Social workers often talk about trauma, and web developers often talk about user experience. What does trauma-informed user experience look like? By combining social work and web design, Haven Connect founder Caroline Caselli discusses how to reduce barriers to finding housing for low-income young adults and youth. Using research from Kaiser's Adverse Childhood Experiences study and Nadine Burke's work in the Bayview, we'll illustrate how trauma-informed user experience can improve health and save lives.

1. Housing the Homeless: Using
Trauma-Informed User Experience
to improve health outcomes
Caroline Caselli
@cmcaselli
@havenconnect

2. A little about me:

3. Who are you?

4. Agenda
• What is trauma?
• Trauma Research – ACEs study + CA study
– What 4 ACEs can do
• Housing stress and health research
• What does Trauma-Informed User Experience
look like?

5. What is trauma?

6. Kaiser Adverse Childhood Experiences
[ACEs] study
• 10 types of childhood trauma measured in the ACE Study.
• Five are personal — physical abuse, verbal abuse, sexual
abuse, physical neglect, and emotional neglect.
• Five are related to other family members: a parent who’s
an alcoholic, a mother who’s a victim of domestic violence,
a family member in jail, a family member diagnosed with a
mental illness, and the disappearance of a parent through
divorce, death or abandonment.
• The study’s participants were 17,000 mostly white, middle
and upper-middle class college-educated San Diegans with
good jobs and great health care – they all belonged to the
Kaiser Permanente health maintenance organization.

7. ACEs affect health and mortality

8. In California
• 61.7% of adults have experienced at least one
ACE, and one in six, or 16.7%, California adults
have experienced four or more ACEs
• ACEs impact Californians from all walks of life
regardless of geography, race, income, or
education. Although the prevalence of ACEs is
generally consistent across race and ethnicity,
high numbers of ACEs correlate with a
person’s poverty, education, and employment

9. What 4+ ACEs can do
• A PERSON WITH 4 OR MORE ACES IS:
– 21% more likely to be below 250 percent of the Federal Poverty Level
(FPL)
– 27% more likely to have less than a college degree
– 39% more likely to be unemployed
• In California, a person with four or more ACEs is 12.96 times as
likely to have been removed from her home as a child as compared
to a person with no ACEs.
• In 2012, over 350,000 California children received a Child Protective
Services response for an allegation of child maltreatment.
• Of the 76,026 children who were found to be victims of
maltreatment in 2012, 86.7% were found to have suffered from
neglect and 18.3% were found to have suffered from emotional
abuse

10. Yet!
Neither ACE Study asks about housing,
homelessness, or housing instability

11. North Carolina Study
• One lesser known adult stressor is housing instability.
Caregivers who have strong mental and physical health
are substantially less likely to create traumatic
experiences for their children and other youth they
come into contact with.
• Childhood stress is a public health issue, since stressed
children grow up to be sick adults. Childhood stress is
strongly impacted by their caregivers’ wellbeing,
indicating that reducing adult mental health issues
would reduce childhood trauma. The stress of being
homeless or searching for housing can impact the
physical and mental health of adults, which can
translate to ACEs for their children.

12. Housing Stress = Trauma
• Access to health care was also associated with
housing stress. This was particularly evident in
the high stress group. The adjusted rates of
not having any health insurance (22.7%), not
having a routine check-up in the past year
(37.2%) and not being able to afford a doctor
visit in the past year (36.3%) were all
statistically significantly higher among those
reporting high levels of housing stress
compared to those with low housing stress.

13. • Homelessness itself potentially poses health
risks to youth and can interrupt normal
socialization and education, which likely
affects a young person's future ability to live
independently.

14. Housing = Health Care

15. The devil is in the details:
User Experience – 4 takeaways
• Don’t make me remember
• Tell me where to go

16. Tell me where to go

17. How I’ve used this research
• Don’t make me remember = no passwords
– text access
• Applicant questions
– Questions that mirror the reality of people’s lives
– SSN presumes citizenship, causes fear for undocumented
applicants
– Trans applicants need pronoun questions to not traumatize
• Waitlist updates online = no need for a postal address
• Most e-signature providers require an email address. That
doesn’t work for this population. So we created a cell-
email combo.

18. Caroline Caselli
@cmcaselli
@havenconnect
Questions?