We conducted semi-structured interviews with 20 members who engaged in community-based effort to reverse overdoses using a smartphone-based app in an Eastern United States (U.S.) city. Drawing from feminist ethics of care, we identify how the caring practices of community members extend from administering a medical intervention to building trust and support between the care receivers and caregivers in the case of opioid overdose response. Contrary to the predominant patient-centered care paradigm, we emphasize community-centered care, which acknowledges the resistance of individuals and attends to reallocating caring responsibility and building relationships within the community. Our results highlight how trust intersects with social ecologies of care in the highly stigmatized context of opioid overdose and that trustful and less hierarchical relationships are critical sources of care for groups experiencing marginalization. We discuss applying harm reduction principles in designing health technologies for substance use disorders. We also discuss research and design opportunities for community-centered design for marginalized individuals and community caregivers.

The design of digital interventions for mental health often overlooks the foundational belief in one’s own self-worth and related ability to develop close relationships with others. Attachment theory explains these interpersonal aspects, which have long been associated with positive mental health outcomes such as resilience when faced with adversity. We report on generative interviews with mentors experienced in supporting youth, as part of design work initiated by community leaders concerned about the traumatic effects of gun violence and systemic racism on local youth. These community leaders wanted to extend their existing mentoring efforts through digital technology. We identified attachment theory as the best fit for helping us understand how mentors are addressing trauma among youth, in ways that can inform how we design in support of these relationships and communities. We introduce attachment-informed design as a set of design principles that represent a novel approach to digital mental health interventions.

Social media platforms exacerbate trauma, and many users experience various forms of trauma unique to them (e.g., doxxing and swatting). Trauma is the psychological and physical response to experiencing a deeply disturbing event. Platforms’ failures to address trauma threaten users’ well-being globally, especially amongst minoritized groups. Platform policies also expose moderators and designers to trauma through content they must engage with as part of their jobs (e.g., child sexual abuse). We consider how a trauma-informed approach might help address or decrease the likelihood of (re)experiencing trauma online. A trauma-informed approach to social media recognizes that everyone likely has a trauma history and that trauma is experienced at the individual, secondary, collective, and cultural levels. This paper proceeds by detailing trauma and its impacts. We then describe how the six trauma-informed principles can be applied to social media design, content moderation, and companies. We conclude by offering recommendations that balance platform responsibility and accountability with well-being and healing for all.

Robots are increasingly being deployed as security agents helping law enforcement in spaces such as streets, parks, or shopping malls. Unfortunately, the deployment of security robots is not without problems and controversies. For example, the New York Police Department canceled its contract with Boston Dynamics in response to backlash from their use of Digidog, an autonomous robotic dog, which sparked fears in the public. However, it is unclear to what extent affected communities have been involved in the design and deployment process of robots. This is problematic because, without input from community members in the processes of design and deployment, security robots are likely to not satisfy the concerns or safety needs of real communities. To gain deeper insight into people's perceptions of security robots - including both potential benefits and concerns - we conducted 17 semi-structured interviews addressing the following research questions: RQ1. What characteristics do people ascribe to security robots? RQ2. What expectations do people have about the function and role of security robots? RQ3. What are people's attitudes toward the use of security robots? Our study offers several contributions to the existing literature on security robots.

Change is an inevitable part of a parent's role, whether due to their child's development, family life, or external events. To understand the information needs of parents navigating change, we studied the effects of the COVID-19 pandemic as a widely experienced disruption in the lives of parents and children. We interviewed 16 parents about their caregiving experience as the COVID-19 pandemic collapsed boundaries between home, school, and work. In particular, we asked about adjustments to behavioral care, or the social learning, supports, and interventions through which children develop social and emotional skills. We focused on parents of children already receiving accommodations and behavioral support from their school, to understand how disruptions in these services affected the role of the parent in meeting their child's individual needs. Applying role theory and the Kübler-Ross change curve, we describe the coping mechanisms that parents used to navigate the stages of change, as well as the information needs that remained unmet, despite their efforts. We discuss how practitioner-initiated and parent-centered supports can be designed around the lived experience of change, by accommodating a parent's capacity to accept and use help at different stages.

Digital educational technologies have been employed in classrooms to collect students’ behavioral data in the hope of supporting teachers in identifying and correcting undesirable behaviors, which raises the concern of heightened surveillance in classrooms. We present a qualitative study of 20 K-8 teachers to understand their experiences and practices of using ClassDojo, a data-driven classroom behavior management intervention. Our analysis reveals a series of unintended socio-technical effects resulting from the use of ClassDojo in practice. In particular, the use of ClassDojo runs the risk of measuring, codifying, and simplifying the nuanced psycho-social factors that may drive children’s behavior and performance, thereby serving as a “Band-Aid” for deeper issues. We discuss how this process could perpetuate existing inequality and bias in education. With the goals of spurring future design and mitigating these unintended effects, we take on the reflexive-interventionist approach and propose three considerations for designing and using future educational technologies: 1) provide context, 2) expose bias, and 3) challenge and reimagine what is normal.

Older adults can experience significant changes to their social networks as they age, triggering changes in their social connection practices. In this paper, we extend research on older adults’ connectedness behaviors using a multimodal connectedness framing—that is, how they engage with others across platforms, devices, and modalities. Using the COVID-19 pandemic as a case study, we investigate how older adults navigate a major change or infrastructural breakdown in their social routines. We conducted a survey with 146 U.S.-based older adults (65+), and follow-up interviews with a subset of 23 survey respondents. Findings revealed the resilience and innovation with which older adults adapted their behaviors across multiple modalities to maintain social relationships and playfully connect with others in person and online. Using these findings, we propose that research on designing for aging extend beyond designing for connection in the smart home; we argue for a design agenda that prioritizes designing for smart relationships with the potential to persist across spaces via multimodal connectedness.

Abstract Taking an action research approach, we engaged in fieldwork with school-based behavioral health care teams to: observe record keeping practices, design and deploy a prototype system addressing key challenges, and reflect on its use. We describe the challenges of capturing behavioral data using both paper and electronic records. Creating records of behaviors requires direct observation, and as a result the record keeping responsibility is challenging to distribute across a care team. Behavioral data on paper must be transferred and prepared for reporting, both inside the organization and to stakeholders outside of the organization. In prototyping a computerized working record, we targeted user needs for capturing details of a behavioral incident in the moment. Challenges persisted through the transition from paper to our prototype, and based on these empirical findings over two years of fieldwork, we present five tensions in representing behavioral data in an electronic health record. These tensions reflect the differences between entering behavioral data into the record for intraorganizational use versus interorganizational use.

Today, teachers have been increasingly relying on data-driven technologies to track and monitor student behavior data for classroom management. Drawing insights from interviews with 20 K--8 teachers, in this paper we unpack how teachers enacted both care and control through their data work in collecting, interpreting, and using student behavior data. In this process, teachers found themselves subject to surveilling gazes from parents, school administrators, and students. As a result, teachers had to manipulate the student behavior data to navigate the balance between presenting a professional image to surveillants and enacting care/control that they deemed appropriate. In this paper we locate two nuanced forms of teachers' data work that have been under-studied in CSCW: (1) data work as recontextualizing meanings and (2) data work as resisting surveillance. We discuss teachers' struggle over (in)visibility and their negotiation of autonomy and subjectivity in these two forms of data work. We highlight the importance of foregrounding and making space for informal data workers' (in our case, teachers') resistance and negotiation of autonomy in light of datafication.

The goal of this study was to examine the work practices of behavioral health professionals with a view towards designing interactive systems to support their work. We conducted a qualitative workplace study, including in situ observations and semi-structured interviews, in a multidisciplinary clinic treating pediatric feeding disorders. This paper contributes a detailed characterization of clinicians' work practices and conducts a comparative analysis of three types of work: treatment, record management, and preparation work. We found that clinicians have a preference for taxing over tedious work. For example, they experience real-time data collection as more taxing but less tedious than retroactive data entry. Design efforts should balance the tension between addressing the taxing (data collection during meals) versus the tedious (manually entering data into spreadsheets). Although addressing the taxing improves within-routine efficiency, addressing the tedious improves overall morale. Further, we hypothesize that there is a rewarding or unrewarding quality to work that is dictated in part by its social, temporal, and clinical characteristics. We discuss conceptual and design implications for supporting clinical work, and highlight considerations unique to behavioral health.

Care coordination involves crossing boundaries to connect services in support of the health and well-being of an individual. In this paper, we describe how care coordination depends on the ability to develop a shared understanding of care goals and progress. A distributed group of professionals and non-professional caregivers need to share information to provide consistent and holistic support across settings. We conducted fieldwork comprising of 20 interviews and 51 hours of observation across three different programs focused on children's behavioral health. From this empirical investigation of practices used by distributed care teams, we generated a conceptual framework of shared understanding in care coordination. We identified barriers to shared understanding, as well as nine practices that contribute to its development via two key mechanisms: (1) building relationships across boundaries, and (2) sharing actionable information. We conclude with design implications for enhancing the collaborative practices of members of a care team to cross boundaries despite the barriers that are common in behavioral health and other contexts requiring complex care coordination.

Direct observation of behavior provides a unique type of data for reflecting on during a process of behavioral intervention. This study focuses on practitioners who specialize in operationalizing, recording, and monitoring behavior using data collection through paper-and-pencil or, increasingly, mobile computing. Applying an action research approach, we conducted fieldwork to understand observational data collection among practitioners providing children with special education support for behavioral needs. We present a model of collaborative data collection, which describes how practices are situated in the process of collecting data that are useful for reflection by teams of practitioners. We discuss how computer-assisted data collection could promote more systematic and rigorous practices, and design considerations for the collaborative aspects of collecting and reflecting on behavioral data. This study builds on research describing the practices of individuals who track their own behavioral data, and improves our understanding of informal documentation practices in organizations.

For some children, behavioral health services are critical in supporting their development and preventing adverse outcomes such as school dropout, substance use, or encounters with juvenile justice. Schools play an important role in identifying problem behavior and providing appropriate intervention, and these efforts are most effective when executed in collaboration with parents at home. However, home-school collaboration is difficult to achieve. In this work, we investigated lack of information sharing as a barrier to collaboration, through a qualitative study including observation, contextual inquiry, and interviews. We found that policies, processes, and tools for documenting behaviors in schools are implemented without significant consideration toward exchanging information with parents. Consequently, a lack of effective two-way information sharing tended to hinder collaboration and erode trust. Combining our empirical findings with evidence-based strategies for parent involvement, we discuss design opportunities for promoting collaboration toward positive behavioral outcomes for children.

When health services involve long-term treatment over months or years, providers have the ability, not present in acute emergency care, to collaboratively reflect on clients' changing health data and adjust interventions. In this paper, we discuss temporality as a factor in the design of health information technology. We define a temporal spectrum ranging from time-critical services that benefit from standardization to long-term services that require more flexibility. We provide empirical evidence from fieldwork that we performed in organizations providing long-term behavioral and mental health services for children. Our fieldwork in this context complements and provides contrasts to previous CSCW studies performed in time-critical hospital settings. Current literature shows a bias toward standardized records and routines in the implementation of health information technology, a policy that may not be appropriate for long-term health services. We discuss how the design of information systems should vary based on temporal factors.

Autism education programs for children collect and use large amounts of behavioral data on each student. Staff use paper almost exclusively to collect these data, despite significant problems they face in tracking student data in situ, filling out data sheets and graphs on a daily basis, and using the sheets in collaborative decision making. We conducted fieldwork to understand data collection and use in the domain of autism education to explain why current technology had not met staff needs. We found that data needs are complex and unstandardized, immediate demands of the job interfere with staff ability to collect in situ data, and existing technology for data collection is inadequate. We also identified opportunities for technology to improve sharing and use of data. We found that data sheets are idiosyncratic and not useful without human mediation; improved communication with parents could benefit children's development; and staff are willing, and even eager, to incorporate technology. These factors explain the continued dependence on paper for data collection in this environment, and reveal opportunities for technology to support data collection and improve use of collected data.

Recorded images of children's activities can be useful to caregivers and clinicians who need behavioral evidence to support children with autism. However, image capture systems for autism are typically complex and provide only a top-down, outsider's view. In this work, we assessed the use of cameras worn by children to record the context of their activities and interactions from their perspective. We used a technology probe to explore how this simple, parent-driven system could be designed for families to adopt in their homes. We present the results of a five-week field study with five families. The system helped parents to (1) see the world from their child's eyes, (2) increase their understanding of their child's needs when their child is uncommunicative, and (3) help them encourage their child's social engagement. We discuss how these systems can be designed and used to their full potential.

Energy feedback systems, particularly residential energy feedback systems (REFS), have emerged as a key area for HCI and interaction design. However, we argue that HCI researchers, designers and others concerned with the design and evaluation of interactive systems should more strongly consider the ineffectiveness of such systems, including not only potential limitations of specific types of REFS or REFS in general but also potentially counterproductive or harmful effects of REFS. In this paper we outline research questions and issues for future work based on critical gaps in REFS research identified from (i) a review of REFS literature and (ii) findings from two qualitative studies of commercial home energy monitors.

Visual schedules--the use of symbols to represent a series of activities or steps--have been successfully used by caregivers to help children with autism to understand, structure, and predict activities in their daily lives. Building from in-depth fieldwork and participatory design sessions, we developed vSked, an interactive and collaborative visual scheduling system designed for elementary school classrooms. We evaluated vSked in situ in one autism-specific classroom over three weeks. In this paper, we present the design principles, technical solution, and results from this successful deployment. Use of vSked resulted in reductions in staff effort required to use visual supports. vSked also resulted in improvements in the perceived quality and quantity of communication and social interactions in the classroom.

A significant focus in the United States recently has been to increase engagement and interest in STEM curricula, particularly among girls and underrepresented minorities [3]. In this work, we take an approach to teaching and learning that supports flexibility, experimentation, and play with technology. With this approach, we aim to make STEM curricula more comfortable and engaging for all types of children and teens, with a particular emphasis on lower socio-economic status female students. We designed and tested a computing course for middle school girls, and this work resulted in three best practices: hands-on work incorporating creativity through crafts into engineering and computing, the frequent presence of an audience to motivate engagement, and engineering-focused individual roles structuring group work. Pre- and post-surveys and exit interviews revealed significant changes in attitudes and an enthusiasm for engineering projects and careers as a result of participation in the course.

Interventions to support children with autism often include the use of visual supports, which are cognitive tools to enable learning and the production of language. Although visual supports are effective in helping to diminish many of the challenges of autism, they are difficult and time-consuming to create, distribute, and use. In this paper, we present the results of a qualitative study focused on uncovering design guidelines for interactive visual supports that would address the many challenges inherent to current tools and practices. We present three prototype systems that address these design challenges with the use of large group displays, mobile personal devices, and personal recording technologies. We also describe the interventions associated with these prototypes along with the results from two focus group discussions around the interventions. We present further design guidance for visual supports and discuss tensions inherent to their design.

In this paper, we present a study of responses to the idea of being recorded by a ubicomp recording technology called SenseCam. This study focused on real-life situations in two North American and two European locations. We present the findings of this study and their implications, specifically how those who might be recorded perceive and react to SenseCam. We describe what system parameters, social processes, and policies are required to meet the needs of both the primary users and these secondary stakeholders and how being situated within a particular locale can influence responses. Our results indicate that people would tolerate potential incursions from SenseCam for particular purposes. Furthermore, they would typically prefer to be informed about and to consent to recording as well as to grant permission before any data is shared. These preferences, however, are unlikely to instigate a request for deletion or other action on their part. These results inform future design of recording technologies like SenseCam and provide a broader understanding of how ubicomp technologies might be taken up across different cultural and political regions.