In creating the team, Dr. Davidson handpicked individuals who possessed harm reduction qualities and were willing to learn from participants whose life experience guide their own care.

Team members were also selected because of their empathy, open mindedness and motivation to help people with substance use disorder; each having lived experience or proximity to someone who has experienced it.

Although multidisciplinary and diverse in experience, the team recognizes it could be more diverse in other aspects, i.e. representation of indigenous, non-binary, and people of colour in the team.

Our Recommendation

• Handpick a group of exceptional people who share the motivation to accompany participants in their individual self-determined journeys, with an intentional focus on recruiting from diverse backgrounds and experiences.

The team was developed with a vision of a horizontal culture, where team members could enjoy agency, and decision making power.

This horizontality leverages the diverse expertise and perspectives of the team in the development of the centres practice and delivery of person-centred care.

However, the initial shift from traditional hierarchical ways of working that many were used to created tensions as people were encouraged to define their own roles and contribute to the overall vision, mission, and practice of the centre.

For those used to more structure and instruction from ‘higher up’, this required a shift in mentality and approach to developing ideas and the responsibility associated with the process.

Our Recommendations

• In practice, a horizontal organisation includes any team member having the autonomy to bring an idea to the table and sharing the decision making power needed to action it.

• Consider that there is going to be a period of adaptation as people move from a hierarchical to an horizontal culture. Some will prefer more structure, instruction and guidance.

Working with people who are pushed to the fringes of society can be draining work. It can be frustrating to see them continually pushed and beat down.

This work is ever changing because participants’ journeys are unique and not always straightforward. It can feel like a rollercoaster, as the team is constantly reassessing and adapting to participants' fluctuating physical, mental and emotional wellbeing, and often volatile contexts.

The work is rewarding, but can also be exhausting or frustrating.

"It’s better to drop the idea of victories and focus on the little things: somebody's cleaning, washing regularly. Somebody got a place to live. Somebody's eating regularly. Somebody doesn't punch somebody when they're angry." - Hadrian Abbott, Licensed Practical Nurse (LPN) at River Stone Recovery Centre

Meeting participants where they in this context means meeting them where they are daily, keeping the focus on each participant’s needs and capacity in the moment and responding accordingly.

Our Recommendations

• Meet people where they are and let them be in the driver’s seat of their recovery journey.

• Be present in the ride and celebrate the small, daily wins, but drop the idea of victories.

• There are going to be setbacks. Take it one day at a time.

The passion and commitment team members have towards accompanying participants in their self-determined journeys has sometimes made it difficult for them to hold space for self-care. The team identified that developing good, firm personal and therapeutic boundaries has been pivotal to their well-being but remains challenging for some.

Creating an environment of respect and open communication that has roots in everyday practice has been essential for team members to continue to do this work in the long run: Friday all-team debriefs; calling someone for help when unsure how to proceed; caring support when something doesn’t go as planned.

The team recognizes sharing a sense of humour as key to relationship building within the centre, both within the team and with participants, especially in this line of work.

Our Recommendations

• Set clear boundaries with your team members.

• Acknowledge how much you can take on, prevent spreading yourself too thin, preserve a work-life balance, and set realistic expectations.

• Create space for routine reflection and sharing as a team.

Boundaries are an essential element of trauma-informed care and important safety mechanism for participants.

Before the centre opened, the team drafted the minimum set of rules they thought was necessary to ensure the safety of participants and staff. This code of respect was displayed at a community BBQ where participants were encouraged to provide feedback on what was included and add anything that they felt was missing.

The refined Code of Respect is now on display in the centre and forms the basis of a contract signed by participants and staff. This intentional boundary setting that occurs at the start of a participant's journey with the team, manifests in ongoing practice.

Given the context of survival in which some participants find themselves, they may sometimes try to negotiate the boundaries or rules. When interactions fall in this gray area, there has sometimes been lack of consistency of what is allowed and what is not. This can sometimes result in conflict, power tensions and the feelings of favouritism. In other instances, the clarity gained through reflecting, refining, and communicating our boundaries has led to greater feelings of safety and understanding.

The team are on an ongoing learning curve and mindful of the opportunities to hone good boundary setting.

Our Recommendations

• Work with participants to build together an understanding of what everybody needs to feel safe to participate in the program, and set expectations between staff and participants up front.

• Place the agreed code of respect in a visible space.

• Being assertive and communicating boundaries and rules early on is trauma-informed care; it promotes consistency and equity within the program.

The line of authority is a fine and sometimes nuanced line to walk for team members. They find themselves enforcing rules to promote safety and much needed predictability and consistency in trauma-informed care, while being aware of being in a position of authority that can be triggering for participants.

Power dynamics are actively mitigated by de-centring the role of the clinician in group therapy sessions, and actively encouraging participants to engage in decisions around their own pharmaceutical and behavioural management.

That said, there is an unarguable power dynamic as long as the River Stone Recovery Centre team holds significant control over an individual's dose and ability to participate in the program. The team tries to empower and support people as much as possible - equalling the balance of power while recognizing they are receiving care.

Our Recommendations

• Recognize power dynamics by being transparent about who has the power to influence decisions.

• De-centre clinicians as experts by promoting peer support, learning, and self-advocacy in group therapy sessions and case management.

When we relocated Phoenix Learning Centre from downtown to a residential neighbourhood, we operated under the intention of making it a permanent location. However, this was dependent upon funding and rezoning. When our zoning application was denied, we had to close the centre six months after opening.

In the meantime, we had been working with Phoenix Learning Centre guests to co-create a safe space with purpose. By doing so, we increased their emotional investment in a vision that we could not guarantee.

Our Recommendations

• Be mindful that people experiencing homelessness frequently have temporary solutions, spaces, and programs taken away from them when funding ends or neighbours complain.

• Be transparent about the risk of projects ending and respect their decision not to engage if they can't invest the emotional labour.

Our intention as designers to co-create and involve people in the design of things that impact them has to be met with the desire and capacity of individuals to participate.

We planned weekly themes that could be explored in multiple modes (e.g., group discussion, personal reflection, visual imagery). Over the course of three months 30 regular guests worked with us, several of them participating each week. Others were less inclined to do so, instead finding relief from the elements and wanting to use their time in the space to rest, connect with others, or think of something other than their situation.

Our Recommendations

• Be mindful not to place the burden of design on participants.

• Lower the barrier to participation in the design process. E.g., leave visible summaries of what is being explored and what is being learned so that participants who aren't actively engaged can provide informal feedback if they feel motivated to.

When planning research activities, we were mindful of how to carry out research in a way that was trauma-informed.

We reviewed activities with the clinical team, ensured we were using the correct language.

We designed sessions that we hoped would be enjoyable for participants, designed for different modes of participation, and reviewed ethical practice routinely.

Despite this planning, we frequently had to adapt on the ground and change plans.

For example, the original research plan intended to explore concepts of safe space and purpose, but we paused research efforts surrounding purpose when we realised that there was more pressing work to be done to create the safe space that was needed first.

Our Recommendations

• Always plan ahead in order to be mindful of trauma, accessibility and ethics but be ready to pivot on the ground.

• Participants are not living by your schedule or deadlines, be ready to accommodate accordingly.

• Prioritize the wellbeing, context, and concerns of participants over the plan or methodological purity.

With a shoestring budget to establish and operate an emergency drop-in centre, the design team could only spend a limited amount of time on site at the Phoenix Learning Centre. We compensated for this by co-creating a plan with the clinical team to set weekly research themes that would kick-off with a designer and be continued by the clinical team over the course of the remaining week.

Despite only being physically present once per week, we were able to build positive relationships with participants, but it took us a long time to understand the nuances of daily life.

Gaining insight sooner into how wellbeing and behaviour fluctuates according to - for example, what day of the month it is, and how much money a person has left, would have enabled us to adapt our approach to respect participants' capacity and priorities.

We also found that as the popularity of the centre grew and winter approached, the clinical team had to prioritize their core service delivery. They didn't have the capacity to fully engage in the R&D process.

Our hope as designers is always to build capacity in the teams that we work with, so that the approach can be sustained after our involvement in a project ends. Even though the team could not participate as originally intended, we shared plans and learnings as we worked in a shared space. We hosted a weekly debrief with those who could attend and shared:

• A recap email sent every week to detail what we were hoping to learn, the activities we had planned, and the findings we were learning.

• An online workbook that documented our progress and that was accessible to everyone in the team and they were encouraged to edit, add or suggest changes.

Our Recommendations

• Having a designer participating from the ins and outs of the centres' operation and daily life of participants helps in creating consistency, familiarity, and insight into the nuances that should be considered and reflected in the project's approach. In contexts where it is not possible to fully embed a designer in the team, it is important not to work in isolation but also be respectful of the team's competing priorities.

• If a team doesn't have the capacity to directly engage in research activities, there is still an opportunity to build capacity by osmosis. Be intentional about working in the open - share plans, materials, and findings; when doing, explain what you’re trying to learn and how.

• Create opportunities for weekly debriefs and recaps for those who can't attend in person.

In addition to designing research activities that allowed themes to be explored in multiple different modes, we also complemented an in-person open house at the Phoenix Learning Centre with a video guided tour.

The in-person open house was attended by 10 people, the video which was uploaded to YouTube and shared on a community Facebook page has been viewed 634 times.

The video increased our reach and played a pivotal role in demystifying the centre and garnering broad support and volunteerism in the surrounding neighbourhood.

Our Recommendations

• Be mindful about who is not in the room and why they might not be there.

• Think of ways to make information and activities accessible and design for alternative forms of participation.

When we encountered negative feedback from the community about the Phoenix Learning Centre in their neighbourhood, our instinct was to protect and advocate for the centre's guests. We highlighted the things that they had in common with the neighbours e.g., a desire for safety, community, and quiet, hoping to humanize and de-other the guests. Instead of reducing the perceived threat that they posed, we came across to some as condescending; minimizing their concerns. While we know that there are some who would never be willing to accept the impact that the centre and its guests had, or could have, on their quality of life, we can't help but question how the discussion may have been different if we had listened and responded with empathy.

Some neighbours challenged our Human-Centred Design practice because of our failure to design for all humans impacted by the presence of the centre. As social innovation practitioners who strive to embed principles of design justice in their work, it was easy to forget that people who don't work in this space may not understand that those of us who benefit from the status quo have to sacrifice some of the privilege we have historically enjoyed if we are to reduce the social inequities in society and make progress towards social justice.

Our Recommendations

• Remember to empathize with all stakeholders, but be prepared for some people to be negatively impacted by the intended and unintended consequences of your designs.

• More work needs to be done to highlight the need to prioritize the marginalized when designing for social justice; that implementing social justice by design means making changes that intentionally favour those traditionally marginalized by society.

In joining the team at River Stone Recovery Centre, who are actively disrupting the system, we didn't join a project, we joined a movement. We bought into the vision and we were committed to making it happen.

In addition to writing grant applications and seeking out funding opportunities, we found ourselves networking and lobbying decision makers. What that meant was that a significant amount of time was spent "away" from what we previously considered "the work" of Human-Centred Design.

This work was unanticipated and not budgeted for, but a very necessary part of the Social R&D. If we didn't put effort into creating the conditions for the movement to grow, we risked committing engagement theatre.

While we were ultimately unsuccessful in securing that space for Phoenix Learning Centre, seeds were planted and there are signs of change on the horizon. As a design team we know we did everything we could at the time.

Our Recommendation

• Be prepared to leverage your networks and power to advocate for the social change that you are designing for.

We knew when we started this project that it was going to be emotionally draining. We encouraged each other to be mindful of the emotional labour involved, and encouraged each team member to take time to reflect and process what they were experiencing and to practice self care. We scheduled time after site visits for private journalling and peer debriefs. We reminded each other to make time to do something that would bring them joy.
Despite having this foresight and these strategies in place, this work was still hard work.

Working with people who are misunderstood and mistreated by our own community made us cry, made us angry, and made us question ourselves, our friends, and family.

This work is hard work, but is nowhere near as hard as the daily work of marginalized folk who are just trying to survive at the intersection of trauma, mental illness, substance use disorder, and poverty, who are continually failed by the system that the rest of us benefit from.

Our Recommendations

• Be aware of the risk of vicarious trauma and ensure your team has support structures in place: practice self-care and look after your team; share the heavy work; preserve space for reflection and decompression.

• Allow yourself time to feel and process your feelings, but remember to be kind to yourself and your peers.

• As designers we're always aware of how things could be so much better, and it can be frustrating when we don't see the scale of change that we want to see in the world. Don't forget, that if for one minute, by being there, by listening, by advocating, by helping, by connecting as a fellow human being - even for just one minute - that impact was already felt.