In this episode, Physical Therapist at Kelly Hawkins Physical Therapy, Meagan Duncan, talks about creating safe spaces for the LGBTQ+ community.
Today, Meagan talks about trauma-informed care, navigating trauma during the subjective exam, and the importance of consent. How can PTs make clinics safe spaces for the LGBTQ+ community?
Hear about the discrimination faced by the LGBTQ+ community, doing community advocacy work, and get Meagan’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
More about Meagan Duncan
Meagan Duncan is a Chicagoland native who earned an associate degree as a Physical Therapist Assistant in 2013 from Kankakee Community College. She then worked for six years in an orthopaedic setting while earning a Bachelor's in Interdisciplinary Studies from Governor State University in Illinois. Later, she moved to Las Vegas to earn her Doctor of Physical Therapy degree from the University of Nevada Las Vegas in 2020.
As a PTA, she developed and ran a pro bono clinic at her first post grad job in her hometown of Joliet, Illinois. She now practices in Las Vegas and specializes in pelvic health after completing a specialty clinical rotation with the VA Hospital in Las Vegas.
Duncan currently works at Kelly Hawkins Physical Therapy, a prominent outpatient physical therapy company in the Las Vegas area. At Kelly Hawkins, she built a successful pelvic health program that she has overseen and grown over the past year and a half.
Duncan also works for NPTE Final Frontier, a premier national physical therapy exam preparation company that works with domestic and foreign trained students to help them pass the board exam. In this role, she tutors PT and PTA exam candidates and assists them with content development. She advocates for students and professionals to balance life outside of physical therapy.
Outside of her profession, Duncan enjoys hiking, biking, paddleboarding and anything she can do outdoors with her husband and dog. She is excited to welcome a new addition to her family soon, as her first child is due in a month.
Healthy, Wealthy, Smart, Physiotherapy, LGBTQ+, Inclusion, Trauma, Pain, Discrimination, Sexual Violence, Advocacy, Consent, Pelvic Health,
To learn more, follow Meagan at:
LinkedIn: Meagan Duncan
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Read the Full Transcript Here:
Hey Megan, welcome to the podcast. I'm happy to have you on.
Hey, Karen, awesome to be here. Thank you for having me.
Yes. And like I said in the intro, today, we're going to be talking about creating physical therapy space, a safe spaces for the LGBTQ plus community. So before we talk a little bit more about that, can you let the listeners know where your passion for this community comes from?
For um, so I guess I feel like I'm just kind of a fan of the underdog in any situation. And I can't say that I have personally experienced, like so much in this community, aside from having a lot of relationships with people, and seeing what they go through and what life looks like on that side of our world, because it's a very different experience from what I've had as a heterosexual, white female. So when I was in high school, I just kind of ended up best friends with a gay man. And he kind of brought me into the circle of his friends, which ended up being just a really large, wonderful welcoming circle of people on all spectrums of the LGBTQ plus community. So I got really interested in just kind of gay rights and things like that went to marches and did all of that. Tried to advocate for the community as whatever I need to do as a 16 year old, which was not very much. And now I found myself in this position that I can do something which is awesome. And it's not even necessarily something I thought about when I went into the niche that I'm in. But I am really happy to be able to finally say that there's like some baggage behind this lifelong commitment that I kind of said that I had towards the community, but was never really doing anything about it other than like, your like Facebook posts here and there that talk about, you know, advocacy or supporting a community that's not well supported. So I'm happy to be able to do something about it now.
And let's talk about what you can do, or what we can do as physical therapists to help support this community, because I'm sure a lot of people may be listening to this and say, Well, what does the community need? That's so different from the rest of of other communities? So what is it about this community in particular, that perhaps they're more exposed to certain things? Or do they not get the care that they need? So go ahead, I'll pass the mic over to you.
Yeah, absolutely. So just discrimination in general, it's a problem in so many realms of social issues, being gender and sexual preference, of course, is one of those huge ones. So people feeling like or actually having less access to healthcare, getting denied health care, or getting given less than optimal treatment, or not really getting the best of their provider because of discrimination or because of biases that those providers have. Likewise, they might be afraid to go to facilities or go get treatments for things that are going through because they've experienced poor care before. So my niche actually, is pelvic floor physical therapy. And in this, there is so much that I can do for the community and physical therapists as well. And I was thinking about this podcast and thinking, what actually makes my job so different from the way everybody should be treating everyone. And I think there's a lot to learn, aside from just treating in pelvic floor PT. But in pelvic floor PT, I see a lot of people in the community because they are much more exposed to sexual violence and sexual trauma. And that correlates really significantly with pelvic floor dysfunctions. So we know from studies that gay men can undergo sexual violence at twice the rate of straight men, transgender people will usually experience about 50% of people will experience some kind of sexual violence in their life, which is a huge number 50%. And then it's even more if they're a minority. So that's a huge community of people where like, most of them need our help or need pelvic floor PT, or need more support than they're getting. So I think that we can play a big role in advocating for people and making spaces where they feel like are welcome. Or be that person that they can come to and after bad experience, bad experience or bad experience in healthcare, they can come to you and feel comfortable. And that's a really great feeling from my end. And I hope that other physical therapists out that out there feel better experienced that because it's awesome.
And you know, when you're talking about sexual trauma, or sexual assault within this community, I mean, the thing that sticks out to me is trauma. And so there is more and more research. And I think more and more people are now aware of trauma informed care. So can you share with us some of the principles of trauma informed care and why physical therapists should care?
Yeah, so this is kind of one of those things I was thinking about. trauma informed care and pelvic floor physical therapy is like, every class every time, we're always talking about every continuing ed course, because the nature of the work is so intimate, and very personal. And we're asking questions that make people uncomfortable, and hopefully not too much, but putting people in uncomfortable positions a lot of times, and it takes a lot for somebody to even come into my office to tackle these issues. But I think we should all be kind of treating in that same way. Because we don't really know like, of course, I know, when people come in for pelvic floor PT, they're probably uncomfortable. Like most of the time, people don't really like, want to be there. They're there because they need it. But that goes for a lot of things in physical therapy, right? Like people don't want to have back pain and come in and like, a lot of people don't want to get like touched and massage like, that's not what they intended on doing. But here they are, because they need it. So being trauma informed in any discipline is really important, because you just don't know what somebody has been through. So talking about trauma informed care, I think understanding a little bit more about trauma is probably a good place to start. So I do kind of think everybody should
reflect a little bit on what that means. So I was thinking of a good example. And I think that trauma can be kind of like pain, where we don't have a measurable, like objective measure for like, what pain is or what trauma is. So I know if a patient comes in says they're in six out of 10 pain, I have a patient with that same diagnosis that might say they're in two out of 10 pain. Or maybe I see, let's say I see somebody with a knee replacement. And I know that like a good healthy knee should have zero degrees extension, right. Or before they leave the hospital, we want them to have 90 degrees of flexion. But like I can't say to somebody, like you have a 15 degree trauma contracture. Like that doesn't make sense. There's no reference point that we know of other than what that person's experienced. So it's important to understand that trauma is different for each person. And some people could be really traumatized by an event. And some people could not really be traumatized by the same event. And that could depend on what factors they have in their cultural background in their other life experiences or the lens that they see things through. So somebody could experience their parents getting divorced, and maybe they came out of that fine. And they're like, Well, I came out of that fine. I don't know why it's so hard for everybody else. But you don't know what it was like to experience that with these other issues around you with being a minority or having financial distress or anything else like that. So understanding traumas is the most important part first. And then when we talk about trauma informed care. And this is from a Substance Abuse and Mental Health Services Administration, there's kind of the principles of trauma informed care, what does that mean? So the first part of that is to realize that trauma is a widespread issue. And it is invasive, and pervasive, and it affects people in a lot of different areas of their life. And then also realizing that there are pathways to potential recovery. After that, we should be able to recognize the five signs and symptoms of trauma. So recognize what is trauma look like? Sound like? How does that patient act? How can we pick up on if they're a traumatized individual. So seeing a patient being uncomfortable in your clinic, they might not make eye contact with you, they might not want to face you directly, you might see their body language is a little bit off, their arms are crossed. Things that we've all seen. We all have patients probably every day ranging anything from like that super bubbly, happy patient to the one that comes in and has done PT before and had bad experiences, and they're really unhappy. So recognizing what does that look like, and then responding by implementing that knowledge into practices and policies within just not just yourself, but the the facility as well. So using what you know, to actually change or adopt practices better, going to be more inviting or more informed and make more comfortable spaces for people that are traumatized. And then we have resisting retraumatization. And this, I think, is the most important part for us as clinicians. So thinking about what we can do to make an environment that does not correlate with any kind of trauma, anybody has had to make them have to revisit that. So and that could be anything again, like there's traumatic events that range from, you know, like really terrible sexual violence, and these are maybe things I hear about, but then there's also the trauma of like, having been misdiagnosed or having been told this or that by that provider or getting a hopeless diagnosis or being told that there's nothing that can be done for them. Those are things that we can actively try to resist re traumatizing that patient in. So being on honest and informative, making sure that we're not making false promise promises, but also that we're providing hope. And then thinking about what our space is like. And this is probably relative, maybe a little bit more for like LGBT, t plus LGBT plus community, where I am making sure that my space has signs that say All are welcome here. And things that make people feel invited, because they very possibly have had an experience before where they walk into a facility and like, immediately feel discriminated against or immediately feel like, this is not a place that I want to be here, this is not a place that's going to give me good care, and maybe the Carolinas without a dentist, but at any rate, they've experienced that and probably are very likely more than once. So I want to make sure that whatever I'm doing is not recreating any of that for them.
And when you are, understanding what trauma is, and really trying to understand the trauma of the person sitting in front of you, right, I would assume a lot of that comes through our subjective exam. So do you have any advice for therapists who are navigating these waters, even newer therapists perhaps are navigating or who maybe aren't, are not as well practiced in the art of the interview? Or in that process of, of that subjective exam? So do you have any like, what types of questions do you ask that kind of stuff?
Yeah, sure. Um, so I asked a lot of questions and pelvic floor PT. But I think the more important concept around that is, um, sometimes instead of asking questions, I, and that's not that we're talking at patients. But I do take a moment to do this. And if I am getting a sense from a patient, that they may have experienced trauma, that they're not going to share that with me. And that is probably more likely than not, especially on the first day, when I'm doing my initial evaluation, they don't know me, they don't trust me, they don't really want to share any of this with me, let alone even be there. So, a lot of times, I'll take the opportunity to talk about how trauma or how other experiences can relate to pain. So I might say to, let's say to my pelvic floor patients, I don't need to know or I don't need you to tell me any details or anything. But I am aware that trauma increases pelvic floor dysfunction increases pain, and it can really affect the way that people recover. So if there's anything that I can do during this treatment to make you more comfortable in any way, let me know if we need to stop anything. We're doing them, you know. So I might just take it as a piece of information, instead of asking a direct question, like making them tell me, maybe they'll do that later on in another session or two. Maybe I might need to know more at some point. But I've really never ran into that situation. A lot of patients will tell me the extent of it right there. They might do it another session or two. But it's not something that I really want to force out to people like day one, because if if I do that, like are they going to come back? Because that re traumatizing them? Have they been forced to talk about it before. I'm not a psychologist, I'm not a psychiatrist. I'm maybe not the person that they want to share all that with. So I want to make sure they have the open door to tell me about it. But I'm not like dragging it out of them.
Yeah, that's, that's wonderful advice. I really love that. And the other thing is, that I heard a couple of times during kind of these principles is creating that safe space, creating that space, where like you said, Everyone is welcome. How do you have any other tips and it could be from the person at the front desk all the way to, to the therapist and every employee in between? So are their conversations with the all the employees who work at the within that space? And and this may seem kind of like a silly question, but I think it's important, but colors on the wall artwork, things like that. I think it makes a difference. Right. So what do you what do you think?
Yeah, so I think that maybe places are a little bit hesitant to, like, fly this giant rainbow flag outside their door, right? Like, I would totally do it if I have my own clinic, but I recognize that I'm like, you know, working we're still working in a world that like from a business model. Maybe we don't want to do that because we want everyone to feel welcome, right? But it doesn't really take much. I think it's about really small gestures. So in our clinic, starting from paperwork, like they fill out paperwork online. And gender, for example, has every option that you can think of. If it is a paper form, gender is a blank space, so that blank space leaves people the option to write how they identify. And I love that option because That's even better than having to choose from like an overwhelming amount of options, or not finding the option that you're looking for. So a blank space for gender is fantastic. And then what we have in our clinic, like I said, small gestures, I think small gestures are really the thing, we have very small little flag stickers, like on the Plexiglas from our front office. Just little flag stickers for like every flag that you can think of, or it has like all the colors that represent different parts of LGBTQ plus community. So that little flag makes such a big difference, because I'll tell you, a lot of our patients are not going to notice it, like your patients that don't identify in any of those ways are not even going to notice it. But those people that do are going to see it, and they're going to love it. And we get compliments on that all the time. They think like, Oh, my God, people are so thankful for this little tiny sticker, we got like four pack on Amazon for like, probably a couple bucks, you know, just doesn't take much. And then another thing that we have in our waiting area is a sign that says All are welcome here. And that's such a simple thing, because that's not offending anybody that's making all people feel welcome. And people that are looking for that in their space, they know exactly what you're talking about when they see that fine. And everybody else is just like, oh, that's a nice thing. And they might not think very much of it. But it's certainly still a good thing to hear like, older people are welcome. Younger people are welcome. Everybody's welcome here. So it's really easy option.
And I love that these are all really easy, inexpensive, and accessible ways to show that you are working hard on creating a safe space for everyone. And like you said, a safe space for the LGBTQ plus community who oftentimes can't find those safe spaces.
Yeah, yeah. Another another small thing that I do personally, because I want my patients before I even go into their room maybe to like understand that I'm an advocate, I just have like a rainbow water bottle. And that's what I drink out of that work. And they see that sitting on my desk, and maybe some other stickers on like my laptop and stuff like that. But something that they might see like, Oh, that's my therapist, and they see like a rainbow water bottle. And it's just like a little thing that makes them feel more comfortable. I love it. I love my water bottle, so everybody's happy.
And do you go out physically into the community for advocacy work or as part of the clinic just so that people know that you're there? You know, like, how, how does that work within your community? Because I'm sure there are people who I mean, I'm in New York City, right? So I talk about like a large amount of people, right? So how do people know how to find? So how do people, especially in these marginalized communities know how to find the people who are creating spaces for them? Yeah,
so most communities, I'm in Las Vegas have support centers or community centers that support or provide or refer to services like my own or other providers that they know, create these safe spaces. So we have a support center here in Vegas, I've spoken to a little bit, I'm not necessarily within everybody's insurance providers. So that makes things a little bit harder. I'm in pelvic floor PT, I get so many patients from all over. And I've had a very long wait time, it's been tough to go out and mark it. And I'm also leaving for maternity leave actually in a couple of weeks. So I have plans for when I come back to reach out a little bit more, but I have been swarmed with what I have. But going out into these community centers, just letting them know who you are dropping off some cards, I have done that. And that is a really good way to at least get started. Get your name or your clinic out there. And maybe you're not what every person is looking for. But if they have your card handy, and they are providing social services to somebody, they might say, it sounds like you could benefit from this I know a great physical therapist that you could go to. And then, of course, we're a little bit bound by insurances. And that's definitely something I see in my future is trying to provide a little bit more preventive care to people that are uninsured or under insured. But that's probably a future problem for me at the moment. Right.
Right. And I think that's great advice. So if you're in a city, reach out to local community groups, community centers, things like that, and I think that's a great way for you to get out and in the community and really make a difference. And now there's one more thing that I want to talk about before we start wrapping things up. And that is the importance of asking patients for consent. So you touched on this a little bit, right? But especially in the pelvic floor world. Where does this explained explain to the to myself and to the listeners, how you go about asking for consent And why this
is yeah, this is definitely like if we can take home anything from if listeners could take home anything, it's to be more vigilant about asking for consent. And I can kind of trace this back to like how I've evolved in asking for consent. And I think about an IC O I think probably hope I'm probably not the only one guilty of this. But when I started, I started as a physical therapist assistant. So way back, when I graduated as a PTA, I went to work at a facility where the, the clinic was pretty manually aggressive, a lot of manual therapy, a lot of kind of aggressive manual therapy, which can be a little jarring for patients that are maybe not prepared for that. But I think about how many patients, I just went into the room and like started palpating, or like, Okay, I'm going to check this and then just like put my hands on them. And I think now about like how strange it would be to just like, grab somebody like psi SS without like telling them where you're going, like grabbing the back of their hips or having them like face a wall and then touching their back. And that can be like a very, that can like reiterate some traumatic events for people being grabbed from behind. That's, it's, I can't believe that I did this being the person that I am now. But I did, I did it every day all the time. And I never really thought about consent, I just figured the patient was there, maybe the provider before me had probably done similar the same things as a PTA, so I assumed PT had done the same. And I just think how crazy that is. Now, to me, it just is like so out there that I would have done that. Um, but asking for consent is something that should be ongoing and all the time. So from the initial evaluation, and education is a big part of asking for consent, I think too, because in order to consent to something, people have to understand what it's going to entail. And for me and pelvic floor, that's certainly relevant because I do do internal pelvic floor exams. So they need to know exactly what I'm going to be doing. And I use a model to demonstrate and to talk about what that's going to entail, and then discuss that they have the option to consent to that or to not consent to that, if they don't, there's other things that I can work on that I can help with. So I don't want them to feel pressured, that they have to consent to anything that I asked for. So consent, those should be informing the patient pretty much every step of the way. So instead of saying, I'm going to check your pelvic alignment, nobody knows what that means, like our patients don't know what that means. So I might ask, Is it okay with you if I touched the front of your hips, and then that's how I started just kind of simple and explaining in layman's terms, what I'm going to do. And a lot of times, I'm asking a patient or giving a patient options. And this is kind of part of trauma informed care is enabling or empowering the patient to make choices or have options. So instead of saying, say I want to do soft tissue work, instead of saying, I will be right back, I'm going to go grab some lotion, and then the patient knows I'm going to do soft tissue, but they didn't get an option to consent to that. I just went to go grab it. And now they feel like they're stuck there. And I'm going to come back with lotion and they're going to get a massage and they don't have a choice. So I might say, I would like to work on this. This is why. So we can do that. If you don't want to do that. We can work on mobility in this other way. So that way they have an option for what they want to do or how they want to do it. So providing options, I think is a really important part of concern. Um, I think yeah, I think that's mostly what I mean with consent.
Perfect. Yeah, I think that's great. And listen, I used to do the same thing. And I can't believe I did that either. Yeah, just like walking into a room and just like touching. Like, I wouldn't want someone to do that to me. I can't believe I did that.
I know. And I wonder is that like, a time? A time thing? Like 10 years ago? Was it just more like then we're just more informed now? Or was I just like totally oblivious? Because that's certainly
possible. I think it's just we're more informed now. I'm gonna I'm gonna go with that, you know, and yeah, and and maybe a little bit of a being oblivious? I don't know. But you're right. Like, I would just come first of all stand up and you just be like, hands on the pelvis. And it's like, what is like, how, what, what was?
And like next to I think, like, we were just yeah, like not grabbing,
grabbing onto people's heads and everything. What's that about? I would never do that. Now. You know, even if I'm just going to touch someone's arm. I was like, I'm just gonna put my hands here if that's okay. And we're gonna. Yeah, it just makes so much more sense. And I love the fact that you tied that in with the patient education component. Because I think like you said, you can't have one without the other. It's just so important.
Right? And I think that we underestimate like how much the patient wants to be educated about things. So and that's a lesson, I think I've learned pelvic floor PT, because so many people did, like they don't even know they have a pelvic floor or what it does. So education's been a huge part of my practice, like the whole first session is really education and training, and bladder and bowel training and things like that. But patients want to know, they want to know all the details, like they love it, tell them so they know what you're doing. So they know if they want that done or not.
Yeah, absolutely. At your right patients want to know, and it doesn't matter the age, they want to know, what's going on with their bodies and and what they can do to be a part of it. So it's also a great way to empower your patient to understand and take control over their, over their bodies. You know, and and give, give the patient some autonomy and some confidence.
Yeah. And to give that the patient the opportunity to, like collaborate with you, instead of be told what's happening. So to have the opportunity for them to feel involved and to have a voice in their decision making and understand even why they're making a decision, like so that they might know. Yes, I do want this internal pelvic floor exam done. Because I want to know more about the tone of my pelvic floor so that I can know why I have pain or why I have difficulty emptying my bladder. I want them to be able to make that connection in their head and be able to consent to it. Knowing why.
Yeah. And it's all part of patient centered care. I mean, that's what we're all supposed to be doing. Right? Yeah, absolutely. It's not patient directed care. It's patient centered care.
Right. And just as relevant as it is for me and pelvic floor. I think it's the same anywhere else across the board.
Yeah, across the board. Absolutely. Well, I, you know, I want to thank you. I think this was a great conversation. I feel like I've definitely learned a little bit more about trauma informed care. So I thank you for that. Now, where can people find you? If let's say they have questions, they, you know, they want to know how they can implement some of the things you're doing in your clinic in their own clinics.
Yeah, sure. So I typically use my work email for anything like that. So that is M Duncan at Kelly hawkins.com. And I like I said, I'm not much of a social media person I wish I could say I was that's probably not the best way to contact me.
I know you're not missing anything. Don't worry about it.
Yeah, but I'm always happy to check emails and respond that way. For people trying to figure out where to start. I did want to mention CSM has a lot of great topics on this, I've certainly gotten a lot of information, or directed myself onto what things I'd like to learn more about by going to CSM and going to these discussions. There is some information on trauma informed care at CSM this year, as well as introductions to pelvic floor PT, for those that are interested. And there are always platforms and other lectures on what we can do for the LGBT Q plus community. Excellent.
Thank you so so much. And before we wrap up, I'll ask you the question I asked everyone. And that's knowing where you are now in your life and in your career, what advice would you give to your younger self?
That's fine to not just go around touching people.
Yeah. That advice to each other.
I think I'm fortunate that never really panned out to be anything too negative, but I would love to go back and not do that. But what I do tell people and recommend as far as career is to find a niche. So my niche is pelvic floor PT. Within that my niche is being passionate and treating the LGBTQ plus community treating patients that are transgender, that is a great niche to be in, not everybody is doing it, it is so needed. If you can find a niche that you're passionate about, and that is needed, you are never going to struggle for work or for satisfaction. Um, it really is kind of been if you build it, they will come situation. And people told that to me when I began pelvic floor pt. And that's what I did, I built a pelvic floor program, the company that I work for now. And like I said, I am very busy, very satisfied with the way my career has gone in. So find a niche and it's not something that every new student is going to know right away. But get out there and explore like go shadow and go find places that are outside your comfort zone. Like I wasn't I didn't think I was going to go into pelvic floor PT. I don't think a lot of us that end up in it do. It's maybe not something I would have thought to shadow I would have been like, that does not sound good. I don't want to do that. But again, outside your comfort zone, go shadow and find therapists that are doing things that you don't think you would ever do, and see if you can find somewhere that you're going to land and be successful.
I love it. That is great advice. Thank you so much, Megan. I really appreciate your time and your knowledge sharing with myself and the Audience So thank you so much yeah thank you and everyone thanks so much for tuning in and listening have a great couple of days and stay healthy Wealthy and Smart