My vision is to initiate a free pilot project offering auricular acupuncture to K-12 students, with the goals of improving student health and educational outcomes. Why? A major limiting factor to student success and wellness is the harmful stress that often accompanies the experience of Adverse Childhood Experiences (ACES).1 Some sources of toxic stress can include low socioeconomic status, racial inequity, and other societal stressors and disparities - a global pandemic, for example.1 The resulting physical and mental-emotional obstacles impact student learning and affect major life outcomes. Although the “fight, flight, freeze” response is an evolutionary adaptation for self-preservation, prolonged experience of this kind of stress becomes harmful. Sadly, 46% of youth under age 18 have experienced at least one ACE, and 20% have experienced at least two.2 ACES impact children’s educational, occupational, and income opportunities, as well as their mental health (risk of anxiety, depression, PTSD, suicide), risk of developing chronic conditions (HIV, STI’s), and prospect of developing chronic conditions (diabetes, cancer).1 ACES also increase the likelihood of traumatic injury, as well as high-risk behaviors such as drug/alcohol use and unintended pregnancy.1 The CDC emphasizes
that “toxic stress from ACES can change brain development and affect such things as attention, decision-making, learning, and response to stress.”1 Many students struggle with the ability to be present, to concentrate, and to learn due to past and present adverse experiences that have fundamentally altered their minds and bodies. Then the pandemic coupled with massive socio-cultural upheaval happened. Not surprisingly, rates of adolescent mental health issues and suicide increased dramatically during the pandemic, adding to an already burgeoning issue.3 We can do better and have effective tools to help our children and young adults!
Acupuncture has tremendous benefits to offer students when used in conjunction with integrative services such as counseling and nursing offices, athletics/movement, and farm-to-school lunch programs. Acupuncture can help to rebalance students’ physiological systems and to serve as a form of educational and social equity that allows each student to perform their best. Acupuncture can offer students the ability to heal from the effects of adverse experiences and harmful stress levels, leveraging equity compared to students who have not had those types of experiences. Particularly at a time when humanity has endured such massive global and local upheaval, we have the responsibility and the imperative to offer these tools to students.
The acupuncture pilot program will provide free services to students and staff as forms of stress management in conjunction with school counseling and nursing offices, serving as a model for integration into schools’ existing support networks. Acupuncture has been shown to be safe and cost-effective,4 and it has been shown to be “safe in children when practiced by trained professionals.”5,6 Evidence exists for the clinical and cost-effectiveness of acupuncture for many conditions that could affect students’ school performance, including headaches, neck/back pain, PTSD, anxiety, depression, insomnia, smoking, obesity, chronic pain, IBS, opiate addiction, as well as learning, memory, and cognition. (7,4,8,9,10,11,12,13,14,15,16,17)
The Acupuncture Evidence Project, published in 2017, provides evidence for the effectiveness of acupuncture. Eight conditions, including headaches (tension/chronic), low back pain, and migraines, were found to have strong evidence for treatment via acupuncture.4 Thirty-eight conditions were found to have moderate evidence, including post-traumatic stress disorder, anxiety, depression, insomnia, neck pain, smoking cessation, and obesity.4 In addition, Liao and colleagues (2020) published a recent study supporting the effectiveness of acupuncture for treating depression and anxiety.8 The Acupuncture Evidence Project found acupuncture to be cost-effective for twenty-four conditions, including chronic pain, low back pain, neck pain, migraines, headaches, and depression.4
The United States Department of Veterans Affairs (USDVA) has recently embraced acupuncture, particularly for pain management.9 In addition, the Evidence Map of Acupuncture, prepared in 2014 for the USDVA, found strong evidence for the effectiveness of acupuncture to treat back and neck pain, headaches, chronic pain, insomnia, smoking cessation, irritable bowel syndrome, depression, and opiate addiction.10 In addition, King et al. (2016) showed that veterans self-reported improved sleep, greater relaxation, decreased pain, and enjoyment of auricular acupuncture treatments.11 For veterans with insomnia and PTSD, acupuncture was shown to be effective in improving sleep.12 Other researchers have found that acupuncture alters human brain chemistry and physiology in ways that alleviate anxiety, depression, as well as “the gastrointestinal and psychological symptoms of IBS [irritable bowel syndrome].”13 The National Acupuncture Detoxification Association (NADA) promotes auricular acupuncture performed on the ears, as “non-verbal” and “clinically effective, cost-efficient, drug-free, and compatible cross-culturally.” NADA advocates auricular acupuncture for use in behavioral health settings such as counseling, education, and self-help.7
Importantly, acupuncture has also been shown to exhibit positive effects on learning, memory, and cognition in animal models.14,15,16,17 Kan and colleagues (2018) showed that 14 consecutive days of acupuncture resulted in altered dendritic cell structure, increased spatial learning, and improved memory in mice.14 Additionally, Zhao and colleagues (2018) concluded that acupuncture was effective at reducing observable “anxiety-like behavior” and enhancing “impaired learning-memory ability” in PTSD rat models.17
By applying this information to educational settings, educators have the potential to improve student quality of life and to improve educational outcomes, not to mention major behavior and health outcomes that could influence the entire trajectory of a student’s life. According to the author of The Body Keeps the Score, “It is critical for trauma treatment to engage the entire organism, body, mind, and brain.”18 By adopting a whole-systems approach to health and healing such as acupuncture, we can benefit students’ whole physiological systems, including their abilities to learn.
Although I dream of initiating a project like this in my home state of Maine, it is true that Oregon is an ideal place to develop the acupuncture-in-schools model. There is existing acceptance of the research supporting acupuncture’s effectiveness within medical and insurance communities, and the importance of access to acupuncture is emphasized within community outreach programs, such as Quest Center for Integrative Medicine, Outside In, Central City Concern’s Old Town and Hooper Clinics, the Legacy Good Samaritan Pain Clinic, and the Providence Cancer Treatment Center.19 The use of acupuncture is also supported at Veterans Centers throughout the U.S., including those in Oregon.9,10 If acupuncture works so well that so many social support agencies, as well as the U.S. government’s military, are using it, why aren’t government-funded public schools trying it? Don’t students deserve to be prepared to enter adulthood with as much resilience training for improved growth and development as possible?
I anticipate and am prepared for resistance. There are clearly barriers to overcome and precautions to consider when introducing this option into a school setting. First, acceptance of acupuncture within the larger community will take time. For many families, acupuncture is an unfamiliar term. Not everyone has tried it, and not everyone wants to. That is okay. Knowledge levels, perspectives, and acceptance of acupuncture may vary widely among school staff, parents, and students. Second, acupuncture often involves needles (yes, it doesn’t always)! But it does involve touch. These are two very sensitive yet important issues to discuss when considering introducing it into schools. Third, misperception of spiritual/religious connotations may be barriers to acceptance and access. Acupuncture is not a religion; it is a form of healing that views human health as whole-health and inextricably intertwined with nature. Unfortunately, if acupuncture is not offered within a school setting, many families who are willing to and want to try it may not have access. It will remain elitist. It is my goal to someday provide acupuncture service at low or no cost via grant funding, sharing costs among schools within a district, and fundraising in conjunction with school nursing and counseling offices. These are all challenges I am willing to embrace. I see the huge potential for so much positive impact and feel a responsibility to offer young human beings every advantage to prosper and to thrive as learners so that they can achieve a life that is as fulfilling and meaningful to them as possible.
The acupuncture in schools pilot project will help to identify the specific ways that acupuncture can help improve student educational and developmental outcomes, including the potential to increase test scores, lower absenteeism rates, and improve students’ overall quality of life. This project has the potential to help educators make transformative changes to the educational system that will foster students who are more resilient and successful throughout the course of their education and human development. This endeavor also has the potential to serve as the foundation for the formation of evidence-based acupuncture programs in schools throughout the world.
-kelly a ilseman
L.Ac., M.Ac.O.M., M.S., M.Ed.
written Sept 2020 and updated Jan 2022
References
1. CDC. Preventing adverse childhood experiences. Page last reviewed: April 6, 2021. https://www.cdc.gov/violenceprevention/aces/fastfact.html.
2. Robert Wood Johnson Foundation (RWJF). Traumatic experiences widespread among U.S. youth, new data show. Published October 19, 2017. Accessed September 20, 2020.
3. American Academy of Pediatrics. AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health; 2022. Accessed January 11, 2022. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
4. McDonald J, Janz S. The acupuncture evidence project: a comparative literature review. Australian Acupuncture and Chinese Medicine Association, Ltd; 2017. Accessed September 25, 2020. https://www.asacu.org/wp-content/uploads/2017/09/Acupuncture-Evidence-Project-The.pdf.
5. Brittner M, Pertel NL, Gold MA. Acupuncture in Pediatrics. Curr Probl Pediatr Adolesc Health Care. 2016;46(6):179-83. doi: 10.1016/j.cppeds.2015.12.005.
6. Jindal V, Ge A, Mansky PJ. Safety and efficacy of acupuncture in children: a review of the evidence. J Pediatr Hematol Oncol. 2008;30(6):431-42. doi: 10.1097/MPH.0b013e318165b2cc.
7. NADA. What is the NADA Protocol? 2018-2021. https://acudetox.com/nada-protocol/.
8. Liao CC, Liao KR, Lin CL, Li JM. Long-term effect of acupuncture on the medical expenditure and risk of depression and anxiety in migraine patients: a retrospective cohort study. Front Neurol. 2020;11:321. doi: 10.3389/fneur.2020.00321.
9. U.S. Department of Veteran’s Affairs (USVDA). Whole Health. Last updated July 6, 2021. Accessed November 5, 2020. https://www.va.gov/WHOLEHEALTH/professional-resources/Acupuncture.asp.
10. Hempel S, Shekelle PG, Taylor SL, Solloway MR. Evidence map of acupuncture. Department of Veteran’s Affairs Health Services Research and Development Service; 2014. Accessed September 16, 2020. https://www.hsrd.research.va.gov/publications/esp/acupuncture.pdf.
11. King CH, Moore LC, Spence CD. Exploring self-reported benefits of auricular acupuncture among veterans with posttraumatic stress disorder. J Holist Nurs. 2016;34(3):291-9. doi: 10.1177/0898010115610050.
12. Huang W, Johnson TM, Kutner NG, Halpin SN, Weiss P, Griffiths PC, Bliwise DL. Acupuncture for treatment of persistent disturbed sleep: a randomized clinical trial in veterans with mild traumatic brain injury and posttraumatic stress disorder. J Clin Psychiatry. 2018;80(1). doi: 10.4088/JCP.18m12235.
13. Chen Y, Zhao Y, Luo DN, Zheng H, Li Y, Zhou SY. Electroacupuncture regulates disorders of gut-brain interaction by decreasing corticotropin-releasing factor in a rat model of IBS. Gastroenterol Res Pract. 2019;2019:1759842. doi: 10.1155/2019/1759842.
14. Kan B-H, Yu J-C, Zhao L, Li Z, Suo Y-R, Han J-X. Acupuncture improves dendritic structure and spatial learning and memory ability of Alzheimer's disease mice. Neural Regen Res. 2018;13(8):1390-1395. doi: 10.4103/1673-5374.235292.
15. Tang, S-H., Du, Y-J., Xiao J-H., Wang Y., Shen F., Sun G-J. (2018). [Acupuncture and Moxibustion Improves Learning-memory Ability of Alzheimer's Disease Rats Possibly by Up-regulating Serum Aβ Internalization Enzyme Contents]. [Article in Chinese]. Zhen Ci Yan Jiu, 43(11):692-697. doi:10.13702/j.1000-0607.170814.
16. Zhao YK, Han YD, Zhang YF, Zhu TT, Ma CB, Zhao ZT, Yan XK. [Acupuncture Intervention Improves Behavior Reactions and Learning-memory Ability in Post-traumatic Stress Disorder Rats]. Zhen Ci Yan Jiu. 2018;43(9):562-6. Chinese. doi: 10.13702/j.1000-0607.170652.
17. Huang KY, Liang S, Yu ML, Fu SP, Chen X, Lu SF. A systematic review and meta-analysis of acupuncture for improving learning and memory ability in animals. BMC Complement Altern Med. 2016;16(1):297. doi: 10.1186/s12906-016-1298-3.
18. Van Der Kolk B MD. The Body Keeps the Score. New York, New York: Penguin Books; 2014.
19. Howlett B. Building an integrative care community. Acupunct Today. 2018; 19(11). Accessed October 1, 2020. https://www.ohsu.edu/sites/default/files/2019-12/2017-2_OCOM%20published%20article.pdf.
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