Working Toward Integrative Health Equity: Reflections from Acupuncture Implementation Within a Pediatric Primary Care Safety-Net Clinic.

Abstract

Complementary and integrative health (CIH) care is well positioned to provide culturally affirming, patientcentered, and evidence-informed care for vulnerable children and families. Our pediatric primary care clinic has responded to the growing evidence base for CIH in pediatrics and the multiple national calls to action to include nonpharmacologic approaches in the treatment of pain by implementing acupuncture. Our clinic, a Federally Qualified Health Center (FQHC) in Oakland, CA, USA, serves a multiracial low-income pediatric patient population with 91% of the patients insured by Medicaid. Families served by this clinic face high levels of community trauma and structural violence, contributing to high prevalence of anxiety, depression, post-traumatic stress disorder, and chronic and acute pain conditions. Within the current biomedical paradigm, treatment options often include pharmaceuticals, lifestyle recommendations, and mental health referrals, but access to these can be fragmented and frustrating for both patients and providers alike. In their call to action, ‘‘Integrative Medicine and the Imperative for Health Justice,’’ authors Chao and Adler urge us to ‘‘leverage integrative medicine to advance health equity, that is, the attainment of the highest level of health for all people.’’ Acupuncture is one form of CIH that has a growing evidence base for use among children. There is strong interest in the use of pediatric acupuncture in the United States, with evidence for the safety and feasibility of pediatric and adolescent acupuncture as well as acceptability of acupuncture by children. The benefits of acupuncture for children have been documented in children experiencing chronic pain chemotherapyassociated symptoms, and anxiety, among other conditions. Widespread implementation of acupuncture has been limited for multiple reasons, including limited or nonexistent insurance reimbursement as well as assumptions that children will be fearful of needles. The term ‘‘acutherapy’’ was introduced in the clinic to encompass acupuncture, acupressure, and Gua Sha. This term was used due to concern about patients’