Innovation in Community Acupuncture Education at People's Organization of Community Acupuncture Technical Institute

In the past two decades, community acupuncture has grown from an experiment to a widely used health care model, providing treatments to many people who could not otherwise afford acupuncture. ^1,2 Providing acupuncture in a group setting differs in some important ways from private treatments, ³ and practitioners ultimately recognized that a different educational model was needed. In 2014, the People's Organization of Community Acupuncture (POCA) opened the POCA Technical Institute to train students who want to serve patients from diverse backgrounds in a group setting.* Although the community acupuncture model has been the subject of some controversy in the acupuncture profession, this brief commentary will focus specifically on how the school has structured the curriculum around meeting the needs of community acupuncture patients.

In community acupuncture, physical safety and social safety are understood as prerequisites to a successful treatment (Fig. 1). Although all acupuncture students are trained to promote physical safety through clean needle technique, POCA Tech students also receive training in trauma-informed care, ⁴ to help cultivate social safety. According to SAMHSA (the U.S. Substance Abuse Mental Health Services Administration), “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.” ⁵

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FIG. 1.

Rohleder's Hierarchy of Acupuncture Needs. ⁶ In this model, the style of acupuncture used (Acu Theory) and the behavior, beliefs, and values of a practitioner or the profession (Culture) become important once patients' needs for physical safety, economic access and stability, and relative social safety are met.

For students, training in trauma-informed care begins with learning about how physical and mental health can be affected by traumatic experiences, including Adverse Childhood Experiences and socioeconomic marginalization, in classes such as Trauma-Informed Acupuncture Foundations and Trauma-Informed Acupuncture and Public Health. Acknowledging the widespread impact of trauma, students learn to implement recognized principles of trauma-informed care—including practices for cultivating social safety, trustworthiness, transparency, collaboration, and mutuality ⁵ —in classes such as Trauma-Informed Rapport Skills and Touch and How to Do It. In the clinic, these principles may take a variety of forms, such as asking for consent before taking pulses, avoiding language that blames or shames a patient for their health issues, and empowering patients to use the clinic as a resource for meeting their own goals. The clothes-on nature of the treatment, predictable clinic systems, and the group setting itself also help create social safety for many patients.

POCA Tech prepares students to provide acupuncture that is accessible, acknowledging that even the most elegant treatment design will not work for someone who cannot afford or find time to get a treatment. Economic accessibility for patients begins with making the school affordable for students, since acupuncturists with heavy debt loads will be less able to provide low-cost acupuncture. Toward this end, the school's clinical internship sites are POCA clinics that donate their staff and facilities. This support from clinics not only reduces tuition but also exposes students to a larger and more diverse patient base than a typical student internship and provides immersive practical experience in running a clinic. Students gain experience needling quickly, managing reception tasks, building a patient base, and holding space in the group treatment room. These experiences help ensure that graduates can smoothly transition from school to treating patients in a busy community clinic.

Of course, a great deal of the POCA Tech curriculum is focused on acupuncture theory and practice. POCA Tech teaches several acupuncture styles, encouraging students to focus on those that resonate with them and work well for their patients. Students learn 10 approaches to acupuncture, including Traditional Chinese Medicine and other systems, such as those taught by Master Tung and Dr. Richard Tan. They leave school with a large toolbox with which to treat their future patient base.

Developing an educational model that meets the needs of community acupuncture patients has involved ongoing trial and error. Given that social safety looks different for different people, teaching how to practice trauma-informed care requires continuing time and attention. Meeting the economic accessibility goal is also challenging; keeping the program cost low means that the school depends on support from the POCA cooperative and member clinics. Lower tuition also means fewer amenities for students and more responsibility for their education.

Although running a school structured around meeting the needs of community acupuncture patients may not be easy, an important lesson from POCA Tech's experience is that creating safety and accessibility for patients is not a natural by-product of clinical education. Clinicians across health care fields—especially those treating in a group setting—may benefit from explicit training in the socioeconomic determinants of health, trauma-informed care, and other skills that foreground the foundational importance of social safety and accessibility.