Closing the Gap Between Research and Practice in Trauma-Informed Pelvic Health

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About the Guests

Are you a patient who has received pelvic health care and is interested in contributing to the development of trauma informed treatment guidelines?

Researchers at the University of Calgary (led by Dr. Lauren Walker, RPsych), have been developing trauma informed care guidelines for pelvic health care with a group of multi-disciplinary health care professionals and patients who have experienced trauma histories and accessed pelvic health care. We are now seeking feedback on a proposed draft of the guidelines. The guidelines are meant to inform providers from a variety of backgrounds including gynecology, urology, oncology, family medicine, sexual health, pelvic floor physio and midwifery. 

We are currently seeking feedback on these guidelines from patients who have received pelvic health care in the past 5 years, who also have a history of experiencing medical or sexual trauma. The survey should take about 15-20 minutes and is best completed on a computer. The survey is approved by the Conjoint Health Research Ethics Board. Thank you for considering participating.

https://survey.ucalgary.ca/jfe/form/SV_blxt6lzKwuUo6uq?Q_CHL=qr

Would you like to contribute to the development of trauma informed guidelines for pelvic medicine?

Researchers at the University of Calgary (led by Dr. Lauren Walker, RPsych), have been developing trauma informed care guidelines for pelvic health care with a group of multi-disciplinary health care professionals and patients who have experienced trauma histories and accessed pelvic health care. 

The proposed guidelines have been contributed to by a multi-disciplinary team of 20 providers representing gynecology, urology, oncology, family medicine, sexual health, pelvic floor physio and midwifery. The team is currently seeking feedback from health care providers from these backgrounds about the proposed guidelines including practices and potential barriers and facilitators to implementation of these practices. 

The survey should take about 15-20 minutes and is best completed on a computer. The survey is approved by the Conjoint Health Research Ethics Board. Feedback to date has suggested

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Transcript

Intro:

New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL than sex, peeing, and poop? But here's the question. What does it take to become a successful, fulfilled, and thriving OT in pelvic health? How do you go from beginner to seasoned and everything in between? Those are the questions and this podcast will give you the answers.We are inspired OTs. We are out-of-the-box OTs. We are Pelvic Health OTs.I'm your host, Lindsey Vestal, and welcome to the OTs in Pelvic Health podcast. 

Lindsey Vestal

Welcome everyone to the OTs and Pelvic Health Podcast. I am so excited to be joined by three other guests today. And I think that there's one thing that I believe all three of us absolutely agree on, and that is approaching pelvic health through a trauma-informed lens is absolutely essential.

So essential that one of my guests today, Lara DeRosier and I actually created the only certification program out there addressing both pelvic floor and trauma. Welcome, Lara.

Lara Desrosiers

So great to be here as always, Lindsay. Thanks for having me. I'm so excited to have this conversation.

Lindsey Vestal

Amazing. Another one of our guests, Krystyna Holland, author, ah does so many other incredible things, but she was actually on our faculty for our certification program. So welcome, Christina. We're so happy to have you here today.

Krystyna 

Hi, it's always so nice to see and see everyone here. So thank you so much for having me.

Lindsey Vestal

Awesome. And lastly, we have Lauren Walker. Lauren Walker is a clinical psychologist and she's on faculty at the University of Calgary. Lauren, I'm so happy to meet you and welcome to the podcast.

Lauren

Thank you so much for having me. I'm so excited to talk about this topic with all of you well-informed folks.

Lindsey Vestal

Amazing. So I think we want to kick it off a little bit talking a little bit generally about trauma-informed care. We'd love to hear from both of you. What, from your perspective, why is trauma-informed care so important when working in pelvic health?

Krystyna 

Lauren, do you want to take that? 

Lauren

Yeah, Who wants to take it away?

Lauren & Krystyna
(Laughing)

Lauren

Well, maybe I'll just, I'll chat a little bit about how I came to find Christina. So Christina and I met online when I found that she was the person on the pulse of what is trauma-informed care in pelvic health. So she'll give you her perspective in terms of why it's important. But as a clinical psychologist, I just always see patients and clients who are coming to me for sexual concerns, for pelvic concerns related to women's health, these kinds of issues who have complex histories and they experience a ton of distress and they're avoidant of going to appointments and they're worried about it. And when they go, they kind of push through and they hope they can get through the experience. And I really work with them to try to help them prepare so that their experiences can be more effective and more efficient. So that's one of the angles that I take really as the psychologist trying to help people work with their distress.

Krystyna 

Yeah, as someone who works with a lot of folks who have persistent pelvic pain, i think it's incredibly important for us to consider trauma-informed care and pelvic health because I think oftentimes what we're missing, if we're missing the trauma-informed care component, is we're actually not getting as good of outcomes as we could be otherwise when we start thinking about how the nervous system as a whole impacts an individual's pain experience and then you know additionally, how trauma and people's lived experiences impact their nervous systems. So one, just from a clinician place from and from a patient satisfaction place, patient outcomes is a huge one, but also because what I found in my own experience, both as a clinician and also as a patient, is I was noticing the ways that not having trauma-informed care was negatively impacting me in and of itself. 

So I was someone who had experienced harm in the medical system and it made me, it really opened my eyes to the idea that clinicians, even really well-meaning, really brilliant, like clinically savvy clinicians could be doing harm to their patients. And I didn't want to be a clinician who was doing that. So I think that is another like huge reason that trauma-informed care is so important, especially in the public health space.

Lauren

And can I just chime in, Krystyna, you talked about being both the patient and the provider and how your experiences are improved. And I think that's true for both of those categories. The patient's experiences are improved, but also I think as a provider, you feel better when you're offering care that seems like it's meeting the patient where it's at versus having a patient leave that is in distress, they're upset, they're not comfortable with what's being done. And so I think it actually helps clinicians have better experiences too.

Lara Desrosiers

I love that so much. I think it highlights like one of those key tenants of trauma-informed care, being able to kind of approach our clients with that curiosity and meeting them where they are at. It's a it's a totally different mindset shift from a lot of our medical model of fix it, right? Like, and and then we have the pressure on our shoulders as providers to fix it. I take so much of that, that pressure off, right, of us as well.

I'm wondering with that in mind, if you could both kind of give us a sense, it's such a broad thing to define, but in a nutshell, what trauma informed care is all about from your perspectives.

Krystyna 

Yeah, the the main kind of thing that I'm always thinking about when I am going into any sort of patient interaction or thinking about trauma-informed care and like, how do i how do I make this really practical and really kind of hold myself accountable to what I'm trying to do here is what is the potential that I am currently doing harm to this patient and what am I doing to be intentional about mitigating that harm? So that's kind of my question.

Those are the two questions that I'm constantly asking myself when I'm asking myself, am I doing this in the trauma informed way or in the way that I'm trying to take care of this patient?

Lauren

One of the things that I think is so important is really examining the lens through which we're approaching our relationship with the patient. So I think that, again, what we're trying to do with our education around trauma-informed care is really come up with practices that are truly relevant across disciplines. And each different discipline of provider has such a different take on how embedded trauma-informed care is within their practice that And so really taking ah like patient autonomy as a number one facet of care, really, that patients are able to make their own decisions. They have good reasons for the decisions that they're making. And even if the provider doesn't agree that that might be the best decision for the patient in terms of a medical outcome, it still may be the best decision for the patient in terms of what they value or what they're capable of or interested in doing. So I think patient autonomy is so important.

And that really speaks to the role of how we value mutuality and how we value collaboration in our care with the people that we're serving.

Lindsey Vestal

Yeah, beautiful, beautifully said, both of you. One of the reasons why we were so excited to have this conversation with you today is your research. You both are doing some pretty groundbreaking work out there, both from the clinician side, as well as the actual client perspective. Tell us a little bit how this project came to be and how pelvic health OTs can get involved and support it.

Lauren

Absolutely. I'd love to talk about some of the origins of this work. It feels like it's been a few years now that Krystyna and I have been championing this initiative. It actually all started in a conversation that I was having with the members of the gynecological oncology team that I work with. So my faculty appointment is primarily in the oncology department at the University of Calgary.

And we were chatting about how can we better improve the care that our cervical brachytherapy patients are receiving. So these are patients who are having internal radiation administered to treat their cervical cancer. And they're often admitted for several days, and it's very uncomfortable. And during COVID, they weren't allowed to have support persons in the room with them. And so it was just really quite a challenging experience. And many of these patients were experiencing post-traumatic stress after their admission. And we thought, how do we make care better?

So a very specific niche area. And it led me to reach out to Krystyna as she was doing such incredible teaching and work in trauma-informed care. And trainings for healthcare providers. And I thought maybe we could get her to come visit and and do a lecture for our team. And I asked her what resources I could be using to help support our team. And essentially, we realized that there is a bit of a lack of some of those resources. And so after putting our heads together for

A few conversations, we realized this is actually really relevant in so many different areas of care. This is not just an oncology thing. This is not just a gynecology thing. And then, in fact, if we worked together, we could probably come up with some helpful resources for all different types of practitioners who are doing sexual, pelvic and reproductive health and medicine. So that was really the start of it all. And we can get into a bit more details about the different phases of the project as it's evolved over time.

But I'm not sure, Krystyna, what was it like for you for you know to kind of connect in this area?

Krystyna 

Yeah, I think my exact response to you was something to the effect of, you know, I have been looking for resources. I have been unable to find them. The things that I've been talking about online and the things that I know about trauma-informed care are largely from experiencing my own medical trauma. And I cannot, in good faith, recommend that as a strategy. 

So that was my beginning into trauma-informed care was that my own experience as a patient that happened actually while I was in PT school. So I was really in this space of really examining and thinking about what I wanted my practice to look like. I was actively learning about being a clinician while also actively you know experiencing what it was like to be a patient. And from that place,I, it took me a while to realize that i was in fact what I was experiencing part of why I was having a hard time is that I had had medical trauma and it was affecting my nervous system and all the ways that that then was impacting my own symptoms. 

And so I got really, I got really curious and when I get really curious I get really nerdy and so I just kind of did a deep dive into what existed about trauma and pelvic pain and there just wasn't that much at the time. 

A lot of the the information, resources, academic literature that existed around trauma-informed care at the time at which I was starting this to have this conversation and really, like again, i was kind of shouting into the void of Instagram just because it was something I was spending a lot of time thinking about, was from the mental and behavioral health space. And I just couldn't figure out why there was so much literature in that space. And it had not made it in any way that I could tell into the physical therapy field that I was in, let alone specifically the pelvic health field. And that just really kind of boggled my mind. So that was kind of what it was like when Lauren reached out to me. I was one very, it felt very validating where I was like, oh, okay, this is great news that you also see this problem. And that thus far, I haven't really put my foot in my mouth, I guess. So that's was all very positive for me.

Lara Desrosiers

It's so great to hear kind of where the research came about and your own experiences and what brought you to it. I can say it from my perspective in starting my practice as someone that does not do any hands-on internal work, I found it really interesting that I started to attract clients that had a trauma history and saw that as, as something as a positive, right. As something that, felt safer to them, that that wasn't going to be an option and started to talk to more physiotherapists around my area. and one of the things that boggled my mind was, trauma-informed care was sort of thought of as something that was nice to have, but not a need to have, right? And so i I just resonate so much with what you said, Krystyna , because it really kind of boggled my mind as well.

I'm curious, because I'm so excited for the research that you're doing. And when I filled out the surveys, it was. Such a great learning experience. it For me, some of the the suggestions or the things we might want to think about that were even in the study as I went through it, there were things that I hadn't considered. And they were so very practical and things that I thought would be so easy for healthcare providers from different settings to be able to implement.

So I'm just curious, again, wanting to hear more about your research and really encourage our listeners here to get involved, fill out those surveys for themselves. What perspectives were you really keen to gather in creating some of those trauma informed recommendations?

Lauren

I'd love to give you a little bit of a background of the process of developing this research study. So it started out with Christina and I putting our heads together and coming up with a list of things that we thought were principles or practices, actual operationalized practices and clinical skills that would be important to be used in pelvic health care. And I think between the two of us, we came up with two or three pages of suggested bullet points.

And then what we did was we branched out to a larger team of multidisciplinary professionals. So we had representatives from gynecology, urogyne, urology, gyne-onk, rad-onk, midwifery, pelvic floor PT, labor and delivery, nurses, as well as sexual assaults response team. So we have this group of 20 providers, we really tried to think of anyone that we could.

And then I learned more about pelvic floor OT. So we tried to get a broad perspective and we had them develop more ideas to add to the list, revise, change the things that we had created.

And I think we ended up with at least double, if not triple, the amount of information that the two of us had originally come up with. So it was so great to have all these different contexts and insights.

What we ended up with was nine different categories of trauma-informed applications.So ranging from how you set up your physical space to how you introduce and engage the patient, even in the waiting room, to how to talk about what examinations or procedures might be necessary or options.

And then really looking at how someone's trauma might interplay into those procedures or expectations for the visit, as well as how do we document care. So really, we talked a little bit before about that autonomy and and being able to choose or refuse treatment without it being pathologized. 

And then we also talked about how do we ask patients about trauma and how do we respond to them when they do disclose trauma? So those were eight categories that came exclusive. Well, those came through a lot of our providers. And then we also did a simultaneous study where we were interviewing patients about their experiences. 

So folks who had had a trauma history, who had had some kind of pelvic health care in the last few years, and And we did semi-structured interviews with them. And all of the advice and suggestions they gave aligned quite nicely with what our providers had said, except they also suggested a whole category on self-reflection and providers being able to look at what kind of practices they were engaging in and how they were thinking about their patients and care. And I thought that was really interesting that that was only something that our patients had actually suggested.

So to kind of give you that overview, we had a group of 20 providers, we had the patient interviews, we came up with this consolidated set of, I think, quite comprehensive guidelines or recommendations.

And then now we're in a stage of getting feedback from both providers and patients. So we have a survey available where we ask folks to lay eyes on each of those nine categories and to give us feedback about whether we're on the right track. Are these things important? What are the barriers that might get in the way? And should they be revised in any way? And so really trying to get some insights from those different disciplines and from the patients themselves about whether this could be a helpful clinical tool.

Lara Desrosiers

Where are you hoping to see these recommendations go? I know there's such this chasm between research and how do we get it translated into practice so that we see this happening more consistently in different spaces. What do you both envision and hope for the outcome of this incredible work that you're doing?

Lauren

I'll give more of the kind of formal response of where I see the project going in terms of end points. So throughout this, it's been such an interesting experience for me as a psychologist to engage all these different disciplines and all these different organizations and bodies that are helping to pull these fields together and lead them in terms of expectations and provide guidance. 

And so I've been learning so much about, you know, even within one specific discipline, there might be you know, five or six different subspecialties and different organizations. And so long term, what I'm hoping is that once we have the data to show that we're on the right track, that these guidelines and recommendations are useful, and that people who know something about this topic, agree that it's valued, that we'll be able to publish this and then we'll have a really reliable evidence-based source to refer to. 

And then I'd like to work with these different organizations in partnership to take these suggestions and this clinical tool into practice. So I would need, you know, again, champions from each of these different organizations to be willing to say, hey, like this, maybe there's some modifications still or some ways to apply this more specifically to their context, but to then take that on and and share that and disseminate that with their group.

Krystyna

Yeah, Lara, one of the things that I have been consistently struck by in the process of doing this research is kind of back to what you said around trauma-informed care still being something considered a nice to have instead of a need to have.

And the way that we talk about trauma-informed care. I think there is still this conception this misconception that trauma-informed care is like a personality trait or it's a set of soft skills or it's something that people like you're born with it or it's something that is touchy-feely and floofy and nebulous. 

And I just don't believe that. I think trauma-informed care skills are hard clinical skills. They are clinical checkoff skills. And that's what we're trying, what we've been trying to do in order in, as we've operationalized this list of them. And so my like big, big hope is that I would love to do some sort of experimental design that shows potentially, or atleast that explores what impact trauma-informed care practices have on patients and also on providers, because I really want to see this exists in the literature in order to sort of combat this ongoing narrative that trauma-informed care just isn't that important from a clinician's side, which I could not believe less. So that's where I'm hoping that it goes. That is obviously an extended, a very extended timeline of research and things that have to happen. And I think for sure that there is so much that can be done before that in terms of getting, as Lauren was saying, these organizations. And I do feel very lucky that as we've done this project, I have become aware of more organizations and kind of gotten to see how professional organizations care for both their members as well as the patients of their members. And it's been cool to see that sort of like professional development, professional um kind of like pushing the profession forward perspective. And so I am really, we're really looking for organizations who are looking to do that to get involved with ultimately disseminating this information.

Lara Desrosiers

Amazing. It really ties it back to, Krystyna, to what you said at the beginning around why it's important. The outcomes, right? Like that we want to have some data to actually demonstrate trauma informed care does lead to better outcomes. I really love that vision as a next project.

Lauren

The other thing I would add to what I've been dreaming about doing, and again, this is all very resource intensive, and I've learned through this project that as much as you set a target and you think you might be done by this date, it's always evolving.

And so, you know, we're continuing to develop ideas about where we want to see this go. And I would love to develop curriculum that is truly interdisciplinary.

So again, as I've chatted with these different groups, I know in Canada, there's the Canadian Association of Midwives has a really great tool online that they use for a lot of their continuing education.

And I know your group, Lindsay, on Facebook, there's a lot of really great resources there. And I would like it to be not something that we have to reinvent the wheel in each of these different organizations.

Yes, there are some specifics, for example, you know, inpatient considerations may be only relevant to some practices and not others, but I'd love for the content to be something that is relevant.

We make videos, podcasts, demonstrate how to conduct exams, even in ways with trauma-informed care practices. we've got We've been developing some infographics to share some of the material from our list of recommendations.

So I'd love to have like a hub where all of this content can live and then different providers and organizations can kind of sponsor or partner with the hub.

Lindsey Vestal

I'm curious, so for everyone listening to the episode who is like on the edge of their seat, they're so excited to help, to get involved in this ongoing mission. What are some ways they can, I know you guys have the survey that's open right now. Can you tell us a little bit more about that? I'm certainly going to link to it in the show notes, but for the sake of timelines and everything, let us know when you plan for it to be open through and how we can get involved.

Lauren

Yes. Amazing. So we have two ongoing surveys right now. The patient oriented survey. So the one where we're trying to get individual patients experience feedback on the guidelines. That is just launched brand new. So that will probably be open for the next year would be my guess. So we would love people to refer your patients or we have little postcards that can be printed off. We can send some out as well if you have a bulletin board in an office and you want to put that up or if you have social media and you want to share that more broadly on your story and link to our survey. The practitioner-oriented survey has been ongoing for a year, and so we're coming closer to the end of it.

But I anticipate that will be open through the winter this year. So perhaps March might be our kind of final deadline there. So we do have a few more months to get our practitioner input.

Lindsey Vestal

March, 2026.

Lauren

Yes, thank you.

Lindsey Vestal

Perfect. Yeah. so all of that will be in the show notes. That's fantastic. In thinking about this journey that you both have been on, and this may be a hard question to answer because it's kind of one of those summary questions that are are always challenging, but What would you think some of your top practical tips for really optimizing safety and comfort in the care we provide that anyone listening can put into practice today?

Krystyna

Yeah, I think going back to what Lauren said about patient autonomy and the way that I think about that very practically is if this were me, as ah even as someone who has experience and as a provider, what information would I need in order to make a decision? What information would what questions might I have?

What insecurities or fears might I have? What are the potential negative effects of any of these clinical decisions that can be made kind of on my behalf or in regards to my own medical care? 

And then how can I take that information of you know this big list of stuff that I would need to note in order to make a good decision for myself, and how can I interpret that in such a way and give that information to patients in such a way that they can utilize it the same way or maybe in a different way than I would, but in order to make their own decisions for them. 

What am I doing then as a clinician in order to facilitate the patient's understanding of whatever we're talking about, of whatever their potential medical options are in terms of what my concerns are or for the risks of either doing a particular procedure or intervention or not doing that procedure intervention. And how am I comun am i communicating those things clearly to patients in ways that are not biased and also very clear?

Am I taking into account their values? Am I asking them about what time they have available? What things they're worried about? What things they're excited about? Basically, just how, what things would I want to know for myself if I were making an important decision about my health or if I were helping, as an example, a family member make an important decision about their health or health care? And what, how am I interpreting that information for the patient in front of me?

Lauren

So, so good. So important. I'm also struggling with like, where, you know, what do I want to summarize this down to? Because there's so many really important things.

I'm drawn to some of the the comments I've got, i have received from other providers who are maybe a little bit hesitant. And so I'd like to address those. So for some providers, I think there's a bit of fear. I don't want to ask the question,

whether there's a trauma history here. I maybe don't want to make the patient uncomfortable. I don't want to force them to disclose. Or if they do disclose, I won't then know how to address all of that or package it all back up again and send them on their way because I can't resolve that issue for them.

Or maybe even the provider's a little bit uncomfortable about their own experiences, right? That they maybe have had histories that They hear a patient describe theirs, and now that's triggering.

So I think one of the really important things is recognizing that trauma-informed care is a universal approach. We do not need to ask patients if they've had trauma.

We can just assume that most people have probably had some kind of a difficult or distressing experience that could be affecting them. In your office or clinic today. And so one of the things I like to do is use more of a generic question. Like, is there anything that would be important for me to know about that might make your care experience better today?

And then it gives people an opportunity if they do want to say something more specific, I have this experience. They can, but I also don't think you need to provide a ton of detail. You can say, look, what is it about that experience that today in this room might be useful for us to consider? Can we put this strategy in place or this strategy in place to make you feel more supported or more comfortable? And I think that also sets you up to know, you know, what are your expectations for the visit?

In many cases, you might have a bit of an agenda as a provider, but you may have to adjust that agenda or the pace at which you may address those items on your agenda. And the other thing I think is really important is phrasing and suggesting things as suggestions. Like these are options for us. You know, if you're interested in this, this is something we could do today or we could schedule this for a future visit or we could discuss this more rather than saying, you know, I see you're overdue for X. Let's do that today. Right. So really coming from a place of. This is an option and putting the patient in that place where they can make these choices, they're not feeling coerced or pressured by what you might think is best. So those are two of the kind of take homes I have for me. And I think that it protects not only the patient, but also the provider again, from navigating things that they may feel they don't have time to address, or they may feel ill-equipped to address, for example.

Krystyna

Just that made me also think about the other thing that I think, especially in doing this work that can be challenging as a provider, is it can be really frustrating when you make suggestions to patients that you think will be helpful to them and they don't take them. And it can be frustrating, especially if patients are not seeing the results that they want to see for themselves, that they're not seeing the results that you want to see for them. And I think one of the gifts that trauma-informed care gives is it helps to reframe the, again, what you had said earlier, Lara, about like, I'm a fixer. um I'm not a fixer. I am a shepherd maybe, but I'm more of an interpretation, a mechanism for all of the things and sort of an introducer to all of the things that we can do.

And then you and I together can make decisions that are going to best support your goals with what I know. and then I can interpret for you so that now you know all the things that you need to be able to in order to to get the results that you're looking for.

And I think just as a provider, that takes such a weight off of my shoulders of like, if this patient makes a decision that isn't necessarily the decision I would make for myself or isn't necessarily the decision that I would make for that patient, I am not responsible.

And not only am I not responsible for that, I'm actually  I know and feel a lot of peace in knowing that it's better that that patient made the decision for themselves than it would have been even if I would have picked something different for that patient.

Lara Desrosiers

Oh, so beautifully said. I love those key takeaways and their emphasis on like how we communicate, how we ask about trauma, because we as individual providers have so much agency over that, right, over how we show up.

And communicate in those ways or how we decide we're going to open the door for for trauma disclosures if the client feels it would be helpful or just provide universal care, which is something Lindsay and I both advocate for.

One of the questions that often comes up from our participants that take our Trauma-Informed Pelvic Health Program is that there is so much to, to the environments and the processes that clients go through from start to finish in terms of their care, where maybe they don't have all the agency or control over those parts of the puzzle.

And so one question that we often get is how do you respond to pushback from maybe employers or other or colleagues where you're trying to advocate for some of these changes, but the buy-in isn't there.

And so I'm wondering if either of you have any tips or strategies or things for our folks to consider in terms of how they might have those conversations with colleagues or employers.

Lauren

You know, I think it's really important to acknowledge that trauma-informed care is something that a practitioner can offer, but there's also a system that we're working in.

And I think we need trauma-informed care systems. And so we need to keep advocating for that. But I also think we work within limitations. And there are many cases in which we just don't have the power to be able to make decisions about certain things, particularly as some of the environmental considerations.

And what's going on in that physical context. Do you use paper gowns or do you use fabric gowns? you know What are the um sanitation procedures that you know the institution you work for guides?

And I do think that sometimes we're not gonna be able to get the change that we want to see. um And it's actually interesting, Krystyna and I had it quite a back and forth many times on the environment section of our of this set of recommendations, because we we wanted to say trauma-informed care practitioners do this, but we realized that what's more important is that they consider doing these things. And sometimes they may not be able to.

And I think that when we acknowledge you know, this may be less than ideal, or I would prefer if we could do it this way, but this is kind of the limitation I have. We're still acknowledging that. But that still is trauma-informed.

So while I do think we do need to advocate and and persist and keep asking for things, and there's more power when more voices ask, and both the practitioner and the patient if they're asking right like I often say when patients can advocate for themselves and I wish that they didn't have to I wish the system just did this um but that the the louder the patients are the more power the practitioners have to then leverage that with their administrators so I do think that the fight needs to keep you know we need to keep the pressure on but I also think sometimes it's

It's not possible. And so we acknowledge that that's something that I've considered and I would like, but I'm unable to do.

Krystyna 

And I think from a perspective of helping your patients, knowing if you're in a system, kind of like what the ladder is, what your organization chart is, what who you can talk to to advocate for things. I mean, part of why I'm excited about this research is getting it in the literature, I hope will be a tool that folks can use for advocacy. But also then being able to explain to your patients who they can talk to. so that their voices get heard up the ladder to the the rooms where people make decisions.

And then, and also that is even in itself, being able to explain to a patient like, hey, just so you know, I think it should be this way or I wish I could do it this way. It's a policy or whatever it is here in that this is kind of how, these are some things that I have to do or this is this is the situation. I totally get that that's not ideal. Is there anything that you think that you can think of off the top of your head that you and I might be able to do a little bit differently or anything like we can do to mitigate this, recognizing that these are the circumstances that we're working under? I think that's like some good scripting around having that conversation. But then being able, even just having that conversation with your patient, having the conversation with your patient around, hey, you do deserve this. I would love to see you advocate for it. Here's who you can talk to. That's a trauma-informed practice. 

So I think just being able to communicate you know directly and knowing what  your boundaries are, both your provider boundaries, but then also your broader system boundaries is really helpful.

Lindsey Vestal

Amazing. Such incredibly tangible points here that you all are making throughout our conversation. As we wrap up here, Krystyna and Lauren, are there anything else that you feel compelled to share with our listeners, either about our day in and day out work or regarding the bigger project that you guys have been working on for this research?

Lauren

Yeah, I wanted to just highlight something that came up at a meeting that Krystyna and I were at where we were presenting this to a group of other clinicians who were around the table with us. And we talked about how even folks who may know a lot about trauma-informed care, where this is really integrated into their practice, might learn something when they do this survey or they read through the recommendations.

And so I i know we were just kind of logging on and talking today, you both maybe mentioned some degree of, hey, I learned something.

Lara Desrosiers

Yes.

Lauren

Yeah?

Lara Desrosiers

Yeah, absolutely. There were certain pieces. I loved how practical it was. So I would definitely be a huge advocate to going in and participating in that survey for your own learning. Because it Lindsey and I always say trauma-informed care is a process. It's not a one and done. It's a process of ongoing curiosity and relearning and staying curious about how we can do things even better. The documentation section in particular for me was like a huge aha moment when I went through that section.

Lauren

Oh, that's awesome to hear. And I think the other flip side of that is that sometimes clinicians might feel like I read all this and there's maybe many things on this list that I'm not doing or I hadn't thought of. And so in no way is this supposed to be like, hey, you're not doing a good job.

You need to be doing more, but rather you're right, this is a process. And so just as Krystyna and I put our heads together and came up with the first sort of chunk of suggestions, there were so many more things that when the rest of the group of 20 people came together, that they came up with that we hadn't thought of.

And even now, I got an email from someone recently who said, hey, you know what?

I don't think there's enough about this topic in there. And so maybe we'll add a couple more before we publish. But the idea is we are always learning and being willing to learn and being curious is such an important part of that.

And we don't need to, you know, kind of criticize or judge ourselves for the care that we were offering five years ago or five months ago or five minutes ago before I read this document. So, you know, I really think that I want it to be an encouraging process rather than something that makes you feel like you're not doing enough.

Krystyna 

Yeah, I think that's so beautifully put. And it was really enlightening and also lovely to have that conversation around. We had a roundtable at one of these meetings and just to hear providers who really, really care, who are really doing the work and doing such a good job and to just to be able to tell them just like Lauren just told you know us and and your audience of like you are doing a good job the fact that you're paying attention the fact that you're being intentional the fact that you're thinking about these things that you're open to them you're doing a great job and also like and keep going let's let's keep making this better for um the profession and better for our patients and i think that kind of leads me into

what I would like to contribute, which is I have a big ask, which is if we can sort of, I would love it if everyone who listens to this conversation could, you know, share the guidelines or advocate for this in some way to both your immediate colleagues, but also your multidisciplinary colleagues. because it has it's gonna be a process. 

One of the things that I have been struck by is there we have received pushback. It has been more challenging in some ways than I had originally anticipated to get buy-in, even from providers in pelvic health. And so I think the way that we're going to be able to make the difference that we wanna see is by kind of joining hands and kind of gently nudging our people forward in this process so i just want to empower folks in order to do that and also to ask for it and thank you in advance for helping us all move all of our professions forward and in the name of safety for our patients and for ourselves

Lindsey Vestal

Exactly. Bringing a full circle. Exactly. For both parties involved. So this is everyone's call to go into the show notes.link, Check out the links, share them. You guys have plenty of time, plenty of time to do this because the clinician one is open through March, 2026. And it's at least a year from now for the client facing side.

So December, 2026. So I want to take you up on getting those QR codes and help you guys spread the word. We can't thank you enough for all of three years. I mean, I just can't even imagine all of the trials and tribulations and wins and celebrations and all that's gone into this process.

So thank you for A taking this on and B, for coming on today and sharing a snippet of it with us. We're so appreciative.

Krystyna

Well, thank you so much for having us. It is always such a joy to get to talk to you about this. And it's so nice. It feels, it really fills my cup and makes me feel warm that I know we have these shared values. And so thank you.

Lauren

Thank you for making a space both where it's such a validated area of care and where people can come and get equipped and learn how to provide trauma informed care.

Outro:

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group, OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to IG, Facebook, wherever you post your stuff, and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health podcast.