Care as Infrastructure

Note: What follows are the prepared remarks I made at the Service Design in Government conference in Edinburgh, Scotland, on September 18th. I was the keynote speaker on day two and gave a 45-minute talk titled “Care for the Public: Trauma-Informed Service Design.”

Introduction

When I look back on my time in Edinburgh, what stands out most is the depth of conversation about what care means in public systems today. The reflections that follow are not a transcription of a talk, but the words I spoke as part of a broader invitation to imagine care as something far more fundamental than sentiment or style. These remarks examine the concept of designing and delivering public services that consider trauma, foster trust, and integrate care into the very infrastructure of governance.

Public service design at a crossroads

Hi everyone. I am so very happy to be here—amongst peers, and with friends who are also colleagues. It feels wild to say, “I have 25 years of _______,” but I do. I have had so many great and important experiences in some aspect of social justice, service, and care work. As I’ve gotten older, I find it easier to categorize this as before I became a social worker and since I became a social worker.

Instead of diving into each of these experiences and sharing what I’ve learned along the way, I’ll simply note that being the first systems thinking social worker at Veterans Affairs in 2010, starting Social Workers Who Design in 2018, being the first (and only) social worker-designer in U.S. Digital Service history from 2022–2024, and then most recently serving as a design supervisor with U.S. Digital Corps from late December to late April are the main sources of inspiration for today’s talk.

But before I dive in, I want to pause and offer some context. There’s always a temptation to jump straight into content, to move quickly into the material. But given where we are — both literally and figuratively — and the kinds of realities we’re facing, it feels important to frame this conversation with just a little bit of pretext. So consider what I’m about to say as a preamble and more as a grounding. A way of naming where we are, so we can better see where we all might go.

Part of why I want to ease in a bit is because when an American, in 2025, is asked to speak about trauma at a service design in government conference, well, there is a giant pink elephant in the room.

So, this brings me to the first grounding, if you will, that I want to name: the chaos that has been occurring, is actively occurring, and unfortunately will continue to occur, is not normal. It may feel normalized. It may feel like the water we’re swimming in. But it is not normal. There is significant civic trauma happening, especially with government workers — and especially those in the U.S.

Acknowledging this matters to me, my work, and my friends and colleagues. If we don’t state that clearly, we run the risk of slipping into what academics call hypernormalization — a collective acceptance of distorted realities as if they were simply the way things are.

It creates a disconnect between what we know to be true and the way we’re expected to act. And when we live in that gap for too long, it generates helplessness, disengagement, and a chronic unease. An unease that eats away at both our individual sense of well-being and our collective capacity to imagine something better.

Rahaf Harfoush, a digital anthropologist, said just a few months ago this about hypernormalization:

“It’s the visceral sense of waking up in an alternate timeline with a deep, bodily knowing that something isn’t right — but having no clear idea how to fix it. It’s reading an article about childhood hunger and genocide, only to scroll down to a carefree listicle highlighting the best-dressed celebrities or a whimsical quiz about: ‘What Pop-Tart are you?’”

That image — the absurdity of scrolling between horror and whimsy — captures so clearly the dissonance of our time. It’s not just unsettling; it fractures us. It leaves us holding two truths at once: what we feel in our bodies and what the world insists we perform on the surface. And what Rahaf describes — the fracture of holding horror and whimsy side by side — is not just cultural. It’s also deeply psychological.

Decades ago, the psychoanalyst Donald Winnicott gave us some of the theoretical frameworks, but more importantly, the language that helps us see what’s happening both individually and collectively today through his concept of the true self and the false self. The true self represents authenticity, vitality, and our inner sense of aliveness. The false self is the mask we create to adapt, to comply, to perform in environments that feel unsafe or unresponsive. Winnicott’s framing helps us see the individual and collective toll of hypernormalization. It shows us how entire systems can push people into living through a false self by masking, adapting, and pretending just to survive within distorted realities.

And this is where it becomes difficult. Because facing that truth and really naming it creates discomfort.

• Discomfort in recognizing that what we’ve accepted as “normal” is sometimes a deeply distorted reality.

• Discomfort in noticing the ways we’ve been performing a false sense of self just to get by.

• And discomfort in admitting that the systems we’ve built and upheld are not always meeting the needs of the people they are meant to serve — and that these same systems we might be working within may be betraying us.

But discomfort is not always the enemy. It is often the teacher. So I want to ask us: Can we sit with this discomfort long enough to imagine new ways of caring? Not to rush past it, not to numb it, not to scroll away from it and self-identify with Pop-Tarts, but to stay present with it, so that new possibilities and opportunities for care can actually emerge.

This discomfort isn’t abstract — it points us directly to the heart of the question I came here to raise. When I first wrote this talk, I thought I had an answer. But over these past months, the truth is it has become less a declaration and more a question. As the world continues to fracture, and as we deepen into this conversation about hypernormalization, false selves, and discomfort, it no longer feels right as a statement. It feels more honest and more urgent as a question: How will we care for the public?

How will we do this in ways that resist false selves, refuse hypernormalization, and center the trauma-informed service design we know is possible? This is the question I want us to carry forward together for the rest of this hour.

Care as infrastructure

For too long, our systems have been designed for compliance, delivery, and control. The guiding, silent (and rarely spoken out loud) questions have been: how fast can we move people through? How many forms can we process? How much efficiency can we squeeze out of the system?

But the truth is, working in these ways without care is actually cruelty. And people feel it. Systems are fraying. Trust is eroding. People are crispy. And yet, this is also a moment of possibility.

We can choose to keep doubling down on efficiency at the expense of dignity, or we can step into the harder, braver work of redesigning these systems with care as the foundation. That’s the crossroads we face.

So how do we meet this moment? For me, it comes down to three things we have to hold at once: reality, hope, and elevating care as infrastructure.

The reality is that our systems are fractured and people are hurting. The hope is that they can be otherwise — that change is possible, and we’ve seen glimpses of it. And the bridge between reality and hope is this: treating care not as a soft idea, but as hard infrastructure.

Budgets, contracts, delivery models — these should all measure care as rigorously as they measure cost or product delivery. Care is not a sentiment. It’s an operating system. And it belongs at the center.

Trauma as a context for design

Writer and somatic practitioner Peter Levine reminds us:

“Trauma is perhaps the most avoided, ignored, belittled, denied, untreated, and misunderstood cause of human suffering.”

And yet, this is the backdrop against which people engage with most government and public services. Most people don’t come to government during calm, easy moments of life. They come when they’re already vulnerable—after a loss, in a moment of crisis, or a period of instability.

So if trauma is the context, then design must account for it.

A project led by Aviva Oskow, formerly of 18F, with the Department of Justice Civil Rights Division —civilrights.justice.gov — offers one example. People who visit that portal are often already in crisis: hurt, scared, or searching for help. The team unified a messy, confusing intake process; centered empathic language and transparency; examined internal workflows and staff experiences; and prioritized accessibility and inclusion. The results tell a story of what’s possible: fewer backlogged complaints, more usable submissions, faster triage, and clearer pathways.

Trauma-informed principles are not abstractions. They live in how we structure workflows, write content, anticipate emotional realities, and build systems that reduce harm and foster trust.

The core principles remain the same: safety, trust and transparency, peer support, collaboration and belonging, empowerment and choice, cultural and historical responsiveness — and, explicitly, hope. These are not theoretical. They are design principles.

None of this is part of a checklist. Rather, it’s a way of working, a way of being, that demands care in every step of the design process.

From throughput to trust

If trauma is the context, then trust is the outcome we must design toward.

We can see this through frameworks like the Berkana Institute’s Two Loops Model of Change. It reminds us that systems rise and fall while new ones quietly emerge beneath them. Our job, as designers and public servants, is twofold: to hospice the decline of harmful systems and to nurture the emergence of care-centered ones.

This is not overnight work. It is long, patient, collective work.

I use a simple decision-making matrix almost daily, influenced by the Design Justice Network:

• Who benefits, and who is harmed?

• Does this align with my values?

• Could I justify this decision publicly?

• Are there alternatives that center care and fairness?

• What accountability, visibility, and responsibility measures are in place?

These questions slow us down intentionally. They prevent us from designing harm — intentionally or unintentionally — by default. They form a compass, not a checklist, helping us orient in the complexity and urgency of public service design.

What we can carry forward

What we need now are trauma-informed civic care interventions that go beyond digital services —beyond websites, portals, and platforms. We need interventions that shape culture itself, that remind us of who we are to one another, that expand the public imagination of what care looks like.

This is why I believe we need something much bigger: a global code of care. Not a checklist, not a one-time initiative, but a shared set of commitments that guide how we build and deliver public services — and how we hold each other accountable.

Imagine if care were as recognizable a civic symbol as a flag, a logo, or a slogan. Imagine if we carried it across sectors, across borders, across governments. What would it look like if our interventions — cultural, civic, and systemic — were guided by a global code of care?

I want to show you an image and ask if anyone recognizes this person? This is Milton Glaser. One of the most influential designers of the twentieth century. And the creator of something you have all seen, even if you don’t realize it came from him.

Glaser was the mind behind the "I ❤ NY" campaign. Now, at first glance, “I ❤ NY” is just a logo. Just three letters and a heart. But in the mid-1970s, New York was in crisis. Crime was up. The city was broke. Tourism had collapsed. And the public mood was quite dark. What Glaser sketched in the back of a taxi was more than a design — it was a true civic intervention — a cultural gesture that helped shift how New Yorkers saw themselves, and how the world saw New York.

It was a reminder: this city had value. That the people had value. I was in NYC just last week and this logo is everywhere. Literally everywhere. At the time of its creation, it was the ultimate expression of care for the New York public. It was a demonstration of the power and influence of design for the public and the power that design can have when it engages not just with systems, but with the civic imagination in a given moment in time.

But years later, just before his death in 2020… Glaser also offered us a critical warning. He said:

“In the world of advertising and marketing, they don’t regard the public as anything except a large mass to manipulate into buying something they don’t really need… That’s why the question of what is my effect on the public has to be raised now more than ever. It is too dangerous to ignore it.”

When he said this in 2019, we were in a similar moment in time as we are now. I want you to consider: What is your effect on the public? As Glaser said six years ago, this question is too dangerous to ignore. Glaser was reminding us that design – in all its shapes and forms – always leaves an imprint on culture, on identity, on public life. 

Which is why, as we close, I want to return to where we began: care. If a logo could reshape the story of a city fifty years ago, imagine what care, as a civic intervention, could do. Imagine if our civic interventions were on and with dignity. Imagine if what we designed was healing? 

I know that the work of trauma-informed design extends beyond government services. It is often about reshaping organizational culture itself. In government work, it is about building civic care into the very fabric of our societies. As public service designers, we cannot afford to be neutral on this critical topic. We cannot ignore our effect on the public.

Which means the question we leave with is this: What would it look like if our next great civic intervention wasn’t about efficiency or technology or product delivery — but about care?

Care that is public. Care that is with the public. Care that is our shared responsibility.

Closing reflection

This keynote was not simply a call to add more compassion into service delivery—it was a call to redesign the foundations of how we build and sustain public systems. Care, when treated as infrastructure, becomes a framework for accountability, trust, and hope. It challenges every assumption of neutrality and efficiency that has shaped public service design for decades.

My hope is that these reflections serve as an ongoing invitation to designers, policymakers, and practitioners alike to reimagine what public care can look like when we take it as seriously as we take budgets, policies, and technology.