, or an Interior Designer, this is my jam.” versus “what are those folks over there doing? Writing about it and using the same phrase.” It’s, it’s compatible. (Janet: yeah). Yeah.

Janet:  I would argue that there are a lot of Architects now that are starting to use the phrase, Trauma-informed Design that do not have the framework that we use. And it is something that is a little concerning to me, but it is something that I think once we all start getting on the same page, that we will be better able to understand.

But I definitely think that there’s certain pieces where if I hear somebody talking about Trauma-informed Design and they aren’t saying some particular types of words that we know are so, so important within this conversation. And if they’re not being brought up, I know that they don’t know what they’re talking about.

Christine: Absolutely.

Davis: Yes, yes, absolutely. It is important to be really careful about what people are claiming if they don’t have an understanding of the human physiological responses to stress, for instance, (Janet: right, right). Then I might keep looking until I found a firm or a team who really understood what trauma is from all levels. Yeah, yeah.

Christine: Great point…they still need to learn. We’re hoping that the tool can help them gain a better understanding.

Janet: Right. We can usually tell when a designer doesn’t understand what Trauma-informed Design is by the language that they use, or the lack of language that they use. (Molly: yeah). And I know one of the benefits of looking at the website– at TraumaInformedDesign.org – and looking at our society and the work that we’re trying to do, they will benefit and have a clearer understanding of what Trauma-informed Design is, or as we’d like to call it, around the office, TiD. And you know, and that’s in part what the tool is about.

Christine: We hope to be a resource to them.

Janet: Right. Yeah.

Molly: And you know Janet, that’s exactly why we did this is, it’s that language, right? It’s the knowledge by creating those domains, we’re trying to help build that knowledge base and understanding of what trauma is, but also what design is. So we’re trying to bridge it. Right?

Janet: Right. Yeah. The important piece of this ultimately is, is that we want people to know that they can get information. If they have questions about Trauma-informed Design, please reach out to the Trauma-informed Design Society. You can do so at TraumainformedDesign.org. And I get requests every day for different people, for different things. So if you have any questions, just let us know.

Davis: Yes.

Janet: You can go to InclusiveDesigners.com to go look up the tool and find out all the information that we’ve kind of provided here. So as we wrap up this episode of Inclusive Designers, is there anything else you guys want to add about the process or the tool or all the research we’ve done? Or maybe even just what do you want to talk about for the future? I’ll just kind of go around the studio. I don’t know if, Davis, you might want to start?

Davis: I am so, so grateful for all of the incredible work that the designers, the schools, and ourselves that we were able to come together in this way. It’s like I’ve mentioned before, it’s the ultimate, let’s take the indignation of the way the planet is right now and put it into an optimistic, forward facing, solution finding applied, uh, project. So I’m just delighted and appreciative every day for the work we do.

Janet: Thank you Davis… Molly?

Molly: I think I just want to, like what Davis said, just, I have this huge sense of gratitude that we find our people and we can all come together and we can all talk about this and we all get it, but it’s collectively coming together and really being able to empower each one of us and those that are different than us to maybe start to embrace another way of thinking and to blend it with theirs. (Janet: right).

I think, isn’t that the power of knowledge and learning? And we’re just bringing a tool that we collectively came together from a lot of voices, and we try to synthesize it, but it doesn’t mean it stops there. It means we do appreciate your feedback and that continues to grow this work.  So I just want to thank, thank everyone.

Janet: Right. A good point, Molly, to mention we do want your feedback. We want to hear from you. And so with that, Christine, final thoughts.

Christine: How am I supposed to follow them? They’re both so great at summing up their experience.

Janet: I know. We could just wrap it up. It’s all good. (laughs).

Christine: I come to this as a personal passion to spread a new way of interacting with one another and interacting with our environment. And I just feel like we all, each of us, have the power to improve someone’s day and then another day, and then another day and eventually their lives.

And it’s such a mind-blowing thing when you understand interactions from this perspective of understanding how trauma can impact a person’s behavior. And I just feel like if more people understood that and understood how it impacts themselves and others, we would have a much different society.

So please just don’t be afraid of the word trauma. (Janet: yeah). Don’t be afraid of the concept that we’re basing something in trauma (Janet: right), or that understanding. It’s all about healing together in relationship. (Janet: yeah).

And thank you, thank you for those people who trust us with their funds to do this great research and to find ways that we can help spread it, that simplify it and make it accessible to others. And if there’s anyone out there who’s looking for something and feels compelled to help us for do more,

Janet: (laughs) something to fund…

Christine: You have the power, as I just said…

Janet: (laughs) we’re always open to ideas…

Christine: it’s all about feeling and being empowered. You have the power to further this research.

Janet: Thank you. And thank you everyone for spending the time, both our listeners and also for the panel today; Dr. Davis Hart, Christine Cowart, Molly Pierce. It’s been an incredible opportunity to work with such smart, thoughtful, caring individuals who are designers or brilliant thinkers and researchers. And I have grown so much as a result of having worked on this particular project, and it’s something that I am extremely proud of, and I am extremely just elated to have been a part of.

And if we can just even just change one school and make some sort of impression. Of course, we like to think it would be for everybody and for every school, but at the end of the day, I think we really, I mean, I know we’ve done an incredible job and I think we’ve really kind of changed and pushed the needle forward.

And so I am forever grateful for being a part of this team. And I know, I know how hard we worked, and I think it shows. And I think that that will also help to create a better foundation for all the other work that we’re planning on doing.

So with that, I just want to let our listeners know that we will have all that information again on our website, InclusiveDesigners.com, and that, you know, reach out to Trauma Informed Design Society at: TraumainformedDesign.org – all one word– if you have any questions for us. With that, I think we’ll end it for the day. Thank you so much. Thank you for joining us today. Bye guys.

Christine: Bye.

Davis: Bye everyone.

Molly: Bye.

(Music / Outro)

Carolyn: That was a great overview of how the TiD-Eval-k-12 Tool shaped up.

Janet: I’m so proud of my team and the hard work we put into this tool. And how it will ultimately change the way we design for the built environment for the future. I mean, I didn’t know when I said to these guys “I have an idea” that it would become this incredible award-winning tool that is just taking off and is going to be applied across many different areas in any kind of piece of built environment. It’s really kind of great.

Carolyn: So I’m now realizing that I’m not the only one you say “hey, I have an idea” to.

Janet: No, in fact I think they all get a bit nervous when I say, “I have an idea”. Christine now actually says it’s the four scariest words she hears coming out of my mouth is “I have an idea.” It usually means more work for everybody.

Carolyn: Well I’ll say, don’t stop because your “I have an idea” to me led to us starting this podcast. And we encourage others to do so too, because it’s that kind of brainstorming that leads to new advances and benefits us all.

Janet: So true, we are so very proud of the work we are doing and how well received it is by the design AND school communities. We could not be more thrilled at the outcome. Sometimes I do have a few good ideas.

Carolyn: Yes, you do. And we should mention that this tool that you and your colleagues developed is really starting to catch on. I think you may have mentioned, it’s now being explored around the world.

Janet: Yes, and we’re now looking to expand this version into studying universities, here and abroad, where we can start applying our tool to higher education. It’s really quite amazing.

We could have never imagined when I said to this incredible group of core researchers that we should apply for this ASID– American Society of Interior Designers Foundation Grant, that so many places would be interested in adapting it for their purposes in ALL of their universities, as well as using the existing tool for their own version of K-through-12 grades.

I think I can speak for everyone on this panel that it goes beyond our wildest dreams, that this tool we created will to continue to expand. We have big plans for it. Or at least I do! (laughs)

Carolyn: And when you do, we’ll get everyone back together and do an episode about that. But for now, we should probably wrap up this one, don’t you think?

Janet: I do. A big thank you to our panel to Davis, Christine, and Molly for joining us today. And ‘thanks’ to all of you as well for listening.

Carolyn: Along with all the regular places you get your podcasts— which now includes Pandora to replace the now defunct Stitcher, you can also find us on YouTube as, you guessed it again, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon button, or the link to our GoFundMe page.

Janet: Yes, please do. And let us know if you have any questions or suggestions for topics you think we should be covering in upcoming shows!

Carolyn: And as our motto says: ’Stay Well…and Stay Well Informed’

As always, thank you for stopping by.

Janet: Yes, thanks again. We’ll see you next time.

(Music up and out)

By: Janet Roche & Carolyn Robbins

Inclusive Designers Podcast: Ed Warner of Motionspot joins IDP to explore the need for inclusive design that is both functional and beautiful… not only in the home, but in hotels, the workplace and even for the late Queen Elizabeth’s palace! Ed shares some great examples of how Motionspot is raising the bar beyond the minimum required standards to design environments for people with a range of physical, cognitive, sensory needs— including neurodiversity. We also discuss the ‘Design Crimes’ being made and how to solve them!

Guest: Ed Warner-  is co-founder of Motionspot, a global firm based in the UK that focuses on creating accessible spaces in the home, the workplace, and hotels. They also started the company ‘Fine and Able’ to take what they learned at Motionspot and use it to provide the best products for a wide range of conditions and needs.

“I’m a big believer that if you get the environment right for people,

Ed Warner- contact: [email protected]

– References: 

Creating Functional Spaces & Solving Design Crimes!

(Music / Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music / Intro)

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: and I am your moderator, Carolyn Robbins…

Janet: Carolyn, we have a great show to share with everyone today,

Carolyn: … and once again, we are going global!

Janet: Yes we are!

Carolyn: We’ve got a smart…

Janet: … and witty!

Carolyn: … and generally wonderful guest from the other side of the so-called pond from us in the US… Ed Warner from Motionspot in the UK.

Janet: Motionspot has it all dialed in. I am excited about the work they are doing. Creating accessible spaces in the home, the workplace, and in hotels. And we even discuss The Queen! —I never thought I would be discussing The Queen and Design on the same podcast, but here we are!

Carolyn:  Ed even said the accessible design work for the Queen was a “step change” in the UK, helping to alter the mindset in the industry.

Janet: Uh huh. We also discuss the ‘design crimes’ being made— I love that term — and how to solve them. Ed will share some great examples of how Motionspot is raising the bar beyond the minimum required standards to design environments for people with a range of physical, cognitive, sensory needs— including neurodiversity.

Carolyn: But first, let me tell you a little more about Ed Warner. He co-founded the inclusive design studio Motionspot with his friend James Taylor…

Janet: (chuckles) … and FYI not the American folk superstar.

Carolyn: Nope. (Janet: Nope, laughs). So true. And what started as a personal quest to help James adapt his home after an accident left him paralyzed, led them to start their own company to design spaces that are accessible, inclusive, and beautiful. Motionspot is now an award-winning industry leader in inclusive design. They are based in the UK but work on projects around the globe.

Janet:  Including here in the US… it’s so impressive. We are very excited to have Ed on the show and could go on and on about him, but maybe it’s time to let him speak for himself, don’t you think, Carolyn?

Carolyn: Yes I do! And with that, here is our interview with Ed Warner… co-founder of Motionspot, creative visionary and inclusive trailblazer.

(Music / Interview)

Janet: Hello and welcome, Ed Warner from ‘Motionspot’ to Inclusive Designers Podcast. How are you today?

Ed: Hello, Janet. I’m really well thanks. Great to be here.

Janet: And you are calling in today from the UK, correct?

Ed: That’s right. I’m calling in today from my home studio in West London.

Janet: Oh, very nice. Well, welcome. I had found you in the magazine ‘Metropolis’ a little while ago. And I felt like your philosophy and Motionspots’ philosophy really was along the same lines on how I approach my inclusive designing. And I thought it would be interesting to talk to you about how you got started, your philosophy, Motionspots’ philosophy. And just to kind of give our listeners an opportunity to really hear the importance of having maybe even an inclusive bathroom within your own home, even if you’re not in a wheelchair.

Ed: Sure, uh well, Motionspot is an inclusive design business based in the UK but working internationally. I set the business up over 10-years ago now after the personal experience of an old school friend of mine and our co-founder James Taylor, who experienced a spinal cord injury in a diving accident, age 25.

He spent 8-months in a spinal injury unit in the UK and then returned to his home in South London as a wheelchair user to live his life as independently as possible. He returned home to a flat that was a beautiful home but was quite inaccessible to meet his needs. And he had a range of specialists come around and make adaptations for him.

I happened to have dinner with him in 2011. And he said to me over dinner every morning I wake up and I’m reminded of my condition because of the products around me. (Janet: Huh). And I looked at his home, and the home was, sort of resembling more like a clinical care home than his own home, full of so many products that tended to be sort of synonymous with aging and disability (Janet: Right).

And I’m a big believer that if you get the environment right for people, you can really positively impact cognitive and physical health. So I did that stupid thing that friends tend to do and said, oh, I’ll help you find some decent products. They must be out there. (Janet: laughs). And realized there was, there was very little on the market in 2011. So that was where Motionspot started.

Janet: That’s a really terrific story. And you’re so right about the cognitive and physical health of somebody. I talk frequently about my dad. He’s 87, so I’ve been helping him put in beautiful grab bars and ways to approach the bathroom that he has to make it more accessible for him at 87. And that includes for him to feel more comfortable, right? Like that he doesn’t think that he’s going to slip, or he is going to fall, right? So there’s certain things that I’ve helped him with.

But the reason why I bring that up is, is that he actually used the word disabled. Like, well, now I’m disabled. And even just those grab bars, and even though they’re beautiful, I mean, they’re the chrome that he loves, they’ve got designs on them. They look like just handles that you would have on your shower door anyways. But he is reminded of the fact that they are indeed grab bars, right?

But I think what’s interesting, like what you just said, is that if we can keep doing more beautiful work, like the work that you’re doing, I think it helps people to age in place, age in place comfortably.

And not sit there and be reminded that maybe they’re not as spry as they used to be, or maybe they are in some cases truly disabled. So, kudos to you. So, yeah, do you want to add anything with that?

Ed: Absolutely. Because I fully agree with the experience that your father has had. And I mean, that was what prompted us to start our business. It was to see how we could design really beautiful spaces that happened to be accessible and inclusive. And that very much started in the home because that was based on James’ experience. And we quite quickly built out a business that predominantly focused around accessible bathrooms for people in their own homes, because it’s the bathroom where so many disabled people and older people want the greatest independence. (Janet: Right).

It’s also the bathroom where the biggest ‘Design Crimes’ tend to happen. (Janet: ‘Design Crimes’, chuckles). But as our business has grown, we’ve expanded out into homes as well as commercial areas, helping to design really beautiful, inclusive workplaces and hotels, as well as housing, predominantly, housing for older people in retirement.

Janet: Yeah, we can talk all day about the failures of hotels, but I love that word ‘Design Crimes’ and you’re absolutely correct. My dads’ bathroom, I mean, it was done 25-years ago, and he didn’t need anything at that time, but let me just point out that they also didn’t put any places for towels, like a hook for a towel, like to come out of your shower.

I mean, it’s a beautiful bathroom, do not get me wrong. It is top of the line for where it was at that point, but it is definitely… I was so floored when I was like, well, where do you put your towels? He’s like, well, they’re over there by the toilet. But the shower is over on the other side of the room! So you’re absolutely, ‘Design Crimes’, I’m going to steal that from you.

Ed: Please do. Please do. Please, please use it. I mean, that experience is, I’m nodding because we come across that all the time. The default position around design for disability is designed for function and whoever comes into a home will design for function by putting some grab bars up and maybe putting in a roll-in shower floor, for example. But actually, designing for function doesn’t design for functionality. (Janet: Right).

So your point about missing robe hooks or towel radiators that keep the room warm, but actually potentially scald exposed skin. You know, the functionality of these bathrooms and other spaces needs thought.

And there’s got to be a much greater understanding that we shouldn’t just design for function. We should design for aesthetics as well as function. And you know, our big belief is, our design principles are shaped by the people who are ultimately using these spaces.

So, you know, we’ve got a brilliant, brilliant design team. Many of whom have got the lived experience of disability themselves, but actually, we really believe in evidence-based design thinking. (Janet: Right). So for us, we run so many focus groups with people with the lived experience of disability, or whatever the protected characteristic is, to get their feedback around what works and what doesn’t work within spaces.

And that’s what’s really exciting about our business. And also where the industry is moving. We are learning all the time as to how to make things better. The more we do and the more we speak to people.

Janet: Yeah. What you’re saying to me is always very exciting. Again, I recognized really early when I was reading that article that our philosophy is really lined up, and you’re absolutely right. Letting our listeners know that using evidence-based design and that this is the way that we should be designing anyways, and it should just become normalized. So, we’ll have all that information on our website, inclusive designers.com.

But I just want to back up just a little bit– how did you get started? So you said 10-years ago, you know, this wasn’t something that you came out of school with your friend James Taylor going, you know, like let’s figure this out, or that you had design background? I’m, I’m not quite sure, can you talk to me a little bit about your journey?

Ed: Yeah, I’m not a designer by training. So my background is in sales and marketing roles for a number of big food and drinks manufacturers. So I had good experience of development of product. And also good experience of understanding customer need, and fitting the product to customer need, and managing supply chain to get those products in front of customers.

But I’ve always been really passionate about design in my personal life. I’m fascinated by the impact that design has on people. And it was the insight that James gave me that really kind of opened my eyes to think actually, “Why? Why is this happening for him?”

And it’s not just him, that this is happening to… there are millions of people who are experiencing some form of challenge within spaces, whether that be in the home or outside of the home. And those individuals don’t want to be seen any differently. They don’t want to be treated any differently. They don’t want different options. They just want a range of designs and products that look great, but also work for them. So that was how I got into it.

And in the very first stages of building the business plan, it was all about, the usual thing with business plans, exploring the market, you know, how big is the market? (Janet: Right). And it became very clear, very quickly that this is a massive (Janet: Massive) market we’re talking about (Janet: It’s huge, laughs), and those numbers keep increasing. And I’m sure you’ve had a number of guests on your podcast talk already about the size of the market. (Janet: Yeah).

I then looked at the challenges that people were facing in that market. I went to speak to quite a range of manufacturers in this space in the UK, back in 2011. And a number of them said, “you are mad.” No one wants to pay for good design because these manufacturers were free issuing equipment through the National Health Service that does put in some adaptations free of charge to residents in the UK, but also housing associations that were providing these adaptations at very low cost. And the manufacturers themselves didn’t have to innovate to sell those products. (Janet: Right).

And I went to some trade shows in the UK, and they were just all really depressing trade shows. (Janet: Right). You’d walk in and it would be depressing equipment in, you know, finishes of light blue or light gray, and it just felt like I was in a hospital rather than in, in somebody’s home. (Janet: laughs).

And I got on a plane, and I went to Scandinavia and went to some trade shows in Scandinavia. And I don’t know if you’ve traveled to Scandinavia in terms of your work in design,

Janet: Not in terms of my work, because again, it’s relatively new for me. but I was getting ready to go to Scandinavia because one of places that they also have, they have like villages for people with dementia. That fascinates me. They have it all dialed in. I mean, they really do.

Ed: They do. And what they think about, Scandinavians, and this is a broad generalization, but is mostly true, is (Janet: Sure), is they think about design from the outset. And they think about design from a universal perspective and actually this is just good design for everyone. This isn’t an accessible space versus a non-accessible space. This is just about designing great spaces that look right for everyone. (Janet: Right).

So it was that again, inspired me that it could happen (Janet: Yeah), and came back to the UK, and initially in 2012, put a very small team of people together that included an interior designer, an occupational therapist who brought the skillset as to what someone required, if they had a specific condition, (Janet: Brilliant), and a really good builder, contractor, (Janet: Yup), and we started fitting out really beautiful, accessible bathrooms with that small team.

And that has since grown to, you know, we’re a team of 24, as I said, based out of a London design studio, but doing work across UK and internationally. So that’s how we started.

Janet: Yeah. Your story is quite fascinating that you also, I mean, you’re not just talking the talk, right? You’re also walking the walk. You have people who are on your staff who have different types of abilities. And so you get a very unique perspective with that as well, right?

Ed: Yeah. It’s really important to us from the outset is to get different perspectives into the business and help shaping the design principles and products. And that will continue as we grow. And we are really keen to involve greater numbers of people, whether they’re actually working in our business, or collaborating with us to give feedback to look at how we can further kind of improve our design principles and ultimately the design of our client.

Janet: Right. Yeah. We just did a podcast with Sour, and we talk about the idea of co-design and how important that process is, especially within this particular field. Right? So it’s important for us to keep that open. And I really applaud you for having had all the boxes checked. You know, you had the designer, the occupational therapist, you had the contractor. And so putting that team together I think has really helped to push your success.

So switching gears a little bit, so let’s talk a little bit about what the work is you are doing in the United States. I know you’re very excited about it. And the products that you’re providing for us. And I don’t want to sound ignorant here because I know the answer, but I want you to answer it. Like, is there any difference between the products that you have to have in the UK versus the products that you would have in the United States, you want to talk about that?

Ed: It’s a good question. There are some differences in product selection in those two markets. Most notably because of the ADA standards that you have in the states have some similarities with the standards in the UK and Europe, but there are some notable differences.

The work that we’ve been doing to date in the US is very much focused around design of inclusive workplaces. So as you know the ADA standards are very clear in the US. They’re very, you know, rigorous in the way that they’re both implemented and there are a number of surveyors that will go out and give reports on how accessible a building is versus ADA standard.

The challenge with ADA standards— and it’s the same with our building code in the UK and it’s the same with standards globally— is those codes are very much focused around a baseline standard which doesn’t necessarily deliver access for everyone. Those baseline standards are predominantly focused around design for physical disability, in particular wheelchair users. But in reality, only 8-percent of disabled people are wheelchair users. (Janet: Right).

So, the work we’ve been doing in the US is to help clients with a number of workplaces across the country understand how they can raise the bar beyond those minimum ADA standards, and design environments to suit people with a range of physical, cognitive, sensory needs— including neurodiversity, which is a big thing we’re being asked to design for at the moment.

But as our company has grown, we’ve been asked to design inclusively outside just disability. So we’re asked to design for faith and ethnic background and culture and gender. So we’ve been putting inclusive design standards in place with clients. And then evaluating their workplaces against those standards to present them a set of recommendations as to how they can improve those spaces. And then working through product solutions with them to make sure the space isn’t designed as a functional secondary space but looks and feels like the rest of the building.

And the main difference with ADA standards and Part M, which is our standard in the UK, is actually primarily focused around toilets, around washrooms. So the layout of an ADA bathroom is different to the layout of an accessible toilet in the UK. And the type of products that are used are slightly different, and the position of grab bars is slightly different. So, you know, our design team need to have knowledge of ADA Standard as well as Part M to be able to supply the products that we’re able to in the US.

Janet: Yeah, I think that that’s really kind of interesting. We’re going to try to do a global overview of the ADA. And who’s doing what, where, what’s really working, what’s not. And we hope you can come back. We’re not finished with you right now, but I just wanted to let you know that we would like to have you back at some other point in time.

Ed: We’d love to support that and actually just connected to that, I know you’ve had a recent podcast with Dr. Matteo Zallio. (Janet: Yes!) based out of Cambridge University. So we’ve done a lot of work with Matteo. I know Matteo very well. He’s done some amazing work with us providing research on different codes across the world and has, you know, had a really important role in shaping the global project I’ve just been talking about.

Janet: Well, we have him lined up. Just so we are clear, we have him, and I think maybe a couple of people in the Asian arena. So we’re going to do a… I’d like to say it’s an extravaganza, but it’s just another podcast. So,

Ed: Autumn extravaganza!

Janet: … extravaganza, but it will be our part to talk about it.

Ed: Yeah. I’m on for that, yeah.

Janet: So, but anyways, but you bring up a couple of good points, again for listeners that just don’t really know. This is not just for people in wheelchairs. Right? It’s two parts. In your discussion around, you know, it’s usually bathrooms, right? Like this is the highlight of the business, right?  But you know, it’s around also religion, and then also families, and gender issues, and so on and so forth. So, however you would like to break it down, you know, discuss whatever you would like to discuss first.

Ed: Sure, accessibility in inclusive design so often starts with bathrooms and washrooms. (Janet: Yes). Because that’s what people see, and that’s where some of the biggest problems happen within a building.

Janet: Right, design crimes. (laughs).

Ed: The design crimes happen. But actually, as clients sort of understand more about the principles of inclusive design, they realize that getting a wheelchair accessible toilet or bathroom located in a space is a sort of foundation stage for what they need to be thinking about. And the work that our team does is getting them to think about someone’s journey through a building.

And actually, we start often with someone’s journey from home to that building because an employer has a responsibility to get their staff from their place of home into their place of work in a safe way. (Janet: Right).

And then navigating through that space, what are all of the touchpoints that are important to think about from a design point of view. And that could be everything from how’s your entrance designed, how easy is it to define where your entrance is within a building.

So many of these new office blocks are heavily glazed structures, and (Janet: Oh, yeah), if you have a visual impairment (Janet: A visual impairment), or a cognitive impairment (Janet: Mm-hmm), you can’t determine where the main entrance is. (Janet: Yeah). Having some form of foyer area to enable people to compose from their transition from outside into a building is really important. (Janet: Right).

Making sure the seating area is right, the height of that seating, so if someone has arthritic hips or knees, or struggles with their core strength, that they have suitable seating for them. That the experience on the reception desk is right. There’s a hearing loop behind reception. You know, there are so many elements that go into the design of the building.

In answer to your question about how things are progressing beyond bathrooms into other protected characteristics outside of disability, we are getting involved in elements like design of faith rooms that, you know, at the moment, so many of our clients we speak to in the early stages of projects and they say, “oh well, we just, we reallocate a meeting room if someone from a different faith needs to pray in that space. And, you know, that meeting room wasn’t designed as a prayer room. (Janet: No). It’s not private enough. It can’t be locked. You know, there’s no ablution facilities for foot washing potentially before prayer.

So these are all sort of considerations that we help clients think about, as well as design of kitchenettes. So, you know, how are you separating halal food preparation from kosher food preparation. (Janet: Right, yeah). How are you celebrating different religious events like Ramadan to be able to screen off eating areas if you need to?

And so many of our conversations at the moment, and I know this has come up in a podcast before with you, is around design of all gender bathrooms and toilets (Janet: Right), and what the provision of those should be.

So, it’s kind of fascinating. Our business, as Motionspot started, designing really beautiful, accessible bathrooms and that so often is the first point of contact with the client (Janet: Sure). But then the penny drops and there’s such a greater understanding that actually the bathroom is just the starting point of it.

Janet: Right. Yeah. You are 100-percent correct. So it was funny, I just had a conversation with somebody the other day and it was around that. And it was a women in leadership type of programming and I said, “you know, like even office spaces are not gender neutral and don’t have special provisions for females.”

Meaning, it’s like, well, we have the same amount of stalls for men as we do for women. Like, well, all right, we know just by walking by the bathroom, there’s a long line of women out the hallway. Like, so maybe just maybe, we don’t have enough bathrooms. And so the women on this call were like, “that’s right”. And then I said, but even like in the office spaces, they’re also really geared towards men. Do you have any insights with some of this? I would be interested to hear about that.

Ed: We’ve done quite a lot of research on this area and it’s an area, particularly when it comes to gender in the workplace, that we’re planning to do a lot more research on this year. So you are right, currently provision of bathrooms and toilets in the majority of workplaces globally have too few facilities for the female workforce. (Janet: Right). And our big kind of recommendation whenever we talk about provision of toilets within a space is to ensure that there is adequate choice for everybody. (Janet: Correct).

So, you know, we’re working with a client at the moment who’s just designed a big 500-thousand square foot campus in Scotland. And they were saying, “how many female toilets do we need to male toilets, and then do we move everything to all gender and actually don’t have any female toilets and any male toilets?”

And we did a lot of research with their staff, but also using our own evidence that suggested moving all toilets to all gender is not the right approach. (Janet: Really). And I must clarify that when I talk about toilets to all gender, these are what’s called “super loos”. So you get the toilet, the basin, all in one cubicle. This isn’t a run of toilets that then has wash basins within the same space. So, they’re enclosed private spaces (Janet: Right).

But all the research has shown you shouldn’t turn everything to all gender. You should have a really suitable provision of female only toilets, (Janet: Right). You should have a good provision of all gender toilets.

You should have some male only toilets, but in terms of percentages, actually the percentage of male toilets should and could be less than all gender. And then you need totally separate wheelchair accessible toilets. (Janet: Right).

It is a fascinating kind of topic (Janet: Yeah), that I would say is still fairly early in terms of the research. But what is coming out and is a trend for us this year that we’re seeing is actually designed for the menopause within workplaces, (Janet: Really!). Yeah, this is something we’re seeing as a major trend for the UK in particular.

And we’ve got some, some really interesting research that’s going to be kicking off this year that begins to look at how you can design inclusive spaces for staff and visitors who are experiencing either perimenopause or the menopause.

Janet: I just put an exclamation point after menopause on my notes. (laughs). I would love to see what work you’re doing around that. As somebody who is of an older age, this fascinates me. And you know, and it was just even saw the other day, it was a commercial talking about menopause, and it was a public service announcement. And I was so floored by that. Well I guess it is something to talk about and they’re right. And holy moly. So, yeah, any kind of information you could push out to our listeners we’ll have all that information on our inclusive designers podcast webpage, again, inclusivedesigners.com.

So let’s switch gears a little bit. I noticed also when I was doing my research and I found that this might be kind of fun to talk a little bit about, you were quoted in the Times, is it the London Times, Is that correct?

Ed: …the Sunday Times, yes.

Janet: Yes. London Times, Sunday Style section, right, exactly. (Ed: Thank you). And it was prior to the Queen dying. And so she was about what, 95, 96 at that time. And they were talking about how they have implemented some of this type of work, some of the accessibility for her in some of the palaces. Some of the palaces or just Balmoral. I wasn’t too sure.

But I found this fascinating, and I want to label this part of the segment: ‘If it’s good enough for the Queen, it’s good enough for you.’ Do you want to talk a little bit about that article? And, we will also have that article up for our listeners to look at. It’s just kind of fun if nothing else.

Ed: That would be great, thank you.

Janet:  Yeah. What was your takeaway from that?

Ed: Yeah. Thank you for picking up on the article. We were actually delighted to have been featured in that particular article. And we’re moving into a new design studio in March of this year, and I’ve just had it framed. (Janet: laughs). It’s going ‘pride of place’ in our office, (Janet: As well it should, yeah).

Yeah. “A Design That’s Fit for A Queen.” It was really interesting when that article came out because as you know, the queen is, uh, was, held in such high regard, not only in the UK but internationally (Janet: Correct). And people were aware of her age and could quite clearly see, you know, how her age was beginning to impact what she was able to do in terms of numbers of public engagements, (Janet: Right).

And when that article came out, I think there was a realization that, even the Queen at 96 needs some additional support in the home. And of course, she doesn’t want her home looking and feeling like a hospital. (Janet: Neither, right). She wants it to be appropriate to suit her home as well as her needs.

And for us, it was a step change in thinking in the UK that actually just got people asking the question of, you know, “this can happen, and this can happen and still look beautiful.”

So many people in the UK, and I’m sure it’s the same in the US, as they get older, they put off the decision to either move into a home that’s suitable for them or adapt their home because they’re fearful (Janet: Correct, yeah), to, we’ve discussed it already, that it will look disabled…

Janet: it’s going to look old. It’s going to look like institutional, right? Granny bars…

Ed: And they will feel disabled. (Janet: Yeah). And you know, that article gave kind of further reinforcement really that, you know, people can and should be thinking about this ideally as early as possible in life. (Janet: Correct).

And, you know, one of our biggest frustrations is when someone in their late 80s approaches us and says, I urgently need this adaptation in the home. And they may have had a condition that they would’ve had leading up to it for many years, but actually, they don’t adapt the home until at a point of crisis. (Janet: Crisis, right). And by the time of crisis, it’s often too, too late. (Janet: Yeah).

So we are trying to change the thinking that, you know, we should all be living in futureproof, adaptable, beautiful homes like the Scandinavians. And if as designers we can be encouraging and inspiring the industry around what to do, then we can all be, ultimately, living in homes that hopefully will be suitable for us as we get older.

Janet: Right. Yeah. And it’s really talking about living in your forever home at that point. And look, there’s definitely going to be certain needs that will need to be addressed by people who have special abilities and trained to take care of these things.

And it also can be something that it’s not a permanent situation or an aging situation where, like you said, it’s just only going to get more into some sort of crisis. I mean, it could just be something that is a temporary situation.

I mean, I know that when I broke my leg, I had  just redone my own bathroom and my own shower and I had the handheld, I had a bench in there. I had the ability to get over the threshold and now I wish I had put the threshold down just a little bit more now that I know better.

But at least I had the ability to have some sort of independence and I just could put on this little plastic, you know, thing over the boot and then be able to get in and out of the shower by myself.

Ed: That concept of flexibility and temporary support is something we see a lot of. And actually one of our most popular products in the bathroom at the moment is a set of removable grab rails and shower seats. So you can fit grab rails and shower seats to a bathroom wall.

And you can literally, without any tools, you can unscrew those grab bar and shower seat when you don’t need it and fit a cover plate over the fixing. And all you see on the wall is this subtle stainless-steel plate. (Janet: Right). And you know, there are manufacturers at the moment working on what to do with that plate. You could turn that into a soap dish or a towel rail or a holder.

But it’s that concept of flexibility and adaptability that is so important in bathrooms (Janet: Correct),  you know, we talk about it as dual design features. (Janet: Nice). So I think you mentioned it right at the start of this conversation when you were talking about your father’s bathroom. It’s the little features that if you didn’t need them, you wouldn’t even know were there. (Janet: Right).

So, you know, another example of it is sort of some integrated hand grips within a wash basin, and it helps a wheelchair user pull underneath the wash basin. (Janet: Yeah). But you can also hang hand towels off those hand grips. (Janet: Yeah). It’s a dual design feature that works for everyone.

Janet: Yeah, it’s absolutely true. Well, I’m kind of mindful of your time Ed.

Ed: Ha, thanks.

Janet: So is there anything else that you would like to add at this point for our listeners? Is there any points that we haven’t touched on that you would like to emphasize? Anything that you really want these listeners to understand about what it is that you and Motionspot do and/or a philosophy, or something? I just want to make sure we get everything out on the table today.

Ed: Thanks, Janet. Just two things I’d like to bring to listeners’ attention. And the first one is, the potential to design really beautiful accessible hotel accommodation. So, certainly in the UK, accessible hotel accommodation for so long has been really poorly provided.

Janet: It’s been horrific.

Ed: And the rooms that have been supplied, have looked like those clinical institutional rooms. And if you speak to any finance director of any hotel, they’ll tell you the least popular rooms are their accessible rooms. Because if someone is put in that room, the first thing they do is go to reception and say, I want to be moved from this room to another.

And we’ve seen a real step change in the UK but also through international hotel operators who are committing to designing 10-percent of their rooms to be fully accessible. So we’ve been working with hotel operators to help them understand how they can design really beautiful bedrooms and bathrooms to be accessible. But also how can they design other features in the hotel, whether that be reception experience, eating, drinking, (Janet: Right), and general sort of access throughout the building.

And we’ll send you some examples of some case studies on this because there’s some great examples of really clever, integrated, track hoist in ceilings, (Janet: Yeah), and really kind of beautiful accessible bathrooms that we’d love to send you. And there’s some really interesting return on investment statistics that are coming out.

Janet: That’d be great.

Ed: So, for example, there’s a hotel in Manchester called Hotel Brooklyn (Janet chuckles- *because she is from Brooklyn NY), that installed 18 accessible bedrooms and bathrooms.

And, you know, they’ve been doing some return-on-investment work that says those accessible rooms have generated them an additional 50-thousand pounds, close to, probably now with exchange rates, 65-thousand US dollars of revenue because those accessible rooms are so popular and disabled guests are actively booking conference rooms.

They put on a wedding for a bride with a disability this year. So, there is all of this sort of hidden income that comes in just from businesses really embracing accessibility in the right way. So, think about accessible hospitality is the recommendation.

And the other area I wanted to touch on is just the advance of accessible technology and the impact that technology is having around inclusive design. And we’re seeing some brilliant products come to market at the moment that will keep people safer in their homes for longer.

And whether that be technology around monitoring health and well being to ‘wash-and-dry’ toilets. We’re seeing a lot of ‘wash-and-dry’ toilets for care bathrooms at the moment. And Japanese style toilets that take away what is a very personal care task and enable people to live independently in their homes for longer.

We’re looking at some mirror technology at the moment that if someone had sort of later stage dementia and they weren’t able to recognize their own reflection in the mirror, at the press of a button, you can transform your mirror into a picture frame or an image of something that’s really special to that individual. So there’s some really interesting things happening with technology.

The one recommendation I’d make is if you’re going down the root of integrating technology, think about how all this tech can communicate with each other, and have the right desired output, rather than being standalone systems that operate independently of each other.

Janet: Talking about the advancement in technology, I’m a big fan of it, but I also know that technology doesn’t always work. So how do you get around that? As a designer, I think there should always be like a backup system. And is that your thoughts as well?

Ed: It is, yeah. Technology in our view is a really important overlay that can enable people to live well and independently, but you could have the best technology and you could put it in a really inaccessible space, and you’re going to have a really inaccessible experience. The technology on its own will not deliver the accessibility and inclusion in the space. (Janet: Right).

So first and foremost, you’ve got to think about how you get the layout of your space, right? What products go in there that will enable that space to meet your needs, but also be adaptable to suit your needs in the future. And then overlay technology that may further enhance your experience at home or in a commercial space. That’s how we see the role of technology being played. (Janet: Yeah). Because importantly, if the technology then fails, you’ve got a space and physical products that will work for you.

Janet: Right. Yeah, exactly. And I found that mirror to be interesting. So one of the things I’ve seen so far is the, you know, putting a curtain over the mirror. I actually didn’t know that. My mom had suffered from dementia, and she didn’t ever get frightened by seeing her face. So I know that this wasn’t necessarily a problem for her, but I know it’s a natural phenomenon.

And so like, I’ve seen the curtains, but I think that that’s fascinating to like, be able to press a button and then maybe a picture of like a baby or a cute kitten or a puppy can come up, and help to lower those stress levels, especially if they’re like sundowning or something of that nature. I’m going to check that out. Yeah.

Ed: Exactly (Janet: Yeah). Exactly that. And, you know, we are big believers in putting designs and products into homes that everyone will want. So if you had an elderly parent that’s, you know, passed away and the house came up for sale, we want to make sure that whoever is buying that house, who may be a younger individual, looks at that space and goes, “wow, that’s a really contemporary bathroom or kitchen that, you know, I don’t need to come in and spend a load of money stripping out.” (Janet: Right). And putting my own design into. (Janet: Yup).

And a lot of the work we do is also connected to sustainability and looking at reducing environmental impact. (Janet: Brilliant). And if you can design inclusively and design beautiful designs from the outset, (Janet: Right), you don’t need to go and fit another bathroom or kitchen or whatever the design is in a home if it works. (Janet: Right).

Then I think if I was to move into a house with a bathroom with a mirror that had a curtain over it, the first thing I’d do is remove the curtain. But if there was a smart mirror there that had the capability for me to put something else on it. (Janet: Yeah), or if I wanted a bath and I wanted music to come out of that mirror, there is the capability for it to be able to do that. And that’s what we’re trying to promote is to think inclusively from the outset so it can appeal to everyone.

Janet: And I would add that there are some days nowadays that I would just assume look at a kitten in the mirror as opposed to my own face. (Ed laughs). But that’s just…

Ed: … Wouldn’t we all Janet, wouldn’t we all.

Janet:  It’s just, you know. (Ed laughs). Yeah, Carolyn’s like, I’m just going to cut that part out, and I’m like, all right. (Ed laughs). But I think one of the things that designers really have to know is that, you know, people get reluctant to do it because they’re afraid that it will look like a granny flat, right? It will look like a, we call them granny bars here and institutional, right? And so how do you kind of get around that?

And I think also, when you’re talking about, like, more of these places like hotels, that there’s a real financial advantage that they can take, well, take advantage of. That they can go in and implement these things and then, the revenue will follow.

And I would argue, kind of going back again to the residential, is that if you can go and provide a beautiful space, I don’t think anybody’s going to sit there and go, “oh, look at all these grab bars.” If it just comes with the design seamlessly, nobody would go and sit there and go, “oh, you know, this is not what I was hoping for” and then, so nobody’s going to lose any value off of their homes.

Ed: Absolutely. (Janet: Right). Yeah. And the only way of changing that mindset is through use of really inspirational content, whether that be through photography, lifestyle photography, or video, is to show what is possible by designing either a really beautiful, accessible home or accessible hotel or accessible workplace to get designers acknowledging that it is possible. (Janet: Right).

And designers, by their very nature are super creative people (Janet: Right). And what unfortunately happens is they’re constrained by regulations like ADA and other accessible building codes across the world. (Janet: chuckles). And they panic and they say, “if I start thinking outside the box, I could get sued here if I get it wrong. (Janet: Right).

And what we encourage is: yes, the fundamentals of ADA have to be in place, but you as designers can and should be super creative in your thinking, (Janet: Thank you!) and let’s design right.

Janet: Yes! Right, I got excited about that because we have talked multiple times, you know on ‘Inclusive Designers Podcast’ about just that. The fact that designers have come to me and have asked me essentially how to get around the ADA. Like, how do I get around this? It’s like an obstacle and it shouldn’t be an obstacle. You’re absolutely right, it should be the challenge. And I tell them that all the time, it’s the challenge. You’re the designer… you figure it out.

Ed: Yeah, totally agree. And to your point about the financial advantage, whether you are a designer designing someone’s home, whether it is your home, yourself that you are designing, or you’re a client that’s looking at the design of a commercial space, whatever you spend on inclusive design during the design stage for both the principles as well as the product, will pay back so many times over.

We worked with a workplace client in the UK that the head of capital projects turned around to me the other day, and she said, “every one pound I spent on inclusive design saved me a hundred pounds in retrofits at a later stage.” (Janet: Interesting). So that’s hundred-times benefit of getting it right from the outset. (Janet: Yeah). And that would equate in dollar terms. This is a global opportunity to get it right from the outset. And, you know, unfortunately, it’s the way the world works. We need to demonstrate the financial benefit. (Janet: Bingo).

But actually there are more and more case studies coming out that if you think about it at the right stage, this not only will create really beautiful, accessible spaces, but it will save you money in the long run. (Janet: The long run). And in fact, for some businesses it will make you money (Janet: Make you money), by doing it.

Janet: Mm-hmm. Yeah. Well, that’s terrific.

Ed: So, hospitality and technology, and I suppose closing message for me is really sort of reinforcing what we’ve been talking about and, you know, it is so possible with the right level of design thought at the right stage of a project to deliver really kind of beautiful, accessible, and inclusive spaces for everybody that don’t necessarily have the cost anymore if they’re thought about at the right stage.

And you know, I’m delighted to have been invited onto your podcast today. And well done for growing the following because we need more of these types of podcasts, and information that’s free to access for everybody to help inspire and get people thinking differently.

Janet: Well, thank you Ed Warner. I appreciate the comments. Thank you so much for coming on our show today. Thank you so much for doing what you do and for all the work that you’re doing. I think it’s fabulous and I’ll have you and Matteo on in maybe in a couple of months or so.

Ed: We’d love to come back.

Janet: Thank you again for coming to Inclusive Designers. We’ll have all of our information on inclusive-designers-dot-com.

Ed: Great!

Janet: Please check us out and please check out Ed Warner at Motionspot.

Ed: Yeah.

Janet: Well, thank you so much, Ed.

Ed: Pleasure.

Janet: I mean this was really fantastic.

Ed: Great to speak to you both.

Janet: Yeah, thank you.

(Music / Outro)

Janet: I really enjoyed talking to Ed… his comments and philosophy are right in-line with our ideas here at Inclusive Designers Podcast. And I am really inspired by the work that Motionspot is doing. They understand the importance of evidence-based design thinking. And believe in transforming spaces— and lives— through beautifully designed, inclusive environments that provide independence… in the home, workplace, hotel, and well, everywhere.

Carolyn:  And in their latest research, they’re exploring cutting-edge designs and products for the workplace and other venues, to make spaces equitable for people of different faiths and genders.

Janet: And don’t forget menopause! I am so curious to hear their findings on that!

Carolyn: Right? And in terms of accessible technology, there are some great advances being made —like that mirror that can change to a picture— who wouldn’t want that?

Janet: I know I do… but as Ed agreed, technology should be an overlay component of good design. If not, you can put the best technology in a really inaccessible space, and you’re going to end up with an inaccessible experience.

Carolyn: Which leads us to his use of the term ‘design crimes’ to describe the examples of bad design, or places where the ‘function doesn’t match functionality’.

Janet: Yup, we’ve all seen it, especially in bathrooms. Hotel design for accessibility is so poor. Maybe we should think about doing that as another episode.

Carolyn: So true, (Janet: um hmm). And according to Ed, case studies are proving that if you design beautiful, accessible, and inclusive spaces right from the outset, it will save you money in the long run by not having to adapt it later.

Janet: Yes, I am so pleased that Ed brought that up. And how about that Hotel Brooklyn in England, (shout out to Brooklyn!), with the financial advantages of having accessible rooms! Listen up people!

Carolyn:  You are the queen of shout outs to Brooklyn (Janet: laughs, Yup). And speaking of queens… Ed discussed that even Queen Elizabeth required accessible updates in her castle as she was aging. It set a great example that these changes can happen and be beautiful. And you don’t have to be a Royal to realize that this can help people who want to age-in-place comfortably.

Janet: Exactly….  and we will share the link for that article, ‘Design That’s Fit for a Queen’… plus how to contact Ed and the links to the incredible work he and his team at Motionspot are doing. And of course, many of the other things that were mentioned along the way during this discussion… all on our website at inclusive-designers-dot-com.

Carolyn: That’s: inclusive-designers-dot-com…

Janet: A big thank you to Ed. And ‘thanks’ to all of you as well for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it again, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page.

Janet: And just as a reminder, drop us a note if you have any questions, or topics you’d like us to cover in upcoming shows! As our motto says: ’Stay Well…and Stay Well Informed’ As always, thank you for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again.

By: Janet Roche & Carolyn Robbins

This in-depth interview with Pinar Guvenc of SOUR Studio explores the importance of co-design in a ‘VUCA’ (Volatile, Uncertain, Complex and Ambiguous) world, and why language matters when designing.  Inclusive Designers Podcast gets Pinars’ honest opinions from whether bad design is just an ego thing, to why seemingly reasonable approaches (like active listening) are the key to GREAT design. We also learn a bit about how Janet’s bathroom reno for her father is going and the challenges she is facing to re-fit a beautiful, but not necessarily functional, space.

Guest: Pinar Guvenc-  is a design strategy expert, co-design advocate & practitioner, educator, mother, frequent actionist, and forever student.

“With a co-design process, you’re 50-percent ahead of the game because the insights you’re generating are so much more meaningful and accurate for the project that you’re potentially eliminating so much cost that will come up in the back end if you don’t do it.”

Pinar Guvenc– contact: [email protected]

– References: 

Definitions:

Co-design– is an approach in which all stakeholders, consumers and users of products or services are involved in the design process as design partners.

VUCA WORLD (Volatile, Uncertain, Complex and Ambiguous)-  “We are in need of emergent practices and innovations that can address the problems of the VUCA world that we live in today. We can only achieve this by creating together with people with diverse lived experiences and professional backgrounds.” SOUR Studio.

Living in a ‘VUCA’ World – The Importance of Co-Design!

(Music / Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music / Intro)

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: and I am your moderator, Carolyn Robbins…

Janet: Carolyn, we have a great show to share with everyone today! But first, I’m happy to say that ‘Feedspot’ still has us as one of the “Best Design Podcasts on the Internet”

Carolyn: … and a big ‘thank you’ to you our listeners for that!

Janet: Exactly

Carolyn: And I think this episode should continue to keep us on that list too.

Janet: Definitely, and especially because our guest today is Pinar Guvenc… a partner at SOUR Studio, where they understand the importance of co-design, and also what it means for inclusive designers.

Carolyn: Fun fact, not only is their name ‘SOUR’ a play on the words ‘Social’ and ‘Urban’ but it also describes their “we’re not going to sugar-coat it” attitude.

Janet: And that attitude helps her, and her team, tackle global design challenges, using collaborative research to find the best solutions. She has some great examples that she will share.

Carolyn: But first, let me tell you a little more about Pinar Guvenc… She is a partner at SOUR, an international, award-winning hybrid design studio with the mission of addressing social and urban problems. At SOUR, Pinar leads their business and design strategy. Their work includes projects from architecture to urban design to product design.

As they describe themselves, quote, “we don’t shy away from challenges. We embrace the discomfort. We take our time— to research, synthesize, and ideate — in order to generate data-inspired and purposeful design solutions,” end quote.

Janet: Pinar will also explain what it means to live in a VUCA world, and the difference between complex and complicated systems.

Carolyn: If like me, you’ve never heard the term ‘VUCA world’ before, stay tuned, Pinar will explain it…

Janet: Yes she will, and we don’t want to keep anyone in suspense for too long, so let’s get to it!

Carolyn: Absolutely. And with that, here is our interview with Pinar Guvenc… Design strategy expert, co-design advocate & practitioner, educator, and forever student…

(Music / Interview)

Janet: Hello and thank you Pinar so much for joining us today on Inclusive Designers Podcast. How are you doing?

Pinar: Good, Janet. Thank you for having me. How are you?

Janet: I’m doing great. I know we just did a little overview about you, but I would love to hear in your own words who you are and what is SOUR and what do you guys do?

Pinar: Of course. Well, I’m Pinar, I’m partner at SOUR. We are a hybrid design studio with the mission of addressing social and urban problems. So as a mission list studio, we get to work on very diverse typology of work, whether that’s from architecture to urban design to product design. And our mission also really calls for us to have ongoing collaborative research.

So it’s very much in our DNA to practice co-design because that’s the only way we could actually serve our mission. It would be very naive for us to believe we can tackle global challenges on our own. I think we’re globally getting to that realization as well. And so that’s what we’re practicing.

And I guess the SOUR is a play on the words social and urban, but we also believe it represents our attitude. (laughs). We don’t shy away from discomfort. We embrace being in the gray. And when we first launched, we said there’s enough sugar coating in the world, so it’s time to get real and be SOUR. So that’s it.

Janet: Interesting. I love that, I really do. It’s, you know, like something like a lemon, right? It’s sour, but there’s something really great and refreshing about it.

Pinar: Yeah, It’s an acquired taste (Janet: Right). And it suits well with us because sometimes people don’t understand us, ‘What do you do exactly?’ Like you get to need to know us. You know? So I think in that sense it represents us. I remember this, this was actually like fun fact when we were first incorporating, I remember our attorney being, like noticing the foreigner names, right? And like maybe, (Janet: Uh, oh), “You do know what ‘sour’ means, right?” (Janet: No!). (laughs). And I’m like, yes.

Janet: Oh my goodness.

Pinar: He was very judgmental.

Janet: He was very judgmental. Oh my goodness, right, oh, I hope you fired him.

Pinar: Yeah. That might be the last time we chatted.

Janet: Oh, that’s wild. Well, let’s kind of hop into like what this means about co-design. I find this topic interesting and especially when we talk about being inclusive designers, right? I mean, it kind of goes hand in hand, but it also, I think it makes us better designers. Do you want to talk a little bit about your theories and your ideas about co-design?

Pinar: Of course. So, you know, obviously when we talk about like the definitions of co-design or parts of story design practices or inclusive design, it feels like a no-brainer and very common sense. But then just because it is common sense doesn’t mean it is common practice. (Janet: Right).

So we like to go back and kind of support it also by just like our current status quo in the world and system theory to really like go into the roots of why it also actually is a survival strategy. It’s not even a nice to have anymore. So, we live in a VUCA world today for people who know that, or don’t know that?

Janet: Yeah, I was going to say, explain to our listeners what VUCA World is, (Pinar: Yeah), and I find this fascinating too.

Pinar: Yeah, so VUCA stands for ‘Volatile, Uncertain, Complex, and Ambiguous’. And it is basically used to define the world that we live in today. And if the pandemic, the war, and all sorts of crazy things happening in the world aren’t, is not enough proof, I don’t know what is. (Janet: Right).

So because we’re in a such complex domain and it’s only getting more complex, when we look into like systems theory, how we address a complex system is very, very different than a complicated system.

Where in a complicated system, you go in and you analyze, you call in experts. There’s some like good practice recommendations. You pick one, you go with it, right? It’s the world of, ‘you know what you don’t know’. So you need to learn what you don’t know, and you figure it out.

But complex systems are the world of unknowns. You don’t even know what you don’t know, right? And that’s the world we live in today. (Janet: Right). So we can’t have an analysis engineering approach. And if we do, we’re always either missing stuff or not testing assumptions, right? Like, there’s a great chance that we’re leaving so much behind that we’re not even aware that’s there.

So a complex system actually calls for probing the system and seeing reaction and therefore really adapting to that, and then finally coming up with an emergent practice. So basically, it calls for innovation, (Janet: Right), right? It calls for rapid prototyping, it calls for rapid experimentation and especially safe to fail experimentation to be able to implement within.

So because having innovation, like design innovation process is necessary for the world that we live in today, the only way we can really innovate in the most proper way is through collaboration. (Janet: Right). Right.

And you know, I think we love to read success stories on like this, you know, big tech person just came out with this… it’s, it’s never that, right? There’s a huge army of people creating things. (Janet: Right). It’s always Interdisciplinary collaboration. (Janet: Yeah),

And it has to be embedded in our DNA, in our practice and how design precedes really in projects and product development processes. So with that, I think just collaboration basically is the only way we could really address where, like, our world today…

Janet: some real problems, right? (Pinar: Yeah). The VUCA World.

Pinar: The VUCA World, and that’s why we have to co-design because collaboration is a very loosely used term. Like even a vendor relationship is called a collaboration, where collaboration is really not that, Right? Collaboration is, parties are involved, but they also have shared goals.

There’s like a partnership involved and co-design enables that partnership. Co-design treats all stakeholders as equal. It values lived experiences as much as professional experiences. And it doesn’t mean, and I’m highlighting this because sometimes I get like a knee jerk reaction from the design community to the concept of co-design where like, but we’re the designers, you know, we can’t design together.

Janet: Right. We’ve had this conversation offline (Pinar: Yeah), is the idea that everybody thinks that they know everything or that they can get it. We do a lot with trauma informed design, and I’m always surprised on how many people think, well, an hour ‘lunch and learn’ ought to do it, right? It kind of floors me. I’ve spent probably just this last year alone, about 1200 hours looking at it, studying it. But yeah, if you feel like you’ve got it over lunch, you know, it’s, it’s good for you. Right.

Pinar: Yeah. And also, it’s such a narrow view, right? Like, to me, when a reaction comes like that, I am realizing how we’re looking at this design process through such a narrow lens, because by co-design we don’t mean people going on Rhino together and trying to 3D model together, right? Like what we mean is authentic partnership in the process.

So, engaging stakeholders from beginning and not necessarily like, sharing ideas and prototypes with almost ready to launch or close to finish. Right? (Janet: Right), which has been the more traditional ways of this working. Like really engaging in exploration, synthesizing the data together, co-ideating, (Janet: Right), And then giving prototype and idea feedback.

This partnership is the process, and it does need to be adapted based on the industry you’re in, the geography you’re in, all the stakeholders involved, like all those are determining factors on how a co-design process could happen in a project.

But the principles are the same, right? (Janet: Right). People are treated as partners, power is shared, and there’s an authentic engagement from commencement to completion. (Janet: Right). So yeah. So because of VUCA, it’s the only way we can survive the world today.

Janet: Right. I do find this, it’s so interesting and just even in my own travels, I’m always surprised on… it’s, I feel like it’s the proper way to think. I feel like it’s something that we, in order to survive in this VUCA world, as you said, I think that that’s the only way to do it. (Pinar: Yeah). And again, and I’m so surprised when people are so unwilling. Do you think it’s just— I don’t want to sound flip about this— do you think it’s sort of like old-fashioned thinking or is it a control thing? Or what exactly do you think, like what drives people to say: ‘No, no, I got this’.

Pinar: Yeah. I mean, I think there are two factors. One being like, we’re creatures of habits, (Janet: Sure). If we’ve been used to doing one thing one way, we want to do that. So that resistance to change might be in place. (Janet: Right). But I think there’s also the myth around co-creation or co-design, like it would take more time, it would be more costly, right? (Janet: Right). So those two, uh, biases towards the process could be a turnoff, I think. (Janet: Sure).

Again man, it’s so wrong, right? Like those who practice know that with a co-design process, you’re like 50-percent ahead of the game because the insights you’re generating are so much more meaningful and accurate for the project that you’re potentially eliminating so much cost that will come up in the back-end or even like mid-project if you don’t do it.

And also that speeds you up in the design process. All designers would agree that if we have a brilliant design brief, that helps in the design process, right? So how we re-frame the problem, how we identify the problem and create a framework for designers through co-design process, I think that really also speeds up and informs the design so accurately.

So I think we need to really change our mindset about what we don’t know, the fear, right? (Janet: Right). So the fear of like trying something new, it might cost more, it might take more, and really, just prove ourselves that we’re wrong, right? (Janet: Right). Like, it’s not necessarily the case.

Janet: Well, I mean, at the end of the day, you come out with a better product, right? (Pinar: Yeah). That’s the sort of the ultimate goal here, that makes so much sense to me, you know. And especially with the human experience within the built environment, (Pinar: 100-Percent). It just, right, makes us happier and healthier and wiser and smarter and, (Pinar: 100-Percent), and likely even, even more wealthy, you know? (Pinar: Yeah!). So, it comes down to, even though it might be more money up front, is it one of those things, right?

Pinar: Yeah, and it’s not even that much more money, right? (Janet: Right). I think like compared to what the end result could actually be to correct it or to do another round of prototyping. Like all those costs are higher than engaging diverse participant and compensating people for their time. Right?

So I think we need to really understand that. And it’s interesting because if you go to a person and say, would you do something very risky or with high budget without validating your assumptions, they would say ‘no’.

But not doing co-design is basically that, because there is no way as humans and in our own teams, and no matter how big of a company you are, you won’t all have the representation that diverse representation needed for projects. (Janet: Right). Like never in your team only can you represent that. (Janet: Yeah).

So we’re already going in with assumptions, our biases, prejudices, we’re human, all of us have it. (Janet: Right), conscious, unconscious… (Janet: Well that’s just it, yeah), yeah. So I think when a person would say like, ‘no, of course I would validate assumptions,’ but then could follow that process, forgetting that that’s what we’re doing when we’re not doing co-design. We just like move on to design with our own assumptions and biases and not even realizing that potentially, because it’s not like designers are malicious people. Like, let’s exclude others.

Janet: I don’t know, I’ve met a few Pinar. I’m just going to throw that out there. (laughs). So, alright, but you know actually, (Pinar: that’s a whole other episode), it’s a whole other episode. Exactly. Malicious designers and, (P: laughs), well, but this brings up a couple of different points. One is this new program that, or program, or what did we decide to call it?

Pinar: You can call it the framework if you want.

Janet: Framework. Okay.

Pinar: Yeah.

Janet: You have this framework and it’s called, Why Language Matters, right? (Pinar: hmm). And when we talk about DEI— and I think DEI should also add an A on there for Accessibility— but, you know, we’re, we’re getting there. But I would love for you to talk to our listeners a little bit about this, because I think it’s so important.

Let me just give you a brief example as to, like you said, we have our own biases and our own things that we’re taught that maybe are just wrong. For example, when Russia invaded Ukraine, I was under the impression we were calling it ‘The Ukraine’. And I was told, ‘no, no’ pretty quickly on that you don’t say ‘The Ukraine’ and, and how it’s demeaning. And it was part of this thing that was, if I understand it correctly, you know, it was sort of to degrade Ukrainians.

And, I had no idea, right, like that that was something that for me was such an eye-opener. But you have this beautiful, well displayed framework about why language matters and, and talking about it in terms of equality. Do you want to talk a little bit about that?

Pinar: Yeah, we recently published that just because in the end, all the processes that we’re involved in, it doesn’t matter if you’re in design, r-and-d, supply chain, they’re very human processes because they’re driven by humans. Even AI is driven by humans, (Janet: Right). AI has the exact biases that its creators carry.

Which is funny because we, actually went with this, like, I just want to like quick caveat, when this like mid journey visual explorations started to happen and we would just dump in bunch of different words to see what visual is going to come up. We put in ‘people and architecture’ in, the words, and nothing. AI wasn’t able to bring up anything. Isn’t that depressing? (laughs). It was just like, there was an astronaut and a weird like architecture, but like what, we were like, ‘what?’ like there’s nothing that AI could come up in ‘people and architect, architecture’ – very insightful for our industry.

Janet: … that’s really insightful, right?

Pinar: Yeah! Because AI is basically scanning anything out there on that and then like comes up with a visual and it wasn’t able to find much, which is sad but true, but also a very sheer realization that we need to do something about it. (Janet: Right).

So basically, I think because everything that is out there is driven or led, or managed by humans, we in the end have to properly communicate with each other, Right?

So, when we did a publication on co-design frameworks too, like one thing we did mention is understanding positionality. Where are we all coming from? What is our own biases? Again, prejudices, experiences that might have impact, positive or negative in the process. Just being aware of that, right? Like going into any process. And then, how do we distribute power also, like maybe there’s a very strong dominant figure in the team, how do we make sure they’re not leading the entire conversation and people feel intimidated and not speak up and all of that, right? (Janet: Right, yeah).

So the initial step is really just like recognizing the positionality of the team and also who’s not here, (Janet: Right), who’s missing, (Janet: Right), why are they missing? So like really just doing a quick reflection on the team and status before going in. And you can do this like throughout the project too.

And then, the next step is the communication, right? Like once the team is there, how do you communicate with each other? Many people, if you’re working on an international project, language is a huge barrier, right? (Janet: right). Trying to understand each other. It’s like…

Janet: …what is sour? (laughs). (Pinar: Yeah, exactly!). What is, do you know what sour means? Right. (Pinar: Yeah).

Pinar: Exactly. (Janet: Right). And you know, one like simple phrase in your culture might be totally offensive in another. (Janet: Correct). So there’s cultural differences, experiential differences, things that we might just be more sensitive to, like certain trigger words based on our own experience, ability, whatever that is, right? (Janet: Right).

So, once we understand people better, that also helps us to think about how we communicate with one another. And it’s just something that we need to exercise on. And just be mindful of the principles, like on an ongoing basis, both for our internal processes first, and then on how we’re communicating things out to the world.

I think what fascinates me, with all this like creative agency capabilities and like powerhouse creative agencies out there, brands follow universal messaging in so many things, which is sometimes fine. Like in a brand identity, you want universal messaging, right? (Janet: Sure).

Like you want to keep things consistent, but then when you launch products, we don’t recognize that we need to adapt language and communication based on both the geography that we’re in, but also the generation that we’re like appealing to, or speaking to, or just different personalities and characteristics, that “intersectionalities” that people might have. (Janet: Right). How do we appeal to that? How do we make sure things resonate with people?

A great example is, we’ve been doing this project that we started mid-year on exploring how people adopt sustainable practices, right? And this is for a consumer goods company that launches a lot of products with more environmental-friendly packaging or formula and things like that. And yet, they don’t see quick interest or adoption of these products and eventually they get discontinued. Right? (Janet: Right).

So, the product is not the problem. It could be, it might have lousy packaging or labeling, whatever. That’s like one other design problem. But also when these things come out, how do we launch it? How do we communicate to people is so, so, so important. (Janet: Right). And so, in understanding that we did really in-depth interviews, like one-on-one interviews and dyads in 11 markets, from Columbia to France to Canada, and in Lebanon, US, let me see, Mexico, Greece, there are a few more. And interview, like talking to people about sustainability in general, right.

And the people you assume that might care, leaves are like composting. They’re like way advanced than I am. And like I consider myself a responsible consumer. (Janet: laughs), I’m like, ‘wow, I don’t do that’. Yeah, and then why do I even have that perception that she might not care, or he might not care, right, like that, like I’m calling out on my own bias. (Janet: Right).

And that was like a very sheer visualization also to the client too because we would compile those and basically create a short documentary. (Janet: Right). But what we also did, we interviewed people from their offices in the same markets too. Because if we really want to achieve a human-centered design, we have to interview both the people who are going to use it and the people who are going to create it. Right?

Because you can’t necessarily dump all the responsibility on the consumer and you can’t necessarily just have this very high level, sophisticated, all like insider knowledge infused, messaging to put it out into the world and expect people to adopt it. Right? (Janet: Right). So it really had to become this common understanding. So that common understanding can only be studied if we basically co-create with everybody involved, the client itself and the consumers.

Janet: Right. Yeah, I was going to say, back to the whole idea co-design. (Pinar: Exactly). I just want to, give our listeners, make sure everybody knows that we’ll have all of the information for Pinar and all the stuff that we’re talking about on our [email protected]. That’s first things first.

And I actually have a background in marketing, and I want to tell our listeners a real quick, kind of cute story, and maybe at some point, Carolyn, we’ll actually just cut it out of the program, (Pinar: laughs), but here we go.

So the, the funniest thing that I ever heard of was, I guess in one particular country, you put the picture of what is in the product, right? So whatever is the products on the inside of the jar or can or whatever, you put the picture on the front. And I think it was like “Gerbers,” I mean, did not understand this, and had the picture of the baby on the jar. So, (Pinar: Oh), right. So the thought. (Pinar: Oh), Right. And, you know, obviously people did not do their homework right. So that’s a notorious, (Pinar: Yeah), example.

And then the other one was, it was a car in Spain, and it kind of dates me, like maybe early or mid-80s or so, and it was the Nova car, (Pinar: Okay), and in Spanish, I believe that means ‘no go’ (Pinar: laughs). Right? So, you know, again, simple kind of like, oops, right.

Pinar: Oh man, I have a recent one I saw, the like, surface cleaner out in like the market and then it said like, ‘ocean bound plastic’, and I was like, so when I use this, this goes to ocean, (Janet: laughs), like that’s what’s happening? Oh, it’s a good way to like de-motivate me from buying, that’s what they’re trying to do. Honestly that’s what I thought.

Janet: They’re clever. I think they really hit the nail on the head with that one. Well that’s just it, you know, like, yeah. Well, you know, again, co-design people, Pinar is telling us, telling the world this is why this is stuff is so important. So anyways, I’m sorry I interrupted you about why language matters and this framework that you put together.

Pinar: No, it’s basically like this type of practice really helps feed understanding of that. Because, in one dyad we saw and we were doing on purpose different generations abilities, experiences, like when we’re like recruiting all these people. And there’s this like example where one millennial, living with his parents was saying, ‘oh, like my mom doesn’t care about like sustainability’. I think this is in like Mexico. And yet he is describing his mother, like consumer behaviors.

She’s definitely more sustainable than I am, whatever we call sustainable. She repurposes what she’s using. She isn’t consuming as much. She is very good at like upcycling things. She’s such a like environmentally friendly consumer. But when you tell her sustainability, she’s like, ‘I don’t use those products, like, what are those’? Right, because the word doesn’t resonate with her. Right? (Janet: Interesting, yeah), it’s just that, what is this, like new word that came out.

But if you tell her this is less waste, she understands that and she totally respects that. (Janet: Right). But when you feel like be more sustainable, she was like, “I don’t, like, I don’t, this is like a new thing. This is like your generation”

Janet: That seems like a lot of work, right?

Pinar: Yes, it’s the same thing, I’m like, you’re more sustainable than any of us here…

Janet: …than most people I know, but okay, yeah, exactly. That’s interesting, right? And so the language really does play a large part of all of this. (Pinar: 100-Percent). And so, yeah, so again, just, you know, for our listeners, it’s all on the website. Please go take a look.

And then, you know, you and I have had, like I said, a little side conversation about when we’re talking about co-design and the importance of designers to listen, not just to their clients, but to the people around them, (Pinar: Yeah). Right? (Pinar: Yeah). Otherwise it’s being designed in a vacuum. Correct? (Pinar: Yeah). I mean, so, (Pinar: Yeah). Right.

Pinar: Active listening is a skill that needs to be practiced, polished, developed. (Janet: Yes). It’s like exercising. Like you don’t become a good listener, and like, “oh yeah, I listened.” Like, no.

I’ve been to like so many workshops and like corporations, where we’re doing like a design innovation workshop or like a co-ideation workshop, and I would witness, it sometimes feels like, “oh, like they need hearing aids and they’re not wearing them.” (Janet: laughs).

Like they would speak over each other, (Janet: Right), or they’re just like waiting for their turn to speak and really did not listen to you. They were just being polite and being quiet, right? Like it feels like that so many times and I’m kind of like, wow, how do we get stuff done in the world?

Janet: Well this is, and also, this is why we have a lot of problems, and I can only hope that I’m doing an okay job listening to you today. That’s my, my hope.

Pinar: (laughs) Oh yeah, totally. But this is active listening. You’re like reacting to what I’m saying too, like, you know, and I think it’s important to, like, understand that we are all responsible of that whatever we do in life. Designers, not designers, right. (Janet: Right). And it’s a practice. Like I don’t think anybody is like born like a great listener. Like we’re as kids, terrible listeners, right? (Janet: laughs). Like it’s just skill we acquired later in life. So we need to like polish and practice and improve it, right? So I think there’s like number one that.

And number two, sometimes designers actually need to get out of the way. Sometimes we’re not the right people that should be listening because we don’t know what to do with that information. (Janet: Right). So, like for example, when we team up with people with disabilities on projects, like 90-percent of the time, an occupational therapist would be facilitating the conversations because how would I understand the implications of disabilities and how that is necessarily having the impact on that interaction, (Janet: Right). Right?  (Janet: Yeah).

I need the right person to be able to communicate to me in the way that I need to hear. (Janet: Right). And the other times that that person is not facilitating, sometimes, especially when there’s distrust in this communities (Janet: Sure), then you know, rightfully so, many overlooked or under-served communities have huge distrust towards institutions or corporations, for various reasons.

Janet: Or all of the above, right?

Pinar: All of the above. (Janet: Yeah). So in those cases, we would actually have trusted community-based organizations facilitate sessions, right? (Janet: Uh huh). Or like, sometimes they’re not intimidated by us or they’re okay to talk to us just because like, we’re at this like a much smaller boutique design studio that more like coming in, like almost like a mediator. So we would, they would be open to talking to us, but do they really trust us? Would they really share? Like, what’s the most meaningful, you know?

So like sometimes it’s just about knowing that should we be the ones listening, right? Like maybe we, we could definitely try to listen, we can be present, but we also need someone in the room who has practiced listening and hearing the community.

So I think depending on the circumstance is really about just like, how do we be better listeners, and should we be the one listening, or should we be the only one in the room listening? Also curating that process based on the audience you’re working with or in the project context you’re working in.

Janet: Hmm. Yeah. So true. Like, I was consulting in a design for a women’s shelter. And I found it interesting, one of the workers that was there, and she was in on this meeting, and I was hoping to go around the table in order to talk to them and hear their experiences so we can provide them with, you know, some really good design ideas and what have you. (Pinar: Yeah).

And, the woman sitting next to her, said to me, “oh, she’s only been here two weeks.” Like basically, and kind of like put her hand on her arm. Like it was almost like a do not speak, do not talk about it. And all I could think to myself was, is that, (Pinar: Hmmm), you know, yeah. Even in two weeks, I’m sure she has a lot to say. Right? I thought the other, you know, the woman that was telling her, and telling me that she doesn’t have any voice and she doesn’t have anything to say. (Pinar: Wow).

And all this other stuff wasn’t important because she’d only been there for two weeks. But it was also, I mean, it was quite the show. I mean, she put her arm on the other woman’s arm, like that was a ‘do not speak’. And this is a woman’s battered shelter. Like I thought to myself, (Pinar: Oh my god), what in the world did I just witness. And myself and, um, my colleague when we walked out of there, you know, we shared…

Pinar: like the observation to you,

Janet: the observations!

Pinar: I want to talk that person…

Janet: and now I want to talk to her more. (Pinar: Yeah). Like the fact that you told me I can’t, (Pinar: Exactly), uh yeah, I’m going to need to talk to her, right?

Pinar: Exactly. Yeah, I mean this is the importance of ethnographic research too, in general, right? Listening also is not enough sometimes, it’s very much observation and understanding context and like dynamics. (Janet: Right). That’s why we love dyads, right? (Janet: Yeah). Because how people talk next to each other sometimes is very different than how they speak one-on-one. (Janet: Right). And also, like, I remember this example like, sorry, didn’t mean to cut you off, but made me think of…

Janet: No, no, no, no, I can listen to you all day.

Pinar: Power of observation…

Janet: Yeah, active listening Pinar. (laughs). I am telling you right now, even if I was washing the dishes, I’d still be active listening to you. (Pinar: Aww), so go ahead…

Pinar: Yes, thank you. Like we were doing this workshop with MIT age lab and there’s like a room of 80-plus-year-old men, (Janet: hmm), which was a very fun group have (Janet: Uh huh). to like, have a design workshop with (Janet: Yeah), I mean, it was super fun.

Janet: Just to be clear, we love them, but yeah, yeah. It’s sort of standard, typical…

Pinar: I love like where elders and like kids in my experience are people who give it to you straight, (Janet: Right), like whatever they think. (Janet: Right). And I’m like, you’re a great co-creator. We need more of that. (Janet: Yeah, yeah). And not to like, you know, sugarcoat things. (Janet: laughs).

Anyway. So they’re like, they’re called, I think they’re lifestyle leaders, that’s what they’re called. (Janet: Interesting, yeah). And they consult and advise on various different projects. So I was asking them if they had any issue dressing up in the morning, like is dressing a problem for them? And, except for one person who clearly needs a caregiver’s help to be able to dress himself, (Janet: Sure), they were all like, “No. Got it.”

So I asked, it was winter, I asked like, can you then put on your jacket and take it off for me? So, you know, like imagine yourself going out of the house and you’re wearing your jacket on is more like, I don’t know, a 20-second act, at least for me, right, with my own understanding and bias, I would think like this is going to be quick for the entire room to do that, I think we like settled. It was definitely close to like six-minutes.

So to me that’s not okay. Right? Like as observing that was like, this is a design problem. It’s not your fault. Right? (Janet: Right). Like if you have, let’s say limited range of motion, and you’re not able to like put your arm through a jacket that easily and it takes you several times or you put one through, how do you get the other. If these are all hard challenges in like the dressing process, to me that is a design problem that needs to be addressed.

Whereas for them, they normalized it, right? (Janet: Right), like they were just like this part of aging. (Janet: Yeah). This is what happens when you’re older. (Janet: Yeah). Right? (Janet: Right). Which is totally human, right? We normalize things. (Janet: We get used to things, yeah). Even like really traumatic things, we normalize it, just for, as a coping mechanism, (Janet: Yeah, exactly, yeah).

So that’s also why it’s really important, and I know we talked about this before, to really observe, understand, be present, listen to the words, but also listen to the behaviors, like what you’re seeing, like what you saw as a very powerful example of how that power sharing is not happening in so many environments. (Janet: Right). Right. If you’re like with a gesture like being shushed. So I think we have to understand active listening is important but diversifying your means and how you’re listening is also very, very important.

Janet: Right. Yeah. I’ll give you another example. I’m helping, my dad is 87, and in order for him to continue to live independently, we’re doing a whole bunch of stuff. We’re adding more grab bars. We’re adding more ways for him to get around. (Pinar: Yeah). And he would like some sort of little mirror, light source what-not next to the light source, next to the window when he’s shaving. (Pinar: Hmmm).

And I kind of don’t understand why between the window, it is morning, right, he’s going to be shaving, (Pinar: Huh), not at like six o’clock at night when it’s pitch black this time of year. (Pinar: Yeah). So there’s the light source from the window, big window. There’s the light source from the mirror, there’s the overhead light.

And so why does he, and I think, you know, again, I know our eyes yellow as we get older, and so I’m sure he is having issues seeing himself. I get that. (Pinar: Um hmm). But I want to know what his routine is. What, how does he go about this? Like is there something else that we can do?

And I have other people sort of like boots on the ground, sort of non-designers that are, well contractors, that are helping do this. And they’re just like, “well, have you found a little light yet?” And I’m like, “no, I want to be able enough to see what he’s doing to warrant this. Maybe there’s another way to go about this.”

And I think that they think I’m out of my mind (Pinar: laughs), like that, it’s sort of whatever Jack wants, Jack gets. I get that… that’s my father’s name. (Pinar: laughs).

You know, like, I feel like there’s maybe another way to approach it and maybe it is just a light, right? I don’t want to diminish his discussion in this or thoughts in this, (Pinar: Yeah, yeah, yeah), but I also want to see what he’s doing that makes him think that this is something that he needs. (Pinar: Yeah). Right, you know.

And again, it is probably right. Just so we’re clear in case dad, you’re listening, you’re always right. (Pinar: laughs), But like at the end of the day, like, I just want (Pinar: Jack, you deserve the best), Jack, you deserve all the best. Exactly. And so, but you know, and I think that that’s such an important piece.

And then the other one was, is that when we were trying to figure out how to put new grab bars in his already complicated shower, and it was interesting to me and they were, now you got to, sometimes you got to think these things through and like actually stand there and physically kind of go through the motions. (Pinar: Yeah).

And so they were going to take off one part of the shower, and I said, but the problem is, if he falls from that? Like, because the door is right there, then now he’s in front of the door. And so we can’t now open the door while he’s on the ground. (Pinar: Yeah). Right, so, and they were like, “oh, right.” You know. (Pinar: Yeah). So, you have to kind of get in there and get all dirty (Pinar: Yeah). And it goes back to I think designers not thinking that they have the time or the money to do that, I mean, but some of this stuff is so important for health and wellbeing. So…

Pinar: Yeah. And also if we don’t have these considerations, how are we going to grow in our profession? (Janet: Correct, yeah). You know, like, to me it’s just, I don’t want to say it’s lazy. Maybe sometimes it is lazy, but also, it’s just that…

Janet: I think it, I, well I don’t you think that there’s some laziness? I totally do…

Pinar: I think there has to be, there has to be. Like the budget, I feel like for a creative person, it’s an excuse sometimes where like some things, I mean, yeah, you didn’t have like written out, spelled out in your scope of work that you will sit in a shower for half an hour to like understand something.

But it is necessary like for you to really just do better design. And I don’t want this like also become an excuse for people. Yes, like inclusive design is not universal design. Inclusive design is one size fits one, right? So it’s really inclusive of the person’s needs. And the idea is that as you design for the edge case, you would actually include a broader audience.

But also it is very important to understand that— I mean we get excited about AI and technology, but like with growing technology— that’s going to help this also scale, right? So because the biggest criticism we get, well its such custom work. How are we going to scale this? (Janet: Right). Like, there’s no way we’re going to be inclusive, but that’s only because of our own limitation. Like how many factors (Janet: Right), or restrictions (Janet: Yeah), in the design brief. (Janet: Mm-hmm), our brains can manage on its own. (Janet: Uh-huh). Like if you have like 20 things we need to watch out for, we’re already like, ‘no way, let’s eliminate 10 of that’. (Janet: laughs).

But this is actually the excitement I have around AI where, well, a machine is going to do all those considerations for you now, right? There’s a lot of conversation around participatory design in order to create inclusive AI. But I think we also need to discuss more and more the reverse where like how AI will actually empower inclusive design. We’re actually working with Nvidia and WPP on a simulator…

Janet: Explain to our listeners what WPP is…

Pinar: Yeah, a creative agency, a global creative agency. (Janet: Um-huh). And Nvidia has this platform ‘Omniverse’ that really enables us to simulate things. So right now the simulator is just a hand where the ability of it we can alter. So, I have like full dexterity and fine motor skills. We can reduce that and see how that interaction changes with a 3D model. (Janet: Wow). So how I’m lifting up a glass now might look completely different then. Right? So not to replace co-creation, but to really be able to create rapid prototyping and understand what design futures we need to watch out for from the beginning.

The only reason why you’re having that challenge in that shower is that because everything else in that shower hasn’t been designed with the consideration of those accessibility needs (Janet: From the get get-go), from the get-go. Right. (Janet: Right, yeah). Exactly right.

So you’re adapting it. You’re trying to hack it to make it work, (Janet: Sure), and that’s challenging. (Janet: It is challenging. Yeah. Thank you. laughs). So, in that sense. Yeah, it’s super challenging… (Janet: Thank you for that. Right). Jack? If you heard us Jack, (Janet: Jack), Janet is trying (Janet: I’m trying).

Janet: (laughs). I know. Well, but there’s a lot to be said for that (Pinar: Yeah), and yeah, well, without going into that particular rabbit hole, I’m sorry I interrupted you…

Pinar: No, no, no, it’s basically like we need to go through that experience personally as designers ourselves, in order to understand “Well, okay, how do we scale this? How do we iterate this design process more frequently, so we include more and more,” right?

So unless we go through that, like suffering of like, I don’t want to say suffering, it could sometimes be fun, but also sitting in the shower for 30-minutes maybe is not fun. (Janet: Right). We need to go through that experience to generate the insights into like ‘how do we go, like evolve from here, like how do we grow’? (Janet: Right). So it is necessary for all designers to go through that.

Janet: It is necessary. Well, in a true way to be very transparent here, I actually have taken a shower in that bathroom, and it’s just, the design, it was kind of done sort of like in the late nineties, but like even that, it was just a poor design. I mean, they didn’t even have a place to put your towels. Like, ‘Why? What, what, what? Hello?’ I didn’t even realize that until like I’m standing there looking around and I’m like, ‘Why isn’t there, like a, like something’… (laughs)

Pinar: Exactly. Well, I feel like I see, would see that in 2022 in New York City. You know, I don’t think it’s like about the era, I think it’s the construction industry.

Janet: I think it was, right. They were like, “what evs” (Pinar: And our industry in general, yeah), what evs, not a big deal. (Pinar: “What evs, by code, we’re like complying with code”). By code, we don’t need a towel rack. Exactly. (Pinar: Exactly). We’re good. (Pinar: Base line). I mean, it’s, it’s a beautiful bathroom, but it’s just, I mean, it’s just really not very functional. (Pinar: Yeah).

So I know we’re kind of coming to the end of our time together. I think, I don’t want to say goodbye to you Pinar just yet. (Pinar: laughs). So I was hoping like, you know, do you want to talk a little bit about Open Style Lab? Is that something you guys want to talk about?

Pinar: Yeah, I mean, I personally, I serve on the board of Open Style Lab and leading strategic partnerships there. And Open Style Lab is a non-profit organization that was initiated at MIT and now is based in New York City with the mission to make style accessible for people of all abilities.

And, with that, it’s also a great case study. And I think in itself it has been an organization that really inspired the design industry on what co-creation can look like.

Because, even at its like origin at MIT when it started as a social service project, it brought together occupational or physical therapists, engineers, and designers with people with disabilities to co-create together throughout a course of a 10-week to find inclusive solutions. So that model, I think, became an example to so many industries in so many different ways that I’m very proud of the team there and just to be part of it.

And I personally learned from it so much. so, so much. (Janet: Wow). And I think even like at SOUR, we learned it’s more about how co-creation can be practiced than anything else. And yeah, for the listeners, if you want to check it out, our most recent summer program in 2022 was sponsored by Genentech, where it was all co-created with the SMA community.

And thanks to Genentech and, big pharma money, we had, (laughs), we actually was able to showcase that co-creation during fashion week in New York Fashion Week. (Janet: How cool). So, it was the first fashion show of the week two, (Janet: Yeah), which really anchored the conversation. (Janet: Wow), and if you Google it, you would be able to find information on that. (Janet: Yeah). And, the intelligence built in, in all the garments that you wouldn’t even know it unless you read about it. So yeah, I encourage everyone to check it out.

Janet: Yeah. Well, again, we’ll have the link on our website, inclusivedesigners.com, for sure, but I just thought I would ask you about it. Like that sounds just quite amazing. Pinar, is there anything that you want to add; is there anything else that you feel like we’re missing? Is there something that you’re like, ‘you know what, I really need to say this part’ about designers and co-designing and collaboration, and is there anything else, any kind of other notes you want to hit on?

Pinar: I guess quickly I can talk about a good to have attitude to practice co-design…

Janet: …like a bad attitude. I couldn’t help myself. I could not help myself. (Pinar: Just be sour). Sour, yes. There you go. That’s great.

Pinar: Key words, like really first, like, we talk about reflexivity, like reflecting on yourself and always, right, like to do a self-check. It’s good for your own personal mental health, but it’s also good for your practice. Also keeping an elastic attitude. And what I mean by that is like knowing that your teams might need to stretch based on the project you’re working on.

Sometimes we have project teams that are bigger than our own studio team just because we have to bring in the right people for a project. So practicing that elasticity for each project I think is important.

And a little bit of being agnostic. And I don’t mean it in a religious way, although that’s totally up to you if you want to do that. I mean it more like an outcome agnostic. Of course we have client briefs and commissions and sometimes very clear asks, but also, we need to understand that throughout co-creation, we might land on better ideas. We might need to reframe the problem, right? The discovery is so big in co-creation that being a little bit of outcome agnostic and being comfortable with that grayness is actually good for you. (Janet: Right, yeah).

So that’s just what I want to highlight. And yeah, we’re, we’ve considered ourselves forever students, forever learners. So we’re happy to like, collaborate and learn from everybody too. (Janet: Right, yeah, exactly). Yeah.

Janet: That’s so it’s such an important part too. And again, going back to that, you know, people with talking about trauma-informed design, they feel like they can figure it all out after a lunch and learn. But I said that 1200 hours, that was just me absorbing new information. (Pinar: Yeah). That’s not all the other hours I’ve worked on the actual projects for this, (Pinar: Exactly). So it’s so important to be, like you said, elastic, to be able enough to understand this and whatever this is, (Pinar: Yeah), and to really kind of make sure that you learn about it too.

Like even just for today, I thought, because you know, again, we had had this conversation prior and, and so I bought John Silber, who was the president of, Boston University when I was actually there. And he had put into BU something like 10 million square feet of new construction. (Pinar: Wow). Right, which is, for anybody, that’s a lot, right? (Pinar: Yeah). I mean, he oversaw it. He wasn’t wielding a hammer by any means of the imagination. (Pinar: laughs. Yeah, yeah).

But it was interesting because his father was a, um, architect. And so I think he had some interest in it. So he wrote this book, and I did read it in order to be more informed to interview you, because he talks about the absurdity of some of the architects that put these buildings together, won’t mention any names, but we’ve all seen it (Pinar: laughs). We’ve all seen these pieces of architecture, (Pinar: You know, you know). You know, you know. And you know, you know, when you see it. (Pinar: Oh yeah).

And that was an ego thing, right, that’s a, you know, look, you know, like this is… (Pinar: It’s a statement, I’m making a statement). It’s a statement piece, (Pinar: Yeah). Right. You know, and I guess there’s a place for that, but sometimes, you know, (Pinar: Maybe in arts, laughs). Yeah, maybe. Exactly.

Pinar: I mean, if other people are going to use it, maybe not. (Janet: Well, that’s just it). I mean, unless you’re like designing a palace for a king, (laughs), maybe that’s like where you make it a person specific interest.

But I don’t understand how you can treat a building like a sculpture. If it’s like open to public, it’s going to be, you know, used by people, like how do you disregard that? That I don’t understand. (Janet: Right). I respect all the work that goes into that. (Janet: Of course). No disrespect to that (Janet: Of course).

Janet: I think the name of the book is like, ‘Absurdity of Architecture’ or something like that, you know. (Pinar: laughs). I’m not promoting his book, obviously. But it’s interesting.

There’s also, you know, designing for human health, we talk about some of these designs all the time. And we also did a podcast with, Don Ruggles, right? And he talks about the importance of beauty in architecture and how it makes us feel and makes us, you know, happy. But if you see this thing that’s just like, going every which way and sideways, it’s just probably, again, not mentioning any names, (Pinar: Yeah), but nope, nope, nope.

Pinar: We’re not bitter. We’re sour.

Janet: We’re sour. Yay. (Pinar: We’re not bitter). Nope. It was sour. (laughs). That’s great.

Pinar: …it’s like, 20 years from now we’re having another interview, Janet, that you’re interviewing me. I’m like completely bitter at that point. Like ‘those people’…

Janet: …’those people, you know who you are’. Right? Exactly. it’s going to be a whole thing. Oh my goodness.

Pinar: …is this going to bloopers. Like we should have an entire, like, bloopers show just like this.

Janet: I’ve always wanted a blooper reel.

Pinar: I would love that. I don’t take ourselves that seriously clearly. So I definitely encourage for the promotion of this episode…

Janet: Oh my goodness. That was brilliant. So, but anyways. (Pinar: Yeah). Pinar, thank you so much. I love the fact that I have an opportunity and a platform to talk to people like yourself and forward thinkers and people who have really, some really great, great ideas and are trying to change the course of how we design.

And so I just, I, again, I could just talk to you all day. Please, please, please think about coming back. Maybe we’ll do a Pinar two. (Pinar: Aww… laughs), Like, you know, we’ll do one of those. (Pinar: Ongoing talk shows), and I, and I’ll keep practicing my active listening in the meanwhile.

Pinar: Oh, well thank you so much, Janet. You were an incredible listener, and conversationalist, and it just felt like an organic conversation and not like a script interview, which I don’t do well in those anyway. I feel like I, (laughs) if it’s like very, you know, too rigid.

Janet: Well, you know, how many times did I have to figure out, it’s framework. You’re like, it’s just framework. Say framework. Use the word framework, right. So yes. There is that too. Right? Exactly.

Pinar: Oh, yeah, totally understand. It was such a treat as always. I feel like anytime we all connect, it’s just like this.

Janet: Pinar, before I let you go, is there anything that you want to add?

Pinar: Yeah. So I encourage everyone to just like reflect on your practice today, and if you have doubts or questions, just reach out to the people you think might have an answer there. Be very open to collaboration… and be sour.

Janet: Be sour. Perfect.

Pinar: There you go. (laughs). Like from now on I’m going to wear like a sweater that says, ‘be sour’ and tees…

Janet: Well you should get t-shirts that say, ‘Be SOUR.’ And mugs!

Pinar: I think it’s going to happen. Our team has been asking for it too, so I think we’re going to do it.

Janet: Be sour.

Pinar: I got over the trauma of the, like attorney. (laughs)

Janet: Well, I just want to throw it down before we leave that, are you guys still in Brooklyn?  (Pinar: Yes, yes, yes). Yes, right. I hail from Brooklyn. I lived in, on Garden Place and Sydney Place growing up as a kid. And yeah, so we’re doing a little shout out. We do occasional shout out because we did one with Judy Heumann, like, because she grew up in Brooklyn too, or, (Pinar: Aww), you know, born in Brooklyn I should say. (Pinar: Yeah). So we’re always like, I have a little posse of us from Brooklyn.

Pinar: Yeah, yeah, yeah, yeah. Representing Brooklyn, based in Brooklyn Navy Yard. (Janet: Representing). Yeah. (Janet: Exactly. Woot, woot, exactly). Yeah.

Janet: Pinar, thank you so much. This has been really terrific.

Pinar: Thank you. Thank you, Janet. Thank you, Carolyn. It was amazing. Thank you so much.

Janet: Thank you.

(Music / Outro)

Janet: I find what Pinar and her group are doing to be so fascinating! She is, well,…

Carolyn: Sour?

Janet: Yes, but in a great way.

Carolyn: You know I couldn’t resist… (laughs)…

Janet: I get it! Seriously though, Pinar and I really enjoyed discussing topics of great importance for inclusive designers. I love her ideas that we need to have attitude, elasticity, and agnostic approaches when we are co-designing! Our own biases and unconscious assumptions really do not help us when designing for the built environment. Or anywhere for that matter.

And that whole concept of ‘Why language matters?’ we need to keep Cultural, Situational and Ability differences in mind when we design… and when we talk to each other.

Carolyn:  I agree, and I think Pinar is right that… designers need to understand that through co-design, they might land on better ideas. They should be very open to collaboration, and if needed, to re-frame the problem to find the best solution. And I loved what she said: “we should all be forever students and forever learners.”

Janet: Exactly…. and we will share the link for how to contact Pinar, and of course, the links to all the innovative work she and her team at SOUR are doing. And also for many of the other things that were mentioned along the way during this discussion… all on our website at inclusivedesigners.com.

Carolyn: That’s: inclusivedesigners.com…

Janet: A big thank you to Pinar. And ‘Thanks’ to all of you as well for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page. And now you can also find us on the Feedspot List of Best Design Podcasts.

Janet: Yes you can! And as our motto says: ’Stay Well…and Stay Well Informed’. As always, thank you for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again.

Music up

By: Janet Roche & Carolyn Robbins

How did design innovations for the NICU (Neonatal Intensive Care Unit) lead to groundbreaking changes for behavior health rooms in hospital Emergency Departments? The answer lies in new adaptive environments, and they are already making a difference to parents, staff and patients in these hospital areas.

IDP talks to Alex Tan, Design Innovation Director at Philips about the process that led to creating these immersive spaces, and spoiler alert… co-design and collaboration were a part of their success.

Guest: Alex Tan-  is the Design Innovation Director at Philips. According to his own bio, he is ‘a visionary thinker and leader with a diverse background that spans across many industries and design disciplines. His leadership style is very hands-on; he leads through example and inspiration. Alex and his multi-disciplinary design team collaborate with research scientists to invent and set the design vision and direction for the future of Healthcare, through a co-creation design process and prototyping’

“One of the key themes I look at is the idea of the adaptive environment – the idea that designs and environment can change and be more responsive to the different needs of different people.” – Alex Tan 2022

– References:

• Alex Tan Bio/ Linkedin

• Next Generation Neonatal Intensive Care Units

• youtube video: LOTUS- Next Generation NICU

• Re-imagining the Behavior Health Experience

• Dutch Design Week- Virtual Talks- 2022

• Shaping Experiences Through Human-Centered Design

• Lumi Plush Nightlight/Little Lantern Studios

Adaptive Environments for Healthcare & Beyond!

(Music / Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music / Intro)

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: and I am your moderator, Carolyn Robbins…

Janet: Carolyn, we have such a wonderful show today! But first, we are thrilled to announce that we are still in the top 20 on Feedspots’ list of “Best Design Podcasts on the Internet”— whoo!— and a big thank you to you, our listeners!

Carolyn: yes, and it doesn’t surprise me at all, but I might be a little bit biased… and I think this episode should definitely keep us on that list. And with that news aside, we welcome you to our first podcast of 2023.

Janet: Yes, moving right along, our guest today is Alex Tan, who is indeed creating a difference within the built environment, and using a collaborative and evidence-based approach to design. The ground-breaking work he and his design innovation team at Philips are doing is changing how hospitals envision the future of both the NICU— which is the neonatal intensive care unit— and adolescent mental health care emergency rooms.

The way they research and implement these next generation spaces, using adaptive research and ambient technology, is truly terrific for any designer for whatever environments they will be creating. We are thrilled to interview him and discuss his process.

Carolyn: But first, let me tell you a little more about Alex Tan, who is the Design Innovation Director at Philips. According to his own bio, Alex is…. ‘a visionary thinker and leader with a diverse background that spans across many industries and design disciplines. His leadership style is very hands-on; he leads through example and inspiration. He and his multi-disciplinary design team collaborate with research scientists to invent and set the design vision and direction for the future of Healthcare, through a co-creation design process and prototyping’.

In his own words; ‘We are the tip of the spear that pushes the boundary of the possible. Our solutions combine hardware, software, environments and services, and aim to solve key challenges in Healthcare.’

Janet: Alex will introduce us to the innovative tools they created and how these human-centered design solutions are making a difference in their pilot emergency room spaces today.

Carolyn: And we even learn about his side project, a design of his own invention, a plush toy that is ‘brightening’ the lives of little ones everywhere.

Janet: (laughs) That is a pun that will make more sense later… but we’ll let Alex tell us about this as well as some important insights that will be of benefit to all of us in the inclusive design field…

Carolyn: And with that, here is our interview with Alex Tan… designer, creator, and innovation director…

(Music / Interview)

Janet: Well, hello and welcome to Alex Tan here on Inclusive Designers Podcast. Thank you so much for joining us today, Alex.

Alex: Yes, thank you for having me on board.

Janet: Thank you. So, why don’t we just jump right on in, and I know that there’s a couple of projects that you’re working on. I think what’s kind of interesting is that there’s so many different parts of dynamics about your process and why don’t you tell us a little bit about how you created these types of things with Philips.

Alex: Yeah, we have, there’s definitely several projects that we work on in Philips, and I think the two that will be worthwhile to talk about this, of course, the Lotus NICU of the future. So that’s one. And the other one, we don’t really have a name for it, but it’s really how to reimagine behavioral health actually, in the emergency department. So I think those are the two projects that were, you know, it’s worthwhile to talk about (Janet: Right), that we can, you know, yeah, look into the process of how we do it and yeah review a bit more.

Janet: One is within the NICU, and one is within the emergency room in terms of behavior… is there one that you want to showcase in the, on the top of the hour?

Alex: Yeah. We can start with the NIC actually as one of the examples.

Janet: Yeah, why don’t we start with the NICU, and this is a pilot program right at this point?

Alex: This is actually, it started off as pilot program, but it’s actually been installed in hospital, actually in Florida, in one of the NICUs actually. So it is, you know, we strive to bring everything into the market because that’s, I think, you know, where it makes the impact actually. Although, you know, I work in the innovation department, we do a lot of research, front end research. We strive to test it out and implement it in the market, so, you know, to really have that impact.

Janet: Right. So why don’t you explain to us a little bit about this particular product, because the piece you’ve got in the NICU is really quite fascinating. You’re looking at all the like different senses— touch, smell, taste, sound, and light— all the things that as inclusive designers, I encourage designers to really kind of look at. So why don’t you talk a little bit about that and then the process and get our listeners into what those particular projects are.

Alex: Yeah. So again, definitely can talk about it. So the project I think started as one of these, you know, of course Philips, you know, we have products in the NICU, you know, we have different things like, you know, monitors, we have, you know, ventilators for the baby.

And, you know, all these are very, very much right now, kind of very separate elements, right? They don’t inform each other. They don’t work together as a complete kind of system. So we kicked off this project, you know, this is, I think several years ago, I’d like to say 2018, where as a project to really try and understand the space of the NICU and how can we create a kind of complete solution to address all the different needs, right? Because with all these individual products, you don’t really connect them together to deliver, you know, more value for the users. In this case, the clinicians, the nurses, and you know, ultimately the baby, themselves.

And in this project, we were very lucky to have worked with some of these thought leaders within the NICU space. And we were introduced to this whole integrative developmental model actually. So meaning that, you know, the idea that you want to, when you look at the baby or treating the baby, you want to be as inclusive as possible in terms of looking at not just your physiological aspects, but also some of the psychological aspects or knowing where sound comes in, where you know, their sensory perception of pain, you know, lights, you know, heat, all these, you know, sort of, temperature, touch even.

And there was this kind of, yeah, model that was created that we kind of worked closely together with the clinicians to really look at how we can create solutions along this kind of, you know, this whole circle actually. So this, yeah, integrative developmental model that we were working on.

And it’s kind of interesting. I think in the aspects of talking about inclusivisity is that, you know, that the parent was also very much part of that solution, right? So we had to include not just the baby and all these different needs of the baby, but the clinicians, the physicians, the neonatologists, the nurses, and the parents, and how much the parents actually played a part in the baby’s, care actually impacted the results. And there’s lots of evidence right, (Janet: Right). So having skin to skin contact with the baby, talking to them, you know, being present and being engaged in this whole process of, in the stay NICU really helped improve the outcome.

So this was a very well-known study, but there were not actually any products or solutions here for the parents, actually. So what we strive to do is just kind of a holistic solution that looked at “How could we create something for all the different stakeholders within this NICU space?” (Janet: Right). So we have, you know, some of the solutions were really looking at a dashboard, for instance, for the physicians to be able to track all the different aspects of the baby’s development, right? So like, like I said, not just the heart rate and the breathing and these kinds of things, but also the temperature of the room, the sound levels, you know, are they getting enough sleep? Are they in pain? Those, all these kinds of things.

And also, we provide a dashboard for the parents as well so they can actually participate in the care of their baby. And being able to be informed “Hey, how’s the baby doing?” And be able to, you know, have almost like a calendar or agenda that they could collaborate with the clinicians to deliver care. So, “Hey, look”, you know, this is maybe a good time, for instance, for them to come in to do kind of this kangaroo care, so this skin-to-skin contact with the baby. And that really, you know, helps their development. So we’re looking, yeah, very much a holistic solution and look at how this room could really facilitate all these folks coming together, all the technologies coming together to work in concert as one.

Janet: Yeah, I think that’s, like it’s really key in the fact that I think it’s fascinating that it took us until 2018 you said, to think like maybe we should be asking the parents, like, who spend the majority of time there, how, what they’re thinking, what they’re feeling, and how they’re behaving within the built environment as well. Right? (Alex: Yeah). Now are you saying that the, so it’s basically, explain it to people that maybe are in the car that are not able to look it up right now. What, like what is this? What, you know, it’s, it’s a touchscreen, right?

Alex: Yeah, so yeah, if I could, to describe what it is, I think it’s definitely, it’s several things. So, it’s firstly the whole room design and the lighting and everything together. So we actually designed the space itself to determine where, how the equipment’s laid out, right? (Janet: Right). So, you know, because in a neonatal ICU, there’s lots of equipment for the baby, there’s a lot of clutters. So how can you design the optimal space for the clinicians to work in there, for the parents also to stay over, right, and provide care for their baby.

So that’s one of the first things is really the environment, spatial design. So looking at the positions of the light, looking at where the monitors needs to sit. So that’s, I think the first thing.

The second thing is this, the dashboard actually. So this is a piece of software that would actually bring in all the different disparate, electronic medical records, all the different monitors, all the equipment data that’s being produced around the baby and bring it together in one place. Because right now all the, you know, doctors and clinicians need to go to different computers, different screens to search up this data and kind of combining in their head to form a picture or diagnosis of the baby. So we’re actually bringing it together in a dashboard that makes it very apparent to get a quick overview of what’s happening, right.

The other part is that we also based the design of the organizational information around this integrative developmental care model, which looks at this 360-view of the baby, you know, through all the, the body organ systems and the kind of, softer care aspect. So that was also something very prominently displayed in our dashboard. So I think that’s, that’s the other thing.

And then the other part of the dashboard that I said is a piece of software, at least for the parents to be able to then come in and be able to view, change that same dashboard, that big screen in the, the baby’s room to a different, let’s say, rendering of the information so it’s more friendly for the parents actually. So it’s not, you know, the clinical jargon. It has been translated and helps them, you know, track how their baby’s doing, that helps them almost kind of suggest education or training videos for them to learn about the development of the baby. So these are the main key aspects, right? So the environment and this kind of what we call the collaborative dashboard. (Janet: Right). So those were the two key elements.

There were some other, you know, let’s say elements that we design as well. So looking at smaller things in terms of around the incubator, having a camera that would basically look at the baby and use that camera technology to sense the vital signs. So you don’t have to put these, patches on the baby’s skin, which are very painful because kind of when they’re premature, their skin is like paper thin. And every kind of electrodes that they put on it and you take off it really tears their skin. So we try to also create a better way of sensing the baby’s vitals. (Janet: Well, that’s interesting). So this is, you know, basically part of that bigger research project. (Janet: Right). Yeah.

And I think also to your point earlier, you know, about clinical care not involving parents or even just the family of patients, I think that’s something that, it’s still a challenge, right? You know, I think a lot of science are now beginning to kind of see that the more the family members are involved in the care of the patient, the better the outcomes and the, you know, better the, the faster the healing is. Right.

And you already have, you know, I’ve kind of seen two schools of, let’s say, practice. Some doctors are really much about “Hey, we want to open up the patient’s chart to the family so they can see everything” right? The family can know everything, so they can be more informed and help with their care journey and the care decisions. And others that say “No, no, no. We don’t want, you know, the families to see that because they just ask more questions and there’s just more work for us to do”. (Janet: laughs). So, you know, there is definitely this kind of, you know, two sides to it (both laugh).

Janet: Right, it’s a complete two sides to the coin, (Alex: Yeah, yeah), for sure. Well, I mean, again, I do think it, you know, I mean, just the word inclusive designers, I mean, that’s what we try to do. And I think getting that family input was really beneficial for you guys. Like, do you remember, was there any particular thing that really stood out to you when, I mean, were you doing interviews with them or were you following them? What was the, what was your process?

Alex: So we definitely, the team spent time in the NICU, and we did a lot of shadowing, right? So going to the NICU, we got permission to kind of observe and just almost be a, like a fly on the wall to observe the staff at work and where the family gave permissions we’re also in the room. And we, we kind of spoke with the staff members and interviewed the families to just kind of get to understand what their thoughts were. Right?

And it’s kind of also striking that this whole new way of looking at this family centered care, this developmental care for the babies. It’s also not something that, in medicine, is being practiced, right? So it’s unequal. We went to hospitals that were very much embracing this, and some hospitals that’ll say, “No, no, we want to keep everything, away from the parents.” So that was the two sides. So we kind of observed this (Janet: Really?). Yeah. (Janet: Wow). And that was kind of eye-opening.

We were actually lucky and not so unlucky in that one of our team members actually, during the project was, you know, she actually had a premature birth (Janet: Oh really), and she spent a long time in the NICU. (Janet: Wow). So she was actually able to provide us a very good, first-hand insights, right. And she also helped drive a lot of the, you know, thought and thinking about, “Hey, look what are parents looking for”, you know, so that was very lucky for us, for our project, but of course, not, not lucky for her.

Janet: Right. (Alex: Yeah). I understand. (Alex: Yeah, I know). Right, it’s a little hard to say lucky in that particular situation, but it there is, I mean, it was advantageous. (Alex: It was advantageous), I guess maybe that’s a better word or something. (Alex: Yes, exactly). So what was her take away? That she was like, you must have, like or this must be, or…

Alex: Yeah, so the one big thing, and we kind of suspected it already, and she kind of emphasizes that, just the sheer amount of information that she had to absorb, right. So she was at a hospital that did not really practice this family-centered care as much, and basically, you know, at the start of her NICU stay, they just gave her a big binder, really, and just say here, that’s all the information there, read it. And there was, you know, it’s just like brochures, all kinds of information, not organized. So that was one of the things that was really overwhelming for her, right, trying to just keep track of “Yeah. You know, what do I need to know?” It’s important, you know.

Janet: Right, I mean, when her brain spinning anyways, right? Her child is in the NICU, like, will they survive, all that stuff and (Alex: Yeah), now try to absorb all of this information.

Alex: Exactly. And actually, one thing I would like to say, her baby’s now doing really well, (Janet: Awww), yeah, he’s, he’s doing great (Janet: That’s good). And one of the things I would say is that, yeah, it is overwhelming, right? As parents, you, you know, the last thing you kind of expect when you’re, you know, you have a pregnancy is, “Hey, I’m going to bring a baby back and a nice nursery”, and that’s kind of just kind of you know, (Janet: Out the window), yeah, (Janet: Right), out the window, exactly. And, you know, you are then spending months in the NICU. So that was one of the, the key things, right?

And I think the other thing was just trying to balance work and, you know, work life with the, you know, having to visit the, you know, the NICU. Because as parents, you want to be there to spend as much time as possible with the baby. And every moment that was away was, of course, you know, yeah, you know, kind of frustrating, right? (Janet: Right). So you have to balance that.

And each time she came back, she’s like, “okay, what are some of the updates? Right? What has happened to my baby?” What, you know, so she wanted to know all these things, and that was very difficult to also discover, you know. So that’s one of the first things that we did in our dashboard was to be able to almost list out as a summary for the parents, “Hey, what happened while you’re away?”

Janet: What happened while they’re away, oh, that’s great. (Alex: Yeah). Yeah, right.

Alex: And, they also had a kind of a, a planning calendar to say, “Hey look, what are the plans for the baby today? You know, are we going to do some, you know, kangaroo care? Are we going to give medications? Are we going to do certain procedures or go for a scan?” So that was kind of very nicely laid out which helped, you know, parents feel more comfortable.

And we also of, of course, incorporated this camera idea for parents to be able to remotely look into the NICU. And this is already existing right now, (Janet: Right), some hospitals have that, to see their baby and, you know, be able to, yeah, just kind of connect with them, see how everything’s doing. But we extended it to include all the dashboard elements so that, you know, on an app on their phone, or a tablet, they could basically, be able to track progress with their baby. So this is really the ambition of what we’re looking to do.

Janet: Right. Yeah. No, I mean, it’s interesting that whole work balance, right, because we don’t really have really good family leave in the United States. (Alex: Yeah), so, I got to think it would be awfully hard to leave, right? (Alex: Yeah). Like, to top it all off, but you know, that everything is sort of planned out and thought out and that you don’t have to maybe go through a binder or something, (laughs), to try to find it, I think is really kind of terrific. So those were a few of the takeaways that you had. (Alex: Yeah). So then the, and you talked about the design implementation of what you did to help to correct that. (Alex: Yeah).

I wanted to say there was something else that you had mentioned at the top. It was that there was the, just kind of fascinated about what I was listening to, (laughs) and then all of a sudden, I was like, I wanted to come back and ask and circle back on that question.

Alex: Was that about the spatial design…

Janet: …the spatial design. Yes, it was about the spatial design. And I wanted to kind of expand on that. Maybe you could talk a little bit more about that and what were your discoveries and how your process came to be for those spatial designs?

Alex: Yeah, absolutely. I think one of the things we looked at, you know, again, in NICU, you know, throughout the country, different hospitals also have the very different philosophy. So, you know, you have the, let’s say the open bay concept, right? So where you have lots of babies in little pods in this one big open room. And the new model of it is really moving towards a single-family room, meaning that you have the baby in the room by themselves, you know that this room is enclosed.

The advantages of that is that, you know, it reduces the disturbance right from other babies crying or other things. So you kind of create this more sound, (Janet: Calming), calming environment. (Janet: Right). So I think that’s one of key, aspects, I, you know, we, we saw that there’s a trend actually. So many of the new NICU built in the US are all single-family rooms.

So with that right in the design of room, we also wanted to accommodate all the different functions of the room, right? So in a sense that, at certain times, you know, because it’s, it is in the hospital, there needs to be medical procedures happening.

So sometimes, you know, babies do crash, and they need to, you know, and there’s an emergency, they want very much the bright lights on and be able to, you know, do an intervention, right. And other times when the mother is there, maybe with, with her baby, and as I said, performing kangaroo care. And this is sometimes they’re trying to encourage, you know, for many hours whereby they sit in the chair with the baby, you know, from 2, 3 hours to 5, 6, 7 hours, you know, just lying there with their baby.

So you want to create this calming, relaxing environment. So we wanted to be able to adjust the lights to that. And also during more just, you know, daily rounding of the physicians to check up on the baby, you maybe want a different type of light, or they’re doing charting and caring for the baby, such as changing the diapers or, you know, changing out the sheets and things like this. You want different lights. (Janet: Right).

So we actually created this, you know, the concept of this adaptive environment that would change and flex according to the different workflows, the different needs and desires for, you know, the people in there to the aspect of, hey look, you know, when the baby is maybe vacating the room and the janitor or the cleaners need to come in, you want also really nice, bright lights, so they will clean the room nicely. To be when the baby’s sleeping, yeah, keep everything calm the lights down. (Janet: Right). And also, they have, yeah, kind of digital signage out there to say “Hey, baby sleeping, do not disturb”.

Janet: …that’s actually cute, right? (Alex: Yeah), I mean, that makes so much sense though, right? (Alex: Yeah).

Alex: So, yeah, and as a company and Philip coming in with you know, to try and use some of these technologies to be able to give indication outside the room about the status of the room. Because with the rooms and the closed doors, you don’t know what’s really happening in there, right, so if you don’t to kind of barge in on the mother and the baby or know something’s happening. So using those technologies to project, you know, that information outside was again, one of the things that we try to look at holistically. How this room could perform as a, you know, as a well-oiled machine in a sense, right?

Janet: Right. And the whole system, right. (Alex: Yeah). I mean, that’s, other part of it. We talk about it a lot, you know, I mean, you’re helping. the baby with their circadian system too, right? (Alex: Yeah). By changing out those lights. (Alex: Exactly). And, and I saw that you’ve got some biophilia, (Alex: Yeah), projected on some of the walls and stuff like that. (Alex: Mm-hmm). So, more ways to calm, (Alex: Yes), the central nervous system. Right? (Alex: That’s correct). And then, like you said, and then to have that information being projected on the outside so that, you know, there’s no kind of disturbance and stuff like that. I’d be interested to hear from you, we talked a little bit about light, you know, we talked a little bit about sound. And I guess the touch part is that kangaroo, right? (Alex: Yes). You called it….

Alex: Yeah. Kangaroo Care,

Janet: Kangaroo Care. (Alex: Yeah), Right. And having that baby with the parent. And can you talk a little bit more about your design aspects for that particular type of programming, I would call it, I guess.

Alex: Yeah. So I think let’s maybe start along the, the touch part, right? So in the room design we’ve tried to, you know, ensure that it’s kind of optimally set up for the, you know, for the baby, to bring the baby of incubator and to be able to, you know, then transfer that to the mother’s chest. So facilitating that whole process because it’s actually not easy. So a lot of babies, they have the, these kind of cords and things connected to them, life support system, ventilator, so that makes it harder.

So, you know, unfortunately we don’t have a solution for it, a wireless Ventilator that’s still rare. So we had, you know, that’s something that, you know, we had to basically design the room and the space itself to make it easier to that transition from incubator to the mother’s lap actually, or body. And to be able to track that time because that timing also, it’s reflected back in the dashboard. So at the end of the, you know, week or the month, they can say, “Hey, how much kangaroo care has been given to this baby?” And then, you know, in the long term, we’re trying to track that correlation. Right. So again, giving data to that, right? (Janet: Right).

The other things that we also, place in the room actually, is also sensors to measure the level of sound, level of light, even, volatile chemicals and compounds actually. So sensors for that.

Janet: I was going to say how you dealing with the sense of smell?

Alex: Yeah, exactly.

Janet: So, these are all sensors, these are all Philips sensors, is that correct?

Alex: Yeah. These are, this is what we call a, a kind of sensor bar that we place in the room. So we developed that using just off-the-shelf components. Right? (Janet: Right). And, but the idea is that just to bring that together in a unique way. So to yeah, basically measure all these things. And that’s again, a study we’re trying to do to just correlate right in the sense of “Hey, you know, the scent, the smell, you know, if they’re using, you know, these bleach and detergents, does it have an impact on the babies” …

Janet: It hurts everybody (laughs).

Alex: So you can maybe also correlate with the heart rate or, you know, things like this. So these kinds of things where you have all these data coming into one place, that’s where we’re trying to, yeah, look at.

Janet: So you’re doing long-term studies with this as well?

Alex: Yeah, we’re hoping to do, do that, actually. So there is not things, yeah, put in place to try and track those things.

Janet: Right. So we can prove to everybody that you were right. (Alex: Yes). Yeah, right. (laughs).

Alex: We’ll see. (laughs). Exactly.

Janet: I’m going with you were right. (Alex: Yeah), so let’s see, we talked about touch, smell. What about taste? What are you doing with taste? What is that?

Alex: Yeah. So taste is something that’s…

Janet: it might just be something minor…

Alex: yeah. It’s something minor. Yeah. I think, so actually what I learned is that the smell and taste sensory organs are very closely tied together. (Janet: Related). Related. (Janet: Right). And yeah, I wish, Leslie one of our nurses that was really, you know, she gave a whole lecture about this. It was very fascinating. And that is basically also something that’s tied to the smell, (Janet: Right), so, you know, we kind of combine them together. They don’t eat anything at that stage, so, you know, that’s not taste, (Janet: Right).

The position of the baby, actually, is also something very important that we’re tracking. So using the camera as well to look at, because the idea that, the baby, if they’re placed in a, let’s say, a position that’s not, you know, good for their development, they end up with really lifelong kind of issues, right? (Janet: Issues, right),

So the bone structure, like the hips, they might be, you know, splayed open if they are, so they need to be constrained actually to provide the muscle tone, because in the womb they’re kicking against the womb to kind of, you know, (Janet: Get their muscles going), basically push and exercise their muscles, yeah (Janet: Right, right). So if the position is not right, so if they lay, you know, let’s say on their back, you know, the arms open for too long, then you know that will contribute to that development of their bone structure differently. The head shape is very, you know, malleable.

Janet: Yeah, we know about the head, right? (Alex: “Yeah). If you’ve, if they’ve been lying too long on, like a mattress on their back, right? (Alex: Yeah). They get that flat head, right? (Alex: Yes, exactly). Yeah.

Alex: So all these kinds of things. So those are, again, tracking that kind of you know, positioning was, something that we also tracked. Trying to work our way around. Of course, the light we know, so not too much, you know, the light, appropriate levels of lights, you know, (Janet: Yeah). And then yeah, looking at circadian rhythm later on in the recovery, you know, so later on, when they’re old enough.

Of course, parental participation was a very important one. (Janet: Right). The parents, actually also, we are tracking, how much they are kind of at least keeping up on their education. Because the idea is that you want to prepare the parents to be able to discharge of the baby safely, right? So when they go home, they have to maybe do some of the changing of the tubes or, you know, change the diaper, or do the washing and there’s certain instructions. So we provide that set of education material that then we could track, “Hey, have the parents been watching it and you know, how, so how far along that kind of, discharge readiness they are” actually. So those are, those are some of the other things that we were tracking.

Janet: Well, but keeping in that same vein, so you just kind of moving on to the next project, which was behavioral, right, (Alex: Yeah), in the emergency room. I thought that this was kind of fascinating. It was also about, if I understood it correctly, it was mostly about juveniles, right, or is it pediatric…

Alex: Yeah, it’s a pediatric behavioral health. (Janet: Right). And this actually, this project, started actually also with just talking to one of the hospitals, actually that was one of our customers, they came to visit our innovation lab in Cambridge. And you know, they at that time were building a new facility or new emergency department and behavioral, I guess, you know, a behavioral health, mental health was one of the big issues with, you know, many hospitals at that time.

And this was pre-covid. Already, you know, there was a single ramping up of (Janet: It’s a problem). Yeah, problems. (Janet: Yeah). Children coming to emergency departments as a last resort, because there hasn’t been any, let’s say, investment in a lot of these, you know, interventions for behavioral health, mental health, you know, lack of investment and lack of infrastructure outside to support these folks. (Janet: Yup).

So what they end up is going to the emergency room and end up clogging up the emergency room. The emergency rooms are not ready to handle these kids, right? And some of them— what they call, psychiatric boarding— will spend days, even I’ve heard weeks in this single kind of room, usually without windows, they have to be really secure. And they’ll spend, you know, hours, days, weeks, depending on their severity in locked up in these rooms actually.

And, you know, at least the thinking is that “Hey, we need to keep these children safe, so they don’t harm themselves or they don’t harm others”. (Janet: Right). So they just basically strip everything from the room, you know, it’s basically a very bare empty room, actually.

Janet: Right. It’s like, it’s a, usually it’s a bed, usually not even like a blanket or what have you. (Alex: Yeah). No, the shoelaces, no belts, no, not nothing. (Alex: Exactly). And I mean, like you just, everything has to go and (Alex: Yeah), and no curtains. (Alex: Exactly). So, so, I’m sorry I didn’t mean to interrupt you, but yes, it’s, it’s, and it’s also very, I mean, how triggering is that for young folks, you know? (Alex: Yeah). And all of your stuff is taken away and right.

Alex: Yeah. And I think it definitely exacerbates the problem, right? (Janet: Right). Being kind of coming into this when you lose control, right, you’re already not feeling well.

Janet: You’re already out of control. Right. And now, like everything is out of your control (Alex: Exactly), and everything is gone, right. (Alex: Yeah).

Alex: And, you know, one of the, the things is that, yeah, you know, if they stand coming there and they have an episode, like, you know, they start acting up, becoming aggressive, then what the hospitals might do is like, restrain them on the bed, right? (Janet: Right), and just sedate them. But then once they come off sedation, again, they’re back to where they are, so it becomes a cycle.

So, you know, this was a problem in the hospital. And they’re building this kind of pediatric wing of this emergency department. And they were looking at our experience lab and we actually have this, a NICU room there. And they saw this adaptive room and they thought, “Hey, look, this might be, you know, a solution that could be adapted to our emergency department space” right? Because at that point they were looking at these holding rooms and they were arguing amongst themselves, “Hey, what kind of mural should we paint on the ceiling, should be the underwater or the jungle scene”. (Janet: laughs)

And the chief experience officer of this department of this hospital was just like, “Hey, no, we should do away with these, kind of very more, kind of legacy way of thinking, right? (Janet: Right). Making a pediatric environment, you know, it means murals, whereas pediatric, a definition of it, it’s like from, you know, zero to 17. So you imagine a teenager, you know, 15, 16, they don’t want to these kinds of  more kind of, (Janet: No), infant, (Janet: Babyish, right?) Babyish. Exactly. Babyish, kind of, decoration. (Janet: Right).

So, basically in during the discussion we thought, “Hey, look, some sort of adaptive environment would be maybe suitable for this kind of space, right?” Of course, but we didn’t know anything about really, behavioral health, you know, this topic is something we never kind of create a solution for.

So I think, you know, the first thing we did is say, “Hey look,” you know, they invited us to their hospital down in Dallas. And we basically went there and, with the understanding that this is going to be a pilot exploration. We couldn’t guarantee we’re going to deliver any results at all actually.

And we just want, you know, we wanted to help right. You know, listening to their situation, the problems, and say, “all right, maybe we can do something, let’s explore this together.” (Janet: Right). So we ended up, you know, spending a few days, myself together with design team, to tour the emergency department and to basically understand the issues, right? So there’s the same kind of shadowing, talking to the staff members. And we were actually lucky enough that one of the ex-patients was willing to volunteer himself to speak with us.

And that gave us, provided us with lots of insights. Because usually that’s more kind of, you know, behavioral health is more of taboo subject. People don’t want to talk about this. (Janet: Right). But this particular young man was very, you know, brave (Janet: Right), and to be able to open up, and gave us his input and gave us, yeah, how he felt actually and what got him into that situation. So that provided us with lot of insights. (Janet: Right),

Janet: Was there any particular part of his interviews, what big takeaway was, did you come away with from those discussions?

Alex: Yeah, I think one of the big takeaways is that, you know, when he came to these kinds of rooms, was that he just felt the loss of control and the loss of, you know, the things that kind of comforted him, right. (Janet: Right). So immediately it was of course, you know, like the mobile devices and things like this, and it’s more than just more mobile device, right. So social media, but entertainment and things like this. So music was, you know, things like he missed (Janet: Music. Big, yeah). Yeah, and also, exercises. “Yeah, I’m locked in this room and I just, you know, couldn’t do anything. I wish that’s a way for me to be able to work out, or at least express myself, get my, you know, something to do, actually”.

Janet: Or even just get my frustrations out. Right? (Alex: Exactly.) We talk about, like, especially when you’re talking about like, even like trauma or whatever, or your brain is kind of screaming. We all do it, right? (Alex: Yeah), you know, people say, “Take a walk around the block” (Alex: Yeah), “or start punching something.” (Alex: laughs). Right? (Alex: Exactly), exactly.

Alex: So, yeah. So that was I think one of the insights to see, you know, that yeah, he wanted this, almost to be normal, right? But you know, of course he knew that he was in, (Janet: Even though he’s there), even when he’s there, right. So to continue to have access to these kind of things. (Janet: Right, yeah). So yeah, I think that was, you know, really interesting part to be able to talk to him. And he definitely had good suggestions of things that were kind of, you know, took into account in our design as well.

Janet: So with this young man, you said that there were a couple big takeaways, was music, and then there was also like the ability to exercise. What did you put in the design in terms of the space that you addressed some of those needs?

Alex: Yeah, so I think the main thing that I think we brought in was, let’s say that the technology element to this space, right? So it’s, you know, it’s pretty much a simple room, you know, standard kind of size that had to be safe for the children. And, you know, usually it’s just bare walls and fluorescent lighting, right? So we looked to change this whole design to bring in this adaptive environment. So using projections both on the ceiling and the walls and colored lighting to be able to just give, paint a different kind of a flavor to the room.

So, you know, biophilia, as you say, we have nature projections. We actually worked on kind of more calming projections versus something that’s a bit more energizing. Because also, in our research we looked at the cohorts of behavioral health. It’s not just one, one type, right? So there you have the kind of folks that are in more on the autistic spectrum and you know aggression and things like this (Janet: Right), was part of that, you know, behavior. (Janet: Even hyper), yeah.

You have folks that are more suicidal, so they’re very depressed and they’re, you know, in a kind of very down stage. And then you have, you know, a small percentage that were kind of, had psychosis, actually. So, you know, they’re basically seeing things, (Janet: They’re seeing things), or hearing sounds. So you wanted them, (Janet: Right), yeah, so you wanted to have a very low stimulus.

So, working together with the kind of, let’s say, the psychiatrists and in the hospitals and the kind of, behavioral health specialists, we kind of mapped up different archetypes of patients. And that helped us, you know, decide that “Hey, with this adaptive environment, how can we change and adapt the environment to basically, address the different age groups, the different kind types of conditions,” right. So that was definitely one thing that we looked at. (Janet: Right).

Actually, one big part of our solution that we didn’t have was basically a way of controlling this environment, right? So we had the technology of the projections, the making of the content, the lighting. And we actually managed to find a partner— this is a third-party company, that’s not Philips— that created this touchscreen that was basically bulletproof, literally.

And so it was, you know, this is a huge touchscreen. They have different sizes, you know, and they had games in there and they actually developed it for also a behavioral health space, you know, with a different kind of, thinking about it. So we actually managed to connect our systems with desks and use their touch screen as a way to control our system. So, that was one of the ways to then allow the children to have control of their space, right. (Janet: Right).

So now they have this, let’s say tool or, or a portal to be able to change the lighting to suit their needs. You know, with this touchscreen we could bring in, you know, television or radio, music. So that was a really a, a great thing. And we even brought in games actually, and funny enough, one of the games was ‘whack-a-mole’ (Janet: Oh, yeah), and you can basically punch this, the touchscreen to, you know, to play this game. (Janet: laughs, That’s perfect, yeah). And so, you know, this kind of was one of the, let’s say, elements that we partner with another company to create, to deliver this solution. So it’s not just one company doing it, but coming together.

Janet: Yeah, I want to just to make sure that everybody kind of hears what you’re saying here because it’s so important. These particular age groups essentially have their own autonomy, right? They have their own agency over their own environment, (Alex: Mm-hmm), which is just so huge, right? (Alex: Yeah). I mean, like, yeah…

Alex: Yeah. Indeed, actually. And you know, so we also work with the hospitals in the sense of looking at how can you provide, you know, give the children incentive, right? And say, “Hey, look, if you promise to take your medication or behave in a certain way, then we’ll slowly give you privileges in terms of, all right, now you can have television, you can have radio, you know.” So slowly kind of using that incentive to give them what they want, so a working partnership.

We also actually found that the touchscreen was actually really useful as a tool for connecting the nurses and clinicians with the child. So basically, by either playing games or a game of chess or whatever game, you know, puzzles, memory game that they do. (Janet: Right). This kind of having them both sit in front of the screen and participate in having a chat create this bond between the clinicians. (Janet: Right). So it became, you know, this technology piece suddenly it’s not replacing, but it’s actually bringing people in together. And that’s, I think that’s really also important, right? (Janet: Right).

Something that I strive to do is how technology, I mean, frequently, it just gets in the way, and you know, and people just, you know, gets focused on it. But how can it become a facilitator of really human relationships, actually. I think that’s also something really important.

Janet: Of human relationships, right, as opposed to, again, closing the door. (Alex: Yeah). I mean, it’s almost like they’re then forgotten, right? (Alex: Yeah), and they don’t know what’s happening. In this way, they can stay engaged (Alex: Yeah), and everything like that. That’s just terrific, Alex. (Alex: Yeah). I just want to ask you one more question about that particular room, (Alex: Mm-hmm), you had mentioned putting projections on the ceiling, not just on the wall. Was there a reason for the ceiling, (Alex: Yeah), projection as well?

Alex: So actually, it was more of a hypothesis that we started with this. So, you know, it was a pilot room. So we went in there trying to at least have the coverage of looking, “Hey, what are the possibilities”, right? And we did the projection, and we knew that with projectors you can kind of, you know, turn it off and then it’s not there at all. So we are not taking up the space. So we’re building, let’s say, the redundancies to be able to test out different hypothesis. And one of them was really to have the children when they’re lying in bed, to have some sort of visual cue of looking up the ceiling, right? So they’re not staring at this blank ceiling.

And one of the content that we developed for this projection was a starry night sky, actually, to help the children relax. (Janet: Right). And we worked with the psychologist to have this star that would gently pulsate to a certain rhythm so that if you don’t know it’s there, you won’t see it. But then the psychiatrist might tell a child, “Hey, look, see that star, that, focus on that, pace your breathing to it”, (Janet: Pace your breathing) and to help them calm. (Janet: Right, yeah). Yeah, so that was a way of, you know, to help kind of wind down an agitated state to help them calm themselves using the content of the projection. (Janet: Right).

And the other projection that we developed was more of a sunny forest. So it was really, you know, trees, you’re looking at the canopy of the trees. (Janet: The canopy of the trees, yeah), Yeah. The sunlight kind of filtering through. So again, something, you know, very nice that reminded you of outdoors. And in that scene, they were actually butterflies that flew across the screen. (Janet: Aww, oh that’s lovely). And the coaching that the, actually the psychiatrist want to do is that hey, you know, they’ll tell the child, “Imagine all your bad thoughts and terrible thoughts. Imagine these are the butterflies and they’re just flying away, floating away.” (Janet: Right). “So one at a time, just let go of it and let them fly away.”

So, we were basically developing these kinds of content to help, you know, with the therapy as well. So, I think for the first time, you know, we’re trying to now bring in therapy into this space where traditionally, you know, they really couldn’t do, they didn’t have the tools actually to really work with the children, right. They might have some usual coloring books and things like this, and you know, for the kids, but that was basically it, right? So we’re trying to bring in some of these technologies to help create this opportunity.

Janet: Yeah. And reduce their stress (Alex: Yeah), and everything, like you said, all the stuff that might be running through their minds (Alex: Yeah), and everything like that. I don’t think I need to see any papers after all of this, I know that what you’re doing is making a difference. (Alex: laughs).

Well as I tell our listeners all the time, as inclusive designers, we look at the biology, psychology, and sociology of spaces, and it really looks like you’ve really tackled all three quite well. So, just to remind our listeners, we will have all this information on our website, InclusiveDesigners.com (Alex: Yeah). Yeah, and is there anything else you wanted to add, was there any last, like takeaways, and what’s the follow up?

Alex: So maybe I think, I would like to end that, you know, at least for this behavioral health room, we’re piloting it and for now, it’s starting to show very good results actually. And I think some of the takeaways that, you know, we created this as a pilot, is that there is definitely some unintended users that, you know, we kind of discovered during our journey.

So there was one anecdote that actually the nurse told us about this child that came into this department. She was basically really aggressive, and out of control. She was basically like, you know, breaking equipment, tearing wallpaper off the walls. And they decided, “Hey, look, let’s try and put the child in this Philips room.” So they brought her over there with restraints and she went to the room, and immediately what she did was she turned on the red lights. You know, she just sat the room to this really intense, bright red. And the staff members were really concerned, like, “Wow, this red light going to aggravate her more.”

And really, you know, so everyone was like really concerned— “Should we just go and intervene?” But one of the head nurses said, “No, no, just leave her alone.” And within an hour, she had really calmed down and de-escalated. They could take off her restraints. And then I think within the, the next half day they could discharge her, and she was already, you know, there for a couple of days being really troublesome.

So it goes to show that, you know, because the red light I remember was one of the things that we said, should we just, you know, block that from happening because that’s really intense, right? But I’m glad we didn’t because I think, children, you know, or our kind of cohorts, find a way of expressing themselves, right? (Janet: Right). And this is something again, we’re still learning, discovering there’s so many different possibilities and who am I to say that red is not the right color, right? And that’s, I think, you know, one of the lessons for me as well, that yeah, there are, you know, different ways of expressing…

Janet: Yeah, but teenagers always have a different way of looking at things anyways, you know? (Alex: Yeah). I might have liked a red light too. (Alex: Yeah). Right? (Alex: Yeah). And again, I think it was in part that she was able to get that agency for herself, right? She was able to have that control. (Alex: Yeah). And be like, yeah, I’m going to have the red light and just not allow anybody to say otherwise, and with, just even with that was probably what helped her to kind of calm down. (Alex: Yeah).

All right. So it’s kind of switching gears a little bit, let’s talk about the innovation lab. (Alex: Yeah). I mean, all this work that you’re doing is just amazing. What do we got coming up? What should we know about as inclusive designers? What do we have?

Alex: All right. So yeah, we have the innovation lab, you know, here in Cambridge, Massachusetts. So this is Philips’ headquarters here. And this is basically a lab where yeah, we, you know, bring together a lot of our different advanced research, right? And we’re trying to bring into this lab, and it’s kind of probing the future of what healthcare could be, right? So we’re thinking about that tomorrow. Thinking about what, you know, is the ICU of tomorrow, you know, what is the cath lab, you know, interventional lab of tomorrow.

So we’re trying to basically bring together these different thinking and groups of designers to build these possible or preferable futures, you know, and we share that with our, you know, customers, the clinicians, and get feedback. So it’s a kind of basically, yeah, I would say, experimentation lab where we bring in technology and we try to, you know, build it in a very tangible way, and invite folks to come and experience it and provide us feedback. And this is how we kind of learn and grow and develop these, these ideas actually. So, yeah…

Janet: Yeah. Well, I think you guys are doing some amazing work. And Alex you also do some amazing work as a sideline. (Alex: laughs). You want to tell our audience a little bit about it, and again, we’ll have all this information on our, on our website.

Alex: All right. Yeah. Thanks. Yeah, so of course, you know, yeah, working in the healthcare, you know, it’s a very kind of serious field. You know, very life and death. And, you know, in my kind of, let’s say spare time, I, you know, do something, you know, other things are more lighthearted, but still in the design area. So, this is something I’ve done is actually a plush toy, nightlight actually. So it is a completely soft, plush toy that also doubles as a nightlight, actually.

So this is something actually I created when my son was born. So that was basically about 15 years ago. For my wife actually, and I for us to do the kind of nighttime nursing feeding. So it gives off a very gentle light so we could basically do our nighttime chores without waking up the other partner.

And then, when he kind of, you know, grew a bit older in the toddler, it became his kind of companion to comfort him at night so he could sleep by himself and have his own personal light that he could control actually. So if you, yeah, the character, that you click its bellybutton, and it glows and then it’s turns off by itself. 15 years later we decided to do a Kickstarter, kind of, you know, a campaign. And it was successful. So now we’ve produced it and I’ve got little side business, at least the selling is…

Janet: A little side business. (Alex: Yeah). I know, and it’s called, it’s called Lumi, right?

Alex: that’s right.

Janet: L_U_M_I

Alex: Yeah, Lumi. Yes.

Janet: What was behind the name? Is that like a children’s book name that I’m not aware of? Is it…?

Alex: I guess it’s because it glows, it’s, yeah, illumination, Lumi. And it does actually come with a storybook as well.

Janet: It comes with a storybook! I didn’t know that. Really!

Alex: Yeah. The life of how Lumi came to become Lumi. And why does he, Lumi, glow.

Janet: Oh, (Alex: Yeah), oh I love that. Well, I can see what I’m getting now, that’s what I’m going to go give a lot of my friends.

Is there, before, as we we’re kind of wrapping this up, our conversation today, (Alex: Mm-hmm), you know, Alex, it seems like you’ve kind of like, kind of conquered the inclusive environment quite, quite well. Is there anything you want our listeners to know, like is there any last parting words? You know, what do you see the future maybe? Or what would you say to yourself if you were a younger designer? (Alex: laughs). Like, kind of riff with me a little bit.

Alex: Alright. Yeah. I wouldn’t say, you know, I’ve conquered the inclusive design. I’m thinking I’m on a journey and there’s always a lot more to learn.

Janet: Well, I know a lot about this stuff, I’ll just let you know right now Alex, and you check a lot of boxes as far as I’m concerned. So, just so you know… (Alex: Thank you). And you’ve written a children’s book, so like, that’s pretty cool, right?

Alex: Yeah, I think, you know, it’s just, you know, having this kind of naivety, I guess, you know, to come into a space, you know, that you don’t know, to be able to open yourself to learn about it, right? And you know, I always say, you know, yeah, it’s not having that, the arrogance to say, I know everything, and this is the way it should be. You know, so really talking to the, to the folks that you are working with.

And I think also my, you know, definition of inclusiveness is also looking at they’re casting a wider net, right? So just like NICU, you know, the parents were not someone that people focused on, but they were actually equally as important, right?

So in any situation, any solution they’re designing, not just look at the immediate user, but who are the other supporting, (Janet: Supporting), stakeholders (Janet: Yeah). Yeah, even, you know, it could be the parents, it could be, you know, at least in the healthcare, know that some of the decision makers that might buy the equipment, all that. So all these people (Janet: Right), working together in this ecosystem, I think, is one of the things that I think we’re starting to look at more.

And also, I think, at least in my field, in the healthcare area, it’s so complex that not one company can own everything. So we’re starting to look at partnerships of different ecosystems where, one company like Philips might deliver one aspect of the solution, and partner with someone else, you know, maybe even a competitor to deliver something else, right? So, but together, at the end of the day, we’re delivering a great solution that works together for the benefit of all the end users. Right? (Janet: Right).

So I think that’s, that’s a key thing. And that’s where, I guess, you know, that’s the change from when I started my career, you know, many years ago, is that, you know, it’s more “alright, yeah, you know, you only have this nice company, we need to own all the space; we need to own everything.” And it’s that singular user, but now I think that’s a lot more actually, that we need to look at as a system.

Janet: Right. Yeah. I mean, I think that’s an interesting journey that you just referenced, that you’ve gone from this like singular look to like really, I mean, I dare say an inclusive approach to, you know, healthcare. (Alex: Yeah.) So yeah, I think that’s really quite lovely. (Alex: Yeah).

Alex: Yeah, and I think that also, maybe just another quick point. I think that also goes for the design team, actually. I think one thing that I’ve discovered is that there’s so many, you know, designs becoming so complex as well. So for instance, design the NICU room and all that. It’s not just, “Hey, look, I’m an industrial designer, I’m a user interface designer, or I’m  a video specialist.” We’re bringing all these folks together from architects, right, from all the different disciplines working together as well. And I think that’s also on that size, including all the different viewpoints in the creating of the solution. And it’s not just, look, you know, it’s the product marketing guy that’s making that, let’s say specification, but it’s everyone coming together and working more in collaboration.

Janet: Yeah, no, I mean, it’s really quite terrific. I mean, because this is the discussion of not doing these things in a vacuum, right? Like, and it’s about really kind of, the collaboration only brings great minds together, which only helps the better good.

Alex: Exactly, yeah. (Janet: Right). Indeed.

Janet: Yeah, no, I mean, it’s just perfect Alex, and I thank you so much for stopping by and we’re going to have all this information for our listeners on Inclusive Designers Podcast website, which is InclusiveDesigners.com. And Alex, thank you again so much for, for being here and sharing your wisdom with our listeners. And, if there’s anything else you want to, I know we just went over this, if there’s anything else you would like to express, please let our listeners know.

Alex: No, yeah, thank you for inviting me, to this show actually. It was a pleasure talking to both of you and sharing my experience, so I thank you very much.

(Music / Outro)

Janet: Alex is so impressive! He is one of those inclusive designers that is thinking of everything in these highly technical environments for some very vulnerable populations. These pilot adaptive environments are amazing in the way they seek to make the experience better for patients, families & clinicians. Using meaningful human-centered innovations, they are truly reimagining the ER experience for both the NICU rooms, and pediatric behavioral health.

Carolyn: In the NICU, I really like how they are using the software and screens to help the parents be more informed and involved in the baby’s care… and for those parents to be able to more easily navigate the information they need, is so important.

Janet:  Yeah, I also found it fascinating that they were then able to take that knowledge and tools from the pilot NICU space to create an alternate for the sterile rooms usually used for pediatric behavioral patients… This work with behavioral health should be inspiring for designers no matter what their area of interest.

They included interactive ambient elements— like the Tune-able lights, calming sounds, and immersive projections. These seem to calm agitated pediatric patients which we know will lessen the need for sedation, and potentially de-escalate patients who might be unregulated. Not only did it give the patient a sense of comfort and control, the projections could even be used by staff for additional therapeutic treatments.

It is interesting to note that this was already in the works before the pandemic. Making a room that allows for some agency, when they have no agency in their lives— in this case a juvenile, who is in crisis mode— can really help to relax and calm the mind.

Carolyn: I know, I think they should consider creating a home version— who wouldn’t like to use that pulsing star to regulate their breathing, or let a butterfly take the day’s stress away.

Janet: Mm-hmm, well you may want one at home, but there are so many other places that could use a calming zone like this too. When we think about Trauma-informed design, for example, these could be great tools to put in the workplace, or schools.

Carolyn:  …and that is why you are the professional (laughs).

Janet: Well, and speaking of professional, one last point that keeps coming up in all our discussions in our field is the importance of co-design. We need to look beyond ourselves and collaborate to reveal the best design decisions.

Carolyn: And stay tuned, we may even have more on this topic in our next episodes, which are already in the works. And we can’t go without giving a quick ‘glowing’ shoutout to Alex for creating his plush buddy Lumi…

Janet: Yeah, gotta love Lumi…

Carolyn: I admit, I’ve already given one to my niece, Alison, and her little one, Jordan.

Janet: And we will share the link for how to contact Alex, and of course, the links to the innovative work that he and his team at Philips are doing, and also for the many other things that were mentioned along the way during this discussion. All on our website at InclusiveDesigners.com

Carolyn: That’s: InclusiveDesigners.com…

Janet: A big thank you to Alex Tan. And thank you all, as well, for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it again, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page. And now you can also find us on Feedspots’ List of Best Design Podcasts.

Janet: Yes you can! And as our motto says: ’Stay Well… and, Stay Well Informed’…  as always, thank you for stopping by. And we’ll see you next time.

Carolyn: Yes, see you next time.

Music up

It’s never been so important to design with inclusion right from the start! Evidence-based research shows the value of inclusive design, but how do you convince clients of these benefits and add more IDEA (inclusion, diversity, equity, and accessibility) into your design process? Dr. Matteo Zallio of Cambridge University has developed a few new tools that provide a way for you to do just that!

IDP digs into the research that led to the creation of the IDEA toolkit, and how it can help designers ask all the right questions and present the best solutions. These tools can help you get your clients to appreciate and embrace the need to create healthier spaces where people live and work. We also sneak a peek into the not-too-distant future to explore Inclusive Design in the Metaverse! Get ready to start designing safe and inclusive virtual immersive environments.

Guest: Matteo Zallio- is a senior research associate at the University of Cambridge, and previously a Fulbright fellow at Stanford University. He is an award-winning designer and researcher with a unique background in helping businesses to develop futuristic technologies that are inclusive by considering human diversity. In his own words, he is on a mission to make everyday spaces and technologies accessible and inclusive for everybody.

– References:

• Website: MatteoZallio.com

• Matteo’s Recent Publications

• University of Cambridge, Inclusive Design Group

• IDEA Toolkit

• IDEA Audit

• Inclusive Design Canvas

• Cambridge Simulation Glasses

• Age Explorer Suit

• Metaverse Inclusivity

• Yannick Benjamin/Contento NYC

• IDP Episode: Serving Up Inclusive Design

• IDP Episode: Insights from Judy Heumann

• IDP Episode: Designing for: Beauty and the Brain

• Feedspot List of Top Design Podcasts

Transcript:

Creating the Best IDEA:

Music / Open

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music up, then lower)

Music / Intro

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: and I am your moderator, Carolyn Robbins…

Janet: Carolyn, we have such a wonderful show today! But first, I’ve got to tell you some big news, ‘Feedspot’ has put us on their list of “The 70 Best Design Podcasts on the Internet”—pretty cool, right?

Carolyn: Very cool. Woohoo us!

Janet: Woohoo us, exactly… and to keep us on that list, we must get to our next guest. Dr Matteo Zallio from Cambridge University. He has done a lot of research on how the built environment influences our perception of a space, our behavior, our interaction with other people and ultimately, our mood and happiness.

He and his team have created some wonderful tools to help designers and architects add Diversity, Equity & Inclusion—or as we call it DEI— in their designs. They named it the ‘IDEAs Toolkit’ which stands for Inclusion, Diversity, Equity, and Accessibility.

Carolyn: Yes, and not only is Matteo Zallio one smart cookie, but he’s our first international guest!

Janet: Our podcast is being heard far and wide, and with that in mind, I think our next season may be even more globally focused.

Carolyn: So true, and a good hint at some interesting future shows we are working on… but first, let’s take a closer look at Matteo, his background and what makes him so impressive…

Dr. Matteo Zallio is a senior research associate at the University of Cambridge, and previously a Fulbright fellow at Stanford University. He is an award-winning designer and researcher with a unique background in helping businesses to develop futuristic technologies that are inclusive by considering human diversity. In his own words, he is on a mission to make everyday spaces and technologies accessible and inclusive for everybody.

Janet: Matteo will introduce us to ways to use the tools they created to help find the best design solutions. And we even take a little side trip into the future to discuss what’s coming in the Metaverse!

Carolyn: And unlike the Marvel heroes, we may already have some super-powers to make the technology more inclusive right from the start!

Janet: Actually Carolyn, the Marvel multiverse may be fictional, but the Metaverse is very real and coming sooner that we think. But we’ll let Matteo tell us about this and many other important insights in his own words.

Carolyn: And with that, here is our interview with Dr. Matteo Zallio… Designer, Scholar, Product Creator, and Inclusive Design Activist.

Music / Interview

Janet: Hi and welcome Matteo. How are you?

Matteo: I’m great Janet. I’m great. It’s great to be here with you.

Janet: And where are you right now? I know you travel all over Europe. Where are you stationed at the moment?

Matteo: Great question. Well, I’ve been traveling prior to COVID a lot. I was in America and around Europe, but now I’m based in Cambridge in England. So I’m currently here.

Janet: Very nice. It’s a beautiful area. So let’s kind of dive right on into it. Let’s start with the broader perspective. What exactly got you involved with inclusive designing and what brings your passion to the table?

Matteo: Well, it might be a long story, but I’ll try to keep it short. (J: laughs). Because you know, I learned about inclusive design, universal design, and accessible design shortly after my master’s degree in architecture, back in Italy. When I was working as an architect in different offices, and I was consulting for some companies. And I understood that, as an architect, I haven’t been clearly understand the concepts of inclusion and accessibility when I was studying.

And with the practice, I understood that there is much more than only just guidelines and regulations. And so, I got more interested into exploring a more people-centric perspective rather than a more technological or, or kind of self-centric perspective of making a beautiful architecture. But I wanted to make beautiful, accessible, and inclusive architectures and products.

So yeah, everything started at that moment. And then, I got a chance to get enrolled into a PhD where I actually started and I did research around that topic, and it’s where, brought me up to here today.

Janet: That’s great. Well, was there also like a particular thing in your life that maybe made you think to go in this particular way, was there like an impetus, was there an ‘aha’ moment? Was there something that you said, ‘this isn’t right, we’ve got to do things a little bit differently’?

Matteo: Well, for sure. I think, the moment when I started seeing my grandma, which, I was very attached to her, you know, getting older and getting more… I would say, with different impairments than the one she had when she was younger.

Well, this made me think that sometimes the house, the home, the place where we live, which is, you know, the nest where we build our family, sometimes can become a prison. And people have the right not to live in a prison, but to live in an environment, in a place, where they feel good, they feel included, and they feel can protect them without safety or security issues.

So, yeah, I think combining that event, those moments with what I was studying, and what I wanted to study in the near future, brought me to be more interested into this topic and to learn really a lot, especially from my trips around the world.

Janet: Right. Okay, my brain just started exploding with all these questions. So you know, I think it was even Judy Heumann said something to the effect of: ‘We’re only disabled by the environment around us’… so, and I thought to myself, that’s very true, right, to your point, that the environment is really the disabler. Right? The thing that becomes the problem. So I know that you’ve done a lot of research at Cambridge University. Can you tell me a little bit about some of your work?

Matteo: Oh, for sure. Janet. Well, we have done quite a lot of research at Cambridge around inclusive design. And especially if we talk about the built environment. We recently understood from a survey that we conducted across different areas of the board, that survey respondents reported that building owners are well-informed about the benefits of designing inclusively.

And unfortunately, we got only 10%, around 10% of the survey respondents, to be really well-informed about that. So what that means… 1-out-of-10 people know about the benefits of designing according to universal design and inclusive design principles. And this led us to think a lot about what we could do as a community, as architects, as designers, to promote inclusive design and to explain about the benefits to business owners, to clients, to facility managers, to everybody who has to be involved in the design process and in the commissioning process.

Janet: Right. It seems reasonable (laughs). But I thought it was interesting that it was only, I don’t know why it surprised me, 1-out-of-10, I thought it would be a little bit higher than that. And I think people do know, but I think that people don’t always then know what to do. I just took a survey about, as a designer, had I come across anything about designing gender neutral bathrooms.

And it was interesting to me because I really had to think about what the other designer who’s asking me for it, and then they had to go back and talk to their stakeholders, right, and discuss this as a concept. And I think that none of them, and maybe even myself included, really understood the, like what I could say, in order to help this as a practice.

And I think people want to do it, but they just don’t know what they’re looking for. Can you, can you give us some examples of maybe some of this as ideas to, to help designers to push the narrative?

Matteo: Totally, Yeah, well, this is very true, and it is correlated to the fact that as people don’t really know about the benefits and maybe even the value of designing more inclusively. There is a sort of a correlated scarcity in their request to the architects to design inclusively. So let me rephrase.

Basically, if people don’t really know about the value of having a building that is not just wheelchair accessible, but it’s actually helping people with sensory or cognitive impairments to live in a better way and to thrive. Then architects, designers and the engineering teams are not really pushed to design for standards that are going above and beyond what we currently know and what we currently envision in terms of design.

So an example that’s really clear, and I think it impacts the life of a lot of people is, you know, when you go to a restaurant. And maybe you are sitting at the table, the lights are pretty low, there is a lot of noise in the restaurant, and you have a group of people around you trying to have a conversation with you.

Well, I personally experienced a lot of times exclusion in that setting because I couldn’t hear clearly what people were telling me; I couldn’t see clearly what I was going to eat; and even more things. Sometimes you are squished into the side of the room with your chair (J: laughs) and you want to go to the toilet and you say, well, it’s better I don’t go now. But I go when I just stand up before paying the check. (J: laughs). Because if I need to move now, I need to move the table, I need to move the other eight friends around me. (J: laughs).

So this is not really about an inclusive experience, (J: No), but this is something that excludes people from having a pleasant evening. (J: right). And that’s an example I think is powerful to understand, not just the value, but the benefits of designing inclusively.

Janet: Right, I’ve experienced that both in separate nature, whether it’s just the poor lighting or the sound is too loud, or I can’t navigate the room, or like you said, all at once. And then when we talked to Yannick Benjamin of Contento, he was a restauranteur and he had really looked to try to design for inclusivity.

And I think what we’re kind of saying here, is that there’s a direct correlation ultimately at the end of the day from inclusivity, because guess what? I’m likely not to go back to that restaurant, right? I’m going to try to persuade my friends not have to go back to that restaurant because I couldn’t hear them, I couldn’t see, I couldn’t navigate getting to the bathroom, or whatever, you know, throw in a couple of glasses of wine, right? I mean, it’s just becomes a whole thing. That’s money out of your pocket.

Matteo: Yeah, I totally agree. And I think this is another example that tells a story for, you know, business owners for example when we talk about a restaurant. But simply, you know, when we go to the hospital, at school, at work, in a shopping center, everywhere— it’s really about trying to make these examples and trying to allow people to develop a narrative and a conversation that allows them to put themselves into the shoes, not of others, but of themselves.

So if you cannot put yourself into the shoes of a wheelchair user, put yourself into your own shoes when you were experiencing exclusion… when you couldn’t enter a door in a shopping center because you had so many bags around you, or you were carrying so much weight, or a kid, or just simply you couldn’t get into the car because you finished the 2-hour session at the gym when you were completely destroyed, right? (J: laughs).

When you, when you try to emphasize these emotions, these feelings, and these behavior for people to really understand ‘how could be the life if you have a physical sense or a cognitive impairment?’ Well, then at that moment people will demand for more inclusive design. People will demand for better designed buildings, and people will understand that at some point that they cannot live without that.

Janet: Right. Let me ask, I want to ask you a more of an opinion question. We’ve talked about this in other episodes as well, is the idea of whether or not, when looking at design to do sort of like the fake walk through, so like, being in a wheelchair, maybe having some sort of eyeglasses that make you have limited vision, or something like that to walk through those spaces. You know, it’s temporary, so that’s where people have an argument with, you know, this is just considered like a blip in time versus a chronic situation that goes on for perhaps the life of the occupant.

Again, there’s two trains of thought… I’ve seen it work both for myself and also for others students and even observers of students going through spaces that have to navigate while pretending to, having some sort of paraplegia, or pretending to have some sort of visual impairment, that type of thing. Do you have any thoughts on that?

Matteo: Absolutely. I have more than some thoughts on that (J: laughs) because, well, first, I could mention that when we developed a study about a year and a half ago, and we tested the ‘Cambridge Simulation Glasses’ which are glasses that exactly do what you were mentioning before. They simulate visual loss, and they simulate, for example, the inability to understand, to clearly see contrast between objects and colors. We did a study— it’s open access, it’s published— about how people can understand by wearing these glasses where points of exclusion are within a building.

And we tried it out in different settings. And we discovered that, for example, stairs. The stairs that have the nose without a color that highlights the end of the step are extremely dangerous. Not just for people who are totally blind, of course, but also for people who have very, very mild visual impairments (J: right), or simply where people are checking their phone, (J: laughs), their messages or their social media, and they are not looking at exactly where the stairs are.

And that’s not everything, because it’s great to develop this sort of empathy for, let’s say impairments that you don’t have. There is a problem here, as you mentioned, wearing those glasses, or trying a wheelchair for a couple of hours a day in a year, doesn’t allow you to have the full experience of a person that lives constantly in a wheelchair, with glasses, or hearing aids. for example. (J: Right).

This is a limitation of approaching the problem in this way, but it’s also a powerful message that allows people to first approach a problem, a need, a demand from the users in a different way. And if they are approaching that way that has not been a conventional way they normally do when they design, well, it helps them to create more empathy and compassion. So then, when they design, they have a better understanding of questions and answers that are out of the box.

Janet: Right. Yeah. I thought I would kind of just ask you about that, because it’s sort of a hot topic within inclusive design and how to navigate some of these spaces and such. So Matteo, are there any resources that you can point to that might be helpful for our listeners?

Matteo: Well, there is a lot of research in this area and there are a lot of studies. Now, if I would mention to you right now a list of studies, we might end up recording the podcast into tomorrow (J: laughs).

Janet: Well, you have kindly provided us with a few resources of your own and we’ll have that on our website, InclusiveDesigners.com.

Matteo: Absolutely. I think it’s worth to mention the variety of studies done from the 60’s when the human rights movement started to mushroom, in America especially, (J: Right), to also studies around the 90’s and 2000, even from Cambridge or also from other universities across Europe and America, where they test products and they test tools to increase this empathy, this experience of living in someone else’s shoes for a bit. (J: Right).

I can just mention, for example, the Age Explorer Suit, which is a sort of a suit that you can wear and you experience for a few minutes or about an hour, whatever time you want to wear it, the feeling of being an older person (J: yup), with, you know, temporary physical impairments.

So there are really a lot, a lot of tools out there. And, (J: Right), it’s just a matter of maybe Googling it and find them.

Janet: Right. I mean, there’s even tools right now that you can put on your phone for Pete’s sake to get some sort of idea of even what visual impairment might look like in a space. So keep that in mind designers, and we will have all that posted on our website, Inclusive Designers.

So going back to your work, so when we were designing spaces that are really inclusive, are we considering all aspects of human beings or sometimes we have to be very specific? I think it’s the ultimate goal is to be as sort of global as all-encompassing as we can be, but is that really attainable?

Matteo: Well, I cannot hide that it’s very challenging for several reasons. And one is that— even if we’re talking about a small architectural firm, a small design firm, or a huge, massive with thousand employees architectural design firm— there’s always a degree of misunderstanding or bias, or even just a lack of knowledge about, you know, designing inclusively for everybody.

But to me it’s important that from the very start, from when you study in college, in your PhD, in your master, even perhaps in your, you know, K-12 education, there has to be an understanding of, for example, the power of diversity. The importance that nobody is equal to another person. I mean, we are all different, but we all need equal rights, right?

So for example, coming back to the work of designers and architects, it’s important to understand the stories and the journeys of stakeholders for the building occupants. It’s important then to brainstorm when we know their stories and their journey, to brainstorm what their capabilities are— what are their physical, their sensory, their cognitive capabilities.

And when we understand about the journey and the capabilities, we can then define the needs, their desires, right? The really so-called ‘need finding’ stage in the design thinking process that is very famous and popular among designers, (J: right), but I’m not sure how popular it is among architects. So knowing about a journey, knowing about the capabilities, allows us to define the needs. (J: hmm).

And once we understand about the needs, we can create design requirements. (J: Right). There are not just a checklist taken from a few standards or regulations, but it’s really something that goes above and beyond our traditional thinking process.

Janet: Right? That is so true. I think when people hear that I’m an Inclusive Designer, those designers and architects come, they mean well, but they’re really trying to get, they’re looking to get around the checklist. They’re not even like trying to get the checklist done.

So I find that that’s in some respects, it’s a simple process, but I think you’re right. I think people just don’t always tend to want to go through it. I think that there’s a, a feeling of design in terms of beauty that that’s the focus and it’s not necessarily on inclusivity. And that ultimately, well, it could win you awards, but it’s probably not going to be like… I just saw something recently in one of the design magazines and they had, it was for some sort of spa. It was just bizarre. There was no biophilia in there which is known to create feelings of calmness and relaxation. And again, it looked like it was like a white cave. It was just, it was bizarre to me, but it made the magazine. Right?

But I thought to myself, well, how long is that going to last? I’m thinking, I just don’t see that as being some sort of like beautiful place in order to go to kind of relax. So, but anyways, so it was just to your point, I’m getting off track here, but I know you also talked a little bit about an ‘Inclusive Design Canvas’… can you talk a little bit about that?

Matteo: Yeah. Well, we did some research here in Cambridge. And other than understanding about ‘what are the challenges’, we try to envision ‘what are the opportunities out of these challenges.’ So other than understanding that there is demand, and with not enough answer to these demands to design inclusively. We try to work with architects and experts. And we are literally a co-design process to try to understand how we can help them in the design process. How can we make the design process an inclusive design process?

So we were able to create this ‘Inclusive Design Canvas’ which is sort of strategic design template that helps people, helps architects, designers to brainstorm and involve real users in the design process.

Janet: Can you tell us a little bit your ‘Inclusive Design Canvas’ and how can inclusive designers access it?

Matteo: For sure, Janet. So, an essential part of the design process is about understanding who we are designing for, what are their stories, their capabilities, their desires, and their journeys. So to help designers to embed inclusive design in their traditional design process, after years of research, we created a design template, this is called ‘Inclusive Design Canvas’ that helps designers, but also public authorities and organizations, to think inclusively and ask the right questions. So the ‘Inclusive Design Canvas’ is a strategic design template that offers an educational springboard for architectural design professionals to embed inclusive design into their design process.

I could say it actually helps to develop community engagement exercises with stakeholders. Or we can just simply use the canvas, which is an A3 paper, an A3 sheet—you can print it or use it on your computer— to brainstorm with, with post-its. For example, with your team, you can brainstorm the journey, the capabilities, the needs, and the design requirements you have to think of in order to go above and beyond accessibility, and really think about inclusion, diversity, and equity when you design.

Janet: Right. I love the idea that just even bringing in the community, I think, designers and architects just don’t even take that into consideration. (M: yeah).

Do you have any suggestions for designers out there that are maybe trying to get their firm to do that type of extra— it’s extra legwork, let’s just be honest, right, I mean, it should be part of the process, but it is extra legwork at the moment. So, do you have any suggestions for those designers that are maybe trying to push that narrative in their design firms and, and getting a little pushback? Do you have any thoughts on that?

Matteo: Well, I would say to your point, it’s not really extra work at the moment, because then you get paid back in terms of happiness, satisfaction and (J: productivity), totally, of the people who are going to live into your, into the building you’ve designed (J: right), after you finish your process. (J: right).

So I think it’s really about embedding in the design process the word ‘inclusive’. So what do you do? I do design— no, you do inclusive design. So inclusive design or universal design should become not just buzzwords, but literally objectives that clarify and make sure people understand how you design.

Let me give you an example, doing universal or inclusive design is not just an add-on, as I said before, it should be really in the mainstream design process. And when you do this, you should start from the very basics from, you know, from the ground up, to think about a blank paper— when you have to sketch a new house or a new office for your client— as an opportunity to use, for example, a structured method like with the ‘Inclusive Design Canvas’, which is an assessable open source tool you can download from on my website or the university of Cambridge, the Engineering Design Center, Inclusive Design Group website. You can use that.

Janet: And we’ll have that on our website.

Matteo: Yeah well, you can just download the canvas and use that as a tool for the very few moments when you start the process to literally think about something that is not just about form and aesthetics, but think about something on form, fit, and function. (J: right). Form, fit, and function are what makes a great architecture, beautiful architecture, to work for real people.

Janet: Right. Yeah. Well, it’s interesting. And what is the website Matteo?

Matteo: Yeah. Janet. Well, you can find it on my website, MatteoZallio.com, or on the Engineering Design Center from the University of Cambridge website. So I think Google will help you a lot to find it.

Janet: (laughs) love Google. Alright, I got a couple, few more questions for you. You said something along the lines of designers have to ask for feedback and evaluate how they can do better. You know, we talk about sort of like post occupancy surveys and stuff like that. We have a, another designer that had thought maybe that they’re kind of becoming obsolete. Or maybe they were becoming obsolete because people just weren’t doing them. She argues a little bit further that maybe we can be doing a better process upfront so that the post-occupancy surveys don’t necessarily, they don’t have to be done. What are your thoughts on that?

Matteo: Post-occupancy surveys are tools or methods that are around since, I would say the 80’s and 90’s. More so in the 2000’s and in recent years, but they have been around and been tested for more than 30-years now.

Yes, there are some challenges, there are some problems with some of the post-occupancy evaluation tools out there but are also great opportunities. In fact, we understood about the opportunities with, with the research we have done, because there is a part of the design process that has to be done in a way that is inclusive. And as I mentioned before, you know, you can use the ‘Inclusive Design Canvas’, but you can also use other tools that I’m sure are out there.

When you talk about getting the data and getting an understanding of what people feel, what people experience in an environment, in a building. Well, to me, it’s important that you just not ask questions about ‘how do you feel in terms of thermal comfort’; how do you feel in terms of access; how you feel in terms of sensory, like auditory comfort? But it’s important really to embed in post-occupancy evaluation tools, or even more in surveys or other mixed method audits, the great variety of information that allow us to live in a space.

And I’m saying about, of course, the relationship between the person and the space, which it can pass as information around access, ergonomics, thermal comfort of course, or the comfort, but also for example, the perception we have about cleanliness and maintenance. And also you have to put together into post-occupancy evaluation, for example, data about how people feel and how people feel with others in a specific environment. So about people, teams’ dynamics, how people feel in their relationship with other people (J: within the environment). Exactly.

Janet: Right. Yeah. Which is so important to understand just even the more nuanced pieces of being in those spaces. It’s something that comes to mind and in just, even a household kind of situation, everything you want is open concept, open concept, open concept for households. And that was huge. And then here came the pandemic and there were no places for people to kind of go because you’re now living with them 24/7. And that’s the interpersonal dynamics, right, I mean of living. Do you think that psychology comes into play a lot more than designers have thought about in the past? Like, what do you think?

Matteo: Yeah, I think that’s not just psychology, but here we are really at, in a crossroad of several disciplines. Of course design, but also there is behavioral science, there is ergonomics and human factors. There is really a variety of disciplines that we actually used to create a tool—a post-occupancy evaluation tool— that really brings together what I mentioned before. The relationship that people have with the space and the relationship that people have with other people in a space, in an environment.

And together, this information can really give a company or a business, or just simply the facility manager, or the person that is in charge of redesigning and refurbishing the building, that environment, or just simply the company’s culture— to understand how the people live, what the people feel, what is their perception.

And with this data from our ‘IDEAs’ audit tool, you can basically get a snapshot of what is happening into your company, into your building and what the real people think about it.

So, yeah, I think it’s powerful to bring together not just the aspects of ergonomics and human factors, but really to bring together behavioral science with design, and allow an understanding of how people feel and how can we do better to make them feel better.

Janet: Right. And can you tell us a little bit more about the new toolkit ‘IDEAs’?

Matteo: Sure. So out of the research we have done… so the ‘IDEAs Audit’ tool is a tool that helps you to understand the perception people have about their working environment.

The ‘Ideas Audit’ tool has been developed out of years of research. And we understood that is really important for companies and architects and designers, to understand the real perception that people have about their working environment or the built environment where they live.

So we developed this tool that helps designers and business leaders and facility managers to understand the perception of inclusion, equity, diversity, and accessibility in a place, in an environment. And this data help really a lot in the design process and in framing new policies for the built environment where people live and work.

Janet: And it’s available now or …

Matteo: it’s already available. you’ll find it on The University of Cambridge website.

Janet: Right. It was always interesting when I started off at the Boston Architectural College for my master’s in Design for Human Health, the cornerstones were that we look at the biology, psychology, and sociology of spaces. And I remember just even my dad being like, why are you studying neuroscience? You’re a designer. Why are you studying, what was the other one… biomechanics. And he just could not wrap his head around some of these more, it seemed like, I think he thought I should be picking up just like a, some sort of protractor and a straight edge and, and kind of call it a day.

But I feel that even those three touchstones, and we’re coming up with more with trauma informed design and our evaluation tool with that, but we have these outside touchstones. So I appreciate you bringing up the, the idea of interpersonal working mindset and the perceptions and stuff like that.

I find it fascinating, but I think what you were touching on was, is that ultimately again, if you can have people just to be happier and healthier within their spaces, productivity goes up or people come back to your spaces or stay longer in your spaces to either eat more, shop more or whatever it is. So it’s really quite great.

So moving forward, what do you see in the future? Like, what do you think our challenges are going to be coming out of COVID? I see a real change that has happened over the last two years. And I think, again, going back to this being more inclusive, more diverse, more equitable. I think people are recognizing that this is something that needs to change. But do you see anything else, or is that the major piece that we’re coming out of as designers? Like that was something that was huge.

Matteo: Well, I have to say, we are at a time in history where there is a lot going on now across the world. And Covid was not even the last of the big challenges we are experiencing, (J: right). And we are just recording the podcast in the moment where we didn’t really expect a few weeks ago what was going to happen now. What the impact in the life of millions of people in the war. (J: right).

And, when I think when we talk about universal design, inclusive design, and when we think about making buildings, neighborhoods, cities, country areas, I mean, making the world better, we really understand that, you know, we are all connected. We are not just one country, another country. What happens in Asia influences America, and what happens in Europe influences Oceania, Australia. (J: Right).

So what I’m trying to say is that when we talk about, you know, understanding about diversity, about equity, and about inclusion, I think in the near future, and also mindful of COVID, we have to really think that if we are in a workplace, and for some moments before COVID, we were maybe able to cope with stress, or cope with a behavior of another person that wasn’t really great for us and this was making us feel more excluded (J: hmm) from the working environment, for example. (J: Right).

Well, now I think we got an understanding of the opposite. We got an understanding of maybe being isolated and not connecting with real people, or maybe being totally immersed in family life. And so we now know more, we were able to put ourselves in someone else’s’ shoes, but also put ourself in our shoes and really understand what are the challenges we can experience in different contexts. (J: hmm). And sometimes for us, different context means the daily context for other people. (J: uh-huh).

And so I would like to close with a message, which is, we have been thinking and working a lot to develop and design places that are wheelchair accessible. It took about 50-years, almost, between the first movements to then get to standards and regulations like the ADA in America, to literally make the voice of certain people heard.

Now we have more power. Now we can make the voice heard much faster, quickly, because we have other tools or instruments. Let’s not forget about continuing the narrative, but also about implementing this narrative in the practice. Because sometimes we listen to podcasts and say, ‘oh, that was great’ and then you forget about how to do things. (J: yeah).

And you know, we are approaching an era where it seems everything is going to be digital. (J: right). Everything’s going to be virtual, everything is going to be immersive.

Janet: Right. Can we just kind of stop you right there, Matteo? I think there’s actually a good segue. Cause you and I had talked a little bit about like the Meta world, right? Do you want to expand a little bit about that and, is it going to be accessible for everybody? I mean, if you’re in a virtual world and you have some sort of visual impairment, how do you see that working? I think also is there an opportunity for it to be more inclusive than what we’ve had in the past? Designers, kind of think about that. Or do you think it’s just going to separate people even further? I know that’s a lot of questions in one. (laughs).

Matteo: Let me say Janet, that there is really a lot to discover about that. And let me also say that I just finished research that is going to be released in a few days— actually think once the podcast will be released, the research is going to be already public— (J: oh), about designing the Metaverse, designing digital immersive worlds. And I can tell you that there are more questions than answers right now.

And there are more questions simply because we can imagine that these digital worlds will be more accessible and partially is correct, but partially is incorrect, because what can seem more accessible, for example. There is no force of gravity, so we don’t need to walk from a space to another. (J: Right).

However, there will be accessibility issues in terms of ‘how can we use the technology to access that space?’ And now equitable opportunities to allow people from under-represented communities or emerging markets can have to access that space. That’s a matter of accessibility.

And so I really think that, you know, the architects of the physical world, as they call them, (J: laughs), will have an opportunity to influence. While the architects know how to design and include in the physical world, will have an opportunity to understand how to inform the design of an inclusive digital immersive world. (J: uh-huh).

So, let me just finish with the fact that we have to be aware there are really endless opportunities there. (J: right). Endless in terms of design, in terms of equity and human rights, and also in terms of technological opportunities. So I’m really curious to see what’s going on in the next few years.

Janet: Yeah, me too. I find it fascinating and let me just ask you a quick follow-up question here, which is, having come from Italy, you know, sort of like the backbone of architecture, right, like that, it wasn’t America, as much as we’d like to think it is. It’s not, (laughs), it could be Greece too, but you know, there’s classical designs that still to this day resonate with both beauty and with presence.

It’s kind of incredible, right? And then at some point as designers and architects, we kind of lost feeling with that. Like, because there’s new materials so we can create new things all good and fine, but the basic beauty was the basic beauty and that was how it was kind of done.

And it doesn’t matter whether even if you were a Picasso. Picasso had gone and studied all the masters, right? And before he became, you know, known with the eyeball over here and the arm over here, and he really kind of thought outside the box.

So I’m wondering, do you think that in order to create this Metaverse, we have to be able to master then the physical environment in terms of inclusivity to go into a more inclusive Metaverse? Or do you think that this is, we can kind of say, okay, we’ve messed that up in the physical and maybe try to do it a little bit better in the virtual?

Matteo: Well, I would start by saying that yes, I’m Italian. (J: laugh). Yes, I studied architecture in Italy, but the concept of beauty is very subjective. So, I think that in terms of physical world, the architecture, everything we build in terms of buildings or cities, or neighborhoods is really context dependent.

So I don’t know exactly if a typical 15-or-1600 house built in Tuscany can fit really well the weather in Wisconsin, or the weather in San Francisco. (J: true). So it’s context dependent. (J: right).

And the beauty of the houses in San Francisco is something that is specifically related to San Francisco. And I can think of something similar in Italy, like ‘Cinque Terra’, where the colorful houses are there. (J: uh huh).

But as we know the technology that was used to build the houses is different than the technology used to build the houses in San Francisco. (J: right). Because in the bay area, there is a high risk of earthquake. In Italy, there is, but it’s a bit lower. So again, this is a big discussion, but in terms of the digital world, I think, as I said before, there are endless opportunities. But also we don’t have to commit the same mistakes we made when we created buildings before in terms of accessibility. (J: Right). And even more, we cannot afford to make the missteps we made when we created the internet. (J: right).

The internet, the web, was created for a purpose. And it wasn’t created with accessibility in mind. (J: uh uh). Nowadays, internet is quite accessible, but just after years and decades of standards developed to make the internet accessible.

So now with the Metaverse, we are at the same point in history as we were about 30, 40 years ago with the internet. (J: hmm). And we are the same point, but with a different knowledge, with different people, with different opportunities and with a different mindset. So what I’m hoping to see is that we start designing the Metaverse as an inclusive space.

Janet: Right. Well, I’m looking forward to all the work that you’re going to be doing with that. I’ve got a couple of just quick questions to kind of wrap this up.

Matteo: Sure.

Janet: When I was getting ready for this interview, I started thinking to myself, you use, it’s funny because I call myself an inclusive designer, right? But it’s not really a term. There’s end user designers, you know, UX. And I don’t know, do you think that that should be a thing? Should we start like branding that? Or should we think it of as a, like: ‘of course I’m a designer. I am an inclusive designer’.

Matteo: Well, that’s what I’m hoping to see already now, (J: me too), but unfortunately, it’s not happening. (J: laughs). So let me say what I would like to see in the near future, even if I’m conscious that it’s going to take several, several years, actually decades, (J: Right). I see people as designers and the word inclusive before designers is already embedded in the word ‘designers.’ (J: sure).

I’m hoping that, you know, inclusive design was born in the 90’s almost in the same time as universal design was born, (J: right). Before we were talking about barrier free design or accessible design, so the concept evolved in a way that is more inclusive. That is more, that is broader. (J: Right). So it’s about 30 or something years that we are talking about inclusive design and universal design and design for all.

However, in 30 years, we still listing who is an inclusive designer, and who is ‘just’, and please understand that just with brackets, designer. We’re all designers. (J: true). I’m hoping that maybe in 2050 we’ll be all designers, but all- brackets- inclusive- brackets- designers. Right? (J: Right). So the word ‘designers’ will be already including the work, the understanding, and the capacities to be inclusive from the ground up.

Janet: Right. Well, one last question. anything you want to throw out there, like as we wrap up here? Is there anything else you want to make sure that you mention? Again, we’ll have a lot of all of your references that you pointed to and talk about on our website, Inclusivedesigners.com. But is there anything you say to yourself, ‘I need the inclusive designer community to really kind of notice and be aware of ‘?

Matteo: Well, Janet, there are really a lot of things, (J: laughs), but one that really is important for me now is that the community of designers, and of course, architects and engineers, for the community of creative people, the people who make things, no matter if they are inclusive or not, they are inclusive because I know in the end they are, will start using the research and the tool we have made.

For what reason, why? Well, simply a reason… because the research we do is not for ourselves. The research we do is for the world, for the people out there. So take your hands, put them on a keyboard, search for our websites, download the tools, download the ‘Canvas’, download all the material that you want because this material is made for you.

And if you have a feedback, get back to us. If you want a training session, of course get back to us. But most importantly is to use whatever is ready out there to make your work simpler and more inclusive.

Janet: Yeah. Well, that’s great. I really appreciate you not only coming on today but taking the time and I hope to actually have you back at some point. I think a great conversation would be about talking about ADA and also European regulations and guidelines and, and such. So if you have some other time at some point, we’d love to have you back on.

But in the meanwhile though, we really do appreciate your time today and we’ll have all this information again on our website and Matteo, thank you so much for stopping by today and giving us your really well thought out ideas on inclusive designers.

Matteo: Thank you so much Janet and Carolyn for having me in the podcast. And I thank a lot all the listeners and I’m looking forward to see more designers-slash-inclusive designers out there.

Janet: Right, yeah. And again, we’ll have his information on ‘Inclusive Design Canvas’ on the website and how to get in touch with Matteo. And we wish you good luck with all the work that you’re doing. And we think what you’re doing is really kind of fantastic.

Matteo: Thank you so much.

Music / Outro

Janet: Ah, Matteo is doing some really important work… so great! As he said, when designing or assessing a built environment, it is important to understand the variety of human needs. We may be more aware of physical disabilities, which are more visible, but as designers, we need to consider the non-visible impairments such as sensory or cognitive as well.

Carolyn: And the tools he and his team created— the Inclusive Design Canvas and ‘IDEA Audit tool’ – are really great resources to increase clients’ awareness of the importance and value of Diversity, Equity, and Inclusion.

Janet: So he’s also mentioned that his tools can help highlight the points of exclusions and challenges that can be solved to make spaces more inclusive, diverse, equitable and accessible.

Carolyn: Both of these tools are readily available to download and put into use. As he said, you can google it, but we’ll make it even easier by putting the links on our website for you.

Janet: I want to emphasize to our listeners what he said: when designing, we need to look at who we are designing for, what are their stories and capabilities, their desires, and journeys. It is so important to think about that when designing inclusively.

Carolyn: And then there is the Metaverse. Your conversation with Matteo really made me think… it’s going to be very interesting for everyone and of course, for inclusive designers.

Janet: I think Matteo is right, designers need to take what we’ve learned from the internet into consideration as we move forward in this new Meta world. And we may have to consider a future episode on that and Inclusive technology.

Carolyn: I think you’re right, but maybe we should finish up this episode first. (laughs).

Janet: Right. Exactly. and we will also share the links for all his work, his IDEAs toolkit, Metaverse and of course, a bunch of other things that were mentioned along the way during this discussion. All on our website at InclusiveDesigners.com…

Carolyn: That’s InclusiveDesigners.com…

Janet: A big thank you to Matteo. And thank you all as well for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it again, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page. And now you can also find us on Feedspots’ List of Best Design Podcasts.

Janet: Yes, you can! And as our motto says: ’Stay Well…and Stay Well Informed’. As always, thank you for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again.

Music up

Judy Heumann is here! Judy Heumann is here!  Inclusive Designers Podcast is very excited to share our inspiring interview with THE Judy Heumann… celebrated civil rights activist, advocate, and rolling warrior.  She has been called “the mother of the disability rights movement” and “an activist who doesn’t take crap, never did.” Judy is best known for leading the charge of disabled activists that sparked the creation of Section 504 and the ADA. IDP talks to Judy about her lifelong struggle to overcome discrimination, and what designers need to know to make changes that benefit both disabled and non-disabled people. And yes, Janet even asks her (way in advance) to meet in person in 2023 to celebrate as the ‘Rehabilitation Act of 1973’ turns 50!

Guest: Judy Heumann- is a lifelong advocate for the rights of disabled people. She has been instrumental in the development and implementation of legislation, such as Section 504, the Individuals with Education Act, the Americans with Disabilities Act, the Rehabilitation Act, and the UN Convention on the Rights of Persons with Disabilities. Her memoir,“Being Heumann: An Unrepentant Memoir of a Disability Rights Activist,” was published in 2020. She is also featured in the Oscar-nominated documentary, Crip Camp: A Disability Revolution. Judy produces a podcast called The Heumann Perspective, which features a variety of members from the disability community.

– References:

• Website: www.judithheumann.com

• Podcast: The Heumann Perspective Podcast

• Books: ‘Being Huemann‘; ‘Rolling Warrior‘

• TED Talk- ‘Our fight for disability rights– and why we’re not done yet’

• Documentary Film: Crip Camp: A Disability Revolution

• Washington Post article: She’s considered the mother of disability rights — and she’s a ‘badass’

• Rehabilitation Act of 1973 / Section 504

• The Convention on the Rights of Persons with Disabilities and its Optional Protocol

• ADA.gov

• Universal Design

• Yannick Benjamin/Contento NYC;

– IDP Episode: Serving Up Inclusive Design

• BROOKLYN!

Disability Rights and Design – Insights from Judy Heumann

Music / Open

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

Music / Intro

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche

Carolyn: and I am your moderator, Carolyn Robbins.

Janet: We have an incredible show for you today, right Carolyn?

Carolyn: Yes, we do! Maybe even more than usual!

Janet: I think so! We have the disability rights warrior herself, Judy Heumann, or as we have been referring to her around here as… THE Judy Heumann.

The Washington Post called her the “Godmother of the ADA; and one bad… I’m not quite sure can I say the last word, but it’s a 3-letter word beginning with an A and ending with a double-S, or another word for a donkey” (laughs).

Carolyn: Technically, you didn’t say it, The Washington Post did, but I know what you mean.

Janet: Well, getting back to our very special guest, Judy will tell us about her life as a disabilities’ activist, from the early days before the 504 and the ADA even existed, to where we are now, and to also look ahead to what should be happening on a more global basis.

Carolyn: As for her credentials… Judy is an is an internationally recognized disability rights advocate and a leader in the disabled community. She has been fighting against discrimination all her life.

She organized protests in college to gain access to classrooms. After graduation, she sued and won the lawsuit against the NYC school system that let her become the first teacher to use a wheelchair in that state.

Judy led the charge of disabled activists for rights that led to the creation of Section 504 and the ADA. Later on, she served in both the Clinton and Obama Administrations. She was also featured in the award-winning documentary “Crip Camp: A Disability Revolution”.

More recently, she published her memoir: “Being Heumann: An Unrepentant Memoir of a Disability Rights Activist,”. and a Young Adult version called “Rolling Warrior.”

And last, but certainly not least in our book, she is currently the host and producer of her own podcast, ‘The Heumann Perspective’. She really has done so much.

Janet: She sure has, I couldn’t agree more. And I’ll add that Judy strives to eliminate the discrimination and physical barriers disabled people of all ages, with all types of disabilities, are facing, both in the United States and around the world.

Carolyn: And you know, her busy office didn’t take a break while we interviewed her, you may even hear the sound of justice being made in the background…

Janet: So true, and you know, like me, Judy grew up in Brooklyn! shout out to Brooklyn. But this was at a time when there were no considerations for disability or inclusion. She helped put much of what you see in place today. But we’ll let her tell you all about that, and more, in her own words.

Carolyn: And with that, here is our interview with THE Judy Heumann, civil rights activist, and lifelong advocate for the rights of disabled people…

Music / Interview

Janet: Hi, and welcome to inclusive designers. I’m your host, Janet Roche. And today we have THE legend, Judy Heumann. (Judy: Hello). We’ve been calling you ‘THE’ Judy Heumann just to emphasize it to people that we’re talking to about that we were going to talk to you today. Judy, thank you so much.

Judy: Thank you for inviting me onto the program.

Janet: Let’s kind of dive right on in, because there’s a lot to talk about. And I just want to say inclusive designers would not be a thing if you hadn’t pushed that needle, right, made sure that everybody was paying attention. When you, before you started with the 504 and your sit-in and what were things like?

I know that you write a lot in your book about that you recognized it. Did you recognize it was discrimination right away? Or you just, did you think it was just unfair? And then did you see ways that people like, why didn’t they do things the way they’re trying to do things now? Like, can you talk a little bit about that?

Judy: Sure. Let me start by saying that there’s so many people who’ve been involved in our movement in the United States and around the world. And I am one of those people, but I never take credit for everything that’s happened.

And at the end of the day, you know, you, Janet and Carolyn, really are the ones who’ve been driving forward the work that you’ve been doing. And I think maybe myself and many other people have helped to open spaces that maybe weren’t as available in the past. But I think it’s still important to say that we, from my perspective, are not yet where we need to go.

Janet: Right. And we’ll dive into that. I see the gaps, I’m sure you not only see the gaps, you know the gaps by heart. So, I love the fact that you like your parents were, were such kind of a rebel rousers, especially your mom like, she was just not having anything that any of the school boards and everything like that was going to throw at you.

When did things start to really click in for you that you thought, I mean, you’re a smart woman. So obviously you probably thought this is unfair, but like what was sort of the impetus was, I mean, we also saw the movie ‘Crip Camp’. Was that sort of the beginning of your ‘aha’ moments, like this is going to have to change or, do you want to talk me through that?

Judy: Sure. So I had polio when I was 18 months old. And like other people who had their disabilities when they were younger, you know, you really don’t understand what’s going on, obviously. And that was something that I gradually, and I would say 6, 7, 8, 9 years old was becoming more aware of the fact that I, in my family and in the neighborhood that I grew up in, I was treated really as an equal to my brothers and neighbors. But when it came to school, as an example, I was not treated equally. (J: Right). Kids at 5, parents took them to school. They got enrolled in school and they went to school every day. But me, that’s not what happened.

Janet: Right. Yeah. You talk about a lot of this, and they called you a fire hazard. It was really, really horrible. Then they, they said, well, we can give you instruction it at home, right. and I couldn’t understand, was it two hours a week or something like that. And it, was cross stitching involved. Maybe you could tell a little bit about that story as well.

Judy: Yes. So when the principal and the school said that I couldn’t go there, told my mom not to worry because the Board of Ed in New York City would send a teacher to my house. Well, they did, but not in kindergarten. And they did for the first, second, third and half of the fourth grade. (J: wow). And they came twice a week, once for an hour, once for an hour and a half. And then at some point, I say it’s as, a, for good behavior, they threw in an OT who was teaching me sewing. (J: Right). So, that went on until the middle of the fourth grade.

When I finally got into a program that was only for disabled children in a regular school, but special classes. And getting involved in that program was the first time I was ever with any other disabled people. I didn’t know any other disabled people really until that point. And the first year, I believe that I went to school in these segregated classes, I also went to camp, not camp Jened but camp Oakhurst. So I went to camp Oakhurst in New Jersey for a couple of summers. And then as I was getting a little older, I started going to camp Jened.

So I was learning from my other friends also that we, in coming together, it also allowed us an opportunity to speak to each other and to realize that not only that we were being treated differently than our brothers, our cousins, our neighbors, but the discrimination that we were experiencing. (J: yeah). So I think the issue of discrimination is also something that we hadn’t talked about earlier as kids.

So I think, you know, what was important for me being with other disabled people is realizing that I wasn’t alone. And then I also was learning from other people that we all felt very similarly. That we were not being treated equally. And we were beginning to talk about why that was, and I think really at a pretty early age and like an age-appropriate way, we were not only talking about the barriers, but we were beginning to think about solutions. (J: hmmm).

And I think that definitely is something that we continue to discuss today. (J: right). That there are so many issues and different solutions. And obviously over the last, you know, 74 years of my life, there have been lots of different kinds of solutions for many different issues and in some areas solutions that haven’t been implemented. (J: right).

We look at things like how many community-based services (J: uh huh), or personal assistance services, this system is quite problematic and the number of people who need to be getting benefits from the government is way underserved and the risks that people are taking because they’re not getting sufficient personal assistant services and how that limits our ability to work and go to school and participate in society.

We, we know the solutions. (J: Right). The government has not put sufficient amounts of money. And then of course, some of the, um, criteria around how to get on things like Medicaid, all of those are still issues that (J: huge), we understand the solutions we just haven’t implemented them.

Janet: Right. And all that healthcare is all important to people’s health and wellbeing and which should be everybody’s right.

I just want to let listeners know that one of the reasons why we’re talking about this, as inclusive designers, I don’t think we can talk about the physical environment without talking about advocacy for the people that we serve. So that is why we want to talk to you today, Judy and get your perspective.

So then let’s jump forward to the, when the— I’m going to get this right— The Rehabilitation Act of 1973, which by the way, I have decided I am coming in September of 2023, I’m going to, I’m going to find you and we’re going to go out and we’re going to have a good time just letting you know. (Judy: Okay).

So the, the 5-0-, um, so now I totally forgot, now that I’ve asked you out on a date, I forgot my question for the, for the 504. That’s actually coming up is the 50th anniversary. And one of the things you talk about in the book, which is “Being Heumann” and we’ll also have that on our website, links to, being able to get the book. It’s “Being Heumann: An Unrepentant Memoir of a Disability Rights Activist” that’s by our guest today, Judy Heumann.

And I thought it was fascinating that, and I want to ask you a couple of questions about that time frame because there was this man that was brought in by Jimmy Carter, his name is Joseph Califano, is that right? (Judy: yes). Alright, just so we’re clear, we can’t swear on the show. So this is going to be where, like, I am going to try really hard not to do it. He was, um, difficult. Did you think that, like, did he, did he not read any of it? I think even when he cited it, I got the impression, he was just like, whatever, get out of my offices. Like, is that, did you get that impression, or…

Judy: So Joe Califano was the Secretary of the Department of Health, Education and Welfare. (J: right). And when the American Coalition of Citizens with Disabilities organized demonstrations around the country, I was one of the members on the board. And we were organizing to hold regional demonstrations.

When the demonstration started in San Francisco, the regional secretary was a man named Joe Maldonado. (J: right). And Maldonado did not know what the regulations were. (J: No). His staff didn’t know. Califano did. I wouldn’t say he was an expert on them, but he knew about them, and he knew what they were.

He had brought a team of people in to review. And the issue for us, wasn’t the fact that he was reviewing the draft regulations. Because it had been a Republican administration, was now a democratic administration. So wanting to do a quick review, that was like appropriate. But what we began to hear is that Califano had a number of concerns…

Janet: Excuse me, I’m sorry, wasn’t one of the concerns that they thought somehow the United States economy would tank with these new regulations… that was not it, you’re shaking your head. Okay, I’m sorry, go ahead.

Judy: No, I mean, I think, um, he had brought a team of knowledgeable people in to do a review. But at the same time, he was hearing from lobbyists, from hospital associations, higher education associations, and others, who were talking about how this was going to be so terrible, and how costly it was going to be. And, Gerald Ford, who was the president prior to Jimmy Carter. He could have signed the regulation, but he didn’t because he said it’d be too costly, and he wouldn’t do it.

So you’re not far off in what you’re saying, (J: Right). But I think the reality of course was that was not true. And especially because the way the regulations were written, uh, there was not an expectation for example, that any building that had received federal money, like a school or a hospital or university, that overnight they would make themselves accessible. That was never the expectation. (J: right).

And when people look at the regulations, you can see that there are many steps. I don’t mean literally steps but many, (J: laughs, right, yeah). Which I think really was done in such a way to make the intent of the law be carried out in a way that wouldn’t adversely affect our ability to keep the law.

So things like a new building would have to be built accessible. Major innovations would have to be accessible. Um, not every building would have to be made accessible overnight. (J: Right).

Janet: And were they also trying to exclude schools or universities at some point, wasn’t that part of the conversation. It was, they were trying to just maybe do federal buildings, but the universities were allowed to do their own thing for a while. It was that whole separate but equal part of it.

Judy: Yes. Well, one of the issues that we were concerned about is the way they were discussing potential changes to the draft regulations that would have, uh, enabled kids and college students not to have the same choices as others. (J: right).

So in the film ‘Crip Camp’, we talk about how we’re not going to accept separate but equal. (J: yeah). And I think the regulations really had a good balance of what needed to happen to ensure that students would not be segregated, at the same time that all schools were not going to have to make it accessible overnight.

Janet: Right, yeah. Now, do you just want to quickly explain to our listeners the difference between the 504 and, uh, the American with Disabilities Act, the ADA. Because one plays off of the other, can you talk to our listeners a little bit about that?

Judy: So section 504 says if you are an entity that is getting money from the federal government, you may not discriminate against one based on disability. There are similar provisions that exist in race and gender, disability came in in ’73. And it’s different than the ADA because the ADA covers the private sector. The ADA really covers everything that 504 didn’t cover. So it covers the business community. It covers um, shopping malls, movie theaters, all these entities that the general public uses, but wasn’t covered under 504 because they didn’t get money from the federal government. (J: Right).

So employment, Title One of the Americans with Disabilities Act was particularly important. Now, 504 covers employment, but it only covers employment if the entity is receiving money from the federal government. So, a university, a city government, a county government, a federal government, a state government, they’re all receiving money from the federal government.

So if someone had a disability and they were denied a job, and, um, or denied an interview and a job, whatever, they could file a complaint with the EEOC.

Like in 1970, when I was denied my teaching license, (J: uh huh), there was no 504 (J: right). So when they denied me my license, when the board of education of the city of New York denied me my license, because I wasn’t able to walk, if this would have happened after the spring of ‘73, then I could have filed a complaint. (J: Right). But it happened before 504 went into effect. (J: yeah).

So, if I applied for a job to work at a bank— banks didn’t get money from the federal government— so if I was denied a job based on the fact that I couldn’t walk, for example, then I wouldn’t have been able to file a complaint until 1990, (J: ‘90, right), under the ADA.

Janet: Right. And for those who want to know a little bit more about Judy’s decision to become a teacher— and I’d argue that you are a teacher like on a larger stage than you probably ever would have imagined— you can listen to her, her terrific Ted talk, which will be on our website.

Judy: The other thing, I would say that if you want to learn more about the ADA and 504 and other laws, if you go to ADA.gov.

Janet: Yeah. Well, for inclusive designers this is a really important piece. Let’s kind of switch gears a little bit and talk a little bit more about design. And maybe we can, um, talk a little bit about what it was like prior. I do remember a time, uh, before there were accessible buses and I do remember there was a ramp like on the subway in Brooklyn— by the way, a little shout out to Brooklyn. I grew up in Brooklyn, myself.

Judy: Yay, Brooklyn.

Janet: Yay Brooklyn, we’ll have a shout out to Brooklyn on the website as well. (laughs). So, but I remember there was at one point they use some sort of ramp, because it was a gap between the, the station platform and those, the subway. But I remember thinking there’s no way to get from the top down to the actual platform.

So anyways, I don’t know if you want to talk to our listeners a little bit about some of the things that were, a lot of the barriers in the built environment that you, you came across. Give our listeners sort of like an idea of where we were, sort of where we are now, and where we would like to be.

Judy: So as far as transportation is concerned, I would say… We’ve come pretty far, (J: right). Where we’re still dealing is in cities like New York, where they’re being sued, um, because, um, disabled people are saying that when they built some new stations, those stations were not accessible. So that’s one issue. But in New York city, for example, all of the buses are accessible. (J: right). And all around the United States, the buses are accessible. (J: right). And the Trailways and all these other bus companies that years ago said they couldn’t do it, they all have done it. And that really is because of laws like 504 and the ADA.

Janet: Oh yeah, absolutely. It’s come a long way and maybe we could talk a little bit about. I do teach. And one of the things that I teach is, it’s a day class, but it’s, um, we sort of do some simulations of different types of health conditions. So everything from visual imparity to paraplegia to mimicking different types of, like I said, human conditions.

And we do also have the, the wheelchair experience. And it’s, it’s fascinating to me. I think when my students get on there, they seem to think it’s going to be an easy ride. They’re just going to sit there, but it’s still, there’s a train station around the corner from the school. There is no access, and they can’t fathom that there’s no access until they’re trying to actually get down to the, down to the train station. Just even a coffee shop will be inaccessible.

I guess what I’m trying to ask is that, in that type of scenario for, for students, for teachers, I know that like in your Ted talk, you also talked about like, did you ever break your arms? So how did that feel? What did that make you feel? And those are temporary conditions, temporary inconveniences, but this is every day for, for millions of people.

Is that a decent idea to have that temporary setup for students to learn? Is that, I found like that’s a big eye-opener, but I make sure that I tell them, and I make sure that they recognize it’s a temporary thing and it’s not permanent. But I think that they’re always pretty wowed at how many things that they take for granted every day that they don’t realize are completely inaccessible.

Judy: So I am not sold on simulations unless they’re done in a really careful way. We had run a project when I lived in Berkeley, and I worked at the Center for Independent Living. We had a grant from the Department of Rehabilitation. And, uh, we brought small groups of rehab counselors to the CIL. And then they would be there for 5 days. And they would live with someone who had a disability. And the disability that they simulated was the same disability as the person they stayed with. Or similar. (J: hmm).

What I liked about that better was, first we had discussions about what they thought about disability, what they thought they would or wouldn’t be able to do. And then they, I think, simulated for like two days, and then they spent another day (J: talking about what they learned). Right. (J: right).

So now I certainly understand that for some people, you know, being in a chair or having their eyes covered, will give them some information, but frequently it may be, it may make them feel more hopeless. Like, ‘oh my God, if that happened to me, what would I do’ as opposed to ‘what changes should have been made/ are we going to fight for?’ So I think how they’re introduced is very important. (J: Right).

I think a lot of us are concerned about simulations with the intent of helping open people’s eyes may in fact not have that same effect, but I think there are appropriate ways that maybe some things can be done. Because that’s important for people to understand there is a step at the corner, but what could there be so it wouldn’t be a problem. And there’s, you know, whatever the issue may be.

So, cautiously, they need to learn more—what do the laws say? Are they being enforced? What changes may I start thinking about in my local community, new housing being built that’s not accessible. The law doesn’t require it to be accessible. Should I be arguing with others that we put a law in place then that in our jurisdiction ‘new construction must have an accessible entrance, then a bedroom and a bathroom on the first floor.’ I mean, different things, you know?

Janet: Right. Well, it breaks up, well, I can talk about this for a very long time with you, because I find that this is a pretty fascinating, but I want it to, then this is a great segue… So Judy, maybe you can talk to us a little bit about how you feel about the future, where we need to be as designers. Um, maybe not just as student designers, but then as designers for inclusivity.

Judy: Well I think universal design is what we should be looking at. We need to understand who our audience is and that we’re designing so that all potential people in the audience can benefit. (J: right). And I believe that just looking at design from a disability perspective isn’t the complete way we should be doing it.

Janet: Well that’s why I wanted you to come…Yeah, I’m sorry. That’s why I wanted you to come on the show because I firmly believe that advocacy and also supporting human rights is an important part of all this.

Judy: I think people need to understand that accessible, usable design benefits all people. (J: right). And at the end of the day, we absolutely know that it does not cost more money to design accessibly, whatever it is that we’re looking at designing. (J: right). So the built environment, technology, clothing, whatever it may be.

Janet: Well, that’s just it. So we talked about the restaurant business. In the interview that we did with the, the owner, Yannick Benjamin at ‘Contento’. I mentioned that I have gotten calls from designers and architects. If they’re doing a restaurant, in particular a restaurant, to try to figure out how to get around the, the ADA, because they have a certain amount of tables that they feel like they need to put into the space.

So I, I think it was one of those things. It really kind of angered me. Can you speak a little bit to other designers about that? I mean, but it, it goes really back to your point that… It’s profitable. It works. It does. It helps our society to become a better place by creating some accessibility to everybody.

Judy: So I think, the point that I’m making is: When you’re not designing for all, you’re excluding beyond the group you may intentionally be screwing. (J: laughs). You may be thinking that you’re screwing. (J: right).

I use a wheelchair. So there are certain things that I need, and standards support that. But if you look at buses and trains as examples, the fact that many of the train systems in the US and in other parts of the world now are accessible, also means that other people can use the buses and the trains. (J: right).

So I don’t know if you’ve ever noticed, but baby carriages from the 50s and ‘60s look pretty different today. (J: right). Baby carriages that were heavier, wider. Things that you wouldn’t have been able to just shlep up and down stairs, um, in many of our major cities with transportation. But now where they are accessible, you can use an elevator. (J: Right).

And likewise, um, accessibility of bathrooms, accessibility of tables, accessibility of counters. (J: yeah). You know, not everybody is tall, (J: no). and not everyone is a little person. So you have people who are five feet tall, and they’re going to be able to access a table and a chair and the ground differently than someone who’s six foot tall. (J: Right).

But if you’re designing for all, then it will benefit most people. (J: Right). And to me, that’s the ultimate thing that we’re trying to do is to have design be done in a, such a way that in such a way that we stop thinking about it as something which is special,

Janet: Right. Yeah. I think you even said something like, “if I have to be grateful for an accessible bathroom, I don’t want to be a part of that community” like it just should be, it should be a part of the community.

I completely agree with what you’re saying, and I find that it really does help. And I think that your example of the baby carriages is a great example. Because when, those elevators help women to get, or mostly women, to get their strollers down the, down to wherever. The coffee shop that I mentioned before that is not accessible at all.

And, they said, you know, even if it’s not somebody in a wheelchair, it could be somebody who has a baby carriage, somebody who doesn’t handle stairs well, somebody who might have some sort of other type of condition that doesn’t allow them. And it’s even just having vertigo for Pete’s sake. Like you might, might again be something sort of temporary.

And so it doesn’t even have to be something in a more permanent basis that, like you said, just allows us to be a better community and a better world and allow everybody to get access to coffee… because that’s what we all need, more access to coffee. (laughs). I have a couple more questions for you, Judy, if you can indulge me.

So two things… the design for the handicap with somebody in a wheelchair, the universal sign, good or bad, yes or no, right or wrong?

Judy: I mean, I think there’s a more modern design of a wheelchair, which I like better than the older one, but the concept of it, I think was important because the space was bigger. (J: right). Um, one of the reasons I always talk about the issue of importance of accessible design. There can be 50 spots, two spots that are designed for someone who’s got a disability. And inevitably those parking spots will be used because they’re closer and they’re bigger. (J: right).

So this reinforces that if they’re doing universal design, then we look at designing our parking spot so they’re appropriate for all, and then a certain number of them as is required are bigger (J: right), so that people using wheelchairs can get in and out of their car.

Janet: Oh, right on. I’ve actually met more like the placard, you know, the blue sign. Yeah. You’re, you’re, you’re good with that. You just want a different wheelchair on the, on the front of that. Because I felt like sometimes it doesn’t include everybody. To your point about the parking spots, I’ve had a lot of friends like who’ve had maybe heart attacks or have a kid who has, is non-verbal autistic.

Judy: Right, but they’re eligible.

Janet: I know, but people then look at them and say- ‘You’re not in a wheelchair. How dare you use this space?’ – which I argue is, that they mean well, unfortunately it’s, it’s very… (Judy: I mean I think that…), I think that they’re trying to punish, go ahead Judy…

Judy: I’d say, I think it’s a good point. And they may be people that are looking at a different sign. But I think the laws typically in states, whether someone is using a wheelchair or not but that they can show medical need, that they need certain things, then they can get it. (J: Right). So we live in an imperfect world.

And what I like about the more modern designs is that the older blue signs were quite non-representative of how people move. (J: right). But I think the point that you’re making, it’d be interesting from your listeners to know if any of them in any of the communities they live in are designing a different kind of sign.

Janet: That’s a good question. I’ll post it when we post all this stuff on social media. Great question, Judy.

So Judy, last question, globally. I know that you talked about the Convention on the Rights of Persons with Disabilities Treaty… can you talk to us a little bit about that and what that means going forward and for the future of disabilities rights?

Judy: I think one of the important parts about the United Nations adopting the Convention on the Rights of Persons with Disabilities in 2006, is that it was a process that brought disabled people together from around the world to work with delegations from every country that is a member of the UN to discuss what forms of discrimination and barriers disabled people of all ages were experiencing.

And then to agree that there was a need for a document called a treaty that would articulate the principle in about 42, 43 articles of what needed to be occurring. So, between 2006 and 2008, I believe the number was 30 countries that signed and ratified the treaty. Now the number is like more than 170. (J: great). Unfortunately, the United States is not one of the countries that’s ratified. There’s like a handful, 2 or 3 countries that haven’t.

But when President Obama was in office, he signed the treaty and then it needs to go to the Senate. The way it works in the United States is, in order for a President to ratify a treaty of any kind, there needs to be a vote from the US Senate, not the House, from the Senate. And it has to be two thirds of the senators voting to support the treaty.

I was working at the State Department at the time that the issue was moving forward, (J: right), and we were unsuccessful with the Republicans. So we could not get sufficient number of votes when the treaty was presented on the floor. And therefore, we haven’t ratified.

But let me say a couple things. One, so many, I mean, basically, as I said, there’s only a handful of countries that have not ratified. What that means is, if a government ratifies the treaty, they’re committing to such things: as all children getting an education. (J: hmm), early childhood, higher education, issues around employment, issues around transit, around health, around communications. On and on.

These particular articles are ones that governments are agreeing that they either have legislation and they review what it is they have to ensure compliance. Or that they will develop new legislation, and that they will take responsibility to help ensure that the treaty itself was being implemented with the ultimate objective of significantly reducing the discrimination and barriers that disabled people with all types of disabilities experience. (J: Yeah).

Now, that obviously is going to take decades. Given the fact that we’ve had lives like 504 for 50 years, (J: yeah), but we’ve made good progress. And in countries that have ratified the treaty and are taking it seriously, uh, you are beginning to see some important changes. And in some ways, some of the important changes are that disabled people’s organizations in their respective countries are getting much more involved with getting laws passed, getting policies developed and implemented. All of that is very important.

I would say the CRPD is slowly changing the way disabled people are seen around the world. And the benefit that we’ve seen in the US of laws like 504 and ADA, we’re seeing similar, slowly, but similar outcomes in many other countries.

Janet: That’s great. All right. Judy, thank you so much. This has been really wonderful. Again, the legend Judy Heumann,

Judy: it’s been great, thank you…

Janet: We couldn’t be happier that you stopped by today to talk to our Inclusive Designers listeners. Any time you want to come back, you can just give me a call and if not, I will see you in September of 2023. I will come find you in Washington and I’ll take you out for a celebratory drink.

Judy: Thank you guys very much.

Janet: Thank you

Judy: We’ll talk soon…

Janet: Thanks Judy.

Judy: Bye-bye.

Music / Outro:

Janet: Judy is SO inspiring and amazing. I think it’s important that we as inclusive designers understand what it was like before the ADA, and how we need to design beyond the regulations to find the best solutions.

As Judy pointed out, “you need to understand who your audience is, and that you’re designing so that all potential people in the audience can benefit. In other words, accessible and usable design benefits everyone.”

Carolyn: Actually Janet, here’s a quick story— after the movie CODA won the Oscar for best picture, Judy said on social media… how proud she was of the example they set about how to make an outstanding film that is truly inclusive. She also mentioned that their director ‘Sian Heder’ would be working on the movie adaptation of Judy’s memoir!

Janet: Oh, I love her story and what she continues to do in terms of disability rights. How great is that!

Carolyn: Well, I can’t wait to see that film get made, and for Judy and the rest of the ‘Section 504’ team to get the recognition they so obviously deserve.

Janet: I am so grateful to Judy Heumann for giving her valuable time to us here at IDP. I cannot thank her enough. And I cannot wait to go down to DC and visit her during the 50th Anniversary of the ‘504 Rehabilitation Act’ in September of 2023.

Carolyn, I got to tell you, I cannot believe I asked her out, I did not plan that, it just came out! Anyways, that said, I do hope the timing works, and we can actually get together to celebrate the 50th anniversary… because that would be awesome!

Carolyn: There will probably be so much more to talk to her about by then, maybe even whether the movie based on her book is up for a future Oscar. Time will tell. And speaking of time, I think it’s about time to wrap up this episode.

Janet: As always, we will share the links for Judy, the ADA, 504, and of course, a few other things that were mentioned along the way during this discussion… all that on our website at: InclusiveDesigners.com…

Carolyn: That’s InclusivDesigners.com…

Janet: Our thanks again to THE Judy Heumann, and to you, our listeners, for stopping by.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that ‘Patreon’ button, or the link to our ‘GoFundMe’ Page.

Janet: As we say around here “Stay Well, And Stay Well Informed” … We’ll see you next time.

Carolyn: Yes, thanks again.

Music up & out

This just in… new changes are coming for those who create spaces for Behavioral Health. Combining the scientific knowledge from Neuroscience and the research evidence from Trauma-Informed Design is opening up new ways to optimize health, performance and access.

IDP is excited to share this 3-part series with Meredith Banasiak that explores the transformational shift in design towards an evidence-based, person-centered culture. She shares her insights for designing for behavioral health projects, from family clinics to eating disorder facilities.

Part 1- Meredith’s story; sensory issues; and the concept of a ‘Shared Experience’

Part 2- The stigma of mental health; Solutions using Trauma-Informed Design for Behavioral Health Facilities.

• Part 3- Social Determinants of Health; improving access to healthcare; designing for eating disorders facilities; and a new way to look at Post Occupancy Evaluations (POE)

Guest: Meredith Banasiak, EDAC, Dir. of Research, Boulder Associates; LinkedIn; Twitter

– References:

• Academy of Neuroscience for Architecture, ANFA

• American Institute of Architects, AIA

• Basic Science of Light / Color

• Boulder Associates

• Boulder Community Health- Della Cava

• Boulder Community Health- Tunable Lighting

• BeWell

• Biophilia

• “Bridging the Gap” (Healthcare Design Magazine article)

• Clinica Family Health

• Eating Recovery Center

• Colin Ellard – Cognitive Neuroscientist

• Evidence Based Design, EBD

• Flexsim Simulations

• GoInvo-Social Determinants model

• HIPAA: Health Insurance Portablitiy and Accountability Act 

• Lifting the Gaze – How to focus to Change Your Brain

• Nationwide Children’s Hospital, Big Lots Behavioral Health Pavilion

• Adverse Risk in Playgrounds

• SAMHSA: Substance Abuse and Mental Health Administration

• Seattle Children’s Hospital, Psychiatry and Behavioral Medicine Unit

• Mardelle McCuskey Shepley, BA, M.Arch, MA, D.Arch, EDAC

• Trauma-informed Design, TiD

• Roger Ulrich Study

• USC Santa Barbara ‘Dormzilla’ (Construction Dive article)

Trauma Informed Design for Behavioral Health- part 3

(Music – open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(music up, then lower)

Intro

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: And I am your moderator, Carolyn Robbins.

Janet: We have a really great show for you today, we are taking a look at how to improve the standard of care in behavioral health using a trauma-informed design approach. And for this important discussion, we are talking to the amazing Meredith Banasiak.

Carolyn: Let me tell you a little bit more about Meredith… she is a Fellow with the Centre for Conscious Design; maintains an advisory role with the Academy of Neuroscience for Architecture. She has published in psychology, medicine, and architectural research journals and books. And now she is here to share her passion for research and evidence-based design with us today.

Janet: And to make it even more special we have asked Davis Harte, or as I refer to her as Dr Harte, to be my co-host. Together we have co-founded the Trauma Informed Design Society and will be adding our insight from that to this discussion.

Meredith has done some incredible work on sensory issues and designing for human health along with Trauma-informed Design, to foster inclusivity and a healthier environment.

Carolyn: There is so much to explore here, that we’ve decided to make this a 3-part series. You can listen straight-through or choose to hear each section separately, let’s call it ala carte.

Janet: In this section, we will look at how nuanced or specialty behavioral health facilities are emerging to treat specific behavioral health conditions. The question becomes: How do we design for these new models of care?

Meredith will walk us through the research and how new technologies were used in the design of a dedicated eating disorders facility that she personally worked on. I really find that story so fascinating, I think you will too.

Carolyn: And of course, if you want to know more about any of the places or studies mentioned, we’ll have a really rich list of resources for you on our website: InclusiveDesigners.com.

Janet: Carolyn, I think we’ve covered all that needs to be said here up front, so I guess we should just start the show now, don’t you?

Carolyn: Agreed. Without further ado, here is our thought-provoking look at combining neuroscience with evidence-based design, with insights from Janet, Meredith Banasiak and Davis Harte …

(music)

Interview- Overview

Janet: Hi, and welcome to Inclusive Designers. I am your host, Janet Roche. And today, we’ve got a special guest host. You’ve seen her before on this show, Davis Harte. And today we’re going to be interviewing Meredith Banasiak. Welcome Meredith. Welcome Davis. How’s everybody doing today?

Davis: Great. Thanks Janet. It’s wonderful to be here…

Meredith: yeah, it’s great to be here.

Janet: Thank you for coming.

Interview- Section 3

Janet: So Meredith, how is behavioral health being integrated into healthcare?

Meredith: Okay. So we’re seeing kind of a move from healthcare systems, changing their care practices. And then in turn, we’re kind of changing the design of clinics and facilities to better support those models of care. So the move to include behavioral health in healthcare generally really comes from healthcare systems who recognize the totality of factors impacting health beyond just medical care or clinical care.

And here I’m really talking about the social determinants of health kind of model here which just includes all the non-medical factors that influence health outcomes. So, addressing those other factors is really fundamental for improving health; reducing inequities in health; and even increasing access to medical care, which is kind of what we consider when we think about healthcare, we only consider that realm.

But if you look at one of the models by ‘Go Invo Boston’, they have a social determinants of health model and their data suggests that only 11-percent of health is attributed to medical care. And the other 89-percent is these other things, like your social circumstances, your individual behaviors. And those are usually not very separate from each other. (J: hmm).

So, for example, your income or your employment status or unemployment status can very much influence your individual behaviors— your sleep patterns; your stress levels; your substance use. And those in turn will manifest in health outcomes and, you know, diabetes or what are considered deaths of despair, which include like suicide or substance related deaths. And those are largely preventable deaths. So, we have to kind of address all those other 89-percent of health factors if we’re really interested in working for a more healthy population.

So, the more innovative healthcare systems— and these tend to be, like community health centers who are working with populations that have more inequities and disparities and health inequities— they’re able to sort of see that totality of factors influencing health and really connect the dots between the way they’re delivering medical care. and then also, providing opportunities for nutrition, or housing, or behavioral health. (J: right).

And one of our clients that we’ve done some community health centers for is ‘Clinica Family Health’. They’re in Colorado. And they were one of the pioneers to sort of introduce integrated or team-based care into their practice. So, team-based care includes your traditional kind of family doc or primary care provider, but then also on the team are a behavioral health provider; a dietician; someone from dental, like a dental hygienist; a case manager. And they all work together in the same shared clinic team space. So they can support the range of patient needs.

In these community health centers, they also have co-located services that can provide housing assistance or nutrition assistance like WIC. So these co-located services, this team-based care model, can really increase access to care for patients who have these diverse needs. So, they’re also really innovative in thinking how to design for supporting this new model of care. They introduced group visits to create support systems for like diabetes management and that sort of thing.

They, before the pandemic, were doing car care. So they were administering flu shots. So kind of the whole family gets in the car. These often happen on weekends or after hours, you know, because that’s another problem with access to care. And sort of drive up and everyone gets their flu shot. It’s really easy. It’s also easier for children, so, right. I don’t know if you’ve had the experience of taking a young one— yes, okay Davis, yes— for their vaccine recently or a flu shot, but transitioning from the car into, for me, we had to go into this clinic, into the basement. It just was an opportunity for anxiety to build up and fears to build up.

So, there’s lots of innovative things that they’ve introduced, and they’re very nimble. They’re quick to change. So, they don’t have that kind of risk aversion, like a lot of other kind of healthcare organizations have. They’re very nimble in order to support the needs of the community and deliver the best care and get healthy outcomes.

Janet: Right. Yeah, I talked to somebody who has a child who has autism and she uses the parking spots. They’re labeled for handicap, and lot of people have yelled at her (M: oh), because she’s not in a wheelchair. How dare she use the handicap placard or handicap parking spot.

And I bring this up because it takes heaven and earth to move her non-verbal kid who has autism from the car, just to the, you know, go into the supermarket just to pick up whatever it is that they need to pick up. (M: yeah). And so, yeah, the thought of like, maybe you’re getting a shot, like people have aversions to getting shots and they get freaked out by all this, and then it’s just another layer.

So to be that kind of nimble and to be able to make things easy, go figure, right. To make them a little bit easier to make them a little bit more accessible, a little less stressful. Pretty great.

Meredith: Yeah. So, in that example where behavioral health and medical care and those other services I mentioned are coming together. We’re also seeing campuses specific to addressing behavioral health come about. There’s a great group in California called ‘Be Well’, that we’ve designed two projects for and so they’re bringing together behavioral health services to address again, the continuity of care from crisis, all the way to management and prevention.

They also include transitional housing. In this case, it’s in the same building. In another project it’s on the same campus, so that they can support patients and clients at every step of the journey. And that’s, that’s usually not a linear journey. It’s a lot of, kind of back and forth, but they can support them at any stage that they’re at. (J: Right).

One of the design challenges with those campuses— so it’s, it’s great to have all these things co-located to support access and continuity of care— but I think one of the things we learned is that you have to have these strategic separations. So for someone who’s coming in in crisis or in need of detox services, you know, how do you support their transition into the center in a way that supports dignity and offers privacy and anonymity, and also doesn’t sort of frighten people who are coming in for just an outpatient. (J: Right). Yeah.

Janet:  It’s, it’s interesting. I was just going to say what were your challenges? Because you know, you’re bringing a lot of different services. I’m sure when you do all the initial interviews and stuff like that, I’m sure you have a list that’s at least an arm’s length of wishes and needs and have to’s. And, do you spend a lot of time trying to connect the dots? Or do things fit together somehow naturally? What’s your process? I guess.

Meredith: (Laughs). Oh…

Janet: How long do we have?

Meredith: laughs.

Janet: (Laughs). Is it one of those, okay. It was a loaded question, but if you can break it down. I mean, because as designers, right, even in the best circumstances, you usually get like a wish list, right? (M: sure). I mean, you get some sort of something like, this is what we would really like to have, and some of the things they might not have even thought of. (M: yeah).

But when you’re dealing with so many different components, yet although trying to provide the same service for the same individual, (M: yeah). How does that work? Like any tips or I guess maybe that’s a better way to look at it at the moment… (M: yeah). We can have Meredith come back for a whole new series just on her methodology.

Meredith: Absolutely. I’d love to, um, so. Oh, gosh.

So first I’ll just say like, these projects are my favorite because they’re new models of care. And so they’re new building typologies. We don’t have precedents that we can turn to. And so we get to be really innovative, which is fun. And so kind of to your point of like, well, where do you start?

So sort of from the human factors perspective, we embrace evidence-based design processes, but we also include experience-based design. And this goes back to a point Davis was making about that lived experience and the importance of lived experience and cultivating empathy.

So I don’t have a prescriptive approach, but I do like to sort of start with the experience which recognizes, you know, that every person’s experience is a very valuable data point. Which is different than evidence-based design, which is like, you know, we need robust evidence and large sample sizes in order to sort of show this as true. And experienced design is like, no, every person’s experience is, is a very valuable data point that we need to consider.

So I like to start with that. I like to sort of start with the stories. And for behavioral health, this can be challenging because their behavioral health patients are considered a protected class. They’re a vulnerable population. And if you’re working with, you know, pediatric behavioral health, they’re kind of twice protected, so it can be really, really challenging.

So some of the ways we’ve sort of gathered their experience is by, accessing family advisory groups that are attached to the organization. So if we can’t go to the children, we can ask their parents and their caregivers to share their experience. Or if they’re adults, we can ask past former patient volunteers who give their time and share their experience in these advisory groups to participate.

I like to do whenever possible sort of walking interviews where you’re walking, and talking because there’s, I don’t know if this is the right use of the word, but there’s like this artifactual memory, or sort of like seeing different artifacts that triggers like ‘oh, you know…’

Janet: ‘oh, that’s right, oh by the way, can you do something with this?’ Right, exactly.

Meredith: Yeah. So we do a lot of that with staff, kind of these walking interviews with staff to talk about what’s working or what’s challenging in certain environments.

So I like to start with kind of that experience. And right away, I think we kind of learn, you know, what’s important, such as, you know: dignity; or reducing stigma; protecting privacy; giving control. Those things kind of bubble up right away and help create targets or goals.

And then we can issue things like surveys to get kind of that larger sample size. But now at least we know the questions to ask from kind of having those stories and learned those experiences.

Janet: Right, yeah. Davis?

Davis: I love talking methods to an ethic approval. Ah, yes, it’s a tricky, it’s a tricky thing to get access to people who are so-called vulnerable, because they’re the ones that we need to study the most. (M: Yeah).

And I love hearing about the walking interviews. It reminded me right away of a different time frame, but a similar approach perhaps, is video reflexive ethnography. (M: hmm). So that’s the work that I was involved with, videotaping an experience, something occurring, and then watching that video with the participants themselves.

And while they’re watching their own selves, they’re recognizing all that was going on, on a subconscious level that they’re now aware of now that they’re sitting and viewing it and having a chance to pause it, and interview and ask what’s coming to the surface for them.

Meredith: Oh, wow. I love that.

Davis: it’s so interesting.

Janet: That’s a great example Davis, right, because that might be something that could, you know it’s technology.

Davis: But another thought I had around getting somebody who you don’t have access to. So we want to design for particular folks and they’re not, we can’t approach them, we can’t talk to them because of privacy concerns and their vulnerable status. (J: Right). So this is where being creative and imaginative and knowing how to be, you know, like having more actors and actresses come into the design world would be amazing because they can become and personify other people role playing.

I did a lot of work when I worked at— and there’s a podcast episode from early on of me speaking about the ABC House— where I worked with folks to design an abuse intervention center. And I wasn’t, I had no intention to talk to any of the people who would be coming to that space, aside from the staff and the clients.

And there, we didn’t have advisory groups like Meredith does, but that would be fruitful. And we, I think we were doing it ad hoc. We were pulling that together and I was finding my nearest children and saying, would you mind coming with me and just giving me your opinion about how this is going to look, because I needed it from your perspective and your angle. And I would put myself on my knees and get to that height so I could see what people are seeing. (M: hmm). So, it’s just fascinating, fascinating work. (J: Yeah).

Meredith: Yeah. What you just described, it, we call those empathetic observations. So the scenario I’m thinking of, we were designing this eating recovery center. It was what they call their spa bath. So it’s the space where patients with eating disorders get ready in the morning. So they shower, they brush their teeth, they get ready, but it’s also where they have weight check-ins and vital check-ins in the morning. So, they’re in a very vulnerable state and it would never be appropriate for us to kind of go and observe this in real life.

So I played the role of a patient, just so we could document the processes in the spaces and really get an understanding— not to say that I would ever understand what it’s like to be a person with an eating disorder or to sort of be in this inpatient eating recovery center— but reenacting the processes they were going through in the morning. And then there was another researcher with me who was kind of writing everything down and doing spaghetti diagrams and that sort of thing, really helped us with some process improvement for the space and then ultimately the design of the space as well.

Janet: Yeah. I think that this is a really fascinating part that you did in your methodology for this particular type of a vulnerable group. And it’s probably one of the more challenging populations to design for and your methodology to go through all of that. And to Davis’ point, you’re putting in sort of an actor into that role, because you’re also trying to have some sort of privacy for those that go through it.

At some point I have gone and taken my students around and I have them in wheelchairs or I have them sort of blindfolded. There’s definitely like you even said, I’m not trying to pretend to know what it’s like to go through it, but, but there’s certain things that I think you can get out of that.

And I guess my, my question is… Did you have an ‘aha’ moment when you were walking through and you were doing your own acting role within this? Did you think it was a good thing to do it that way, I mean obviously we would like to have those that go through it but is there something else that you would have preferred? Did it work?

I guess I have a hundred questions, so I don’t know which ones to ask first, (M: laughs). I think that that’s what it comes down to. So if you want to expand a little bit more on, on your experience with that, that would be great…

Meredith: Sure, sure, sure. So, there’s not like a prescriptive sort of methods I roll out for every project, it’s really kind of matching the right tools and techniques to whatever it is we’re trying to address. For that particular space, there was an issue of sort of, of waiting in line in order to have weight and vitals checked. And these patients are in a really vulnerable state they’re sort of in a gown, besides just the ‘waiting is waste’ sort of thing.

And so our objective was, you know, how do we get rid of that waiting experience, and then also just create sort of more dignity around what’s happening during their morning routine. So the empathetic observation was one piece to really capture the processes. And there were some also, some things that I experienced just, different proximity to other people, that felt very uncomfortable, again, when I was in that vulnerable state and I did put on the gown and all of that.

Janet: Wow. So you really are a method actor, as they would say. So it’s sort of like what we do with my students. Right.

Meredith: Yeah. So right, even though I don’t have that eating disorder, there were still environmental elements that I was very hyper aware of, that I would imagine sort of would translate. So we can check our assumptions on that by issuing a patient survey, which we did to former patients. They have a whole alumni group of volunteers who took the survey and did respond to some of the assumptions that I had so that those were validated in the survey.

The other thing we did is we did some simulation testing using a digital software program called ‘FlexSim’, which you can set up the architecture, you know, floor plan or a 3d model. And then if you have the processes correct, and sort of timestamped, you can actually run these fake patients through and understand sort of where the bottlenecks are.

And then, you know, you can figure out, do I need to add another staff member? Is this an operational thing? Do I need to cut out one of the process steps? Or is it a design thing? Do I need to add another shower? Do I need to add another exam room? And so you can quickly change these different variables and then run patients through as a simulation and see if wait time is reduced, if sort of the bottlenecks go away.

I think that testing during design is really, really important, so we’re not waiting until the project’s built, and we can’t do anything about it. (J: about it, Right). Yeah.

Janet: Yeah. That’s an important piece. So, yeah, but I just think it was such an interesting project that you did and I think there was probably more challenges than other projects. Did I understand that correctly?

Meredith: So again, this is kind of one of those new ways of delivering care, so kind of specific to an eating disorder population. Even though anorexia is the most— gosh, I feel like I need to get my words correct— but I want to say anorexia is the most fatal psychiatric disorder. There’s not a lot of funding to support treatment. It’s getting better, like they’re passing legislation to recognize it as a disorder and then sort of provide insurance treatment. But historically it’s been really difficult. (J: right). So without the insurance to sort of fund treatment, there haven’t been facilities to have the treatment, which is, I mean, it’s sort of mind-blowing.

Sometimes these patients go into traditional behavioral health care settings, but eating disorders are really different. And the what the patients are experiencing and their treatment programs are very, very different from sort of, (J: just like, alcoholism…) sure, yeah. Any of those sorts of things. (J: right) And so, again, this is an opportunity with the rise of these eating recovery centers, which are now all over the country to say, well, what is the right design to support the care that they’re giving.

One of the things that came up was proxemics, comfortable proxemics. So sort of part of eating disorders diagnosis is a misperception of your body, the kind of the space your body is taking up. And related to that, sort of a misjudgment of maybe body to body distances; or body to wall distance; or body to furniture distance. That perception is off, that judgment is sort of off.

So like in the dining area, which is a really stressful part of treatment, you know, we heard from the patients that they felt cramped or crowded. And so we created smaller dining cafes, so there weren’t as many patients in the dining space together. And then we created— and I forget what sort of the recommendation is between, diner to diner— but we almost doubled that to give them more space and more comfortable proxemics there.

Janet: I mean, I find that fascinating you know, that there’s some sort of body dysmorphic anyways, but that they are also reading the built environment incorrectly in terms of their body. Am I understanding that correctly? (M: yeah).

And then I start to wonder who, those others, like psychological issues that I think would probably also have that same sort of thought processes— like maybe people who have schizophrenia— in terms of themselves versus the built environment. (M: hmm). But in terms of eating disorders, I mean that’s pretty incredible. And I’ve got to think that there’s, I mean, we talk about it anyways, right, to a certain degree, but this is, I feel like it’s more tangible and more understandable.

Davis:  It might even be more or, or even less than the thought process, because that’s putting it on the individual that they’re thinking or not thinking correctly, but really what we’re talking about is it is a circuitry… (J: misfire), you know, neural connection (J: right), that, uh that can be altered. And once the chemistry of the body is, is shifting. And in addition to the thinking training along with the, you know, the spaces is therapeutically supporting that process. Right?

Meredith: Yeah, absolutely. Right. And another thing with persons with eating disorder is they have dis-regulated circadian rhythms because eating and regular meals is a regulator of our circadian system.

So, you know, I think that’s where daylight becomes really, really important in their recovery process as we’re, you know, trying to retrain the circadian systems. And that’s hard for behavioral health because by code you’re required to have patient rooms have windows and that’s a code requirement. But often patients aren’t using their rooms during the day. So all of the spaces that could have daylight are often kind of moved to the core. and that’s just, that’s not good for their, their recovery process.

Janet: You learn something new every day, Meredith. (M: laughs). That’s an interesting point, but it’s, it’s a really good point, right? I mean, you don’t spend all that time and if you do it’s mostly at night.

Well, there’s that, ah I’m not going to remember the name. They just did a whole thing. Some very wealthy donor gave a lot of money. It was for a dormitory….

Meredith:  oh yes, at “USC” Santa Barbara.

Janet: Yes. So just for our listeners, in case you don’t know, they put all the dorm rooms on the interior, right? And they put all of the public spaces on the outside. And there’s been a lot of outcry from the design and architecture community that this is probably not a good thing. And they are sticking to their guns. They are sticking to their guns. Any thoughts on, on that…

Davis: Well doesn’t it bring up that we need more good science and good evidence because, well, you know, you’re manipulating the experiences of thousands and thousands of people without necessarily the logical evidence that can create that… you know, tossing hypotheses at a construction plan that will become an actual building and a place where a person will live for long time, not the length of a cruise. You know, but what is it when you get back to the evidence part of it?

Well, is it the photons of light coming through the window that are helping people feel better, or is it the gaze of the eye that’s connecting to the brain that’s helping people feel better? We just don’t know, do we. (J: right). I mean, it’s bringing to the front a complex matter that needs a lot of good smart people coming together and talking to each other, just like we’re doing.

Janet: I was going to say just like Meredith and Davis… it’s all good…

Meredith: (laugh). It certainly is a move that does not seem supported by any evidence that I’m aware of. (J: Right). And, when we did a project for Boulder Community Health. This was an adult inpatient behavioral health unit. And the design team included tune-able lighting throughout the whole unit. And it’s the first that we’re aware of that the inpatient behavioral health that had tune-ables throughout the whole units, even in the patient bathrooms, for example.

So the tune-able changes over 24-hours to mimic changes in, in natural daylight. And, you know, you have higher intensity blue light in the morning to suppress your melatonin and keep you awake and alert, and then kind of eliminating that blue light spectrum in the evening to allow melatonin and support sleep.

Now, because this had never been done, our lighting designer really struggled with: “what time do I make the shifts?” “What should be the light intensity at four o’clock versus nine o’clock?” “What should be the color spectrum at, you know, 11 o’clock at night versus 8:00 AM in the morning?”

So she made use the best use of the evidence, but I remember having many conversations with her about, ‘we don’t know what if we are doing harm here, because we don’t know.’ And, but certainly, you know, we made really the best decisions we possibly could make using the evidence we had available. (J: right).

The great thing about tune-able is you can change it and, and we’ve collected data and we have gone back and changed it. So, that’s great. It’s not sort of like a traditional lighting system where you got to change out all the fixtures in order to make a difference.

But this question of designing when you don’t have the evidence, it does become sort of a little bit of an ethical responsibility to consider. (J: right). But UCSB, I don’t see any evidence supporting what they’re doing at all. (laughs).

Janet: No. Well, I think that’s why it made the news. (M: yeah). I think that’s why everybody was sort of up in arms about it. I kind of didn’t mean to go off topic, but again, it was, you know, again, it goes back to this sort of like what kind of evidence that we have, and, you know, in much like the lighting that you’re talking about, we will always have to kind of keep tuning those pieces of evidence because things will come out and things will change. And who knows, even with some of the stuff that we’re dealing with the pandemic will change sort of how we also live, and how we, maybe inherently biologically like it’s still, a lot of this stuff is still the same, but maybe things will change just a little bit that again, just need to be finely tuned.

Meredith: Yeah, I think this is a really interesting time we’re in, because evidence-based processes are great when we’re in stable systems. And when I think about the pandemic, we’re in this time of great disruption. And the evidence keeps changing, and policy keeps changing every single day, right?

Janet: And we’re getting used to the uncertainty…

Meredith: We’re getting used to the uncertainty and those who have relied on evidence-based medicine or evidence-based processes to make decisions, I think they’re really struggling right now. sort of what is best practice. Even for our designs, you know, they’re supposed to last at least 40 years. And we don’t quite understand ‘what is best practice now’ considering this pandemic and transmission and all of those things. So…

Janet: Right. Going back to what you were talking about in terms of the neuroscience of it. (M: yeah). Is any of this, you know, again, back to trauma, is some of this trauma also changing some of the wiring in our brains? Is that going to be some sort of factor? Is the 40-year time span really relevant?

I find this kind of stuff fascinating. I think it’s going to, you’re right, this is a destructor, right. So, but we get an opportunity to kind of maybe look at things (M: yeah) and, maybe it is that we will have things that we have already known to be true, but maybe we will also pivot.

I know Davis and I have both talked about how a lot of people are like, ‘oh, I haven’t done anything by make bread for the last two years.’ (M: laughs). Davis and I both though, have— I don’t know about you— have found that this is a very busy time for us. It’s been very, very busy. And because I think people were trying to figure things out and, and we’re trying to all kind of, I think, maybe help each other.

Meredith: Yeah, I think, you know, Davis made a point about healthcare, well specifically to healthcare being risk averse. And absolutely, we see most healthcare organizations being risk averse. But because of the pandemic, I think there’s a real opportunity rather than just using evidence to inform design— they like to use evidence that can validate this model that’s been used 50 times is the best nurse station or patient program or that sort of thing— now we can use evidence to transform design. So to me that’s really exciting because we weren’t able to sort of take those innovative leaps with a lot of healthcare clients today. And, because we have this great disruptor, now we can…

Janet: We have an opportunity for change, right? I agree with you, mentioned it to my students recently as well. (M: Yeah.). That’s great. Meredith. So what do you think about going forward? What do you think about the future about methodology? What do you think about, in terms of some of the things that we might be seeing? Because we’re now just talked about the pandemic and how things are disruptors. Like, so what do you see as our future? What are your hopes and what are your thoughts about that?

Meredith: Okay. So from the research perspective, I see sort of this move into data. I’ve heard others kind of describe that data, not drawings, is our new currency. I think it’s probably data in drawings, because drawings are the way that we communicate. So how do we infuse data into the drawings? So I’ve been— even as Director of Research— I’m increasingly uncomfortable with kind of this post-occupancy evaluation, which is sort of what we’re trained as design researchers is the gold standard.

Janet: You might not be able to see me, but my eyes just went “what?” …

Meredith: (Laughs). Don’t throw rotten fruit at me, please, please. They’re going to take away my title as researcher. But hear me out first for a second. Because post-occupancy— so here’s my issues is that— it looks at a facility at one point in time. And I think that we need to realize that certainly people are dynamic. We get that. We change. And also groups of people and, uh, sort of staffs can have turnovers or different cultures. And those change too.

I don’t know that we think enough about how dynamic environments are. And I’m not just talking about sort of longitudinal change that happens over a building’s life cycle. Like, okay, now this storage closet becomes a break room. I mean, that is important to consider as well, but I’m thinking of just the short-term dynamic changes that happen in our environment.

So if you’re in an environment with windows, you’re exposed to different light levels and color spectrums of light throughout, you know, almost minute by minute. If you’re in a room with a lot of people, you have different noise levels and those can change, again within a day. Your air quality. Again, if you have a room full of people, you might have higher CO2 levels, which can really affect your cognition and your alertness. So those kind of environmental variables are constantly changing and affect our performance in those environments. (J: right).

So I think that we need to think about continuous monitoring of both the environmental and humane parts of that ecosystem. Going back to the ecosystem model, in order to sort of understand this as a complex interacting system. So, our methods, instead of post-occupancy, I might offer, you know, can we move into continuous occupancy evaluation? Instead of looking at just one project, can we look at portfolios of projects?

So we’re really lucky because we have repeat clients who, like ‘Eating Recovery Center’ who I mentioned earlier, who have multiple facilities and sites that offer the same programs.

So, when I’m doing a study, I never just look at one project. I always look at sort of their whole portfolio. Right now, we’re looking at eight different programs sites for them in order to sort of understand what’s best moving forward.

So it’s sort of this big data approach and taking multiple streams of data. And then, you know, maybe looking for outliers of, ‘oh, this facility is really doing something great, what can we learn from them on this dimension’ versus ‘this facility isn’t working at all’.

So in terms of technology, we’re starting to introduce sensors and wearables. Like a ring measuring stress. We have not used it in a healthcare setting yet. We’ve sort of just set up a system using volunteers from our own staff to do sort of an office worker study, just so we can kind of get the components in the system set up.

We have done a study where we had inpatient behavioral health staff wear light sensors to understand their lighting exposures. This was under the tune-able system which was really important.

But any time you have a sensor— whether it’s an environmental sensor or a biometric sensor— that’s timestamped, you can bring all of this data into the same spreadsheet and then look at interactions between them and really start to understand the system as this ecosystem

Davis: That is so fascinating. Being a lifelong, um, sensor wearer due to— which I’m also forthright about sharing my lived experience— of having type one diabetes. It was only recently that they’ve developed a continuous glucose monitor sensor. So to know that information for me on an ongoing constant evaluation is fruitful and helpful, and I can see patterns and trends.

And one moment in time with a blood sugar test is useless. (M: yes). So having something that’s responsive to the immediate needs is much, much more helpful. So I really love your evolution of post-occupancy evaluation. In fact, I was just speaking with Mardelle Shepley yesterday, because she said that also— something she was hedging in that direction I believe, I might be putting words in her mouth— but it’s a little too broad. The POE, it’s, it’s a broad ‘here let’s just plunk it into the building and take advantage of this’, not knowing what the actual specific typology is; what the actual population needs are. It’s not able to be nuanced and fine-grained enough. So the ‘Continuous Occupancy Evaluation’ – Meredith Banasiak, C-O-E. I’ve got a termed here now, it’s a thing. (laughs).

Meredith: Sweet! Yeah, I love, I love the analogy you shared Davis about your monitoring your diabetes. That’s, I might have to borrow that one as well. I think that makes a strong case. And I also think it’s setting us up as designers for creating kind of feedback loops. So not just the monitoring of this human environment system, but adaptive environments. And that sounds really sci-fi, but it’s really possible with the tune-able lighting. I mean, we’re almost there. We don’t have the AI built into the tune-able system, but we’re not that far away that it could respond to different occupant measures and automatically adapt.

Davis: Right. And once we get sleep under control individually and as a collective community, we’re all going to just start feeling much, much better. And getting a handle on our lighting needs, will feed, it’s that feedback loop, its, it’s just perfect. And the sensors and the lighting and the battery life is just eclipsing each other, the competition is amazing. I wear my aura ring here and can track my sleep measures quite well. So, I’m excited to hear about the future of technology and how we can integrate and incorporate these new streams of data. (M: hmm). It’s Fantastic. (M: Yes).

Janet: “Right, so, before we go, any last thoughts from your perspective, meaning like what do you want designers to take away or know on neuroscience and designing for behavioral facilities? Is there anything else we should know?

Meredith: So, when the Academy of Neuroscience for Architecture was just emerging, it aimed to bring together neuroscientists and architects, because that’s all we had as our starting point. But, you know, fast forward almost two decades later, we have bridges. We have, like you, like Davis, like Janet. We have bridges in this field who are bilingual in the sciences or in evidence-based and in design. And those bridges are really critical to help making the translation between the evidence. And also for conducting practice-based research which is absolutely a necessary part of this research spectrum.

We absolutely want to make use of the findings coming out of the lab, but we also need to do research in naturalistic settings which is very different from the way they do research in the lab and the findings they’re getting in the lab. So, I would just say, we need more bridges in this field in order to advance the field.

Davis: Well, thank you so much. This is such a treat and, I love the emergence of a new job description, the design bridges of the world. So, I look forward to speaking with you more personally, but I also would invite you to share how folks who are listening, who would like to hear more about your work or learn more about what you’re up to, how they can be in touch with you.

Meredith: Oh, I’m happy to share anything. It’s great, I love connecting with people who are interested in this stuff. So I’ll provide a link to our site at BA Science. And I can also be found on Twitter and LinkedIn and look forward to connecting.

Janet: Meredith, thank you so much for this time. This has been a fantastic episode and there is so much more to discuss. Maybe we can continue this conversation in a future episode…

Meredith: Yeah, absolutely. Thank you so much for the opportunity to be a guest on your show. I have such respect for the work you’re doing and the resources that you’re sharing with our design community so we can help move the culture forward.

Janet: Yeah, I know I’m excited about it too.

Davis:  and I look forward to more conversations with you Meredith, thank you.

Janet: Thank you Meredith, Thank you Davis.

Outtro- Section 3

Janet: Boy, Meredith really knows her stuff. I am so impressed with her and the work that she is doing in this area of behavioral health facilities. One thing that really stayed with me was the use of Tune-able lighting. Although Carolyn I got to tell you, my cat was just a little disappointed, she thought it was tuna-able lighting. Get it?

Carolyn: (laughs) I do get it… I think my sense of humor is rubbing off on you.

Janet: But in all seriousness, daylight is so important to recovery, and to be able to adjust the lighting is huge. I also love how Meredith stresses the use of research evidence and scientific knowledge together to inform real projects. This optimizes the design for health, performance and access.

Carolyn: From what she said and the examples she gave, these methods have proven to help the staff at the facilities, as well as the patients and their families. Meredith is very forward thinking and to quote from her own bio, she ‘supports a transformational shift in design towards an evidence-based, and person-centered culture.’

Janet: With that we’d like to thank both her and Dr. Harte for this inspiring, empathetic and scientifically considered talk today. I cannot thank them enough. As Dr. Harte said, this was a gift for us to have this type of conversation with Meredith.

Carolyn: And I can see us bringing Meredith back to dig into these topics even more in the future.

Janet: I’m nodding my head, absolutely, but getting back to this episode… we will also share the links for Meredith; Davis; Trauma Informed Design; and of course, the many more things mentioned during this discussion… all on our website at: inclusivedesigners.com…

Carolyn: That’s: inclusivedesigners.com…

Janet: Thank you to Meredith & Davis. And thank you all as well for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page.

Janet: And as we say around here: ’Stay Well…and, Stay Well Informed’.

Thank you as always for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again.

Music up

This just in… new changes are coming for those who create spaces for Behavioral Health. Combining the scientific knowledge from Neuroscience and the research evidence from Trauma-Informed Design is opening up new ways to optimize health, performance and access.

IDP is excited to share this 3-part series with Meredith Banasiak that explores the transformational shift in design towards an evidence-based, person-centered culture. She shares her insights for designing for behavioral health projects, from family clinics to eating disorder facilities.

Part 1- Meredith’s story; sensory issues; and the concept of a ‘Shared Experience’

• Part 2- The stigma of mental health; Solutions using Trauma-Informed Design for Behavioral Health Facilities.

Part 3- Social Determinants of Health; improving access to healthcare; designing for eating disorders facilities; and a new way to look at Post Occupancy Evaluations (POE)

Guest: Meredith Banasiak, EDAC, Dir. of Research, Boulder Associates; LinkedIn; Twitter

– References:

• Academy of Neuroscience for Architecture, ANFA

• American Institute of Architects, AIA

• Basic Science of Light / Color

• Boulder Associates

• Boulder Community Health- Della Cava

• Boulder Community Health- Tunable Lighting

• BeWell

• Biophilia

• “Bridging the Gap” (Healthcare Design Magazine article)

• Clinica Family Health

• Eating Recovery Center

• Colin Ellard – Cognitive Neuroscientist

• Evidence Based Design, EBD

• Flexsim Simulations

• GoInvo-Social Determinants model

• HIPAA: Health Insurance Portablitiy and Accountability Act 

• Lifting the Gaze – How to focus to Change Your Brain

• Nationwide Children’s Hospital, Big Lots Behavioral Health Pavilion

• Adverse Risk in Playgrounds

• SAMHSA: Substance Abuse and Mental Health Administration

• Seattle Children’s Hospital, Psychiatry and Behavioral Medicine Unit

• Mardelle McCuskey Shepley, BA, M.Arch, MA, D.Arch, EDAC

• Trauma-informed Design, TiD

• Roger Ulrich Study

• USC Santa Barbara ‘Dormzilla’ (Construction Dive article)

Trauma Informed Design for Behavioral Health- part 2

(Music – open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(music up, then lower)

Intro

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: And I am your moderator, Carolyn Robbins.

Janet: We have a really great show for you today, we are taking a look at how to improve the standard of care in behavioral health using a trauma-informed design approach. And for this important discussion, we are talking to the amazing Meredith Banasiak.

Carolyn: Let me tell you a little bit more about Meredith… she is a Fellow with the Centre for Conscious Design; maintains an advisory role with the Academy of Neuroscience for Architecture. She has published in psychology, medicine, and architectural research journals and books. And now she is here to share her passion for research and evidence-based design with us today.

Janet: And to make it even more special we have asked Davis Harte, or as I refer to her as Dr Harte, to be my co-host. Together we have co-founded the Trauma Informed Design Society and will be adding our insight from that to this discussion.

Meredith has done some incredible work on sensory issues and designing for human health along with Trauma-informed Design, to foster inclusivity and a healthier environment.

Carolyn: There is so much to explore here, that we’ve decided to make this a 3-part series. You can listen straight through or choose to hear each section separately, let’s call it ala carte.

Janet: In this section, we will look at the stigma of mental health, and what the research is telling us about how best to design for these environments. Meredith will provide specific examples of Behavioral Health facilities where these were successfully implemented.

Carolyn: And of course, if you want to know more about any of the places or studies mentioned, we will have a really rich list of resources for you on our website: InclusiveDesigners.com.

Janet: Carolyn, I think we’ve covered all that needs to be said here up front, so I guess we should just start the show now, don’t you?

Carolyn: Agreed. Without further ado, here is our thought-provoking look at combining neuroscience with evidence-based design, with insights from Janet, Meredith Banasiak and Davis Harte …

Interview- Overview

Janet: Hi, and welcome to Inclusive Designers. I am your host, Janet Roche. And today, we’ve got a special guest host. You’ve seen her before on this show, Davis Harte. And today we’re going to be interviewing Meredith Banasiak. Welcome Meredith. Welcome Davis. How’s everybody doing today?

Davis: Great. Thanks Janet. It’s wonderful to be here…

Meredith: yeah, it’s great to be here.

Janet: Thank you for coming.

Interview- Section 2

Janet: So Meredith, let’s talk a little bit about behavioral health facilities, and then how they’re being improved by using trauma informed design. You want to talk a little bit about that? Maybe talk a little bit about Boulder Community Health program or the pediatric inpatient part that you’ve been working on.

Meredith: So yes, we’re seeing this move toward trauma informed design in behavioral health services. And if we, you know, think about behavioral health facilities, they’ve historically been designed to support care that can trigger a patient’s experience of trauma during treatment.

So think about, you know, the use of seclusion and restraint. if you’ve never been in a behavioral health facility, I, I’m not saying that Hollywood paints an accurate picture of that at all, but that there are practices in some of those movies that we’re familiar with which we see historically in behavioral health treatment programs like seclusion and restraint, very sort of barren institutional environments that lack environmental complexity. So, you know, for example, the thought is, you can’t put furniture in or art hanging on the wall or something, because that could be used to hurt someone or the patient themselves. (J: as a weapon). Yeah. (J: right).

So, and also isolation from family and loved ones. So the support system of the patient is often removed from the treatment plan during inpatient stays. And so that makes the transition, you know, when they go back to home really challenging because the family or loved ones don’t know how to support the patient, they’re not aware of like what that recovery process includes.

So all of those practices really historically again, you know, have created adverse effects, certainly for the patients, but also the staff. They’ve sustained injury by having to put patients in seclusion or in holds, and also for the family, just kind of having that sense of isolation and separation and not being involved in care.

So, the change moving into trauma informed design is one that is coming from our behavioral health clients themselves. They’re moving toward a trauma informed care model of how they’re delivering care and how they’re delivering treatment. So, I’m going to just read a definition of what that means, and this is from the ‘Substance Abuse and Mental Health Services Administration’, which says “trauma informed care realizes the widespread impact of trauma in clients or patients, families, staff, and others involved in the system, and responds by fully integrating knowledge about trauma into policies, procedures, and practices to actively resist re-traumatization.”

And I think trauma informed care really recognizes the context that the treatment occurs in, what the role of context plays on outcomes. And so that’s where we have this really amazing opportunity to come in and design the context to support this new model of care.

So how are we doing that? Roger Olrick wrote a lot about this cycle of reducing a patient’s stress and then how that stress reduction in turn creates better outcomes for the patient and also for the staff. So, a stress reduction in the environment would include fostering more opportunities for control, patients to have control; to mitigate crowding stress; to minimize environmental stressors, like noise; and then, you know, promoting exposure to restorative elements like biophilia, uh, nature, kind of that sort of thing that have been shown to reduce stress.

So when the environment is designed to reduce stress, then there’s less triggers for patients, and, and we see better outcomes: reduced physical violence; reduced verbal aggression; and ultimately, reduced restraints and isolation.

Janet: It’s such an important part… you started off talking about, like Hollywood has like the fair portrayal, but you kind of really don’t see what really happens afterwards. And there’s not a, the built environment is an afterthought, I think anyways, within these, I think things are getting better. I see things are getting better, but it’s still pretty ragged.

Davis: Might I interject that it seems to me that there’s a very much a risk averseness that is so interested in reducing possible risks that they are doing harm in doing so. (J: Good point). We see the same trajectory in playgrounds, (M: Exactly). You know, we’re so concerned about risk and somebody’s hurting themselves that there’s actually nothing there for the kids to do. (M: Yes).

Janet: Here’s your little feather, go play, right? (laughs). But there’s a lot to be said for that as well. But I think there, I mean, Meredith can tell me if I’m wrong, but there’s a way to have that. There is a way to show biophilia without, there’s some sort of risk to them. There’s a way to have different types, even just like have things non-institutional, because people tend to think that then they’re broken and they think it just kind of spirals from there, but there’s a way to present that, there’s a way to have those types of things and make them feel like they’re also worthy, right?

Meredith: Yeah. I think the stigma around behavioral health is a huge problem and that, you know, trauma informed care is this kind of model of treatment is really trying to address that. In some of the interviews I’ve conducted with parents and caregivers of pediatric mental health patients, you know, they say, ‘why is my child treated differently than, you know, the child who is an inpatient and being treated for some kind of medical, cancer or something like that. Why is my child treated, almost like a criminal’, because this is what that child is being taught and that carries with them and they’re more prone to live that out.

And so definitely the stigma is a big issue that these new sort of treatment models are trying to address and the design is also trying to address. I love the analogy you made of the playground and sort of safety first and sort of then people become bored and agitated.

And, you know, I think of animals who, when they’re bored or in crowded situations, they pick at themselves or they pick at each other, right?

And, staying on this theme of animals, we have this amazing wild animal rescue sanctuary in Colorado. And it takes in animals that have experienced great trauma and lots of abuse. And the people who have worked with abused wild animals for so long really understand the kind of environments that they need to sort of reduce their anxiety, reduce their sense of threat. And when you visit, you’ll notice the animals are really calm. They don’t have those sort of pacing behaviors like you see when you go to the zoo. I mean, I haven’t seen tigers and bears in the wild, but I would imagine it seems like their behaviors are more natural.

And, you know, some of the design features that they have in this wild animal sanctuary are lessons we can take kind of in our own sort of trauma-informed design. Like one is low density. So these animals have large acre habitats, and there’s not a lot of them in the same enclosure. They have environmental complexity. They have toys to play with that are appropriate to their species. So if they’re cats that like to climb, they have lots of climbing structures and opportunities. If they’re bears who like to explore there’s different scenarios for them to do that.

And then the other thing they do is with transition. So when an animal comes in, it’s not this sort of abrupt and here’s your new home, which is super scary and super threatening, and you don’t know what to expect. But the transition is very gradual and takes place over a pretty long period of time. So the animal can become more trusting and understand that this isn’t going to be threatening for me.

Another feature of the wild animal sanctuary is that as a visitor, you observe them from a 30-foot-high elevated walkway and you’re never on their ground level. And so for these wild animals, this space exists above their visual field. it’s beyond their body or their scope of reach. And so they don’t perceive you as a threat.

And this is different than humans because we’re one of the few species who have this notion of extra personal space. And cognitive neuroscientist, Colin Ellard writes about this phenomenon a lot where there’s a part of our brain that understands this sense of the infinite or kind of, sometimes we associate with divinity when we see these distant expanses and stuff like that.

And that when we look up to the sky or to these distant expanses, it primes us to think about these very positive notions of kind of sublime, or like I said, maybe divinity. And so this idea for humans of lifting the gaze to inspire these positive thoughts could be really beneficial in all of our environments, but especially for trauma informed design. (J: like a healing environment). Yeah. (J: Right). So, that’s not one that’s in our kind of typical playbook of evidence-based design, but it should be. Kind of this idea of lifting the gaze and what kind of positive thoughts that inspires…

Davis: Right, I am so interested in that Meredith…

Janet: I don’t know if you noticed that I leaned in, right. I was like, really? Yeah. Okay. (laughs).

Davis: We need an invitation to do some research on gaze and how that affects our sense of calm and relaxed versus alert and attending and what that does to our nervous system and how the built environment can facilitate it. We all hear over and over again about, oh, the window view is so beneficial. Well, is it the view out of the window or is it the fact that the eyes are moving and tracking in a way that is different than focused on some focal point that’s creating the sense of stress. So that’s fascinating discourse there. (M: Yeah). More, more is needed, right? (M: Yes, yeah) …

Janet: Absolutely. (M: Yeah). Well, I mean, you know, the whole idea, like you said, the whole famous study with the window looking out to the brick wall versus the, it was a park, I guess it was, but that goes back to sort of our more animal instincts of being able to kind of see the distance and see whatever kind of threat is coming at us. But yeah, I wonder if, you know, when you’re downtrodden, right, like you keep your gaze down, right? (M: uh huh). And you, maybe you’re not creating some sort of eye contact, your shoulders are slumped, you’re maybe not breathing as well. But if you’re lifted and you’re looking and up that the physiology of that as well, might… (M: Yes). Am I going too much into the weeds here, ladies? (laughs).

Meredith: I don’t have evidence to point you to, but I’ve always felt similarly, Janet. I mean, in one of our behavioral health settings, the design team talked about sort of using this flooring pattern that had a biophilic design and biophilia is healing. And I was like, really, do you want to draw their attention down to the flooring? Is that really where you want their attention to be? Because that, that just doesn’t feel right to me.

Janet: Right. No, well, it does… all right, so let’s talk about a design challenge here. So I was doing a piece with a trauma informed design in terms of sex trafficking. It was with this group of students and, and somebody had come up with the idea of designing stuff on the ground for help to do some wayfinding. And at first I was thinking that, you know, you’re coming in, you’re probably not maybe doing eye to eye contact. I think that the sign should be up above, but I also thought, well, why the hell not to have designs on the bottom? You know to have some sort of a wayfinding on the ground as well, but now I’m starting to maybe rethink that. Any, any thoughts on that?

Meredith: Oh, I would say wayfinding is different. And also exterior environments are different, but, but with, you know, with wayfinding, I would say, be redundant with your cues all over as much as you can. Especially, you know, in healthcare when people are coming to that setting often under stress. If they’re in the emergency room or something, you know, you’re under acute stress and we know stress diminishes your, your cognitive capacity and your ability to problem solve.

So we need to make sort of wayfinding cues, like, in my opinion, super redundant across all the senses and across all your visual fields to, because we don’t want to add to people’s stress. I don’t know that, you know, if someone’s coming into the emergency department with the severed leg, I don’t think we’re going to be able to necessarily reduce their stress in that moment, but we certainly don’t want to add to it by making wayfinding more challenging for example.

Janet: Right. Well, anybody who’s ever been into a hospital knows that like, even if you’re just there to visit someone, trying to find where you’re going is usually pretty, it’s pretty stressful. (M: Right). Even as, as a general rule. Well, so I appreciate you talking a little bit about that, uh, Davis, do you have anything to add?

Davis: This is so fascinating, but I know we have lots of other interesting things to talk about, so I’m happy to put a pin in this…

Janet: Yeah. And we’ll keep talking about things. So Meredith, can you give us any examples of some of the work that you have done.

Meredith: Yeah, sure. Do you want me to talk a little bit about kind of pediatric inpatient and kind of point to some of those examples as part of trauma informed design in some of our behavioral health projects?

Janet: yeah, we’d love to hear more.

Meredith: NBBJ, the design firm NBBJ, has done a couple of really amazing pediatric inpatient units.

One is the Nationwide Children’s Hospital in Columbus, Ohio. And here they’re changing their care model to include parents and caregivers if the patient treatment plan works to do that— it doesn’t always— but to include parents and caregivers in the stay.

So just like parents and caregivers are, often stay in other inpatient hospital rooms for medical stays, parents can do that with these patients in behavioral and mental health. So the bedrooms are designed to accommodate that. And a lot of the other rooms are as well. And so this really helps.

So in the interviews I’ve done with parents and caregivers, they’ve shared that, one of the most traumatic moments during their child stay is leaving visitation time. So the parent or caregiver comes to visit, visitation is over, and then there’s this huge separation. And it’s hard on the child, it’s hard on the parent. And so kind of having the parent there avoids that, but also it helps include the parent in the care plan. So that they’re understanding, what the treatment plan is. And they can, when the patient goes back home, they can really be part of that recovery. And there’s more continuity of care going on there as well.

Another pediatric inpatient behavioral unit is Seattle Children’s Hospital. And that group also has adopted a trauma informed care behavioral management philosophy. And so, the design of those units don’t include seclusion rooms, so they’re seclusion free and restraint free, and they really strive to avoid these hands-on interventions. So again, for that to work, the rest of the environment has to be designed to reduce stress so that you’re not having those triggers in the first place.

So those are two examples of how the care model itself is changing, and then how the design is also changing to support that kind of care.

Janet: Right. Yeah, that’s pretty great. Davis, do you have anything to add?

Davis: Well, yeah, this is just such a gift to be able to hear in depth live from you, with what all you’ve been working on. And my mind is spinning in many directions and taking lots of notes. But the supporting the supporter part for the parent and child dyad to me is core. And it’s something that, well, I have an affinity for it because that was my topic of my PhD work in childbirth environment.

So the supporter is expected to be there. They want to be there. They’re beneficial. Evidence shows that there it’s important to have them there, yet the space itself is discouraging actively or, you know, creating this unbelonging paradox of, well, you shouldn’t be here, you’re getting in the way. you know. (M: yeah) So having the core understanding of this social cohesion that is necessary for true human potential to be activated is key. And so having spaces where parents are not only allowed to be there, but designed, yes, this is your place, be here. (M: Yeah.) This is part of the plan. I love it (M: Absolutely).

Janet:  it’s, it’s, it’s taking a village, and that support is really quite important. So terrific. These are great examples. And I think moving forward, we should find solutions other than restraint and seclusion, and to ultimately make better design choices, right?

Meredith: Yeah, so there’s this interesting shift that we’re seeing at a professional level that’s happening. And specifically, I’m talking about the AIAs code of professional ethics and conduct which now includes this accountability for human dignity and health and safety and welfare. And one thing that happened last year in 2020 was the AIA code of ethics included a mandatory rule of conduct against designing spaces for torture and solitary confinement in prison and justice facilities. Did you guys know…

Janet: Oh, not only did we know about that, (M: okay,) yes, I did a whole thing on prisons and trauma informed design. (M: that’s right) We definitely want to talk about that because it was such an important, I don’t think it got the press that it probably should have.  I think it was such a huge, huge step (M: Yes) for designers, and for them to basically say no more, (M: Yes) and I was over the moon.

I’m a big advocate in terms of trauma informed design. I used to be a therapist for juvenile delinquents in incarcerated facilities. So I’ve always had this little soft spot in my heart for incarceration and people who are in incarceration. And of course, they have been through a lot of trauma. And then it is the ultimate environment to retraumatize, right. (M: Yeah) And so, yes, I was so pleased that they had done that, so please continue forward…

Meredith: Right. And yeah, as you said, there so much advocacy for it. I want to say like almost 10-years leading up to this and, you know, ultimately the neuroscience evidence did show it’s not just psychological harm, it’s structural damage to the brain that’s occurring as a result of solitary confinement. And for me, the new rule really was significant because, now we’re talking about affordances here, we’re talking about having ethical standards for space programs. So this is sort of beyond just our ethical obligation to do no harm as far as like, you know, make sure our buildings don’t fall down and kill people or make sure, you know, we have guard rails if there’s an elevation change that people don’t fall off the edge. This is about space program and affordances here.

So, you know, I want to be careful, long-term solitary confinement is not the same as temporary seclusion, which is used to sort of protect patients from harming themselves or others. So I’m not trying to make that analogy at all. But I do think this new code of ethics that’s really getting at dignity and health and safety and welfare. And thinking about space program is really important for our profession and thinking about how we can minimize the use of traumatic practices, like seclusion and restraint, because we are designing the environment to reduce stress as we were talking about earlier.

Janet: Right. And it was even going back to what you were talking about earlier about ‘why is it my child? Why is my child then being treated very differently than somebody who might have had cancer?’ And I’m really kind of not trying to exactly equate the two, (M: right) but it does come down to, you know, it’s usually the people who are impoverished and people who have disabilities and that are in these particular types of correction facilities. And yes, occasionally we do need to separate people from the greater population, just in order to help reregulate themselves. But it’s a really important, I think conversation and I think we’re only going to be doing ourselves some sort of justice at the end of the day if we take care of this stuff. And that includes pediatric, psychiatric and incarcerated individuals.

Meredith: Yeah.

Janet: Well getting off of my soapbox. Well, that’s it, that’s the show (laughs). We fixed the societal ills, it’s all good.

Outro- Section 2

Janet: Her work using Trauma-informed Design, or TID – in behavioral health, especially for pediatric inpatient environments, is so inspiring. As Meredith pointed out, we as designers need to minimize the use of traumatic practices, such as seclusion and restraint, in order to help design the environment to reduce stress.

Carolyn: She also pointed out that the code of professional ethics and conduct by the American Institute of Architects, or AIA, now includes this accountability for human dignity, health, safety and welfare.

Janet: As we said at the beginning, we decided to break our discussion with Meredith into 3 sections that you can listen to either all at once, or separately.

Carolyn: even if you listen to this as the straight through version, you may want to take a short pause for a bio break, or to grab something to eat, or just to digest some of this information before moving on.

Janet: in this next part, we will look into how Social Determinants of Health can be used to improve medical care as well as access to healthcare.

Carolyn: And also, some future trends that may surprise you. I know one in particular that really surprised Janet.

Janet: yes, it did. I think I actually said ‘What?’ …

Carolyn: And if you do stop here, we’ll just add a quick thank you to Meredith & Davis. And thanks to all of you for stopping by too. Either way, we hope you enjoy all three parts of this forward-thinking series.

Janet: and as always, we will share the links for Meredith; Davis; Trauma Informed Design: and of course, many more things mentioned during this discussion… on our website at: inclusivedesigners.com…

Carolyn: That’s: inclusivedesigners.com… And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page.

Janet: we hope to see you soon.

Carolyn: … and maybe very soon if you are continuing on to the next part of the discussion.

Janet: and if not, stay well and stay well informed.

(music to end)

This just in… new changes are coming for those who create spaces for Behavioral Health. Combining the scientific knowledge from Neuroscience and the research evidence from Trauma-Informed Design is opening up new ways to optimize health, performance and access.

IDP is excited to share this 3-part series with Meredith Banasiak that explores the transformational shift in design towards an evidence-based, person-centered culture. She shares her insights for designing for behavioral health projects, from family clinics to eating disorder facilities.

• Part 1- Meredith’s story; sensory issues; and the concept of a ‘Shared Experience’

Part 2- The stigma of mental health; Solutions using Trauma-Informed Design for Behavioral Health Facilities.

Part 3- Social Determinants of Health; improving access to healthcare; designing for eating disorders facilities; and a new way to look at Post Occupancy Evaluations (POE)

Guest: Meredith Banasiak, EDAC, Dir. of Research, Boulder Associates; LinkedIn; Twitter

– References:

• Academy of Neuroscience for Architecture, ANFA

• American Institute of Architects, AIA

• Basic Science of Light / Color

• Boulder Associates

• Boulder Community Health- Della Cava

• Boulder Community Health- Tunable Lighting

• BeWell

• Biophilia

• “Bridging the Gap” (Healthcare Design Magazine article)

• Clinica Family Health

• Eating Recovery Center

• Colin Ellard – Cognitive Neuroscientist

• Evidence Based Design, EBD

• Flexsim Simulations

• GoInvo-Social Determinants model

• HIPAA: Health Insurance Portablitiy and Accountability Act 

• Lifting the Gaze – How to focus to Change Your Brain

• Nationwide Children’s Hospital, Big Lots Behavioral Health Pavilion

• Adverse Risk in Playgrounds

• SAMHSA: Substance Abuse and Mental Health Administration

• Seattle Children’s Hospital, Psychiatry and Behavioral Medicine Unit

• Mardelle McCuskey Shepley, BA, M.Arch, MA, D.Arch, EDAC

• Trauma-informed Design, TiD

• Roger Ulrich Study

• USC Santa Barbara ‘Dormzilla’ (Construction Dive article)

Trauma Informed Design for Behavioral Health- part 1

(Music – Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(music up, then lower)

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: And I am your moderator, Carolyn Robbins.

Janet: We have a really great show for you today, we are taking a look at how to improve the standard of care in behavioral health using a trauma-informed design approach. And for this important discussion, we are talking to the amazing Meredith Banasiak.

Carolyn: Let me tell you a little bit more about Meredith… she is a Fellow with the Centre for Conscious Design; maintains an advisory role with the Academy of Neuroscience for Architecture. She has published in psychology, medicine, and architectural research journals and books. And now she is here to share her passion for research and evidence-based design with us today.

Janet: And to make it even more special we have asked Davis Harte, or as I refer to her as Dr Harte, to be my co-host. Together we have co-founded the Trauma Informed Design Society and will be adding our insight from that to this discussion.

Meredith has done some incredible work on sensory issues and designing for human health along with Trauma-informed Design, to foster inclusivity and a healthier environment.

Carolyn: There is so much to explore here, that we’ve decided to make this a 3-part series. You can listen straight-through or choose to hear each section separately, let’s call it ala carte.

Janet: In this section, Meredith takes us through her life experiences that led her to the exciting field of Neuroscience and Architecture. We’ll also focus on sensory issues and the concept of a shared experience.

Carolyn: And of course, if you want to know more about any of the places or studies mentioned, we will have a really rich list of resources for you on our website: InclusiveDesigners.com.

Janet: Carolyn, I think we’ve covered all that needs to be said here up front, so I guess we should just start the show now, don’t you?

Carolyn: Agreed. Without further ado, here is our thought-provoking look at combining neuroscience with evidence-based design, with insights from Janet, Meredith Banasiak and Davis Harte …

Interview- Overview

Janet: Hi, and welcome to Inclusive Designers. I am your host, Janet Roche. And today, we’ve got a special guest host. You’ve seen her before on this show, Davis Harte. And today we’re going to be interviewing Meredith Banasiak. Welcome Meredith. Welcome Davis. How’s everybody doing today?

Davis: Great. Thanks Janet. It’s wonderful to be here…

Meredith: yeah, it’s great to be here.

Janet: Thank you for coming.

Interview- Section 1

Janet: So Meredith, let’s start this off a little bit. Let’s talk a little bit about your background and how you got started and, we did a little intro at the beginning, but we’d like to hear a little bit more about you from yourself.

Meredith: Great. Well, thank you so much for having me and thank you for all the work that you are doing on trauma informed design and all the resources that you’re making available.

So, I’m going to kind of go back to, all the way to childhood, because I have always struggled with sensory issues in the environment. And, when environments are overstimulating like in the city or the sort of sensory experience is just sort of really invasive, and intense, the first thing that comes to mind is, is almost like a church situation where, you know, as a little child and you’re in this very dense environment and you don’t have a visual field cause everyone’s taller than you and the smells are very invasive.

Those kinds of sensory experiences, I struggled with. And I felt they almost sort of hijacked my ability to think and my emotional state. And so, I always kind of wanted to understand what was happening in my brain, so I could kind of suppress it and make it stop. And at the same time, I wanted to design environments where I didn’t have to feel this way, or, you know, I didn’t know if everyone felt like I did. I kind of assumed that they did, but I kind of want to design environments where people didn’t have to feel the way I was feeling.

So, that’s my background into kind of this track of understanding people and then also designing environments. And so when I was in undergrad, this career of design research didn’t exist. And so I was, you know, I think we’ve all sort of forged our own path of how do you prepare for a career that doesn’t exist yet? For me, I was pre-med because I wanted to kind of go into the science and neuroscience, which even then wasn’t really a thing. And then I also followed this path of classics. So studying Latin and Greek and classical archeology.

What I came to realize later in life is that architecture is just doing archeology in reverse. So archeologists study artifacts and ruins to understand people and how they were behaving and what groups of people were doing. And architects, ideally speaking, should study people and cultures to be able to design our artifacts and buildings that can support those behaviors and support those cultures. So I feel lucky to kind of have experienced this equation from both ends, and it’s the same equation you’re just sort of solving for different variables along the way.

So, kind of, that’s my background and sort of how I got into this field. My professional degree is in architecture, but that came later in life. And when I graduated, I learned of an organization called the ‘Academy of Neuroscience for Architecture’, which was just emerging. This was around 2004. And it sounded exactly what I had been sort of preparing my whole life for. And I reached out and said, you know, how, how do I be part of this movement, of this initiative? And, at the time they had what they call the pioneer program where they brought a small group of people on to essentially pioneer what would be a new discipline in neuroscience for architecture.

So, I, I sort of took that on as a full-time role for a time, moved to Washington DC because that’s where the scientific funding agencies were, the AIA headquarters was located there. And as part of my training, I also got to work with a neuroscientist at George Mason University who studied learning and development in twice exceptional children.

So these are children who maybe have like attention deficits and giftedness, or maybe dyslexia and giftedness. And, and so, that was really interesting to study a population who also had an experience that, where they might be struggling with sort of environments. Cause if you think about attention, if there’s something in the environment that’s grabbing your attention, that’s preventing you from internally sort of focusing or staying on task.

So kind of that experience of being able to work with her, as well as just kind of my own sensory background, really motivated me to pursue a career in designing for inclusivity. And for people that fall outside this, mythical average, which most of our world is designed for.

Janet: Right. it’s kind of always fascinating to me that people like yourself and me, and I can’t really necessarily speak for Davis, but you’ve had this personal experience. Right. And you realize that your own built environment, maybe wasn’t what it should have been in order to foster you and you recognize that, that’s pretty amazing. I think most people just kind of go about their way and think to themselves that there isn’t anybody like me. I can give you a quick example. I’m allergic to latex and rubber, and I used to blow up balloons when I was a kid. And I would ask everybody else, like all my kid friends, and ask them if they too felt like their throats were closing up, if their tongues were getting fat, their lips and cheeks were on fire.

And then blowing up balloons is kind of a hard activity on your mouth and your cheeks and everything like that. They’re like, oh yeah, us too. And I’m thinking to myself, I can’t breathe. It can’t be the same thing. But for you, I think it’s really kind of interesting that you recognize that this is not, you know, this was not working for you.

Meredith: Yeah, absolutely. And, you know, in the seventies and eighties, there wasn’t really, sort of a label other than ‘sensitive child’ or ‘picky eater’, probably ‘my mom spoiled me too much’ was kind of the explanation.

Janet: The list goes on. I remember that. Right. (M: yeah). You know, it was sort of like, suck it up buttercup. (M: yeah). So I don’t know, Davis, did you have an experience like that?

Davis: well, I have a few thoughts just from this early part of the conversation is that, yes, this lived experience is so invaluable. And the more we talk about evidence-based design and research and information gathering, real-lived experiences are becoming more appreciated for their value that they bring to how we shape our spaces. So that’s one point, in the one bucket. And then, I mean, the second bucket is, is very personal because of knowing how my own family members experience, um, sensory processing issues and watching them navigate the world.

And what I’m feeling is that now we are coming to a place where the podcast and the information and the people are, we’re finding each other and realizing, all right now, we are outside of the, the bell curve, let’s center the edges of the population into this core of our designs. Very attunely in a way that can meet the needs of all kinds of allergies and all kinds of processing needs.

Our nervous systems are all at the core the same as each other’s but some are much more finely attuned and other, you know, how we process information coming in (J: Right) and circuitry can be de-emphasized with lower stress environments, as well as managed upwards once this knowledge and knowing about it.

My person is very aware of their sensory processing and they’re still young and they, to a certain degree, they know what’s going on in their brain. They’re happy and ready to articulate it to anybody and advocate for their needs in a way that was non-existent a decade ago. Never mind, when we were all children. So, I just applaud this, the wave that’s happening. And I am so excited to hear what else Meredith can share with us because it’s, it’s amazing. It’s an amazing place we’re in.

Janet: Right. And, both Davis and I really think that the Academy of Neuroscience for Architecture is a really kind of remarkable and wonderful place. We got an opportunity to present our poster earlier this year, or maybe it was even a couple months ago— time is but a blur at this moment— but we were really thrilled with that because we knew it’s such an important part of what we’re trying to do, how we’re trying to create this inclusive environment for everybody. So, yeah. It’s great. (M: Yeah).

Janet: So Meredith, tell us a little bit more about the role that you have now and what you’re doing with Boulder Associates and how do you describe what it is that you do?

Meredith: Yeah, sure. So ultimately I ended up in healthcare design, where, you know, inclusive design is an ethical obligation because everyone needs access to healthcare. So you know, when access to care or quality of care is somehow diminished or compromised for certain populations who are again outside this mythical average because of design, because designers weren’t thinking of them when they were doing these designs, then I think we failed as a design community in a major way.

So the firm I work for is Boulder Associates and we do exclusively healthcare and senior living work. And my role is Director of Research for the firm, but the cool thing is I am part of a group that we call BA Science which is our science-informed design entity under the design firm umbrella. And, and in a sense, we kind of function as a startup with the services that we provide.

BA science brings together human factors, which is sort of the effort that I lead.  And then I have a counterpart who does process and operational improvement, so kind of like using Leed methodologies. And then a third expert in sustainability. So often you see in firms like these, or even in projects, if these roles exist there, they’re kind of siloed out. And I found that, you know, when we came together and integrated, we were really able to approach projects as an ecosystem, where we weren’t just sort of told to stay in our lane.

And, you know, only, in designers, I think we feel this all the time, like all we can control is the design of the built environment. And when you consider that the built environment is this larger ecosystem which includes people and relationships and operations and processes, it’s a very sort of narrow and limited view. And you’re not fixing, you’re not solving the issues of the entire system.

So, you know, once we started working together, um, as a BA science group, we would come into projects, and, you know, sometimes it wasn’t always a design solution. It was an operational kind of process improvement solution that we were giving to the client. And that just felt right, because I, I think this sort of systems approach, that buildings environments are sort of this ecosystem. And so approaching it that way is just a better way to solve the challenges.

Janet: Right. For you, I think it’s more of like a personal project. Do you feel like that’s, sort of what you’re seeing with some of the shifts and the changes within the design world? Like, are people bringing their, their own experiences to it, or people are just recognizing that things are shifting? Do you want to speak a little bit on that?

Meredith: Yeah, no, I mean, I think there’s this growing need for expertise, but then the more experts you bring, sort of does it make things more disconnected? And so I think there’s also this responsibility to consciously integrate and work together, to again, to try to address the whole system. So ideal state, I would love for architects and designers to culturally begin to approach projects this way. Realistically, is this happening? Maybe not as much as we would like right now, I mean, you know, change takes time.

Janet: Right.

Davis: Yeah, the notion that it’s a way of working that is more both expansive, but also more intentionally focused. So, you know, what is transdisciplinary work or translational work, where, you know, you and other scientists are taking the time to do evidence, but we want that to be very hands-on tools for the architects and the designers. And they’re able to hit the ground and keep in budget and time. (M: Right).

And where the two shall meet, you know, that’s the excitement of trying to create these bridges that don’t add a lot of extra time and effort for all of those involved in doing it. because everybody agrees. ‘Oh, right, right. We do want to build spaces that are more inclusive’. it’s not like that’s really the problem so much as how the work experience is same as our lived experiences and the same as how we learn. There are many ways of knowing. It’s a shift that’s happening, but how do we help make that happen even more is the question… (M: Right).

Janet: Yeah, how do we help make that change? Because I think Davis and I have both run into this at the Boston Architectural College, where we look at designing for human health, (M: yeah) and then Davis and I in our work with trauma informed design. And, I still talk to architects to this day that basically will say things like, ‘we do that anyways’. And I’m like, ‘but no, you don’t. I can point to, like 12 things that you have that you just have not, you have either glossed over it or have thought very little of it or have not implemented it.’ (M: Yeah). So, you’re absolutely right. We need to, we want to kind of talk about how maybe we can make some of those changes or designers moving forward can start making those changes.

I don’t know what Davis’s experience has been with students recently, but I’ve noticed a real shift in how they are designing in just one semester, because now they have been now through three semesters of COVID and their design outlook is looking very different than it was just even a semester ago. (M: hmm) So I don’t know, Davis if you’ve, have seen that as well, or…

Davis: Yes, something along those lines. I hadn’t named it that way, but I think we’re all forced to look inward and be with ourselves in a way that we hadn’t ever had to before. And that’s creating a lot more of an uptick and understanding about human physiology and basic ways of responding. And what, how am I feeling in my body when this is happening or that’s happening or, and so, it’s forced us to be in our built spaces in a way that is very illuminating. Absolutely.

Janet: Right. I was so surprised at it. It was such a dramatic shift, right? Because now these particular students have just spent their entire academic career in COVID at this point. So, I don’t know Meredith if you want to jump in…

Meredith: Yeah, well, I love hearing your experience of students and COVID because this idea of the environment impacting us, our brains, our bodies, our ability, our behaviors, all of those things up until the pandemic was sort of a, had a niche following, I would say, but the pandemic, the general population understands that the environment impacts our health. and I think what’s frustrating is how much time we’re spending protecting ourselves from our built environment. There’s such a burden on us as human beings, instead of extending that out into the environment. Our environments shouldn’t cause us harm and they are right now.

So now this is now kind of mainstream knowledge. Everyone, the general population has accepted sort of the built environments really do impact their health. We live with this every single day.

And so it’s no surprise to hear sort of how your students are, are reacting in turn. you know, the other thing I was thinking is the work you’re doing as educators and sharing this knowledge, this evidence, with the focus on human factors with your students is really important, but if we think about sort of how long it takes for your students to actually, I don’t have a hand in managing projects and actually designing real public buildings, that might be 10 years from now. So, you know, are we looking at a 10-year long limbo period before this is sort of accepted as part of our design culture and practice?

Janet: I was almost going to hit the desk cause you’re absolutely right about that. I actually said that to the students too, because I was, as they were going through their finals, it was funny. I talked to each one of them individually and I knew what they were all doing, but it wasn’t until I had them essentially all in one room when we were sharing the finals with the whole cohort, I realized, I’m like, ‘oh my God, they’re like, they are now interpreting the world very differently. Right? And maybe it’s much more about no further than their own backyard, a la, you know, Dorothy of Oz, right? But I did think to myself, I’m like, well, wait a minute, like these are not people that are just start making some of these decisions for another 10, 15, 20 years…

Davis: I’ll counter all of that because it’s true that many people are pivoting and are new in the field. But in our cohort of students, there are some, you’ll meet them as they progress through the curriculum, Janet, who are actively working at firms right now and going back to school to get a master’s so that they can implement more sustainable human health changes at work today. (J: interesting).

Similarly, many students wonder, when I mentioned to them that they’re contributing to the field, that’s like unheard of to them. They can’t imagine what I’m talking about. But the fact of their interest cumulatively as a collective, as design scientists working together, their interest in certain topics, such as nervous systems or trauma informed design, that’s helping to shape the discourse, (J: right), and its building momentum.

So there may be— as is true for, you know, white coat science— it takes a while to show up in the public. But the urgency of the situation is for built spaces is such that there are folks doing things today. I got an email last week from somebody in Colorado who said, here’s the work my firm is doing, working with law enforcement officers in their space and how we’re putting ‘Design for Human Health’ principles into place to the best of their abilities. So not discounting all that has been said, but another layer of information for the conversation.

Janet: Absolutely. And it’s an important layer to have. I think both ends are correct, right? I mean, again, just the shift within these young designers, they were starting to look at things very differently because of the pandemic, right? And more involved with the idea of health and uh, human factors and really kind of understanding the brain and how we also work within the environment. I mean, just talking about biophilia, I’m not even talking about healthcare or you know, residentials or what have you. So I think both are very, very true.

And it will be interesting to really see, Davis and I, we already knew this was going to be a thing, but it was still a little bit of a hard kind of nut to break. But I think with the pandemic things have changed quite a bit and have really made a difference within the design community.

Meredith: yeah, absolutely.

Outro- Section 1

Janet: Meredith is so great… Her own story on how she got into Inclusive Design and Research is inspiring.

Carolyn: And since then, she has done so much more… as you’ll hear in the other sections.

Janet: As we said at the beginning, we decided to break our discussion with Meredith into 3 parts, so you can listen to either all at once, or separately.

Carolyn: Even if you’re listening to this as the straight through version, you may want to take a short pause for a bio break, or to grab something to eat, or just to ‘digest’ some of this information before moving on.

Janet: Coming up in the next section, more with Meredith as we explore how Behavioral Health Facilities are making good use of Trauma-informed Design, or as we call it here at IDP…TiD.

Carolyn: And if you do stop here, we’ll just add a quick thank you to Meredith & Davis. And thanks to all of you for stopping by too. Either way, we hope you enjoy all three parts of this forward-thinking series.

Janet: and as always, we will share the links for Meredith; Davis, Trauma Informed Design: and of course, many more things mentioned during this discussion… on our website at: inclusivedesigners.com…

Carolyn: That’s: inclusivedesigners.com… And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page.

Janet: We hope to see you soon.

Carolyn: … maybe very soon if you are continuing on to the next part of the discussion.

Janet: … and if not, stay well and stay well informed

(music to end)

This just in… new changes are coming for those who create spaces for Behavioral Health. Combining the scientific knowledge from Neuroscience and the research evidence from Trauma-Informed Design is opening up new ways to optimize health, performance and access.

IDP is excited to share this 3-part series with Meredith Banasiak that explores the transformational shift in design towards an evidence-based, person-centered culture. She shares her insights for designing for behavioral health projects, from family clinics to eating disorder facilities.

Part 1- Meredith’s story; sensory issues; and the concept of a ‘Shared Experience’

Part 2– The stigma of mental health; Solutions using Trauma-Informed Design for Behavioral Health Facilities.

Part 3- Social Determinants of Health; improving access to healthcare; designing for eating disorders facilities; and a new way to look at Post Occupancy Evaluations (POE)

Guest: Meredith Banasiak, EDAC, Dir. of Research, Boulder Associates; LinkedIn; Twitter

– References:

• Academy of Neuroscience for Architecture, ANFA

• American Institute of Architects, AIA

• Basic Science of Light / Color

• Boulder Associates

• Boulder Community Health- Della Cava

• Boulder Community Health- Tunable Lighting

• BeWell

• Biophilia

• “Bridging the Gap” (Healthcare Design Magazine article)

• Clinica Family Health

• Eating Recovery Center

• Colin Ellard – Cognitive Neuroscientist

• Evidence Based Design, EBD

• Flexsim Simulations

• GoInvo-Social Determinants model

• HIPAA: Health Insurance Portablitiy and Accountability Act 

• Lifting the Gaze – How to focus to Change Your Brain

• Nationwide Children’s Hospital, Big Lots Behavioral Health Pavilion

• Adverse Risk in Playgrounds

• SAMHSA: Substance Abuse and Mental Health Administration

• Seattle Children’s Hospital, Psychiatry and Behavioral Medicine Unit

• Mardelle McCuskey Shepley, BA, M.Arch, MA, D.Arch, EDAC

• Trauma-informed Design, TiD

• Roger Ulrich Study

• USC Santa Barbara ‘Dormzilla’ (Construction Dive article)

Trauma Informed Design for Behavioral Health- part 3

(Music)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(music up, then lower)

Intro

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: And I am your moderator, Carolyn Robbins.

Janet: We have a really great show for you today, we are taking a look at how to improve the standard of care in behavioral health using a trauma-informed design approach. And for this important discussion, we are talking to the amazing Meredith Banasiak.

Carolyn: Let me tell you a little bit more about Meredith… she is a Fellow with the Centre for Conscious Design; maintains an advisory role with the Academy of Neuroscience for Architecture. She has published in psychology, medicine, and architectural research journals and books. And now she is here to share her passion for research and evidence-based design with us today.

Janet: And to make it even more special we have asked Davis Harte, or as I refer to her as Dr Harte, to be my co-host. Together we have co-founded the Trauma Informed Design Society and will be adding our insight from that to this discussion.

Meredith has done some incredible work on sensory issues and designing for human health along with Trauma-informed Design, to foster inclusivity and a healthier environment.

Carolyn: There is so much to explore here, that we’ve decided to make this a 3-part series. You can listen straight-through or choose to hear each section separately, let’s call it ala carte. 

Janet: In this section, Meredith takes us through her life experiences that led her to the exciting field of Neuroscience and Architecture. We will also focus on sensory issues and the concept of a shared experience.

Carolyn: And of course, if you want to know more about any of the places or studies mentioned, we will have a really rich list of resources for you on our website: InclusiveDesigners.com

Janet: Carolyn, I think we’ve covered all that needs to be said here up front, so I guess we should just start the show now, don’t you?

Carolyn: Agreed. Without further ado, here is our thought-provoking look at combining neuroscience with evidence-based design, with insights from Janet, Meredith Banasiak and Davis Harte …

Interview- Overview

Janet: Hi, and welcome to Inclusive Designers. I am your host, Janet Roche. And today, we’ve got a special guest host. You’ve seen her before on this show, Davis Harte. And today we’re going to be interviewing Meredith Banasiak. Welcome Meredith. Welcome Davis. How’s everybody doing today?

Davis: Great. Thanks Janet. It’s wonderful to be here…

Meredith: yeah, it’s great to be here.

Janet: Thank you for coming.

Interview- Section 1

Janet: So Meredith, let’s start this off a little bit. Let’s talk a little bit about your background and how you got started and, we did a little intro at the beginning, but we’d like to hear a little bit more about you from yourself.

Meredith: Great. Well, thank you so much for having me and thank you for all the work that you are doing on trauma informed design, and all the resources that you’re making available.

So, I’m going to kind of go back to, all the way to childhood, because I have always struggled with sensory issues in the environment. And, when environments are overstimulating like in the city or the sort of sensory experience is just sort of really invasive, and intense, the first thing that comes to mind is, is almost like a church situation where, you know, as a little child and you’re in this very dense environment and you don’t have a visual field cause everyone’s taller than you and the smells are very invasive.

Those kinds of sensory experiences, I struggled with. And I felt they almost sort of hijacked my ability to think and my emotional state. And so, I always kind of wanted to understand what was happening in my brain, so I could kind of suppress it and make it stop. And at the same time, I wanted to design environments where I didn’t have to feel this way, or, you know, I didn’t know if everyone felt like I did. I kind of assumed that they did, but I kind of want to design environments where people didn’t have to feel the way I was feeling.

So, that’s my background into kind of this track of understanding people and then also designing environments. And so when I was in undergrad, this career of design research didn’t exist. And so I was, you know, I think we’ve all sort of forged our own path of how do you prepare for a career that doesn’t exist yet? For me, I was pre-med because I wanted to kind of go into the science and neuroscience, which even then wasn’t really a thing. And then I also followed this path of classics. So studying Latin and Greek and classical archeology.

What I came to realize later in life is that architecture is just doing archeology in reverse. So archeologists study artifacts and ruins to understand people and how they were behaving and what groups of people were doing. And architects, ideally speaking, should study people and cultures to be able to design our artifacts and buildings that can support those behaviors and support those cultures. So I feel lucky to kind of have experienced this equation from both ends, and it’s the same equation you’re just sort of solving for different variables along the way.

So, kind of, that’s my background and sort of how I got into this field. My professional degree is in architecture, but that came later in life. And when I graduated, I learned of an organization called the ‘Academy of Neuroscience for Architecture’, which was just emerging. This was around 2004. And it sounded exactly what I had been sort of preparing my whole life for.

And I reached out and said, you know, how, how do I be part of this movement, of this initiative? And, at the time they had what they call the pioneer program. where they brought a small group of people on to essentially pioneer what would be a new discipline in neuroscience for architecture.

So, I, I sort of took that on as a full-time role for a time, moved to Washington DC because that’s where the scientific funding agencies were, the AIA headquarters was located there. And as part of my training, I also got to work with a neuroscientist at George Mason University who studied learning and development in twice exceptional children.

So these are children who maybe have like attention deficits and giftedness, or maybe dyslexia and giftedness. And, and so, that was really interesting to study a population who also had an experience that, where they might be struggling with sort of environments. Cause if you think about attention, if (pop) there’s something in the environment that’s grabbing your attention, that’s preventing you from internally sort of focusing or staying on task.

So kind of that experience of being able to work with her, as well as just kind of my own sensory background, really motivated me to pursue a career in designing for inclusivity. And for people that fall outside this, mythical average, which most of our world is designed for.

Janet: Right. it’s kind of always fascinating to me that people like yourself and me, and I can’t really necessarily speak for Davis, but you’ve had this personal experience. Right. And you realize that your own built environment, maybe wasn’t what it should have been in order to foster you and you recognize that, that’s pretty amazing. I think most people just kind of go about their way and think to themselves that there isn’t anybody like me. I can give you a quick example. I’m allergic to latex and rubber, and I used to blow up balloons when I was a kid. And I would ask everybody else, like all my kid friends, and ask them if they too felt like their throats were closing up, if their tongues were getting fat, their lips and cheeks were on fire.

And then blowing up balloons is kind of a hard activity on your mouth and your cheeks and everything like that. They’re like, oh yeah, us too. And I’m thinking to myself, I can’t breathe. It can’t be the same thing. But for you, I think it’s really kind of interesting that you recognize that this is not, you know, this was not working for you.

Meredith: Yeah, absolutely. And, you know, in the seventies and eighties, there wasn’t really, sort of a label other than ‘sensitive child’ or ‘picky eater’, probably ‘my mom spoiled me too much’ was kind of the explanation.

Janet: The list goes on. I remember that. Right. (M: yeah). You know, it was sort of like, suck it up buttercup. (M: yeah). So I don’t know, Davis, did you have an experience like that?

Davis: well, I have a few thoughts just from this early part of the conversation is that, yes, this lived experience is so invaluable. And the more we talk about evidence-based design and research and information gathering, real-lived experiences are becoming more appreciated for their value that they bring to how we shape our spaces. So that’s one point, in the one bucket. And then, I mean, the second bucket is, is very personal because of knowing how my own family members experience, um, sensory processing issues and watching them navigate the world.

And what I’m feeling is that now we are coming to a place where the podcast and the information and the people are, we’re finding each other and realizing, all right now, we are outside of the, the bell curve, let’s center the edges of the population into this core of our designs, very attunely, in a way that can meet the needs of all kinds of allergies and all kinds of processing needs.

Our nervous systems are all at the core the same as each other’s but some are much more finely attuned and other, you know, how we process information coming in (J: Right) and circuitry can be de-emphasized with lower stress environments, as well as managed upwards once this knowledge and knowing about it.

My person is very aware of their sensory processing and they’re still young and they, to a certain degree, they know what’s going on in their brain. They’re happy and ready to articulate it to anybody and advocate for their needs in a way that was non-existent a decade ago. Never mind, when we were all children. So, I just applaud this, the wave that’s happening. And I am so excited to hear what else Meredith can share with us because it’s, it’s amazing. It’s an amazing place we’re in.

Janet: Right. And, both Davis and I really think that the Academy of Neuroscience for Architecture is a really kind of remarkable and wonderful place. We got an opportunity to present our poster earlier this year, or maybe it was even a couple months ago— time is but a blur at this moment— but we were really thrilled with that because we knew it’s such an important part of what we’re trying to do, how we’re trying to create this inclusive environment for everybody. So, yeah. It’s great. (M: Yeah).

Janet: So Meredith, tell us a little bit more about the role that you have now and what you’re doing with Boulder Associates and how do you describe what it is that you do?

Meredith: Yeah, sure. So ultimately I ended up in healthcare design, where, you know, inclusive design is an ethical obligation because everyone needs access to healthcare. So you know, when access to care or quality of care is somehow diminished or compromised for certain populations who are again outside this mythical average because of design, because designers weren’t thinking of them when they were doing these designs, then I think we failed as a design community in a major way.

So the firm I work for is Boulder Associates and we do exclusively healthcare and senior living work. And my role is Director of Research for the firm, but the cool thing is I am part of a group that we call BA Science which is our science-informed design entity under the design firm umbrella. And, and in a sense, we kind of function as a startup with the services that we provide.

BA science brings together human factors, which is sort of the effort that I lead.  And then I have a counterpart who does process and operational improvement, so kind of like using Leed methodologies. And then a third expert in sustainability. So often you see in firms like these, or even in projects, if these roles exist there, they’re kind of siloed out. And I found that, you know, when we came together and integrated, we were really able to approach projects as an ecosystem, where we weren’t just sort of told to stay in our lane.

And, you know, only, in designers, I think we feel this all the time, like all we can control is the design of the built environment. And when you consider that the built environment is this larger ecosystem which includes people and relationships and operations and processes, it’s a very sort of narrow and limited view. And you’re not fixing, you’re not solving the issues of the entire system.

So, you know, once we started working together, um, as a BA science group, we would come into projects, and, you know, sometimes it wasn’t always a design solution. It was an operational kind of process improvement solution that we were giving to the client. And that just felt right, because I, I think this sort of systems approach, that buildings environments are sort of this ecosystem. And so approaching it that way is just a better way to solve the challenges.

Janet: Right. For you, I think it’s more of like a personal project. Do you feel like that’s, sort of what you’re seeing with some of the shifts and the changes within the design world? Like, are people bringing their, their own experiences to it, or people are just recognizing that things are shifting? Do you want to speak a little bit on that?

Meredith: Yeah, no, I mean, I think there’s this growing need for expertise, but then the more experts you bring, sort of does it make things more disconnected? And so I think there’s also this responsibility to consciously integrate and work together, to again, to try to address the whole system. So ideal state, I would love for architects and designers to culturally begin to approach projects this way. Realistically, is this happening? Maybe not as much as we would like right now, I mean, you know, change takes time.

Janet: Right.

Davis: Yeah, the notion that it’s a way of working that is more, both expansive, but also more intentionally focused. So, you know, what is transdisciplinary work or translational work, where, you know, you and other scientists are taking the time to do evidence, but we want that to be very hands-on tools for the architects and the designers. And they’re able to hit the ground and keep in budget and time. (M: Right).

And where the two shall meet, you know, that’s the excitement of trying to create these bridges that don’t add a lot of extra time and effort for all of those involved in doing it. because everybody agrees. ‘Oh, right, right. We do want to build spaces that are more inclusive’. it’s not like that’s really the problem so much as how the work experience is same as our lived experiences and the same as how we learn. There are many ways of knowing. It’s a shift that’s happening, but how do we help make that happen even more is the question… (M: Right).

Janet: Yeah, how do we help make that change? Because I think Davis and I have both run into this at the Boston Architectural College, where we look at designing for human health, (M: yeah) and then Davis and I in our work with trauma informed design. And I still talk to architects to this day that basically will say things like, ‘we do that anyways’. And I’m like, ‘but no, you don’t. I can point to, like 12 things that you have that you just have not, you have either glossed over it or have thought very little of it or have not implemented it.’ (M: Yeah). So, you’re absolutely right. We need to, we want to kind of talk about how maybe we can make some of those changes or designers moving forward can start making those changes.

I don’t know what Davis’s experience has been with students recently, but I’ve noticed a real shift in how they are designing in just one semester, because now they have been now through three semesters of COVID, and their design outlook is looking very different than it was just even a semester ago. (M: hmm) So I don’t know, Davis if you’ve, have seen that as well, or…

Davis: Yes, something along those lines. I hadn’t named it that way, but I think we’re all forced to look inward and be with ourselves in a way that we hadn’t ever had to before. And that’s creating a lot more of an uptick and understanding about human physiology and basic ways of responding. And what, how am I feeling in my body when this is happening or that’s happening or, and so, it’s forced us to be in our built spaces in a way that is very illuminating. Absolutely.

Janet: Right. I was so surprised at it. It was such a dramatic shift, right? Because now these particular students have just spent their entire academic career in COVID at this point. So, I don’t know Meredith if you want to jump in…

Meredith: Yeah, well, I love hearing your experience of students and COVID because this idea of the environment impacting us, our brains, our bodies, our ability, our behaviors, all of those things up until the pandemic was sort of a, had a niche following, I would say, but the pandemic, the general population understands that the environment impacts our health. and I think what’s frustrating is how much time we’re spending protecting ourselves from our built environment. There’s such a burden on us as human beings, instead of extending that out into the environment. Our environments shouldn’t cause us harm and they are right now.

So now this is now kind of mainstream knowledge. Everyone, the general population has accepted sort of the built environments really do impact their health. We live with this every single day.

And so it’s no surprise to hear sort of how your students are, are reacting in turn. you know, the other thing I was thinking is the work you’re doing as educators and sharing this knowledge, this evidence, with the focus on human factors with your students is really important, but if we think about sort of how long it takes for your students to actually, I don’t have a hand in managing projects and actually designing real public buildings, that might be 10 years from now. So, you know, are we looking at a 10-year long limbo period before this is sort of accepted as part of our design culture and practice?

Janet: I was almost going to hit the desk cause you’re absolutely right about that. I actually said that to the students too, because I was, as they were going through their finals, it was funny. I talked to each one of them individually and I knew what they were all doing, but it wasn’t until I had them essentially all in one room when we were sharing the finals with the whole cohort, I realized, I’m like, ‘oh my God, they’re like, they are now interpreting the world very differently. Right? And maybe it’s much more about no further than their own backyard, a la, you know, Dorothy of Oz, right? But I did think to myself, I’m like, well, wait a minute, like these are not people that are just start making some of these decisions for another 10, 15, 20 years…

Davis: I’ll counter all of that because it’s true that many people are pivoting and are new in the field. But in our cohort of students, there are some, you’ll meet them as they progress through the curriculum, Janet, who are actively working at firms right now and going back to school to get a master’s so that they can implement more sustainable human health changes at work today. (J: interesting).

Similarly, many students wonder, when I mentioned to them that they’re contributing to the field, that’s like unheard of to them. They can’t imagine what I’m talking about. But the fact of their interest cumulatively as a collective, as design scientists working together, their interest in certain topics, such as nervous systems or trauma informed design, that’s helping to shape the discourse, (J: right), and its building momentum.

So there may be— as is true for, you know, white coat science— it takes a while to show up in the public. But the urgency of the situation is for built spaces is such that there are folks doing things today. I got an email last week from somebody in Colorado who said, here’s the work my firm is doing, working with law enforcement officers in their space and how we’re putting ‘Design for Human Health’ principles into place to the best of their abilities. So not discounting all that has been said, but another layer of information for the conversation.

Janet: Absolutely. And it’s an important layer to have. I think both ends are correct, right? I mean, again, just the shift within these young designers, they were starting to look at things very differently because of the pandemic, right? And more involved with the idea of health and uh, human factors and really kind of understanding the brain and how we also work within the environment. I mean, just talking about biophilia, I’m not even talking about healthcare or you know, residentials or what have you. So I think both are very, very true.

And it will be interesting to really see, Davis and I, we already knew this was going to be a thing, but it was still a little bit of a hard kind of nut to break. But I think with the pandemic things have changed quite a bit and have really made a difference within the design community.

Meredith: yeah, absolutely.

Outro Section 1

Janet: Meredith is so great… Her own story on how she got into Inclusive Design and Research is inspiring.

Carolyn: And since then, she has done so much more… as you’ll hear in the other sections.

Janet: As we said at the beginning, we decided to break our discussions with Meredith into 3 parts, so you can listen to either all at once, or separately.

Carolyn: Even if you’re listening to this as the straight through version, you may want to take a short pause for a bio break, or grab something to eat, or just to ‘digest’ some of this information before moving on.

Janet: coming up in the next section, more with Meredith as we explore how Behavioral Health Facilities are making good use of Trauma-informed Design, or as we call it here at IDP…TiD.

Bumper – Section 2

Janet: Welcome back. So in the first part, we learned Meredith’s own story of how she became passionate about Inclusive Design and Research, even before it officially existed as an acknowledged field of study.

Carolyn: And now it’s time to move forward in time to the present… as we dive into Meredith’s work on Behavioral Health Facilities and how they use Trauma informed Design, or TiD, to improve the experience for both staff and patients.

Interview Section 2

Janet: So Meredith, let’s talk a little bit about behavioral health facilities, and then how they’re being improved by using trauma informed design. You want to talk a little bit about that? Maybe talk a little bit about Boulder Community Health program or the pediatric inpatient part that you’ve been working on.

Meredith: So yes, we’re seeing this move toward trauma informed design in behavioral health services. And if we, you know, think about behavioral health facilities, they’ve historically been designed to support care that can trigger a patient’s experience of trauma during treatment.

So think about, you know, the use of seclusion and restraint. if you’ve never been in a behavioral health facility, I, I’m not saying that Hollywood paints an accurate picture of that at all, but that there are practices in some of those movies that we’re familiar with which we see historically in behavioral health treatment programs like seclusion and restraint, very sort of barren institutional environments that lack environmental complexity. So, you know, for example, the thought is, you can’t put furniture in or art hanging on the wall or something, because that could be used to hurt someone or the patient themselves. (J: as a weapon). Yeah. (J: right).

So, and also isolation from family and loved ones. So the support system of the patient is often removed from the treatment plan during inpatient stays. And so that makes the transition, you know, when they go back to home really challenging because the family or loved ones don’t know how to support the patient, they’re not aware of like what that recovery process includes.

So all of those practices really historically again, you know, have created adverse effects, certainly for the patients, but also the staff. They’ve sustained injury by having to put patients in seclusion or in holds, and also for the family, just kind of having that sense of isolation and separation and not being involved in care.

So, the change moving into trauma informed design is one that is coming from our behavioral health clients themselves. They’re moving toward a trauma informed care model of how they’re delivering care and how they’re delivering treatment. So, I’m going to just read a definition of what that means, and this is from the ‘Substance Abuse and Mental Health Services Administration’, which says “trauma informed care realizes the widespread impact of trauma in clients or patients, families, staff, and others involved in the system, and responds by fully integrating knowledge about trauma into policies, procedures, and practices to actively resist re-traumatization.”

And I think trauma informed care really recognizes the context that the treatment occurs in, what the role of context plays on outcomes. And so that’s where we have this really amazing opportunity to come in and design the context to support this new model of care.

So how are we doing that? Roger Olrick wrote a lot about this cycle of reducing a patient’s stress and then how that stress reduction in turn creates better outcomes for the patient and also for the staff. So, a stress reduction in the environment would include fostering more opportunities for control, patients to have control; to mitigate crowding stress; to minimize environmental stressors, like noise; and then, you know, promoting exposure to restorative elements like biophilia, uh, nature, kind of that sort of thing that have been shown to reduce stress.

So when the environment is designed to reduce stress, then there’s less triggers for patients, and, and we see better outcomes: reduced physical violence; reduced verbal aggression; and ultimately, reduced restraints and isolation.

Janet: It’s such an important part… you started off talking about, like Hollywood has like the fair portrayal, but you kind of really don’t see what really happens afterwards. And there’s not a, the built environment is an afterthought, I think anyways, within these, I think things are getting better. I see things are getting better, but it’s still pretty ragged.

Davis: Might I interject that, it seems to me that there’s a very much a risk averseness that is so interested in reducing possible risks that they are doing harm in doing so. (J: Good point). We see the same trajectory in playgrounds, (M: Exactly). You know, we’re so concerned about risk and somebody’s hurting themselves that there’s actually nothing there for the kids to do. (M: Yes).

Janet: Here’s your little feather, go play, right? (laughs). But there’s a lot to be said for that as well. But I think there, I mean, Meredith can tell me if I’m wrong, but there’s a way to have that. There is a way to show biophilia without, there’s some sort of risk to them. There’s a way to have different types, even just like have things non-institutional, because people tend to think that then they’re broken and they think it just kind of spirals from there, but there’s a way to present that, there’s a way to have those types of things and make them feel like they’re also worthy, right?

Meredith: Yeah. I think the stigma around behavioral health is a huge problem and that, you know, trauma informed care is this kind of model of treatment is really trying to address that. In some of the interviews I’ve conducted with parents and caregivers of pediatric mental health patients, you know, they say, ‘why is my child treated differently than, you know, the child who is an inpatient and being treated for some kind of medical, cancer or something like that. Why is my child treated, almost like a criminal’, because this is what that child is being taught and that carries with them and they’re more prone to live that out.

And so definitely the stigma is a big issue that these new sort of treatment models are trying to address and the design is also trying to address. I love the analogy you made of the playground and sort of safety first and sort of then people become bored and agitated.

And, you know, I think of animals who, when they’re bored or in crowded situations, they pick at themselves or they pick out each other, right?

And, staying on this theme of animals, we have this amazing wild animal rescue sanctuary in Colorado. And it takes in animals that have experienced great trauma and lots of abuse. And the people who have worked with abused wild animals for so long really understand the kind of environments that they need to sort of reduce their anxiety, reduce their sense of threat. And when you visit, you’ll notice the animals are really calm. They don’t have those sort of pacing behaviors like you see when you go to the zoo. I mean, I haven’t seen tigers and bears in the wild, but I would imagine it seems like their behaviors are more natural.

And, you know, some of the design features that they have in this wild animal sanctuary are lessons we can take kind of in our own sort of trauma-informed design. Like one is low density. So these animals have large acre habitats, and there’s not a lot of them in the same enclosure. They have environmental complexity. They have toys to play with that are appropriate to their species. So if they’re cats that like to climb, they have lots of climbing structures and opportunities. If they’re bears who like to explore there’s different scenarios for them to do that.

And then the other thing they do is with transition. So when an animal comes in, it’s not this sort of abrupt and here’s your new home, which is super scary and super threatening, and you don’t know what to expect. But the transition is very gradual and takes place over a pretty long period of time. So the animal can become more trusting and understand that this isn’t going to be threatening for me.

Another feature of the wild animal sanctuary is that as a visitor, you observe them from a 30-foot-high elevated walkway and you’re never on their ground level. And so for these wild animals, this space exists above their visual field. it’s beyond their body or their scope of reach. And so they don’t perceive you as a threat. And this is different than humans because we’re one of the few species who have this notion of extra personal space. And cognitive neuroscientist, Colin Ellard writes about this phenomenon a lot where there’s a part of our brain that understands this sense of the infinite or kind of, sometimes we associate with divinity when we see these distant expanses and stuff like that.

And that when we look up to the sky or to these distant expanses, it primes us to think about these very positive notions of kind of sublime, or like I said, maybe divinity. And so this idea for humans of lifting the gaze to inspire these positive thoughts could be really beneficial in all of our environments, but especially for trauma informed design. (J: like a healing environment). Yeah. (J: Right). So, that’s not one that’s in our kind of typical playbook of evidence-based design, but it should be. Kind of this idea of lifting the gaze and what kind of positive thoughts that inspires…

Davis: Right, I am so interested in that Meredith…

Janet: Yeah, I don’t know if you noticed that I leaned in, right. I was like, really? Yeah. Okay. (laughs).

Davis: We need an invitation to do some research on gaze and how that affects our sense of calm and relaxed versus alert and attending and what that does to our nervous system and how the built environment can facilitate it. We all hear over and over again about, oh, the window view is so beneficial. Well, is it the view out of the window or is it the fact that the eyes are moving and tracking in a way that is different than focused on some focal point that’s creating the sense of stress? So that’s fascinating discourse there. (M: Yeah). More, more is needed, right? (M: Yes, yeah) …

Janet: Absolutely. (M: Yeah). Well, I mean, you know, the whole idea, like you said, the whole famous study with the window looking out to the brick wall versus the, it was a park, I guess it was, but that goes back to sort of our more animal instincts of being able to kind of see the distance and see whatever kind of threat is coming at us. But yeah, I wonder if, you know, when you’re downtrodden, right, like you keep your gaze down, right? (M: uh huh). And you, maybe you’re not creating some sort of eye contact, your shoulders are slumped, you’re maybe not breathing as well. But if you’re lifted and you’re looking and up that the physiology of that as well, might… (M: Yes). Am I going too much into the weeds here, ladies? (laughs).

Meredith: I don’t have evidence to point you to, but I’ve always felt similarly, Janet. I mean, in one of our behavioral health settings, the design team talked about sort of using this flooring pattern that had a biophilic design and biophilia is healing. And I was like, really, do you want to draw their attention down to the flooring? Is that really where you want their attention to be? Because that, that just doesn’t feel right to me.

Janet: Right. No, well, it does… all right, so let’s talk about a design challenge here. So I was doing a piece with a trauma informed design in terms of sex trafficking. It was with this group of students and, and somebody had come up with the idea of designing stuff on the ground for help to do some wayfinding. And at first I was thinking that, you know, you’re coming in, you’re probably not maybe doing eye to eye contact. I think that the sign should be up above, but I also thought, well, why the hell not to have designs on the bottom? You know to have some sort of a wayfinding on the ground as well, but now I’m starting to maybe rethink that. Any, any thoughts on that?

Meredith: Oh, I would say wayfinding is different. And also exterior environments are different, but, but with, you know, with wayfinding, I would say, be redundant with your cues all over as much as you can. Especially, you know, in healthcare when people are coming to that setting often under stress. If they’re in the emergency room or something, you know, you’re under acute stress and we know stress diminishes your, your cognitive capacity and your ability to problem solve.

So we need to make sort of wayfinding cues, like, in my opinion, super redundant across all the senses and across all your visual fields to, because we don’t want to add to people’s stress. I don’t know that, you know, if someone’s coming into the emergency department with the severed leg, I don’t think we’re going to be able to necessarily reduce their stress in that moment, but we certainly don’t want to add to it by making wayfinding more challenging for example.

Janet: Right. Well, anybody who’s ever been into a hospital knows that like, even if you’re just there to visit someone, trying to find where you’re going is usually pretty, it’s pretty stressful. (M: Right). Even as, as a general rule. Well, so I appreciate you talking a little bit about that, uh, Davis, do you have anything to add?

Davis: This is so fascinating, but I know lots of other interesting things to talk about, so I’m happy to put a pin in this…

Janet: Yeah. And we’ll keep talking about things. So Meredith, can you give us any examples of some of the work that you have done.

Meredith: Yeah, sure. Do you want me to talk a little bit about kind of pediatric inpatient and kind of point to some of those examples as part of trauma informed design in some of our behavioral health projects?

Janet: yeah, we’d love to hear more.

Meredith: NBBJ, the design firm NBBJ, has done a couple of really amazing pediatric inpatient units.

One is the Nationwide Children’s Hospital in Columbus, Ohio. And here they’re changing their care model to include parents and caregivers if the patient treatment plan works to do that— it doesn’t always— but to include parents and caregivers in the stay.

So just like parents and caregivers are, often stay in other inpatient hospital rooms for medical stays, parents can do that with these patients in behavioral and mental health. So the bedrooms are designed to accommodate that. And a lot of the other rooms are as well. And so this really helps.

So in the interviews I’ve done with parents and caregivers, they’ve shared that, one of the most traumatic moments during their child stay is leaving visitation time. So the parent or caregiver comes to visit, visitation is over, and then there’s this huge separation. And it’s hard on the child, it’s hard on the parent. And so kind of having the parent there avoids that, but also it helps include the parent in the care plan. So that they’re understanding, what the treatment plan is. And they can, when the patient goes back home, they can really be part of that recovery. And there’s more continuity of care going on there as well.

Another pediatric inpatient behavioral unit is Seattle Children’s Hospital. And that group also has adopted a trauma informed care behavioral management philosophy. And so, the design of those units don’t include seclusion rooms, so they’re seclusion free and restraint free, and they really strive to avoid these hands-on interventions. So again, for that to work, the rest of the environment has to be designed to reduce stress so that you’re not having those triggers in the first place.

So those are two examples of how the care model itself is changing, and then how the design is also changing to support that kind of care.

Janet: Right. Yeah, that’s pretty great. Davis, do you have anything to add?

Davis: Well, yeah, this is just such a gift to be able to hear in depth live from you, with what all you’ve been working on. And my mind is spinning in many directions and taking lots of notes. But the supporting the supporter part for the parent and child dyad to me is core. And it’s something that, well, I have an affinity for it because that was my topic of my PhD work in childbirth environment.

So the supporter is expected to be there. They want to be there. They’re beneficial. Evidence shows that there it’s important to have them there, yet the space itself is discouraging actively or, you know, creating this unbelonging paradox of, well, you shouldn’t be here, you’re getting in the way. you know. So having the core understanding of this social cohesion that is necessary for true human potential to be activated is key. And so having spaces where parents are not only allowed to be there, but designed, yes, this is your place, be here. (M: Yeah.) This is part of the plan. I love it (M: Absolutely).

Janet:  it’s, it’s, it’s taking a village, and that support is really quite important. So terrific. These are great examples. And I think moving forward, we should find solutions other than restraint and seclusion, and to ultimately make better design choices, right?

Meredith: Yeah, so there’s this interesting shift that we’re seeing at a professional level that’s happening. And specifically, I’m talking about the AIAs code of professional ethics and conduct which now includes this accountability for human dignity and health and safety and welfare. And one thing that happened last year in 2020 was the AIA code of ethics included a mandatory rule of conduct against designing spaces for torture and solitary confinement in prison and justice facilities. Did you guys know…

Janet: Oh, not only did we know about that, (M: okay,) yes, I did a whole thing on prisons and trauma informed design. (M: that’s right) We definitely want to talk about that because it was such an important, I don’t think it got the press that it probably should have.  I think it was such a huge, huge step (M: Yes) for designers, and for them to basically say no more, (M: Yes) and I was over the moon.

I’m a big advocate, well now in terms of trauma informed design. I used to be a therapist for juvenile delinquents in incarcerated facilities. So I’ve always had this little soft spot in my heart for incarceration and people who are incarceration. And of course, they have been through a lot of trauma. And then it is the ultimate environment to retraumatize, right. (M: Yeah) And so, yes, I was so pleased that they had done that, so please continue forward…

Meredith: Right. And yeah, as you said, there so much advocacy for it. I want to say like almost 10-years leading up to this and, you know, ultimately the neuroscience evidence did show it’s not just psychological harm, it’s structural damage to the brain that’s occurring as a result of solitary confinement. And for me, the new rule really was significant because, now we’re talking about affordances here, we’re talking about having ethical standards for space programs. So this is sort of beyond just our ethical obligation to do no harm as far as like, you know, make sure our buildings don’t fall down and kill people or make sure, you know, we have guard rails if there’s an elevation change that people don’t fall off the edge. This is about space program and affordances here.

So, you know, I want to be careful, long-term solitary confinement is not the same as temporary seclusion, which is used to sort of protect patients from harming themselves or others. So I’m not trying to make that analogy at all. But I do think this new code of ethics that’s really getting at dignity and health and safety and welfare. And thinking about space program is really important for our profession and thinking about how we can minimize the use of traumatic practices, like seclusion and restraint, because we are designing the environment to reduce stress as we were talking about earlier.

Janet: Right. And it was even going back to what you were talking about earlier about ‘why is it my child? Why is my child then being treated very differently than somebody who might have had cancer?’ And I’m really kind of not trying to exactly equate the two, (M: right) but it does come down to, you know, it’s usually the people who are impoverished and people who have disabilities and that are in these particular types of correction facilities. And yes, occasionally we do need to separate people from the greater population, just in order to help reregulate themselves. But it’s a really important, I think conversation and I think we’re only going to be doing ourselves some sort of justice at the end of the day if we take care of this stuff. And that includes pediatric, psychiatric and incarcerated individuals.

Meredith: Yeah.

Janet: Well getting off of my soapbox. Well, that’s it, that’s the show (laughs). We fixed societal ills, it’s all good.

Outro- Section 2

Janet: Her work using -Trauma-informed Design, or TID – in behavioral health, especially for pediatric inpatient environments, is so inspiring. As Meredith pointed out, we as designers need to minimize the use of traumatic practices, such as seclusion and restraint, in order to help design the environment to reduce stress.

Carolyn: She also pointed out that the code of professional ethics and conduct by the American Institute of Architects, or AIA, now includes this accountability for human dignity, health, safety, and welfare.

Janet: As we said at the beginning, we decided to break our discussion with Meredith into 3 parts that you can listen to either all at once, or separately.

Carolyn: Even if you listen to this as the straight through version, you may want to take a short pause for a bio break, or to grab something to eat, or just to digest some of this information before moving on.

Janet: in this next part, we will look into how Social Determinants of Health can be used to improve medical care as well as access to healthcare.

Carolyn: And also, some future trends that may surprise you. I know one in particular that really surprised Janet.

Janet: yes, it did. I think I actually said ‘What?’ …

Bumper- Section 3 

Carolyn: Welcome back. So far we learned about Meredith’s passion for bridging the gap between life experience and design, and also how Trauma informed Design, or TiD, is being used to improve behavioral health facilities.

Janet:  In this next part, we will discuss the benefits of collecting data to make sure the perspectives of both the patient and the patient’s caregivers are all included in the design process, and to measure all those results.

Interview- Section 3

Janet: So Meredith, how is behavioral health being integrated into healthcare?

Meredith: Okay. So we’re seeing kind of a move from healthcare systems, changing their care practices. And then in turn, we’re kind of changing the design of clinics and facilities to better support those models of care. So the move to include behavioral health in healthcare generally really comes from healthcare systems who recognize the totality of factors impacting health beyond just medical care or clinical care.

And here I’m really talking about the social determinants of health kind of model here which just includes all the non-medical factors that influence health outcomes. So addressing those other factors is really fundamental for improving health; reducing inequities in health; and even increasing access to medical care, which is kind of what we consider when we think about healthcare, and we only consider that realm.

But if you look at one of the models by ‘Go Invo Boston’, they have a social determinants of health model and their data suggests that only 11-percent of health is attributed to medical care. And the other 89-percent is these other things, like your social circumstances, your individual behaviors. And those are usually not very separate from each other. (J: hmm).

So, for example, your income or your employment status or unemployment status can very much influence your individual behaviors— your sleep patterns; your stress levels; your substance use. And those in turn will manifest in health outcomes and, you know, diabetes or what are considered deaths of despair, which include like suicide or substance related deaths. And those are largely preventable deaths. So, we have to kind of address all those other 89-percent of health factors if we’re really interested in working for a more healthy population.

So, the more innovative healthcare systems— and these tend to be, like community health centers who are working with populations that have more inequities and disparities and health inequities— they’re able to sort of see that totality of factors influencing health and really connect the dots between the way they’re delivering medical care. and then also, providing opportunities for nutrition, or housing, or behavioral health. (J: right).

And one of our clients that we’ve done some community health centers for is ‘Clinica Family Health’. They’re in Colorado. And they were one of the pioneers to sort of introduce integrated or team-based care into their practice. So, team-based care includes your traditional kind of family doc or primary care provider, but then also on the team are a behavioral health provider; a dietician; someone from dental, like a dental hygienist; a case manager. And they all work together in the same shared clinic team space. So they can support the range of patient needs.

In these community health centers, they also have co-located services that can provide housing assistance or nutrition assistance like WIC. So these co-located services, this team-based care model, can really increase access to care for patients who have these diverse needs. So, they’re also really innovative in thinking how to design for supporting this new model of care. They introduced group visits to create support systems for like diabetes management and that sort of thing.

They, before the pandemic, were doing car care. So they were administering flu shots. So kind of the whole family gets in the car. These often happen on weekends or after hours, you know, because that’s another problem with access to care. And sort of drive up and everyone gets their flu shot. It’s really easy. It’s also easier for children, so, right. I don’t know if you’ve had the experience of taking a young one— yes, okay Davis, yes— for their vaccine recently or a flu shot, but transitioning from the car into, for me, we had to go into this clinic, into the basement, it just was an opportunity for anxiety to build up and fears to build up.

So, there’s lots of innovative things that they’ve introduced, and they’re very nimble. They’re quick to change. So, they don’t have that kind of risk aversion, like a lot of other kind of healthcare organizations have. They’re very nimble in order to support the needs of the community and deliver the best care and get healthy outcomes.

Janet: Right. Yeah, I talked to somebody who has a child who has autism and she uses the parking spots. They’re labeled for handicap, and lot of people have yelled at her (M: oh), because she’s not in a wheelchair. How dare she use the handicap placard or handicap parking spot.

And I bring this up because it takes heaven and earth to move her non-verbal, kid who has autism from the car, just to the, you know, go into the supermarket just to pick up whatever it is that they need to pick up. (M: yeah). And so, yeah, the thought of like, maybe you’re getting a shot, like people have aversions to getting shots and they get freaked out by all this, and then it just, it’s just another layer.

So to be that kind of nimble and to be able to make things easy, go figure, right. To make them a little bit easier to make them a little bit more accessible, a little less stressful. Pretty great.

Meredith: Yeah. So, in that example where behavioral health and medical care and those other services I mentioned are coming together. We’re also seeing campuses specific to addressing behavioral health come about. There’s a great group in California called ‘Be Well’, that we’ve designed two projects for and so they’re bringing together behavioral health services to address again, the continuity of care from crisis, all the way to management and prevention.

They also include transitional housing. In this case, it’s in the same building. In another project it’s on the same campus, so that they can support patients and clients at every step of the journey. And that’s, that’s usually not a linear journey. It’s a lot of, kind of back and forth, but they can support them at any stage that they’re at. (J: Right).

One of the design challenges with those campuses— so it’s, it’s great to have all these things co-located to support access and continuity of care— but I think one of the things we learned is that you have to have these strategic separations. So for someone who’s coming in in crisis or in need of detox services, you know, how do you support their transition into the center in a way that supports dignity and offers privacy and anonymity, and also doesn’t sort of frighten people who are coming in for just an outpatient. (J: Right). Yeah.

Janet:  It’s, it’s interesting. I was just going to say what were your challenges? Because you know, you’re bringing a lot of different services. I’m sure when you do all the initial interviews and stuff like that, I’m sure you have a list that’s at least an arm’s length of wishes and needs and have to’s. And do you spend a lot of time trying to connect the dots? Or do things fit together somehow naturally? What’s your process? I guess.

Meredith: (Laughs). Oh…

Janet: How long do we have?

Meredith: laughs.

Janet: (Laughs). Is it one of those, okay. It was a loaded question, but if you can break it down. I mean, because as designers, right, even in the best circumstances, you usually get like a wish list, right? (M: sure). I mean, you get some sort of something like, this is what we would really like to have in some of the things they might not have even thought of. (M: yeah).

But when you’re dealing with so many different components, yet although trying to provide the same service for the same individual, (M: yeah). How does that work? Like any tips or I guess maybe that’s a better way to look at it at the moment… (M: yeah). We can have Meredith come back for a whole new series just on her methodology.

Meredith: Absolutely. I’d love to, um, so. Oh, gosh.

So first I’ll just say like, these projects are my favorite because they’re new models of care. And so they’re new building typologies. We don’t have precedents that we can turn to. And so we get to be really innovative, which is fun. And so kind of to your point of like, well, where do you start?

So sort of from the human factors perspective, we embrace evidence-based design processes, but we also include experience-based design. And this goes back to a point Davis was making about that lived experience and the importance of lived experience and cultivating empathy.

So I don’t have a prescriptive approach, but I do like to sort of start with the experience which recognizes, you know, that every person’s experience is a very valuable data point. Which is different than evidence-based design, which is like, you know, we need robust evidence and large sample sizes in order to sort of show this as true. And experienced design is like, no, every person’s experience is, is a very valuable data point that we need to consider.

So I like to start with that. I like to sort of start with the stories. And for behavioral health, this can be challenging because their behavioral health patients are considered a protected class. They’re a vulnerable population. And if you’re working with, you know, pediatric behavioral health, they’re kind of twice protected, so it can be really, really challenging.

So some of the ways we’ve sort of gathered their experience is by, accessing family advisory groups that are attached to the organization. So if we can’t go to the children, we can ask their parents and their caregivers to share their experience. Or if they’re adults, we can ask past former patient volunteers who give their time and share their experience in these advisory groups to participate.

I like to do whenever possible sort of walking interviews where you’re walking, and talking because there’s, I don’t know if this is the right use of the word, but there’s like this artifactual memory, or sort of like seeing different artifacts that triggers like ‘oh, you know…’

Janet: ‘oh, that’s right, oh by the way, can you do something with this?’ Right, exactly.

Meredith: Yeah. So we do a lot of that with staff, kind of these walking interviews with staff to talk about what’s working or what’s challenging in certain environments.

So I like to start with kind of that experience. And right away, I think we kind of learn, you know, what’s important, such as, you know: dignity; or reducing stigma; protecting privacy; giving control. Those things kind of bubble up right away and help create targets or goals.

And then we can issue things like surveys to get kind of that larger sample size. But now at least we know the questions to ask from kind of having those stories and learned those experiences.

Janet: Right, yeah. Davis?

Davis: I love talking methods to an ethic approval. Ah, yes, it’s a tricky, it’s a tricky thing to get access to people who are so-called vulnerable, because they’re the ones that we need to study the most. (M: Yeah).

And I love hearing about the walking interviews. It reminded me right away of a different time frame, but a similar approach perhaps, is video reflexive ethnography. (M: hmm). So that’s the work that I was involved with, videotaping an experience, something occurring, and then watching that video with the participants themselves.

And while they’re watching their own selves, they’re recognizing all that was going on, on a subconscious level that they’re now aware of now that they’re sitting and viewing it and having a chance to pause it, and interview and ask what’s coming to the surface for them.

Meredith: Oh, wow. I love that.

Davis: it’s so interesting.

Janet: That’s a great example Davis, right, because that might be something that could, you know it’s technology.

Davis: But another thought I had around getting somebody who you don’t have access to. So we want to design for particular folks and they’re not, we can’t approach them, we can’t talk to them because of privacy concerns and their vulnerable status. (J: Right). So this is where being creative and imaginative and knowing how to be, you know, like having more actors and actresses come into the design world would be amazing because they can become and personify other people role playing.

I did a lot of work when I worked at— and there’s a podcast episode from early on of me speaking about the ABC House— where I worked with folks to design an abuse intervention center. And I wasn’t, I had no intention to talk to any of the people who would be coming to that space, aside from the staff and the clients.

And there, we didn’t have advisory groups like Meredith does, but that would be fruitful. And we, I think we were doing it ad hoc. We were pulling that together and I was finding my nearest children and saying, would you mind coming with me and just giving me your opinion about how this is going to look, because I needed it from your perspective and your angle. And I would put myself on my knees and get to that height so I could see what people are seeing. (M: hmm). So, it’s just fascinating, fascinating work. (J: Yeah).

Meredith: Yeah. What you just described, it, we call those empathetic observations. So the scenario I’m thinking of, we were designing this eating recovery center. It was what they call their spa bath. So it’s the space where patients with eating disorders get ready in the morning. So they shower, they brush their teeth, they get ready, but it’s also where they have weight check-ins and vital check-ins in the morning. So, they’re in a very vulnerable state and it would never be appropriate for us to kind of go and observe this in real life.

So I played the role of a patient, just so we could document the processes in the spaces and really get an understanding— not to say that I would ever understand what it’s like to be a person with an eating disorder, or to sort of be in this inpatient eating recovery center— but reenacting the processes they were going through in the morning. And then there was another researcher with me who was kind of writing everything down and doing spaghetti diagrams and that sort of thing, really helped us with some process improvement for the space and then ultimately the design of the space as well.

Janet: Yeah. I think that this is a really fascinating part that you did in your methodology for this particular type of a vulnerable group. And it’s probably one of the more challenging populations to design for and your methodology to go through all of that. And to Davis’ point, you’re putting in sort of an actor into that role, because you’re also trying to have some sort of privacy for those that go through it.

At some point I have gone and taken my students around and they have them in wheelchairs or I have them sort of blindfolded. There’s definitely like you even said, I’m not trying to pretend to know what it’s like to go through it, but, but there’s certain things that I think you can get out of that.

And I guess my, my question is… Did you have an ‘aha’ moment when you were walking through and you were doing your own acting role within this? Did you think it was a good thing to do it that way, I mean obviously we would like to have those that go through it but is there something else that you would preferred? Did it work?

I guess I have a hundred questions, so I don’t know which ones to ask first, (M: laughs). I think that that’s what it comes down to. So if you want to expand a little bit more on, on your experience with that, that would be great…

Meredith: Sure, sure, sure. So, there’s not like a prescriptive sort of methods I roll out for every project, it’s really kind of matching the right tools and techniques to whatever it is we’re trying to address. For that particular space, there was an issue of sort of, of waiting in line in order to have weight and vitals checked. And these patients are in a really vulnerable state they’re sort of in a gown, besides just the ‘waiting is waste’ sort of thing.

And so our objective was, you know, how do we get rid of that waiting experience, and then also just create sort of more dignity around what’s happening during their morning routine. So the empathetic observation was one piece to really capture the processes. And there were some also, some things that I experienced just, different proximity to other people, that felt very uncomfortable, again, when I was in that vulnerable state and I did put on the gown and all of that.

Janet: Wow. So you really are a method actor, as they would say. So it’s sort of like what we do with my students. Right.

Meredith: Yeah. So right, even though I don’t have that eating disorder, there were still environmental elements that I was very hyper aware of, that I would imagine sort of would translate. So we can check our assumptions on that by issuing a patient survey, which we did to former patient. They have a whole alumni group of volunteers who took the survey and did respond to some of the assumptions that I had so that those were validated in the survey.

The other thing we did is we did some simulation testing using a digital software program called ‘FlexSim’ which you can set up the architecture, you know, floor plan or a 3d model. And then if you have the processes correct, and sort of timestamped, you can actually run these fake patients through and understand sort of where the bottlenecks are.

And then, you know, you can figure out, do I need to add another staff member? Is this an operational thing? Do I need to cut out one of the process steps? Or is it a design thing? Do I need to add another shower? Do I need to add another exam room? And so you can quickly change these different variables and then run patients through as a simulation and see if wait time is reduced, if sort of the bottlenecks go away.

I think that testing during design is really, really important, so we’re not waiting until the project’s built and we can’t do anything about it. (J: about it, Right). Yeah.

Janet: Yeah. That’s an important piece. So, yeah, but I just think it was such an interesting project that you did and I think there was probably more challenges than other projects. Did I understand that correctly?

Meredith: So again, this is kind of one of those new ways of delivering care, so kind of specific to an eating disorder population. Even though anorexia is the most— gosh, I feel like I need to get my words correct— but I want to say anorexia is the most fatal psychiatric disorder. There’s not a lot of funding to support treatment. It’s getting better, like they’re passing legislation to recognize it as a disorder and then sort of provide insurance treatment. But historically it’s been really difficult. (J: right). So without the insurance to sort of fund treatment, there haven’t been facilities to have the treatment, which is, I mean, it’s sort of mind-blowing.

Sometimes these patients go into traditional behavioral health care settings, but eating disorders are really different. And the, what the patients are experiencing and their treatment programs are very, very different from sort of, (J: just like, alcoholism…) sure, yeah. Any of those sorts of things. (J: right) And so, again, this is an opportunity with the rise of these eating recovery centers, which are now all over the country to say, well, what is the right design to support the care that they’re giving.

One of the things that came up was proxemics, comfortable proxemics. So sort of part of eating disorders diagnosis is a misperception of your body, the kind of the space your body is taking up. And related to that, sort of a misjudgment of maybe body to body distances; or body to wall distance; or body to furniture distance. That perception is often, that judgment is sort of off.

So like in the dining area, which is a really stressful part of treatment, you know, we heard from the patients that they felt cramped or crowded. And so we created smaller dining cafes, so there weren’t as many patients in the dining space together. And then we created— and I forget what sort of the recommendation is between, diner to diner— but we almost doubled that to give them more space and more comfortable proxemics there.

Janet: I mean, I find that fascinating you know, that there’s some sort of body dysmorphic anyways, but that they are also reading the built environment incorrectly in terms of their body. Am I understanding that correctly? (M: yeah).

And then I start to wonder who, those others, like psychological issues that I think would probably also have that same sort of thought processes— like maybe people who have schizophrenia— in terms of themselves versus the built environment. (M: hmm). But in terms of eating disorders, I mean that’s pretty incredible. And I’ve got to think that there’s, I mean, we talk about it anyways, right, to a certain degree, but this is, I feel like it’s more tangible and more understandable.

Davis:  It might even be more or, or even less than the thought process, because that’s putting it on the individual that they’re thinking or not thinking correctly, but really what we’re talking about is it is a circuitry… (J: misfire). Yeah, you know, neural connection, (J: right), uh that, that can be altered. And once the chemistry of the body is, is shifting. And in addition to the thinking training along with the, you know, the spaces is therapeutically supporting that process. Right?

Meredith: Yeah, absolutely. Right. And another thing with persons with eating disorder is they have dis-regulated circadian rhythms because eating and regular meals is a regulator of our circadian system.

So, you know, I think that’s where daylight becomes really, really important in their recovery process as we’re, you know, trying to retrain the circadian systems. And that’s hard for behavioral health because by code you’re required to have patient rooms have windows and that’s a code requirement. But often patients aren’t using their rooms during the day. So all of the spaces that could have daylight are often kind of moved to the core. and that’s just, that’s not good for their, their recovery process.

Janet: You learn something new every day, Meredith. (M: laughs). That’s an interesting point, but it’s, it’s a really good point, right? I mean, you don’t spend all that time and if you do it’s mostly at night.

Well, there’s that, ah I’m not going to remember the name. They just did a whole thing. Some very wealthy donor gave a lot of money. It was for a dormitory….

Meredith:  … oh yes, at “USC” Santa Barbara.

Janet: Yes. So just for our listeners, in case you don’t know, they put all the dorm rooms on the interior, right? And they put all of the public spaces on the outside. And there’s been a lot of outcry from the design and architecture community that this is probably not a good thing. And they are sticking to their guns. They are sticking to their guns. Any thoughts on, on that…

Davis: Well doesn’t it bring up that we need more good science and good evidence because, well, you know, you’re manipulating the experiences of thousands and thousands of people without necessarily the logical evidence that can create that… you know, tossing hypotheses at a construction plan that will become an actual building and a place where a person will live for long time, not the length of a cruise.

You know, but what is it when you get back to the evidence part of it? Well is it the photons of light coming through the window that are helping people feel better, or is it the gaze of the eye that’s connecting to the brain that’s helping people feel better. We just don’t know, do we. (J: right). I mean, it’s bringing to the front a complex matter that needs a lot of good smart people coming together and talking to each other, just like we’re doing.

Janet: I was going to say just like Meredith and Davis… it’s all good…

Meredith: (laugh). It certainly is a move that does not seem supported by any evidence that I’m aware of. (J: Right). And, when we did a project for Boulder Community Health. This was an adult inpatient behavioral health unit. And the design team included tune-able lighting throughout the whole unit. And it’s the first that we’re aware of that the inpatient behavioral health that had tune-ables throughout the whole units, even in the patient bathrooms, for example.

So the tune-able changes over 24-hours to mimic changes in, in natural daylight. And, you know, you have higher intensity blue light in the morning to suppress your melatonin and keep you awake and alert, and then kind of eliminating that blue light spectrum in the evening to allow melatonin and support sleep.

Now, because this had never been done, our lighting designer really struggled with: “what time do I make the shifts?” “What should be the light intensity at four o’clock versus nine o’clock?” “What should be the color spectrum at, you know, 11 o’clock at night versus 8:00 AM in the morning?”

So she made use the best use of the evidence, but I remember having many conversations with her about, ‘we don’t know, what if we are doing harm here, because we don’t know.’ And, but certainly, you know, we made really the best decisions we possibly could make using the evidence we had available. (J: right).

The great thing about tune-able is you can change it and, and we’ve collected data and we have gone back and changed it. So, that’s great. It’s not sort of like a traditional lighting system where you got to change out all the fixtures in order to make a difference.

But this question of designing when you don’t have the evidence, it does become sort of a little bit of an ethical responsibility to consider. (J: right). But UCSB, I don’t see any evidence supporting what they’re doing at all. (laughs).

Janet: No. Well I think that’s why it made the news. (M: yeah). I think that’s why everybody was sort of up in arms about it. I kind of didn’t mean to go off topic, but again, it was, you know, again, it goes back to this sort of like what kind of evidence that we have, and, you know, in much like the lighting that you’re talking about, we will always have to kind of keep tuning those pieces of evidence because things will come out and things will change. And who knows, even with some of the stuff that we’re dealing with the pandemic will change sort of how we also live, and how we, maybe inherently biologically like it’s still, a lot of this stuff is still the same, but maybe things will change just a little bit that again, just need to be finely tuned.

Meredith: Yeah, I think this is a really interesting time we’re in, because evidence-based processes are great when we’re in stable systems. And when I think about the pandemic, we’re in this time of great disruption. And the evidence keeps changing, and policy keeps changing every single day, right?

Janet: And we’re getting used to the uncertainty…

Meredith: We’re getting used to the uncertainty and those who have relied on evidence-based medicine or evidence-based processes to make decisions, I think they’re really struggling right now. sort of what is best practice. Even for our designs, you know, they’re supposed to last at least 40 years. And we don’t quite understand ‘what is best practice now’ considering this pandemic and transmission and all of those things. So…

Janet: Right. Going back to what you were talking about in terms of the neuroscience of it. (M: yeah). Is any of this, you know, again, back to trauma, is some of this trauma also changing some of the wiring in our brains? Is that going to be some sort of factor? is the 40-year time span really relevant?

I find this kind of stuff fascinating. I think it’s going to, you’re right, this is a destructor, right. So, but we get an opportunity to kind of maybe look at things (M: yeah) and, maybe it is that we will have things that we have already known to be true, but maybe we will also pivot.

I know Davis and I have both talked about how like a lot of people are like, ‘oh, I haven’t done anything by make bread for the last two years’. (M: laughs). Davis and I both though, have— I don’t know about you— have found that this is a very busy time for us. It’s been very, very busy. And because I think people were trying to figure things out and, and we’re trying to all kind of, I think, maybe help each other.

Meredith: Yeah, I think, you know, Davis made a point about healthcare, well specifically to healthcare being risk averse. And absolutely, we see most healthcare organizations being risk averse. But because of the pandemic, I think there’s a real opportunity rather than just using evidence to inform design— they like to use evidence that can validate this model that’s been used 50 times is the best nurse station or patient program or that sort of thing— now we can use evidence to transform design. So to me, that’s really exciting because we weren’t able to sort of take those innovative leaps with a lot of healthcare clients today. And, because we have this great disruptor, now we can.

Janet: We have an opportunity for change, right? I agree with you, mentioned it to my students recently as well. (M: Yeah.). That’s great. Meredith.

So what do you think about going forward? What do you think about the future, about methodology? What do you think about, in terms of some of the things that we might be seeing? Because we’re now just talked about the pandemic and how things are disruptors. Like, so what do you see as our future? What are your hopes and what are your thoughts about that?

Meredith: Okay. So from the research perspective, I see sort of this move into data. I’ve heard others kind of describe that data, not drawings, is our new currency. I think it’s probably data in drawings, because drawings are the way that we communicate. So how do we infuse data into the drawings? So I’ve been— even as Director of Research— I’m increasingly uncomfortable with kind of this post-occupancy evaluation, which is sort of what we’re trained as design researchers is the gold standard.

Janet: You might not be able to see me, but my eyes just went “what?” …

Meredith: (Laughs). Don’t throw rotten fruit at me, please, please. They’re going to take away my title as researcher. But hear me out first for a second. Because post-occupancy— so here’s my issues is that— it looks at a facility at one point in time. And I think that we need to realize that certainly people are dynamic. We get that. We change. And also groups of people and, uh, sort of staffs can have turnovers or different cultures. And those change too.

I don’t know that we think enough about how dynamic environments are. And I’m not just talking about sort of longitudinal change that happens over a building’s life cycle. Like, okay, now this storage closet becomes a break room. I mean, that is important to consider as well, but I’m thinking of just the short-term dynamic changes that happen in our environment.

So if you’re in an environment with windows, you’re exposed to different light levels and color spectrums of light throughout, you know, almost minute by minute. If you’re in a room with a lot of people, you have different noise levels and those can change, again within a day. Your air quality. Again, if you have a room full of people, you might have higher CO2 levels, which can really affect your cognition and your alertness. So those kind of environmental variables are constantly changing and affect our performance in those environments. (J: right).

So I think that we need to think about continuous monitoring of both the environmental and human parts of that ecosystem. Going back to the ecosystem model, in order to sort of understand this as a complex interacting system. So, our methods, instead of post-occupancy, I might offer, you know, can we move into continuous occupancy evaluation? Instead of looking at just one project, can we look at portfolios of projects?

So we’re really lucky because we have repeat clients who, like ‘Eating Recovery Center’ who I mentioned earlier, who have multiple facilities and sites that offer the same programs.

So, when I’m doing a study, I never just look at one project. I always look at sort of their whole portfolio. Right now, we’re looking at eight different programs sites for them in order to sort of understand what’s best moving forward.

So it’s sort of this big data approach and taking multiple streams of data. And then, you know, maybe looking for outliers of, ‘oh, this facility is really doing something great, what can we learn from them on this dimension’ versus ‘this facility isn’t working at all’.

So in terms of technology, we’re starting to introduce sensors and wearables. Like a ring measuring stress. We have not used it in a healthcare setting yet. We’ve sort of just set up a system using volunteers from our own staff to do sort of an office worker study, just so we can kind of get the components in the system set up.

We have done a study where we had inpatient behavioral health staff wear light sensors to understand their lighting exposures. This was under the tune-able system which was really important.

But any time you have a sensor— whether it’s an environmental sensor or a biometric sensor— that’s timestamped, you can bring all of this data into the same spreadsheet and then look at interactions between them and really start to understand the system as this ecosystem

Davis: That is so fascinating. Being a lifelong, um, sensor wearer due to— which I’m also forthright about sharing my lived experience— of having type one diabetes. It was only recently that they’ve developed a continuous glucose monitor sensor. So to know that information for me on an ongoing constant evaluation is fruitful and helpful, and I can see patterns and trends.

And one moment in time with a blood sugar test is useless. (M: yes). So having something that’s responsive to the immediate needs is much, much more helpful. So I really love your evolution of post-occupancy evaluation. In fact, I was just speaking with Mardelle Shepley yesterday, because she said that also— something she was hedging in that direction I believe, I might be putting words in her mouth— but it’s a little too broad. The POE, it’s, it’s a broad ‘here let’s just plunk it into the building and take advantage of this’, not knowing what the actual specific typology is; what the actual population needs are. It’s not able to be nuanced and fine-grained enough. So the ‘Continuous Occupancy Evaluation’ – Meredith Banasiak, C-O-E. I’ve got a termed here now, it’s a thing. (laughs).

Meredith: Sweet! Yeah, I love, I love the analogy you shared Davis about your monitoring your diabetes. I might have to borrow that one as well. I think that makes a strong case. And I also think it’s setting us up as designers for creating kind of feedback loops.

So not just the monitoring of this human environment system, but adaptive environments. And that sounds really sci-fi, but it’s really possible with the tune-able lighting. I mean, we’re almost there. We don’t have the AI built into the tune-able system, but we’re not that far away that it could respond to different occupant measures and automatically adapt.

Davis: Right. And once we get sleep under control individually and as a collective community, we’re all going to just start feeling much, much better. And getting a handle on our lighting needs, will feed, it’s that feedback loop, its, it’s just perfect. And then the sensors and the lighting and the battery life is just eclipsing each other, the competition is amazing. I wear my aura ring here and can track my sleep measures quite well. So, I’m excited to hear about the future of technology and how we can integrate and incorporate these new streams of data. (M: hmm). It’s Fantastic. (M: Yes).

Janet: Right. So before we go, any last thoughts from your perspective, meaning like what do you want designers to take away or know on neuroscience and designing for behavioral facilities? Is there anything else we should know?

Meredith: So, when the Academy of Neuroscience for Architecture was just emerging, it aimed to bring together neuroscientists and architects, because that’s all we had as our starting point. But, you know, fast forward almost two decades later, we have bridges. We have, like you, like Davis, like Janet. We have bridges in this field who are bilingual in the sciences or in evidence-based and in design.

And those bridges are really critical to help making the translation between the evidence. And also for conducting practice-based research which is absolutely a necessary part of this research spectrum.

We absolutely want to make use of the findings coming out of the lab, but we also need to do research in naturalistic settings which is very different from the way they do research in the lab and the findings they’re getting in the lab. So, I would just say, we need more bridges in this field in order to advance the field.

Davis: Well, thank you so much. This is such a treat and, I love the emergence of a new job description, the design bridges of the world. So, I look forward to speaking with you more personally, but I also would invite you to share how folks who are listening, who would like to hear more about your work or learn more about what you’re up to, how they can be in touch with you.

Meredith: Oh, I’m happy to share anything. It’s great, I love connecting with people who are interested in this stuff. So I’ll provide a link to our site at BA Science. And I can also be found on Twitter and LinkedIn and look forward to connecting.

Janet: Meredith, thank you so much for this time. This has been a fantastic episode and there is so much more to discuss. Maybe we can continue this conversation in a future episode…

Meredith: Yeah, absolutely. Thank you so much for the opportunity to be a guest on your show. I have such respect for the work you’re doing and the resources that you’re sharing with our design community so we can help move the culture forward.

Janet: Yeah, I know I’m excited about it too.

Davis:  and I look forward to more conversations with you Meredith, thank you.

Janet: Thank you Meredith, Thank you Davis.

Outro- Section 3

Janet: Boy, Meredith really knows her stuff. I am so impressed with her and the work that she is doing in this area of behavioral health facilities. One thing that really stayed with me was the use of Tunable lighting. Although Carolyn I got to tell you, my cat was just a little disappointed, she thought it was tuna-able lighting. Get it?

Carolyn: (laughs) I do get it… I think my sense of humor is rubbing off on you.

Janet: But in all seriousness, daylight is so important to recovery, and to be able to adjust the lighting is huge. I also love how Meredith stresses the use of research evidence and scientific knowledge together to inform real projects. This optimizes the design for health, performance and access.

Carolyn: From what she said and the examples she gave, these methods have proven to help the staff at the facilities, as well as the patients and their families. Meredith is very forward thinking and to quote from her bio, she ‘supports a transformational shift in design towards an evidence-based, and person-centered culture.’

Janet: With that we’d like to thank both her and Dr. Harte for this inspiring, empathetic and scientifically considered talk today. I cannot thank them enough. As Dr. Harte said, this was a gift for us to have this type of conversation with Meredith.

Carolyn: And I can see us bringing Meredith back to dig into these topics even more in the future.

Janet: I’m nodding my head, absolutely, but getting back to this episode… we will also share the links for Meredith; Davis; Trauma Informed Design; and of course, the many more things mentioned during this discussion… all on our website at: inclusivedesigners.com…

Carolyn: That’s: inclusivedesigners.com…

Janet: Thank you to Meredith & Davis. And thank you all as well for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page.

Janet: And, as we say around here: ’Stay Well…and, Stay Well Informed’.

Thank you as always for stopping by. We’ll see you next time.

Carolyn: Yes, thanks again.

– music up