Trauma-Informed Care and Adverse Childhood Experiences (ACEs)

“May all brings be peaceful. May all beings be happy. May all beings be safe. May all beings awaken to the Light of their true nature. May all beings be free.”

— Buddhist Metta Prayer

We have followed closely the ongoing immigration crisis taking place at the US-Mexico border. As a trauma-informed clinic, we are well aware of the long-term effects this policy will likely have on the children and families that are enduring painful separation. The images are disturbing at best and despite mass public outcry, lawmakers have made little to no impact in reuniting separated parents and children.

As this continues to unfold, we as community acu-punks and health advocates are feeling angry and sad. Community acupuncture, by its very nature, is committed to battling oppression on a daily basis, bringing acupuncture to the working-class, and creating a safe place for all peoples to thrive, heal, and coexist. We recognize that this itself is a radical act. As POCA Co-Founder Lisa Rohleder states: "...society doesn't treat poor people or working-class people well, or women and children, or immigrants or people with mental illness....[ Acupuncture Points Are Holes: A Case Study in Social Entrepreneurship, pg. 169]. 

As part of this movement, we are compelled to change that narrative. We want to share an important study that highlights the potential long-term effects of today's immigration policy that is deeply affecting families and children. The Adverse Childhood Experiences study (ACEs) is summarized by the Centers for Disease Control and Prevention as follows: "Childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue."

To flesh this out further, the ACEs study has shown that long-term exposure to traumatic events (such as sexual, physical or verbal abuse; physical or emotional neglect; a family member who is in prison; the loss of a parent through abandonment or divorce; and household dysfunction), can greatly increase the risk of mental health problems and substance abuse, as well as physical health problems later on in life.

In essence, no matter what side of the immigration platform you stand on, detained children are being setup for high ACEs scores and long-term health consequences. As this continues, they're at greater risk for:

• risky health behaviors,
• chronic health conditions in adulthood (such as pain due to arthritis, headache or chronic back or neck pain)
• low life potential, and
• early death (due to cardiovascular disease, liver disease, chronic lung disease, and cancer)

That isn't to say that these outcomes are set in stone. The study also recognizes the role that resiliency has in early development and the key role that close relationships have in building resiliency in a person. But, as is the case with detained children, they have been separated from the very people that might help them recover from these experiences. More than likely, their lives, liberty, and ability to find happiness, will be a challenge that lingers far beyond the moment if/when they find their families.

As we process this information and the news in the coming days, weeks, and months, we can allow ourselves the space to acknowledge, talk about, and do what we can to provide relief.  In talking with a patient about this crisis, we agreed it is not something to simply "get over" or ignore.  The full effects of these policies are unknown but clearly they are harmful to people now and they will likely have significant, long-term effects.

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If you would like to learn more about the ACES study, visit the CDC's website or read this NPR article, the latter of which includes an ACEs test you can take to see if the research outcomes ring true for you.

There is also a wonderful graphic zine, Trauma is Really Strange, that recognizes how "stress and trauma [change] how our brains work"; how if you "squeeze any human hard enough, [they] will be overwhelmed"; how "the best way to reset the old parts of our brains is to slowly wake up the body"; and how "healing trauma is not about remembering, it is about self-regulating to turn down intense reactions in the body." It adds that "being in a body, without chronic tension patterns and a sensitized brain, will lead us to being happier and healthier."

Given the widespread effect of trauma, we offer trauma-informed acupuncture to help you process these experiences. Acupuncture is no panacea, but it can help calm the nervous system, treat many of the symptoms and diseases brought on by chronic stress and trauma, and help manage PTSD symptoms. To quote Lisa again: "...many, many people are suffering from stress, injuries, or emotional problems that make it difficult for them to work. If acupuncture can help people recover and return to work, acupuncturists have a social responsibility to help them, particularly at a time of economic difficulty for the entire country. (Acupuncture is Like Noodles)". We welcome anyone to our clinic who is feeling like they need a safe space to heal. We (and all of our affiliated POCA clinics) will hold space for you. 

Healing. It takes a village.

If you’ve worked with me before, then I’m sure you’ve heard me say the words, "healing takes a village".  It’s a light-hearted phrase I use to remind folks of the simultaneous strengths and limitations of acupuncture.  Personally, I believe that acupuncture is a powerful medicine--a belief that has been reaffirmed daily in my work with many of you!  It has been effective for such a variety of conditions, such as stress, infertility, allergies, digestive disorders, autoimmune disease, organ dysfunction, anxiety, and the common cold.  But, like any other medicine, it would be a folly to assume that acupuncture is all-encompassing.

Despite acupuncture’s wide-ranging benefits, certain conditions and injuries may require a little extra help from another modality.  Researchers have found, for example, that yoga and acupuncture can effectively treat back pain. In other cases, for those experiencing depression or anxiety, a combination of acupuncture, talk therapy, yoga, and/or emotional freedom technique might offer greater benefits. 

Sometimes, however, it’s necessary to consult a physician.  Eastern and Western medicine are so often placed at odds with each other, but they can create a beautiful synergy when used together.  I often encourage patients to return to their medical doctor for further review when it’s appropriate to do so.  This has, in some cases, led to a significant diagnosis and medicine that has helped the patient avoid major illness.  

In one case, I was working with a patient who complained of GERD.  Acupuncture successfully treats GERD using needles and herbs most of the time.  However, after working with this patient for over a month, their condition remained unchanged.  They took my advice and a local GI doctor diagnosed them with advanced esophageal damage after performing an endoscopy.  With that knowledge, the patient agreed to take the prescribed medication and returned for biweekly acupuncture. In a few months their esophageal damage had fully healed.

As we continue our work together let’s discuss what options may best suit you.  If you need a referral please ask us the next time you come in.  We have a great list of practitioners from a variety of modalities.  In the end, as your health care provider, it is our goal to ensure that you're receiving the best set of options to heal.

How Did you Hear About Us?

This post is dedicated to the remarkable life and legacy of community member, S.B..

On our intake forms, we ask new patients how they were referred to us simply to see where people are finding out about Long Beach Community Acupuncture (LBCA). It’s always fun to read a familiar name that answers the question. Sometimes people simply write “a friend” and often the name of some social media platform. Recently, a new person had written in the name of one of our patients who died earlier this year. When I read her name in the referral, it made me smile because that patient had a wonderful smile, an infectious laugh, and a life perspective that was unique and uplifting.

It made me glad that I had had the opportunity to treat her during a terminal illness and while I cannot pretend to have known her very well, I know I will never forget her. She brought light to many and when I remembered the network of referrals, a gallery of faces hung in my thoughts. At least three other LBCA patients had all been touched by her life.

When community acupuncturists get together, we often talk about how heart-opening our work is. This is not just an emotional response; it’s visceral, in the solar plexus. I felt that feeling when I first heard about community acupuncture in my last semester of school. I read an article in CJOM (California Journal of Oriental Medicine) by a woman who had opened her community clinic in San Francisco. From the description of her practice, I knew deep down that I just HAD to practice this way--it was a feeling beyond words.

Every business wants word-of-mouth advertising--it’s free and it’s the best. When patients come in, I remember how they got here and remember the ones who have sent in others over and over again. It is a map of connection among friends, family, and community.

I know referrals happen in private practice for people too, but there is really something unique and special about the way community clinics work that facilitate relationships. Often couples come in to nap together and certainly friends do too. Just the other day, a patient came in only to find her boss and boss’s husband sleeping in the chairs next to the one she picked! It was a happy realization.

It is easy to feel isolated in our culture and that’s one of the best things about the community treatment room. You don’t have to nap next to your spouse, lover, co-worker, or friend. It is salutary to know that you are not alone in this world. And it is a beautiful way of remembering others, if they’ve passed on or moved away.

Over and over again, I am filled up by working in this clinic; it keeps my heart wide open to human beings, how complicated we all our, how deep our needs and wounds.

Cannabis Basics: History & Law, Science, Purpose, & Advocacy

In February, LBCA hosted Pam Chotiswatdi, MPH, for an event titled, "Cannabis Basics for the Cannabis Curious".  We had such positive feedback after this event that we asked Pam to share the information she presented for those who missed it. The following is what Pam had to say about the event. 

It was a pleasure to facilitate the first "Cannabis Basics" workshop at Long Beach Community Acupuncture. I’ve always been a cannabis supporter, but never an active advocate until I was studying for my Masters of Public Health degree. During this time I had access to a range of studies, reports, and data, and started to look deeper at the cannabis movement, related policy history, and scientific studies.

I observed in my readings a fair amount of misinformation as well as data that was skewed by bias (arising from stigma surrounding cannabis).  I also felt there was a lack of a community perspective and that reports from the "cannabis sector" did not tell the whole story. 

For this reason, I make a point to share the whole story surrounding cannabis when I speak to communities. The following is a summary of our discussion into Cannabis History & Law, Science, Purpose, and Advocacy.

- Pam C.

Read More:

Click here to read more about Cannabis History & Law 

Click here to read more about Cannabis Science & Research

Click here for a Discussion of Medical vs. Recreational Cannabis Use & Public Health Concerns

*DISCLAIMER: It is important that clients rely on advice from their healthcare practitioner to employ sound clinical judgment for their specific conditions. This information is not intended to be a substitute for the advice of a healthcare practitioner nor a recommendation of any particular treatment plan. Please consult with your physician or healthcare practitioner for professional advice pertaining to your particular disease state.

More About Pam: I am a big believer in credibility – academic and street. So, a little about me: Born in Downey, California, I moved around a bit to surrounding cities and counties with my family and then on my own. I moved to Long Beach while earning an undergrad at CSULB – Go Beach! I have spent the last 16 years in Long Beach. I married a Long Beach local and I call the city by the sea my home. I earned a masters degree in public health, specifically in health education in January 2017 and transitioned careers--from being a 10-year editor at a local publication to helping a Long Beach nonprofit. Most recently, I took a key position to help the cannabis industry with health education. Find my blog CannabisCloset.org and on Instagram @cannabiscloset and Twitter @canabiscloset

Community Acupuncture, Distal Treatment, & Trauma-Informed Care (TIC)

“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.”                Trauma-Informed Oregon

As I followed the trial and sentencing of Larry Nassar, the doctor who molested young female athletes for decades, I was reminded of how often private medical settings can be places for traumatic events. Whether allopathic or holistic, small private offices can be triggering for people who have experienced sexual assault during what was supposed to be a routine visit. Even if the trauma wasn’t physical, it may have been verbal or emotional, as when a practitioner berates a patient for being overweight or not being able to stop smoking.

What does this have to do with community acupuncture, you might ask? Well, POCA clinics have been discussing ways to address trauma in our communities and all of us are working to provide trauma-informed care. In this blog, I’d like to focus on two aspects of community clinics that help us learn to support people with trauma histories: the group setting and distal needling.

The main defining factor, other than cost, of community acupuncture from current private models is the group treatment room. Not only does it enable us to keep our fees as low as possible but it can allow patients to feel safe because they are not alone with a practitioner in a small private room. Depending on the traumatic experience, a group setting might not work, but often in a community space, patients experience a sense of safety; they can easily see others, and if a patient is new and nervous about how needling might feel, watching people get treated, seeing them relax--even sleep--can be calming.

Best of all, patients do not have to disrobe. This is good for practitioners and patients alike. Even in holistic offices, disrobing and lying on a table while the practitioner remains dressed, standing over the patient, can be re-traumatizing. Most often at LBCA, we ask that patients expose forearms and lower legs, so that we can treat their issues “distally”--meaning away from the site of pain or organ system. This approach initiates one of the main questions we get. When we treat back pain, for example, someone always asks: How you can treat my back, if you aren’t going to put needles right where it hurts?

As a practice, acupuncture acknowledges that body parts and organ systems are interconnected and that the pathways of the acupuncture channels (or meridians) are inter-related. Some of our best points for back pain are on the hands and feet! As a POCA volunteer writes, “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.”

Distal needling offers us many advantages. In general, it is safer than “local” needling, especially around the chest and shoulders; there is little possibility of puncturing organs, like the lungs. And in terms of trauma as a “wound”--whether it’s physical or emotional--I prefer not to stick a needle right into a wound. After providing over 15,000 treatments myself, I know that distal treatment works more often than not and I learn more and more every day. Sometimes I treat locally, depending on the problem and how it has responded, but my favorite treatment styles are those of Master Tung and of Richard Tan--distal treatments that can address almost any issue from musculoskeletal problems to organ dysfunction.

Distal treatment allows us to be transparent with what we are doing: patients can watch, if they want, when we insert and remove needles. As a mutual experience, we encourage them to let us know if there is discomfort or pain and honor requests to remove or adjust needles if they are uncomfortable

Any practice is a learning process and as we work to implement TIC into all of our systems, from the front desk to the treatment room, LBCA consciously adheres to the principles of TIC: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment.

Whenever anyone seeks help from a doctor, acupuncturist, chiropractor, massage therapist, reiki master, or psychic, they are admitting that they need help, which is not always easy for people to do. It is a vulnerable position to inhabit and people, generally, do not feel empowered. Our goal is to empower patients and establish trust. Treating in a quiet, common space, and using effective distal treatment are two of the ways we try.

This is the first in a series of installments on TIC and community acupuncture. Stay tuned!