The concept of “trauma-informed” or sensitivity to trauma is discussed in detail here.

In terms of physical space design, there are three important things harm reductionists need to bear in mind when creating harm reduction spaces, vis-à-vis trauma. Many leaders said that designs created for harm reduction spaces need to:

• Recognize trauma and its impact on behavior.
• Respond to the trauma that both participants and staff carry.
• Resist re-traumatization.

And that they needed to think about:

• Comfort
• Space Utilization
• Privacy
• Color
• Decorations
• Noise & Music
• Being Inviting

Comfort—One thing that a lot of harm reduction leaders talked about during the process for creating Space Hacks was the idea that harm reduction spaces and services should, as much as possible, do the opposite of most institutional settings and center the physical comfort of harm reduction participants.

This means comfortable chairs, lowered lighting, and a generally more home-like and less institutional aesthetic. This is because many harm reduction service participants have been deeply traumatized in institutional settings such as hospitals, schools, foster care centers, youth detention camps, prisons, jails, etc. Think about getting water- and stain resistant couches for high traffic areas, using lamps, and natural lighting. For fixed site mobile or vehicular outreach, consider carrying stools or chairs for participants. Certainly, there are practical limitations on this—bright lights may be essential in clinical settings, for example, for very important reasons, but it is equally not necessary to light waiting and lounge areas with nothing but cold fluorescents.

Space Utilization—Space utilization is another important consideration when it comes to trauma sensitivity in harm reduction spaces. Being packed into too small a space universally causes agitation, so it’s important that there’s plenty of room for people to move around in any harm reduction space.

Another important point of space utilization is ensuring adequate room for privacy for people to discuss things that may be sensitive such as health issues or their drug use with staff. At some service locations this means that supplies are given off to the side so that the conversation can take place, or that one-on-one services like testing or overdose training can be administered.

Privacy—For a lot of people substance use is emotionally tied to trauma and, as a consequence, to shame. For this reason, it can be very difficult for people to discuss their use and their use-based habits with anything approaching candor if they feel in any way exposed. Moreover, it should go without saying that people who are criminalized require discretion when discussing potentially illegal activities. For these reasons, it’s very important for all harm reduction services and sites to think about ways to maximize privacy for participants on every level. Syringe service and harm reduction service programs have provided anonymous services for decades for these reasons. Instead, many harm reduction programs use unique identifiers to gather statistics. This may mean having a private room where people get their supplies; it will certainly mean private spaces for doing anything resembling counseling or testing. For mobile services, it will mean being judicious about where and how you discuss things with people. It will mean checking your surroundings to ensure that you’re alone if you are on foot, for example.

Color—Another consideration is color. Too often institutions use a very limited color palette, mostly pastels, neutrals, and white. Though there is some utility to using neutrals, there is a fair amount of research showing that certain colors, especially blues and greens, have a calming effect on mood while warmer colors, like reds and pinks, are stimulating. So, think about painting your space. Paint is a relatively cheap way to create a more inviting space. Alternatively, invite your participants and other stakeholders to help pick the colors and paint. This can be a great way for them to contribute and for them to feel invested in your space.

Decorations—It may seem trivial, but the decorations that you choose for your space can make your space more inviting, or they can be upsetting to people and trigger responses that you did not expect. For example, health education posters may be well intentioned, but they may be also upsetting to people for unexpected reasons—one leader spoke of a participant who was upset by HIV testing posters in the lobby because they had been given a positive test result and it triggered that experience—so be judicious about the kind of educational posters you’re putting up, and make sure that you have other things on your walls besides information about HIV, STIs, drug use, etc. Making room to celebrate your community, its history, its accomplishments, its s/heroes and those it has lost, is critical to creating a truly community space.

Noise Control and Music—Noise levels can be extremely agitating for people and also trigger their trauma response. This is especially true of very low bass or very high-pitched noises, so avoid this. Use baffling in the environment, such as fabrics, carpets, and other things that can absorb sound. Harm reduction leaders also reported that if they were going to play music, they made sure it was mellow in tone.

Be Inviting—Again, this may seem superfluous, but people who have been traumatized often have been traumatized by rejection; by feeling like they were not welcome and did not belong. So creating an environment in which it’s explicit that they are invited is essential for creating thriving community spaces and services.

Note and Disclaimer

Note—certain spaces, like vehicles, bathrooms and showers, require special considerations outlined in the section on Specific Spaces.

Disclaimer—this is not an exhaustive list of the ways that you can prepare your services to be more trauma-informed. It is a quick and dirty shortlist of things that you should be thinking about when designing the physical spaces that your participants will be using. When in doubt ASK YOUR PARTICIPANTS what works for them and LISTEN.