National Acupuncture Detox Association

Employee Use and Perceived Benefit of a CAM Wellness Clinic atBenefit of a CAM Wellness Clinic at

a Major Military Hospital: Evaluation of a Pilot ProgramEvaluation of a Pilot Program

Al i D J t Li ht C th MillAlaine Duncan, Janet Liechty, Cathy Miller, Gail Chinoy, & Richard Ricciardi

May 15, 2011

Purpose

Describe the design, rationale, use, and perceived impact of the Restore & Renew® p pWellness Clinic.

• Theoretical principles on which the R&RWC model is based and theirR&RWC model is based and their relevance to symptoms of secondary traumatic stress.

• Clinic features and therapeutic interventions including modalities offered, staffing, and logistics. g, g

• Methods and results of the program evaluation, recommendations for further action and research related to CAM and workplace wellness. Bethesda Magazine, Health,

September/October 2008, p. 225

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Secondary Traumatic StressBackground - Secondary Traumatic Stress

The war’s long duration, and the emotional i t d i d kl d i t dimpact and increased workload associated with treating critically wounded young Service members, can:

• magnify stress,

,

• erode sleep, and

• may impact staff health and performanceperformance.

Palgi Y, Ben‐Ezra M, Lnger S, Essar N.  The effect of prolonged exposure to war stress on the co‐morbidity ofPTSD and depression among hospital personnel.  Psychiatry Res 2009: 168:262‐264.

j1

Slide 3

j1 This quote might fit better toward the end -- the slide is about secdondary trauma and stressful military hospitals. We haven't yet told them about hte clinic, so the quote doesn't make sense yet. Move it to later? I think the set-up about healthcare environmental stressors and military hospitals is important. jliechty, 4/24/2011

A New Model Of Workplace Stress Reduction Was Needed

• Wellness care, supportive, not stigmatizingstigmatizing 

• Hospital‐based, on‐site, walk‐in, free, open to all employees

• Multiple modalities, team approach

• Healing environment

• Based on principles of   Chinese medicinemedicine

• Theoretically grounded in research on autonomic nervous system regulation and traumatic stress.Peaceful Solutions, Chronicle of Philanthropy, October 30, 2008, p. 7.

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Chinese Medicine Principles: Our Theoretical Foundation

• We influence and are influenced by the quality and quantity of qi that surrounds us

• Qi moves in a dynamic and fluid interplay of opposites. Yin is quiet,

t l ti d i t l Y icontemplative and internal; Yang is active, assertive and external.

O• Our bodies, minds and spirits are an integrated whole, linked by the movement of qi and this dynamic interplay of Yin andof qi and this dynamic interplay of Yin and Yang.

Kaptchuk TJ.  The Web That Has No Weaver: Understanding Chinese Medicine, 2ed. NY: McGraw‐Hill, 2000

Our Vision: Spread Coherent Heart Qi

Coherent, balanced and ,harmonious heart qi influences cognition, physical, emotional

d i i l ll b iand spiritual well-being.

A coherent cardiac rhythm has a “ripple effect” that can influence others nearby – it may support the creation of amay support the creation of a calmer workplace and more heart-felt compassion.heart felt compassion.

McCraty R, Childre D.  Coherence: Bridging personal, social, and global health. Altern Ther Health Med 2010; 16(4): 10‐24

Team Approach to Healing Environment

Creating an optimal healing environment starts with ourenvironment starts with our staff:

• Orientation and continuingOrientation and continuing education in common clinical frameworks

• Meditation before each clinic

Reg lar debriefings• Regular debriefings

• Encouragement of self-care and self-regulationcare and self regulation.

Restore & Renew® Wellness Clinic

A Peaceful Environment

The creation of a calm, quiet, healing environment was established by:

k i li ht d• keeping lights and voices low,

l i l i i• playing relaxing music, and

• having clinicians focus• having clinicians focus on being mindfully present and in a loving and caring internal state.

Jonas, W.B. and R.A. Chez, Toward optimal healing environments in health care.J Altern Complement Med, 2004. 10 Suppl 1(1): p. S1-6.

“Let A Chair/Table Choose You”

Participants were invited toParticipants were invited to choose a preferred modality and get settled on a treatmentand get settled on a treatment table or acupuncture chair.

Gentle eye contact was made to communicate the intention of caring non judgment andof caring, non-judgment, and presence.

Restore & Renew® Wellness Clinic

Inviting A “Felt Sense” of Somatic Mindfulness

• Orient to physicalParticipants were given time to: physical surroundings

B i•Bring awareness to the support the table or chairtable or chair represented

• Experience aExperience a grounded, somatically

i df l t tmindful state before we began.

Gendlin ET. Focusing-oriented Pychotherapy: A Manual of the Experiential Method. NY: Guilford Press, 1996.

Maintaining A Witness State

Participants were encouraged to maintain this mindful embodied state by continuing to be 

t t th ipresent to their experience while they experiencedexperienced acupuncture or bodyworkbodywork.  

Restore & Renew® Wellness Clinic

Anchoring And Harvesting Greater Coherence

Do you have a word for how you feel differently now?differently now?

Take a moment to go back to the place called ‘peaceful’, ‘calm’, ‘smooth’, p , , ,‘quiet’, or ‘relaxed’.

Notice everything there is to notice b t thi labout this place.

We want you to be able to find your way back to this place, and know youway back to this place, and know you have arrived.

You can practice coming back to this place often and especially as you fall off to sleep at night.

Restore & Renew® Wellness Clinic

Bringing Balance to Yin and Yang

The R&RWC provided opportunities to:

• Nourish innate yin energy in participants

• Experience its deeply p p yrestorative effect during sessions; and

• Access this state later, anchored in embodied memory.

Restore & Renew® Wellness Clinic

Ear Acupuncture

• Shen Men• Shen Men• Sympathetic• Kidney• Liver • Hippocampus

Together these points are believed to help bring balance to the ANS, improve sleep ease tension and pain increase energy and enhance

Montgomery Goes Under The Needle, Washington Post, March 24, 2008, Metro Section.

improve sleep, ease tension and pain, increase energy and enhance focus. Ear acupuncture is used globally to improve health and wellness

Chen HY, Shi Y, Ng CS, et al. Auricular acupuncture treatment for insomnia: A systematic review.J Altern Complement Med 2007;13:669-676.

j2

Slide 14

j2 Did you want to put in a bar over the eyes to protect identity? jliechty, 4/25/2011

Clinical Acupressure

The Seva Stress Release is a Clinical Acupressure protocol p pdesigned to:

• ease stress• ease stress, • support well-being,• settle anxiety and• settle anxiety, and• calm body, mind and spiritand spirit.

Raheem, A.  Clinical Acupressure Basic applications Handbook and Study Guide.  Los Altos, CA: Soul Lightening, 2007.

Zero Balancing®

ZB supports alignment of the b d ' t t ith tt tibody's structure with attention to energy flow in muscle, fascia and bone ZB:fascia and bone. ZB:

• Relieves stress,• Supports internal order• Supports internal order and clarity,• Addresses chronic pain pconditions, and • Helps maintain emotional

ll b iwell being.

Smith, FF.  Inner Bridges: A Guide to Energy Movement and Body Structure, 2ed.  Atlanta, GA: Humanics, 1994

Program Evaluation Questions

• Will military caregivers y gparticipate in an onsite CAM wellness clinic?

• What benefits will participants perceive the wellness clinic offers?

• What life changes will• What life changes will participants attribute to their participation?

• Is there a “ripple effect” from participants’ greater coherence to relationships at home or at work?relationships at home or at work?

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Methods

Sample: Inclusion criteria: hospital employees or volunteers• Inclusion criteria: hospital employees or volunteers

• 1,346 participants signed consent forms• 2,756 surveys collected from 1,010 of the participants• 80% Clinical Personnel

Setting: • Major military medical center (capacity = 1,000 beds)• Once weekly clinic 8 am-2 pm for 12 months

I t ti (P ti i t l t d d liti )Interventions: (Participants selected one or more modalities)• 58% received Ear Acupuncture • 60% received Therapeutic Bodywork SEVA Acupressure• 60% received Therapeutic Bodywork – SEVA Acupressure

or Zero Balancing®

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Measures

Anonymous 1-page exit survey

• Perceived benefits first visit: relaxation energy mental clarity stress pain• Perceived benefits, first visit: relaxation, energy, mental clarity, stress, pain• Perceived benefits, subsequent visits: sleep, mood, compassion for self, compassion for others, pleasure, ease in relationships, awareness of need for self careself care• Write-in comments on behavior changes

Most important features enabling participation• No cost• Hours• Location• Anonymity• Supervisor encouragement

Write in suggestions to improve clinicWrite-in suggestions to improve clinic

Opportunity to write comments on mural

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Findings

Agreed/strongly agreed withAgreed/strongly agreed with short- term benefits:

98% more relaxed98% - more relaxed94% - less stress84% - more energy84% more energy79% - less pain96% - my mind at ease

97% would recommend to coworker

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Sustained Exposure May Be Important

Participants who Strongly agreed with the following benefits, at 2nd and 12+ visits:2nd Visit 12th Visit2 Visit 12 Visit

• More compassion for patients 43% 77% • Improved sleep 40% 77%• Ease in relations with coworkers 41% 76%• Pleasure in personal relationships 41% 78%• Improved mood 59% 85%• Increased awareness of need for self-care 68% 87%

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Compassion Creates Compassion

Moreover, reported compassion forcompassion for patients rose with each visiteach visit.

2nd - 43%3-4 - 49%5-8 - 60%9 11 75%9-11 - 75%12+ - 77%

Is this a “ripple effect” of coherent heart qi in the system?

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Health Habit Changes

547 write-in health habit changes were reported.

Categories included:

• Improved diet and nutritionImproved diet and nutrition• Increased exercise • Increased stress-reduction• Increased stress-reduction

practices• Improved cognition and moodImproved cognition and mood• Decreased use of addictive

substances• Improved sleep

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Limitations

• Surveys were anonymous to maximize participation; nomaximize participation; no individual longitudinal data on changes was collected g

• No standardized measures of stress symptoms were usedstress symptoms were used

• No comparison group or randomizationrandomization

• Findings are descriptive - no causal inferences can be made atcausal inferences can be made at this time

Duncan, A, Liechty JM, Miller C, Chinoy G, Ricciardi, R. Employee use and perceived benefit of a CAM wellness clinic at a major military hospital: Evaluation of a pilot program. J Altern Complement Med. In Press. 

Summary of Findings

• RRWC, a hospital-based wellness clinic based on principles of Chinese medicine, was feasible, well-utilized and perceived by most participants to have positive health benefits related to stress reduction at work, improved mood and sleep, and lifestyle.reduction at work, improved mood and sleep, and lifestyle.

• Repeated visits appear to have cumulative benefits.

• Participants report that increased clinic visits led togreater compassion for patients, and more ease with co workers and otherswith co-workers and others.

Restore & Renew® Wellness Clinic

j3

Slide 25

j3 These should correspond somewhat to our programm evaluation questions we posed earlierjliechty, 4/25/2011

Bringing Peace to War

Our experience is particularly relevant as our nation explores approaches to mitigate the impact of nine years of war and secondaryof nine years of war and secondary traumatic stress on health care employees caring for wounded p y gveterans.