By Beth Sommers, PhD, MPH, LAc and Kristen Porter, MS, MAc, LAc
The following interview is with two acupuncturists from the Integrative Therapies Program for Children and Adolescents in New Jersey at St. Joseph's Children's Hospital at St. Joseph's Regional Medical Center, a member of St. Joseph's Healthcare System in Paterson, New Jersey. Christine Marcarian, MSOM, LMT, L.Ac from Acupuncture Body and Diane Rooney, MSOM, LMT, L.Ac from Chi Medicine.
Q. Tell us about the holistic programming at St. Joseph's Children's Hospital, New Jersey.
A: The Integrative Therapies Program for Children and Adolescents is open to parents, families, and all pediatric patients in the Center for Pediatric Cancer and Blood Disorders. The program offers: acupuncture, acupressure, massage, reflexology, aromatherapy, and guided visualization. Ongoing research projects include acupressure cupping techniques for sickle cell pain and Yunnan Baiyao (Chinese herb formula) for hemostatic care.
The goals of the program are to reduce the symptoms and complications of the disease and the side effects of the allopathic therapy. As Integrative Therapists, we also teach parents and families how to use the therapies with their child. The program recently started a lending library to provide information through CDs, books and DVDs.
Q: What types of children do you treat?
A: St. Joseph's Children's Hospital Center for Pediatric Cancer and Blood Disorders treats a patient volume of roughly 4,700 visits per year. Within that, 1,100 – 1,200 are sickle cell patients. The remaining populations are oncological, hematological and various other chronic diseases with high morbidity rate. The demographics include Caucasian, Hispanic, Arabic and African American children and adolescents. St. Joseph's is the second largest provider of charity care in the state of New Jersey.
Q: How many kids do you treat there per week?
A: We provide 15-20 sessions per week of integrative therapies.
Q. Share with us how the Acupuncture (Integrative Therapy) Program got started?
A: The inception of the Integrative Department was underwritten solely by private donations. As a result, St. Joseph's Children's Hospital's Integrative Therapies for pediatric hematological and oncological patients has been thriving for several years. Diane Rooney, one of the therapists at St. Joseph's, is also a staff member at the Integrative Therapies Program for Children with Cancer at New York Presbyterian Hospital and Columbia University Medical Center. She was approached by the staff at St. Joseph's in 2009 to bring the same program model to its own hematological and oncological children. Due to the success and subsequent demand, the program grew and expanded thereby bringing on Christine Marcarian in 2011.
Q. How does the hospital deal with liability issues?
A: Before any therapy is given, the parent or guardian must sign an informed consent. If they choose to receive an acupuncture treatment, an additional informed consent is given. Each integrative therapist, before working at St. Joseph's Children's Hospital must go through a credentialing process, like all medical staff and carries her own malpractice insurance as well. All therapies are charted in the same system as the medical staff so they can refer to it at any time.
Q. Could you describe the favorable factors you experienced as you were planning and organizing getting these services into the hospital programming? Who were your allies in the hospital? Could you describe any difficulties you encountered in planning and organizing this service?
A: Integrative therapies are offered to the out-patient clinic, inpatient services and the pediatric step down and intensive care unit. The out-patient clinic welcomed the program quite readily. The staff was interested in being trained in the therapies and their benefits.
Although in-patient treatment was initially met with skepticism by the clinical staff, they eventually recognized the benefits for the patients. They witnessed the parent's requests for more therapies and eventually asked Diane to educate them through lectures and conferences.
Within this time frame, Diane created a "Staff Day." She gathered massage therapists, reflexologists, and acupuncturists from the surrounding area and provided these services for any pediatric staff member, including administrators, in the hospital. It was met with great enthusiasm. As a result, the staff was able to recommend integrative therapies to their patients having experienced these, first-hand.
Q. How did you prepare the hospital community for the addition of these integrative services? Did you do any community outreach to promote these services?
A: A brochure was created and mailed out to the community. Community citizens, parents of children under the integrative therapies care of Diane and Christine and other philanthropic organizations offered donations to continue and expand the program. Because of this, the nursing staff in the pediatric intensive care unite (PICU) is undergoing regular classes of aromatherapy and bodywork education.
Diane has presented the use of integrative therapy in a hospital setting at many conferences including dental, nurse practitioners, PICU staff and palliative care.
Diane is also a board member of the Killian Mansfield Foundation whose mission is to offer integrative therapy to every newly diagnosed child of a life threatening disease in the country, one hospital at a time. She is doing this by offering them a co-written handbook on integrative therapies with self help tips on acupressure, aromatherapy, reflexology and massage as well as educating the staff in each of these hospitals. These books come in a kit called "The Grumpy Fish Kit" which also contains two bottles of essential oils with directions for home use.
Q. What conditions are integrated therapies most sought after? Are there particular treatments / points that you can share? What results do you see?
A: The modalities are most used to help treat pain, insomnia, fatigue, nausea & vomiting, constipation, anxiety, stress and other side effects associated with their disease for allopathic treatment.
For patients with sickle cell who are undergoing pain crisis treatment – we often use acupressure or acupuncture & magnetic cupping proximal and distal to their pain as well as other therapies to help them relax. The use of essential oils is almost always utilized. The most common oils used are peppermint (for pain relief, headaches, sinusitis, neuralgia, fatigue), lavender (for anxiety, stress, insomnia, burns/wounds, headaches), frankincense (for spiritual bereavement, depression, dry skin, skin ulcers, asthma), and lemon (to help lift spirits, fatigue, and sharpen the mind).
Melt (Myofascial Energetic Lengthening Techniques) hand and foot treatments are used to educate parents how to manage stress. It is particularly useful for children who do not necessarily want to accept treatment but would rather choose to engage in something hands on, physical and interactive.
When acupuncture is used, each patient receives a full TCM differential diagnosis and is given an acupuncture treatment with the appropriate points. Therefore, each patient receives a different treatment every time they are seen and every patient has a specific treatment administered that's different from any other.
The acupuncture points most commonly used for hematology and oncology patients are: Yin Tang, Spleen 4, Pericardium 6, 8, Spleen 6 & Stomach 36 and scalp points. Sea-Bands are used to sustain acupressure at Pericardium 6.
Q. What drew you to this population? What was the inspiration? How do you deal with loss or burnout?
A: Children are a blessing and filled with joy. Even if they are struggling with a life-threatening disease, they still play and cry and run like any other child.
They, themselves, are a healing force and Christine and Diane have commented that they become better people and better practitioners by working with them. It is an honor to see children exhibit courage through their treatments and prevail and emotionally transform their fears into survivorship.
Q. What is your vision for the program?
A: Our vision for the program is to expand to all of pediatrics. In five years the integrative team can expand both in hours, days and number of employees to reach more kids. We'd like to see expansion from the hematology and oncology to all pediatric departments in the hospital. In 10 years, our vision is a centralized Integrative Therapies Department serving the whole hospital, at no cost to the patient. This includes adults as well as pediatrics and adolescents.
Sustainability is always an issue to be considered for programs such as these. We will continue to rely on donors as well as increasing awareness of its benefits through education of staff and administrators in the hospital. True sustainability can be kept if not only donations continue, but also the inclusion of insurance coverage and hospital participation.
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