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This week, I’m thrilled to introduce you to Cassi Starc, a top-tier occupational therapist from Vancouver Island and the founder of
YouFlourish. Cassi is leading the way in helping clinicians bring trauma-informed care (TIC) into practice—not as a theory that sits on the shelf, but as something clinicians become intentional about and as something clients actually feel in the room with us.
Below, she shares a story from her own clinical practice, ties it to new research, and offers some practical steps you can use on Monday morning.
Thanks Cassi. Enjoy everyone!
Hey all, Cassi Starc here 👋
Let’s start this Friday 5 off with a story from my practice.
🧹 I was working with a client living with chronic pain after a motor vehicle accident. Alongside her pain, she was still experiencing trauma symptoms that made everyday activities, like vacuuming, a real challenge.
✅ We decided to try graded exposure (a trauma-informed framework that differs from graded activity). Before starting, I explained what it was, why it worked, and shared examples of how it had helped others in similar situations. Most importantly, I made it clear that she was in charge—choosing what to try, for how long, and with full permission to change her mind at any point.
🎉 From there, we built her exposure hierarchy together and picked vacuuming as the first focus. She succeeded where more traditional exercise simulation and graded activity had failed.
Can you spot the five TIC principles—safety, trustworthiness, choice, collaboration, empowerment—woven through that process?
Heywood and colleagues (2024) took a close look at physiotherapy practice in a large Australian hospital and mapped what they saw against the five trauma-informed care (TIC) principles:
safety, trustworthiness, choice, collaboration, empowerment.Here’s where things stood:
- Safety 🛡️ → Physiotherapists were approachable and attentive, which supported interpersonal safety. But “safety” was mostly viewed as physical (fall risk, mobility). Psychological and emotional safety, things like privacy, pacing, and acknowledging difficult emotions, were rarely addressed. A consistently upbeat, “cheerleader” approach sometimes shut down space for discomfort or distress.
- Trustworthiness 🤝 → Touch was a reflexive “go-to.” While often professional and caring, it wasn’t always explained, and explicit consent was often assumed rather than sought. That assumption—doing what’s “best for the patient”—risks eroding trust.
- Choice 🎯 → Patients were usually given small, low-stakes choices (“Do you want to walk now or later?”), but meaningful decision-making was rare. Many patients couldn’t identify moments where they had real agency in their care.
- Collaboration 👥 → Some physios used “let’s do this together” language and worked with patients, but collaboration often broke down under time pressure or when clinicians believed they knew the “right” treatment. The power imbalance—clinician as expert, patient as passive—wasn’t always acknowledged.
- Empowerment 🌱 → Encouraging independence was common (getting people up, walking, regaining function), but empowerment of non-physical skills—like pacing, grounding, or building confidence—wasn’t emphasized. The focus often defaulted to “getting the physical stuff done.”
The takeaway: physios (and OTs) are already doing pieces of trauma-informed care well—listening closely, validating symptoms, and being warm and approachable. But the practice is patchy, and often confined to the physical. To truly align with TIC, we need to widen our scope: expand what safety means, ask for consent explicitly, give meaningful choices, share power, and build skills that go beyond mobility.
Here are a few ways you can bring trauma-informed care into your sessions—small shifts that add up:
- Ask permission every time 🛡️🤝 Don’t assume consent for touch. Ask clearly.
- Think beyond physical safety 🌱Privacy, pacing, tone all matter.
- Match the energy ⚖️Upbeat is good, but leave space for harder emotions.
- Offer real choices 🎯Not just when, but how and if care happens.
- Do with, not to 👥Use inclusive language and co-create the plan.
- Build non-physical skill🧘♀️Grounding, pacing, awareness alongside movement.
Even one of these shifts can change how safe and empowered a client feels.
This fall, I’m teaching a course:
Practical Trauma-Informed Care for Healthcare Providers.
We’ll move from principles to practice—session-ready strategies that help you bring safety, choice, and collaboration into real rehab encounters. You’ll learn how to apply graded exposure for trauma, chronic pain, anxiety, and kinesophobia, and leave with tools you can use right away.
👉
Click here to learn more and sign up!
Trauma-informed care isn’t an “extra.” It’s the foundation.
When clients feel safe, have choices, and share power, they don’t just move more—they recover with meaning and agency.
As Maya Angelou put it, “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
That’s the essence of TIC. Our clients may not remember every exercise or cue we give them, but they will remember whether they felt safe in our presence, whether they felt heard, and whether they had a say in their own care. Those experiences shape not only outcomes, but the trust that makes recovery possible.
At its heart, TIC is about how people experience care. Warmth and expertise matter, but so do voice, transparency, and partnership. When we weave those into practice, we create the conditions where people can truly flourish.
