11.6 Stages of Life, Mental Health & Trauma-Informed Care

Stages of Life, Mental Health & Trauma-Informed Care

1. Why Life Stages and Psychosocial Conditions Are Tested

The PCs-PIs appendix lists three related groups of commonly occurring conditions: common clinical conditions that present as variables of stress, pain, mood, anxiety, sleep, and cognition; conditions with multi-factorial considerations, including trauma and abuse; and the stages of life—pregnancy, infancy and childhood, adolescence, adulthood, senior years, and end of life. Pregnancy and older adults are covered in 11.3; this section addresses the remaining stages and the psychosocial presentations that change how assessment and treatment are delivered.

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2. Infants, Children, and Adolescents

Physical Considerations

• Size and tissue: Lighter pressure, smaller contact surfaces, and shorter sessions; children chill and tire quickly.
• Growth plates (physes): Open growth plates are weaker than surrounding ligaments, so a "sprain" in a child may be a physeal injury. Traction apophysitis is common in growing athletes—Osgood-Schlatter disease at the tibial tuberosity and Sever's disease at the calcaneus. Avoid deep friction over painful apophyses.
• Adolescence: Rapid growth can temporarily reduce flexibility and coordination; adolescent idiopathic scoliosis is screened with the Adam's forward bend test (6.1); sport injuries and overuse are common.
• Communication: Use age-appropriate language, explain each step, and offer choices. A parent or guardian is usually present for younger children.

Consent for Minors in British Columbia

The age of majority in BC is 19. Under the Infant Act, a person under 19 may consent to health care if the provider has explained the nature, consequences, and reasonably foreseeable benefits and risks, has made reasonable efforts to determine and is satisfied that the young person understands, and has concluded that the care is in the young person's best interests. If the young person cannot meet this standard, consent is obtained from a parent or legal guardian. CCHPBC's informed consent standard requires licensees to apply the Infant Act and document how capacity was determined.

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3. End of Life and Palliative Care

• Goals: Comfort, relaxation, relief of pain and anxiety, and connection rather than tissue change.
• Approach: Short sessions (often 15–30 minutes), gentle holding, light effleurage, hand and foot massage, and positioning for breathing comfort (semi-Fowler or side-lying).
• Skin: Fragile skin and pressure injuries develop over the sacrum, heels, hips, and other bony prominences. Never massage directly over reddened, non-blanching skin or an open pressure injury.
• Edema and medications: Opioids blunt pain feedback; lymphatic or venous edema needs very light technique; follow the palliative team's plan and respect the client's and family's wishes.
• Medical assistance in dying (MAID): RMTs do not provide MAID but may treat clients who are considering it; respect confidentiality and refer questions to the care team.

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4. Stress, Mood, Anxiety, Sleep, and Cognition

Suicide Risk

If a client discloses thoughts of suicide, listen calmly and ask directly whether they are safe. Canada's 9-8-8 Suicide Crisis Helpline (call or text 9-8-8, available 24/7) connects people with trained responders. If there is immediate danger, call 911 and do not leave the person alone. Document what was said and what was done.

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5. Trauma, Abuse, and Trauma-Informed Practice

Massage involves touch, undressing, and vulnerability, so clients with a history of trauma may experience strong reactions (freezing, dissociation, tearfulness, or a startle response) even when treatment is technically correct.

Principles of Trauma-Informed Care

1. Safety: A predictable, private environment; explain each step before it happens.
2. Choice: The client chooses clothing, draping, positioning, pressure, and which areas are treated.
3. Collaboration: Plan treatment together and check in often.
4. Trustworthiness: Do what you said you would do; keep boundaries clear.
5. Empowerment: Reinforce the client's control, including the right to pause or stop at any time.

If a client appears distressed or dissociated, stop, remove your hands, speak calmly, orient them to the room, and let them decide whether to continue.

Recognizing and Responding to Abuse

• Possible signs: Unexplained bruises in different stages of healing, injuries in sheltered areas, fearfulness, or a partner who answers for the client.
• Children: BC's Child, Family and Community Service Act (section 14) requires anyone who has reason to believe a child needs protection to report promptly to a child welfare worker; the duty overrides confidentiality.
• Adults: For a capable adult experiencing intimate partner violence, offer information and resources and respect their decisions. Vulnerable adults who cannot seek help themselves can be reported to the designated agencies under BC's Adult Guardianship Act.
• Documentation: Record objective observations and what the client said, using their words.

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6. Clinical Vignette

A 15-year-old competitive soccer player attends alone with knee pain over the tibial tuberosity that worsens with jumping. The therapist explains the proposed assessment and treatment, its benefits and risks, and alternatives in plain language, confirms through questions that the athlete understands, and judges the care to be in her best interests, so her consent is valid under the Infant Act; the discussion is documented. Assessment is consistent with Osgood-Schlatter disease. Treatment avoids pressure on the painful tuberosity and focuses on quadriceps and hamstring tone, with a home program of gentle stretching and load management; the therapist suggests a physician visit if pain persists or a lump becomes very tender.