Trauma-informed care: Indigenous healthcare designed for empathy, wellness, and safety
June 21, 2023
June 21, 2023
Indigenous healthcare facilities can embody empathy, well-being and healing, and safety by applying the principles of trauma-informed care
Like so many of my peers, I continuously ask myself “how do we design healthcare facilities that meet the needs of the people using them?” Not just their medical needs but all the experiences—good and bad—that shape our lives.
In my work as an architect and practice leader in British Columbia, I get to work with many communities across the province. I also live and work in Kamloops, located on Tk’emlúps te Secwépemc territory, situated within the unceded ancestral lands of the Secwépemc Nation. When the Truth and Reconciliation Commission of Canada (TRC) published their report in 2015, my question, whilst still valid, deepened and changed. Of the TRC’s 94 Calls to Action, 7 relate to health. I encourage you to read them all. The health-related Calls to Action talk about acknowledging the impact of residential schools, closing the gap on health outcomes, recognizing the value of Aboriginal healing, the importance of healing centers, and more.
With the findings of the TRC, I realized my question is even more important when working with First Nations health authorities and communities, designing healthcare facilities that meet their individual community needs. My question now is this: “How do we integrate trauma-informed care into the design of healthcare facilities?”
Every person has their own experience and personal story that leads up to the day they find themselves needing medical help. Given what we know from the TRC report and Calls to Action, accessing healthcare for those in Indigenous communities can sometimes be a source of trauma in and of itself.
How can our healthcare facilities embody the principles of empathy, well-being and healing, and safety? How can we create spaces that acknowledge the history and traditions of Indigenous communities, creating trust, calm, and safe spaces for healing? How can healthcare design address the TRC Calls to Action? The answer: trauma-informed care.
Trauma-informed care isn’t a one-size-fits-all model. It begins with listening and working with the local First Nations’ communities to tailor our approach. Listening can help integrate beliefs and needs into the design of these crucial spaces. As I’m currently working on a health center project in a First Nations community, we heard how family and community are instrumental in helping care for the person receiving medical treatment—so the design must reflect this. Rooms are purposely designed with space for extended family, so people can gather to support and care for their loved ones. The importance of physical space for families to gather creates a safe space for those both receiving and giving love and care.
Trauma-informed care is a series of broad principles that inform design. The resulting spaces help promote three essential principles.
Empathy: The ability to understand another person’s thoughts and feelings in a situation is critical to grasping their point of view. For many First Nations, Inuit, and Métis people accessing the medical system can be traumatic. It is critical to understand how both the past and current experiences of trauma can affect a person’s experience within the medical system. To be empathetic, we must work with those individuals and communities to design spaces in a good way to promote cultural safety, dignity, empowerment, and well-being.
Trauma-informed care isn’t a one size fits all model. It begins with listening and working with First Nations’ communities to tailor our approach.
Well-being and healing: Sounds and smells all invoke memories—both happy and sad. There are a lot of sounds in hospitals: alarms, machines that beep, call bells. All of them are needed but they’re not relaxing, particularly for patients suffering mental health distress or who may have sensory sensitivities. Facilities that embrace trauma-informed care offer separate settings for those in distress and promote safety for all.
Connections to nature can also help in multisensory environments. Natural light, maximizing views, and cool colors all help in the healing journey. Introducing familiar smells can also help.
Safety: Spacious areas, good signage, and clear sight lines create calm and familiar spaces. Integrating aspects of culture can also help with the feelings of familiarity. Design elements like seating are also important. For example, corner-to-corner seating can help build trust and confidence. Soft chairs and furnishings remind people of home. All these features add to a sense of empowerment and control for healthcare facility users.
Here are some examples of how we can design with trauma-informed care.
The importance of smell: In 2022, we completed the first of 15 First Nations Wellness Centres in British Columbia. It serves as a model of First Nations healthcare service delivery, combining primary healthcare, social services, and Indigenous health support in one team-based care model. During our meetings with representatives of the Dakelh Dene, Secwepemc, and Tsilhqotin Nations, we learned about the importance that familiar smells can have in the healing journey. In designing the Wellness Centre, we positioned a kitchen adjacent to the main entrance and waiting area. This allows the smells of traditional foods to greet patients and visitors on their arrival, helping invoke a sense of familiarity and comfort.
The importance of natural elements: The use of wood in building is common in First Nations communities across Canada. It provides a sense of noninstitutional warmth and texture to the design. Taking account of infection control and ensuring surfaces are easy to clean, wood elements have been used throughout the Cariboo Memorial Hospital Redevelopment project’s interior and exterior design. There are also medicinal plants in garden beds located around the hospital, further enhancing the connection to nature and healing. We consulted with members of the local T’exelcemc people to select plants local to the area and that can be used medicinally or as part of their care. Families can now go out into the garden, pick a plant, and use that plant in a traditional way for healing purposes.
Local First Nations communities also told us about the importance of ceremonial smudging. As such, the design of the mechanical exhaust system means families can smudge almost anywhere in the building. Knowing the importance of the ceremony and designing the freedom to smudge promotes a feeling of control, rather than limitation. The community can also access plants for smudging from the garden.
Familiarity and connections: The Cariboo region’s topography—from lake bottom to bluff—is reflected in the hospital building’s form and character. The hospital is also layered with abstract references to the art and artifacts of the local First Nations. This includes large-scale, film-applied graphics that will be installed on the large expanses of glazing on the facility. We consulted with the local Indigenous community for the graphics. They will include important healing references to the historic pictographs that can be found in the area.
The material palette is important too. It promotes variation and avoids a clinical and repetitive feel. The exterior of the facility is highly animated with playful elements that add visual interest.
The plan is to use durable building materials that are appropriate to the Cariboo region. Welcoming wood poles and transparent glazing is used at the base of the facility. Terra-cotta panels are used to define the inpatient units on the upper floors. The color of the panels reference the silt bluffs found in the river valleys in the region.
“How do we integrate trauma-informed care into the design of healthcare facilities?” By listening to communities and having a laser focus on empathy, wellness and healing, and safety. Trauma-informed care is a continued learning journey for designers. And it’s an important one. It has the power to improve community access to healthcare services when delivered in a personalized and meaningful way. As designers, this is an important step on the journey of reconciliation and addressing the TRC’s Calls to Action.
It doesn’t stop here either. I’m excited for our next project—a primary care center for the Binche, Nak’azdli, and Tl’azt’en First Nations in British Columbia—where trauma-informed care will be at the heart of our design approach.
We continue to learn with and from our relationships with First Nation, Métis, and Inuit communities. We’re finding new ways to partner with local initiatives and collaborating with Indigenous organizations for a better future. Embracing diversity of all kinds enables us to provide a work environment and culture that is safe, inclusive, and diverse.
Learn more about Stantec’s Indigenous Relations.