Trauma Informed Acupuncture

A POCA Volunteer's picture

Over the past 20 years, research has emerged that concludes that trauma can have physical, mental and emotional effects that are not only deep and lasting for individuals, but also create significant challenges for public health.  It is vital that workers in healthcare and related services are able to respond appropriately to counteract and mitigate the effects of trauma in the populations they serve. The state of Oregon has established a collaborative initiative to support Trauma Informed Care practices, policies, guidelines and procedures for all service providers.

Trauma Informed Oregon provides the following definitions:

“Trauma is a wound. Typically trauma refers to either a physical injury, such as a broken bone, or an emotional state of profound and prolonged distress in response to an overwhelmingly terrifying or unstable experience. Some trauma, like wounds, heal relatively quickly, some heal slowly, and many influence life going forward, like scars. Scars and trauma do not result in defects or deficiencies; rather they are markers of life experience one has survived.

Trauma Informed Care (TIC) recognizes that traumatic experiences terrify, overwhelm, and violate the individual. Trauma Informed Care is a commitment not to repeat these experiences and, in whatever way possible, to restore a sense of safety, power, and self-worth.”

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) also has developed a Trauma Informed Approach for use in organizations. According to SAMHSA, “A program, organization, or system that is trauma informed:

  • Realizes the widespread impact of trauma and understands potential paths for recovery;
  • Recognizes  the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
  • Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
  • Seeks to actively resist re-traumatization.

A trauma-informed approach can be implemented in any type of service setting or organization and is distinct from trauma-specific interventions or treatments that are designed to address the consequences of trauma and to facilitate healing.”

SAMSHA also counts 6 Key Principles of a Trauma Informed Approach:

  1. Safety – feeling psychologically and physically safe.
  2. Trustworthiness and Transparency- organizational operations and decisions are conducted with transparency and the goal of building and maintaining trust among staff, clients, and family members of people being served by the organization.
  3. Peer Support – can take any number of forms.
  4. Collaboration and mutuality – true partnering and leveling of power differences between staff and patients; recognizing that healing happens in relationships and in the meaningful sharing of power and decision-making.
  5. Empowerment, voice and choice – recognize that every person's experience is unique and requires an individualized approach.
  6. Cultural, Historical, and Gender Issues – the organization addresses cultural, historical, and gender issues; the organization actively moves past cultural stereotypes and biases (e.g. based on race, ethnicity, sexual orientation, age, geography, etc.), offers gender responsive services, leverages the healing value of traditional cultural connections, and recognizes and addresses historical trauma.

Similarly, the Trauma Informed Oregon website states: “Agencies demonstrate Trauma Informed Care with policies, procedures and practices that:  a) create safe context through physical safety, emotional safety, trustworthiness, clear and consistent boundaries, transparency, and predictability;  b) recognize and honor the individual through relationship, respect, compassion, acceptance and non-judgment, mutuality, and collaboration; and c) restore power through choice, empowerment, strengths focus, and skill building.”

Trauma Informed Acupuncture

More recently, research has begun to suggest that acupuncture is an effective intervention for post-traumatic stress disorder. One study stated that “acupuncture is a safe, potentially non-stigmatizing treatment that reduces symptoms of anxiety, depression, and chronic pain….”  and “acupuncture is a novel and therapeutic option that may help to improve population reach of PTSD treatment.”

According to the Adverse Childhood Experiences (ACEs) study, long term traumatic stress in childhood appears to greatly increase the risk in later life not only of mental health problems and substance abuse, but also physical health problems. The study created a scoring system for ACEs to assess long-term risk of chronic disease: a kind of “cholesterol score for childhood toxic stress”.  ACEs seem to be associated with chronic pain in adulthood due to arthritis, headache or chronic back or neck pain, as well as cardiovascular disease, liver disease, chronic lung disease, and cancer.  People often seek acupuncture for the treatment of pain, especially back and neck pain. The ACEs study suggests that trauma is far more widespread in the general population than previously believed. Taking all these factors into account, it is highly likely that many people who are receiving acupuncture treatment have trauma histories, whether or not they identify them to their acupuncturist or even to themselves.

Between the demonstrated effectiveness of acupuncture for the treatment of trauma, and the probability that the population that receives acupuncture includes a high proportion of people with trauma histories, there are compelling reasons to investigate what Trauma Informed Care would look like in the context of acupuncture treatment. How can the delivery model for acupuncture become more Trauma Informed?

The Community Acupuncture Model

There are a number of possible delivery models for acupuncture. In Asia, it was common practice both historically and in the present day for people to receive acupuncture in a group setting. In the US, auricular acupuncture for substance abuse treatment is typically delivered in a group setting. Over the past forty years, as many non-Asian practitioners have entered the profession, the conventional setting became similar to the setting for massage or a physical exam: one patient in a cubicle on a table, often delivered by a practitioner wearing a white coat.

The model that is known as “community acupuncture” dates back to the 1970s, when the Young Lords and the Black Panthers pioneered the use of auricular acupuncture in a group setting for community-based detoxification in New York. The Black Panthers went on to establish the Black Acupuncture Advisory Association of North America and the Harlem Institute of Acupuncture. The National Acupuncture Detoxification Association (NADA), founded in 1985, promoted the use of auricular acupuncture and established many public health programs. One challenge that all community-based or public health acupuncture programs face is funding: because acupuncture is considered an alternative modality, it is often difficult to support with federal or state funding.

The community acupuncture model began to develop in a different direction in 2002 in Portland, Oregon, when two public health acupuncturists lost their jobs due to budget cuts and set out to replace them. They founded Working Class Acupuncture, which currently includes 3 clinics and provides over 50,000 treatments per year. One of the founders came from a working class/working poor family, and also happened to have a high ACE score.  As a result, the community acupuncture model took shape with an emphasis on sustainable self-funding, accessibility to working class people, and – fortuitously – trauma.

The People’s Organization of Community Acupuncture (POCA) is currently one of the largest and fastest-growing acupuncture organizations in North America. It is a multi-stakeholder cooperative with about 200 clinics that provide over 1,000,000 treatments per year.  As POCA’s website explains:

“Community Acupuncture offers acupuncture:

  • in a setting where multiple patients receive treatments at the same time;
  • by financially sustainable and accountable means; and
  • within a context of accessibility created by consistent hours, frequent treatments, affordable services, and lowering all the barriers to treatment that we possibly can, for as many people as possible, while continuing to be financially self-sustaining.

Community Acupuncture is not just a description of acupuncture in a group setting, but also describes who is served by acupuncture: our communities. Community Acupuncture is not a one-way relationship of acupuncturists to their communities but the relationship of communities to acupuncture, the clinic, practitioners, and other staff. Community Acupuncture represents the connection and the contract between Acupuncture and Communities.”

The first clinic of the POCA Cooperative, Working Class Acupuncture, use recliners in a living-room type arrangement. Patients make individual appointments, but receive treatment in the same communal space. The clinic is self-funded with fees on a sliding scale of $15 -$35, with patients choosing what to pay based only on what they feel comfortable with. Patients rest with their needles in for as long as they want, so what you see when you enter the clinic space is a softly-lit room full of peacefully dozing people.

Because acupuncture as a modality is at least 2,000 years old, and because it has been practiced in different cultures all over the world, there are many different ways of doing it. The World Health Organization formally recognizes 361 “classical” acupuncture points and 48 “extra” points. In addition to these, there are a number of “microsystems” or acupuncture points located on only one part of the body which are used to mirror and treat the whole: the ear, the hand, the scalp, the wrists and ankles, the face, and even the nose. Furthermore, there are many separate “lineage” systems, using points that were carefully protected family secrets and never included on the classical lists. While there is an emerging body of research on the efficacy of acupuncture in general, there is no research or data that compares the efficacy of different styles or systems of acupuncture. Anecdotal reports suggest that all systems and styles seem to work equally well.

The community acupuncture model did not invent any clinical strategies for acupuncture. Community acupuncture clinics, however, have opted to use styles of acupuncture that emphasize so-called “distal points” as opposed to “local points”. For example, there are a number of popular distal point strategies for the treatment of back pain which focus on acupuncture points on the hands, feet, and head rather than on the back itself. Distal points and microsystems lend themselves easily to a setting in which patients are being treated in recliners and are not removing their clothes.

Community Acupuncture As Trauma-Informed Acupuncture

Because of the history of community acupuncture, core elements of the model align themselves neatly with core elements of Trauma Informed Care. In economic terms, community acupuncture is all about low cost and high volume, and it would not have been as successful as it has if a large number of people were not willing to try it. The low cost is certainly a major factor in attracting hundreds of thousands of patients to POCA clinics, but it seems likely that another reason is that the model works for people with trauma histories. This means:

1) Safety: physical and emotional

Acupuncture is an extremely safe modality compared to other forms of medical care. Serious adverse events are rare. The acupuncture profession in the US has almost universally adopted single-use disposable needles, which further decreases the risk of infection and bloodborne pathogen transmission. And community acupuncture is even safer.

The most serious adverse events in acupuncture involve organ puncture, most often of the lungs due to needling too deeply on the upper back and trapezius areas. In community acupuncture clinics, the points that are most often chosen are located below the elbows, below the knees, and on the head. Points on the neck, upper chest, and on the abdomen may be added as a supplement but are not usually essential to treatment. 

Another characteristic of community acupuncture is that a key clinical strategy is “needle retention”: allowing the patients to rest with the needles, often for as long as they want. This is in contrast to clinical strategies that rely on the practitioner stimulating the needles by twisting, thrusting, and/or twirling them. Strong and deep needle stimulation over organs is more likely to lead to organ puncture. Needle retention, by contrast, often involves shallow insertion: the practitioner simply inserts and positions the needle just deeply enough so that it will stay in place and the patient can relax.

Emotional safety can be more difficult to achieve in the delivery of acupuncture, especially if the patient is alone with the practitioner and partially clothed and lying on a table while the practitioner is standing up, wearing a white coat, administering an unfamiliar, potentially painful modality. This scenario is potentially overwhelmingly vulnerable, even re-traumatizing, for a person with a trauma history whether that history is conscious or not. Community acupuncture intentionally circumvents it.

One of the beauties of the diversity of acupuncture clinical strategies is that treatment can be adjusted for a patient’s comfort level. In community acupuncture clinics, it is typically suggested to patients that they take off their shoes and socks, roll up their pant legs above the knee and their sleeves above the elbow. If a patient who has heard this suggestion sits down in a recliner without doing any of those things, the community acupuncturist can assume that the person is uncomfortable with having their feet, legs, or arms needled. The next step would be for the practitioner to ask, “Is it OK if I try a point in your hand?” Or ear, or head, or any other easily reachable microsystem – until the patient gives their consent.  There is no need to push the patient to expose any part of their body. There are enough options that most people will be able to be needled in a way that makes them comfortable.

Similarly, in a community acupuncture setting, it is rare that a patient will be alone with a practitioner. There are always other people present and close by, even if they are asleep. Certainly the group setting is not going to work for every person with a trauma history, since every person is unique. However, the prevalence of sexual abuse in particular makes it worth taking into account that the experience of being alone and unclothed in a room with someone who has more power is likely to be problematic for a significant percentage of the population.

Community acupuncturists have discovered that a happy consequence of the group setting is that new patients very often come for treatment with a friend or relative who has already tried acupuncture and liked it. If new patients are nervous, they can watch their friend or relative be treated first, and then they can relax with their needles side by side. This kind of social support creates emotional safety.

Another important element of emotional safety has to do with disclosing information. One of the other beauties of the diversity of acupuncture clinical strategies is that many methods of diagnosis do not involve the patient having to verbally tell the acupuncturist much in order for the acupuncturist to successfully choose useful points. In certain kinds of acupuncture, great emphasis is placed on intakes that are similar in detail to a physical exam or to psychotherapy. However, there is no evidence that this kind of extensive questioning produces better clinical outcomes than strategies that are mostly non-verbal. Community acupuncture intakes rely on a relatively brief health history plus a short conversation with the patient about their goals . The assumption is that trust will grow in the process of treatment and patients may feel more comfortable disclosing more information over time, if needed. However, it would be a mistake to assume that level of trust at the beginning of the relationship. The reality of how acupuncture seems to work, though, is that there is rarely any need for the acupuncturist to ask invasive questions, and patients never need to disclose anything that would make them uncomfortable.

“Working in a Trauma Informed way does not require disclosure of trauma; rather there is a recognition of the need for: physical and emotional safety;  choice and control in decisions affecting treatment; and practices that avoid confrontational approaches.” Cheryl S. Sharp, MSW, “Becoming Trauma-Informed”

2) Trustworthiness, transparency and predictability

The practices that keep a community acupuncture clinic’s costs low enough to offer treatments at an affordable rate also enforce a certain kind of transparency. The communal treatment room itself as well as whatever marketing the clinic does are examples of areas where simplicity, straightforwardness, consistency and trustworthiness are required if the clinic is going to function at all, let alone be financially self-sustaining. These qualities are not a question of virtue but of survival.

Everything that happens clinically in a community acupuncture clinic happens in the open. Patients can see their practitioner talking (briefly) with and treating other patients in the community room. This requires the acupuncturist to have integrity in their interactions; if they don’t, everyone will notice.  Similarly, patients can know what to expect by observing what is happening. If a community acupuncture clinic is functioning smoothly, there are rarely any surprises.

The purpose of a first visit and intake in a community acupuncture clinic is to orient the patient to the clinic and to give them enough information to decide if acupuncture is something they want to use. The message to the patient is, “Let’s see if you like this.” The acupuncturist’s role is to facilitate, and to let patients draw their own conclusions about acupuncture. Clinic processes have to be transparent and comprehensible.

The low cost of individual treatments has several consequences: one is that a lot of patients have to try, and like, acupuncture for the clinic to survive; another is that there is little or no budget for marketing. Community acupuncture clinics must rely on word of mouth to bring in new patients. Because acupuncture is unfamiliar to many people, if a community clinic is to attract enough patients to be financially self-sustaining, consistency is of paramount importance. People need to be able to explain to their friends and family what will happen if they get acupuncture, and what they said will happen had better be what actually happens when their friends and family show up at the clinic. Otherwise  word of mouth marketing doesn’t work and the clinic will fail.

Finally, treatments in a community acupuncture clinic are simple. The process is almost always the same: the patient arrives, checks in, settles into a recliner, the acupuncturist finds them and asks, “what can I do for you today?”, there is a conversation that lasts less than five minutes, the acupuncturist puts in the needles, the patient relaxes for anywhere from 15 minutes to several hours, the acupuncturist takes the needles out, the patient leaves. Acupuncture in a community clinic is not like massage, or therapy, or a doctor’s appointment. It’s just acupuncture, and generally very predictable. For many patients, a weekly treatment is a kind of ritual of self-care, a comforting habit. The transparency and predictability give everyone, but especially people with trauma histories, a sense that they are in control of their treatment.

3) Peer support

Many community acupuncture patients have volunteered that being in the presence of other people receiving acupuncture feels supportive and encouraging. “All these other people, just trying to take care of themselves” was how one person put it. The shared intention to heal is something people can lean on without ever having to talk about it.

For people with trauma histories, being able to relax is never a given. Sitting quietly in a room with other people who already are relaxed can be a step in the right direction. It’s a good thing to try, and virtually no interaction is required. A patient can answer the acupuncturist’s question, “What can I do for you today?” with just one word, “Stress” – and that can be the extent of it. The treatment allows people to turn inward and pay attention to themselves, while being surrounded by half a dozen other people doing the same thing.

4) Respect, compassion, acceptance and non-judgment

Because there is a long tradition of food therapy and lifestyle practices associated with Chinese medicine, some kinds of acupuncture treatment can cross the line into life coaching or health coaching. While many patients find such conversations valuable, many others do not. An unfortunate consequence of the combination of lifestyle advice with acupuncture in a one-on-one treatment setting is that acupuncturists can feel such pressure to deliver results that they begin to push their patients hard to make changes, even “firing” them from acupuncture if they refuse to change their diets, take up exercise or learn to meditate. “I just can’t help you if you don’t help yourself,” is a common refrain.

What community acupuncturists have found is that acupuncture itself often can help, whether or not patients change anything else. Acupuncture reduces inflammation, promotes better sleep, eases pain, reduces stress, and gives people more energy. Getting regular acupuncture can also lead to other lifestyle changes without the acupuncturist saying a word about it, as a result of patients sitting quietly with themselves and becoming more aware of their own bodies and minds. As a result, the community acupuncture model explicitly discourages giving lifestyle advice.

One of the primary goals of community acupuncture is to be inclusive. Many clinics have succeeded to the point that their patient populations include a striking array of cultures, languages, and lifestyles. It is dangerous to dispense advice about how to live when you have no knowledge of how that advice might be received in light of a patient’s religious practices, cultural norms, or personal circumstances. Community acupuncturists avoid the topics of weight loss and smoking cessation: if patients bring them up as goals, community acupuncturists may respond supportively and choose points appropriately, but they should never initiate such a discussion.

As a result, community acupuncture can be uniquely helpful for people with trauma histories, because the model is designed to avoid interpersonal pressure of any kind. Community acupuncture recognizes that patients are taking a personal risk by trying something unfamiliar. Everyone who shows up in the clinic deserves respect, compassion, acceptance and non-judgment, particularly since they are already extending themselves.  The goal is simply to welcome them and to encourage them to use the clinic to take care of themselves.

5) Collaboration and mutuality

The one-on-one acupuncture setting can unfortunately emphasize the power differential between practitioner and patient. This differential can feel highly charged to people with trauma histories. Lying down on a table is a physical demonstration of passivity and vulnerability. A practitioner wearing a white coat is a demonstration of social power and authority.  The cubicle space is dominated by the practitioner’s presence. This setting can highlight the premise that the practitioner has potent, secret knowledge about how the patient’s body works, and so the practitioner’s instructions have to be obeyed. Giving lifestyle advice can seem like the practitioner is trying to take control over how the patient eats, exercises, and even practices spirituality. The indicators of a medical environment themselves can communicate to a patient with a trauma history that they are “broken” while the practitioner who is supposed to “fix” them is presumably whole.

Community acupuncture seeks to construct a different narrative. A large, open room with more patients than practitioners communicates that the space belongs to the patients, and the practitioner(s) are moving around in it to serve patients. When a patient enters the room, they choose their own recliner and make themselves comfortable as they would as if they were at home. Sitting in a chair – even one that reclines – is a significantly more active position than lying flat on a table. Most community acupuncturists do not wear white coats, so in a clinical setting there may not be immediate visual cues about who is a practitioner and who is a patient, other than that the practitioners are working and the patients are relaxing. Community acupuncture clinics are intended to convey a soothing ambience rather than a biomedical one.

Since the clinical interaction is brief and focused on the patient’s goals -- “what can I do for you today?” -- there is less room for the feeling that the practitioner has potent, secret knowledge as well as social power over the patient. The setting emphasizes that what matters is for the patient to be able to connect with themselves through the experience of acupuncture. Refraining from giving lifestyle advice allows space for the patient to listen to their own experience and draw their own conclusions. The role of the practitioner is to partner with and facilitate for the patient, rather than exercise authority over them.

All these efforts to defuse the power differential between the patient and the practitioner, as well as the presence of other relaxing people who are setting the tone for the space are typically reassuring to people with trauma histories. Furthermore, efforts to level relationships are not confined to the treatment space: they extend throughout the structure of the clinic to include financial relationships.

In our society, money and power are inextricable and the healthcare setting is no exception. For people of limited means, seeking care can be a humiliating experience. One-on-one acupuncture is too expensive for most people to pay for out of pocket, but insurance that covers it is also usually too expensive for the average person to afford. If people are fortunate enough to have that kind of insurance, they still have to deal with elaborate gate-keeping procedures to access acupuncture, and the odds are high that their coverage will be limited – possibly too limited to ensure any clinical results.

In community acupuncture clinics, all patients either pay a low flat rate or they choose what to pay on a sliding scale.  Many POCA clinics explain up front to patients that there are no third-party payers involved and the clinic itself runs on a shoestring. The only way the clinic can function financially is if a lot of people are getting acupuncture, they genuinely feel good about what they are paying, and they spread the word. POCA clinics depend on their patients for financial survival; nobody else is underwriting them.

The POCA Cooperative itself as an overarching structure is an expression of the mutualism of the community acupuncture model. Patients can become members of the cooperative, serve on the Board of Directors, and vote in elections. Many patients opt to join the Cooperative in order to volunteer for jobs like writing the monthly newsletter, participating in membership drives, or helping with conferences. Many POCA clinics also allow POCA patient members to volunteer directly in clinics by working at the front desk, putting up flyers, or helping with laundry. This gives patients a direct sense of ownership in the cooperative and creates another opportunity to build relationships where healing can happen.

6) Empowerment and Choice

Just as collaboration and mutuality are built into the systems of a community acupuncture clinic, so are empowerment and choice. For example, as part of the process of receiving treatment patients choose how much they want to pay, where they want to sit, and how long they want to retain their needles. Where the needles are placed may be a topic of discussion between the acupuncturist and the patient, but the patient  always has the final say.

Beyond the process of an individual treatment, though, the overarching question for any patient of a community acupuncture clinics is: how do you want to use acupuncture to give yourself a better quality of life? This question comes from a very practical perspective: for acupuncture to be effective, people have to show up and get it. For many chronic conditions, they have to show up regularly for months or years and get a lot of it. The part of the treatment where the patient shows up and sits down in the recliner is equally as important as the part of the treatment where the acupuncturist inserts the needles. It’s vital for everybody involved to be clear about this.

Community acupuncturists always suggest a treatment plan. The frequency of treatment is based on the intensity of the problem:  for example, if a patient reports 8/10 pain on a scale of 1-10, the acupuncturists will recommend treatments at least 3 times a week. However, the treatment plan is a recommendation; the patient is the authority. People can only answer the question, how do you want to use acupuncture? by finding out how acupuncture feels in their own bodies and how it impacts their particular issues. There are any number of parameters at work, and most of them are only going to be sorted out by the patients themselves.

Particularly in the case of chronic illness and/or chronic pain, successful management usually requires a highly individualized approach. Most patients need to tackle their problem as if it were a unique jigsaw puzzle of interventions and personal practices. For any given patient with a chronic illness and/or chronic pain, acupuncture may be a piece of the puzzle or it may not. The only way to find out is to try and see if it fits. It may be a larger or a smaller piece, a frequently occurring or an occasional piece. Trial and error is almost always involved.

Patients may choose to use acupuncture for prevention, for maintenance, for acute problems, or only in dire situations when nothing else has worked. They may choose acupuncture to manage stress or to treat the side effects of chemotherapy. From the perspective of a community acupuncture clinic, all of these choices are equally valid.

The financial structure of a community acupuncture clinic also supports this kind of empowerment and choice. Patients may adjust what they pay on the sliding scale if they feel they need to come in more frequently for a given issue, and community acupuncturists encourage this. At Working Class Acupuncture, it is common practice to suggest that patients pay less than the low end of the sliding scale if necessary. The high volume of the clinic means that it’s possible to make individual adjustments to make sure people can get as much acupuncture as they need or want, while still keeping the lights on.

Many one-on-one acupuncture practices focus on insurance billing in order to be financially viable. It is difficult or impossible for a clinic with a sliding scale to bill insurance, since insurance companies are not receptive to the idea of different patients paying different amounts for the same service and may even consider it fraud. In any case, the infrastructure required to bill insurance would require a community acupuncture clinic to raise its fees, which would defeat the purpose. Moreover, it is arguable that freedom from third-party payers makes the community acupuncture more Trauma-Informed with regard to empowerment and choice.

Among the numerous downsides of insurance are the need for the patient to have a “billable diagnosis” initially, and for the acupuncturist to prove the “medical necessity” of treatment in order to continue it. From a patient perspective, this means that someone in authority gets to judge whether your distress is valid and deserving of treatment. Dealing with gatekeepers can be demoralizing for anyone, but particularly for people with trauma histories.  Being able to decide how much acupuncture you think you need,  for whatever problem you define, without consulting anyone but yourself, is potentially healing in its own right.

7) Strengths Focus and Skill Building

Relaxation is a skill. Accessing support is a skill. Using a community acupuncture clinic to manage acute and chronic physical, mental and emotional issues is also a skill. Because the setting of a community acupuncture clinic emphasizes that patients are active participants rather than passive recipients, many people develop a sense of competence around getting acupuncture without even needing to talk about it. All community acupuncture clinics depend on a core group of “regulars” that grows over the years, and all of those regulars, one way or another, approach the clinic as a tool that they use to manage their particular circumstances.

8) Cultural, historical, and gender issues; recognizes historical trauma

Community acupuncture only exists as a model because the Young Lords and the Black Panthers organized to address the needs of their communities and chose acupuncture as one way to meet those needs. The goal of the model is to treat all patients as humans deserving of dignity and care. The model’s functions include mixing people from different cultures and socioeconomic backgrounds in the same space and also breaking down the isolation that people with chronic illnesses and chronic pain often suffer. Making community acupuncture clinics more welcoming and inclusive to everyone is a never-ending effort, but it is an effort that the model itself is designed to make.

One aspect of historical trauma that many communities have in common is the experience of being cut off from access to resources. The structure and processes of community acupuncture clinics are meant to communicate that you can have as much acupuncture as you want; the supply is unlimited.

The POCA Cooperative recognizes that addressing cultural issues and historical trauma will require having more acupuncturists who represent underserved communities, particularly acupuncturists of color. Training these representatives is a long term of goal of POCA’s new acupuncture school, the POCA Technical Institute.

The People’s Organization of Acupuncture and Trauma-Informed Care

“ (Social safety) :The sense of feeling safe with other people…There are so many traumatized people that there will never be enough individual therapists to treat them. We must begin to create naturally occurring, healing environments that provide some of the corrective experiences that are vital for recovery.”[1]

Community acupuncture will not necessarily be useful to every person with a trauma history, since everyone is unique and has different needs.  However, the model is designed to offer a sense of social safety to large numbers of people. The POCA Cooperative is in the process of learning more about Trauma-Informed practices and is exploring their implications at different levels.

    1.    In 2014, several acupuncturists who identify as trauma survivors began a public conversation about working with trauma in POCA clinics through presentations at POCA’s biannual conference (POCAfest) and on the POCA forums. In the process of researching their presentations, they learned more about the overlap between Trauma-Informed Care and what an acupuncturist calls Universal Precautions for Trauma in Community Acupuncture Clinics. The premise of Universal Precautions for Trauma is that trauma-sensitive care should be offered to all patients without exception, since it is impossible to know who has a trauma history and who doesn’t.  This public conversation about trauma began the process of establishing peer support for POCA acupuncturists with trauma histories.
    2.    Beginning in late 2013, Working Class Acupuncture began a collaboration with a Trauma-Informed program that provides better care to “high utilizers” of health care services, especially emergency rooms.  Clients of the program are likely to have multiple chronic illnesses and to face intersecting oppressions (racism, classism, disablism, etc).  Many also have trauma histories. The premise of the collaboration was that any program client who wanted could receive unlimited acupuncture. (Initially WCA donated the treatments.) It became clear that: the community acupuncture model was a good fit for the clients who chose to use it; the partnership was easy and productive; “high utilizers” of health care with complex, chronic problems are not at all difficult or burdensome for the clinic; and what works best for clients with trauma histories is also what works best for the general clinic population.
    3.    In 2014, POCA opened its own acupuncture school, the POCA Technical Institute. Its Director, one of the aforementioned acupuncturists with trauma histories, had had a difficult time with her own acupuncture education due to some of the potentially re-traumatizing aspects of the one-on-one delivery model and how that delivery model is taught in acupuncture schools. It is clear that people with trauma histories potentially make very good acupuncturists, but not all of them can make it through acupuncture school. POCA Tech began incorporating discussions of trauma into the curriculum and also began exploring how to modify teaching policies and procedures to better accommodate  students with trauma histories. POCA Tech is exploring what it would mean to become the first Trauma-Informed acupuncture school.




Needling an ankle
Photo courtesy of
Dave Hudson