Massage Therapy Body of Knowledge

Comment

Comment by Keith Eric Grant on October 24, 2009 at 1:16pm

Mike,

KSA's are the A,B,C's. The come from defining the tasks that have to be done and then looking as the knowledge, skills, and abilities, with proficiency levels, needed to accomplish those tasks. They don't change what students need to know and have achieve, that comes from the task specification for the job. What the process does is elucidate what needs to be learned cognitively and kinesthetically to accomplish those tasks. How else do you expect to know what your A,B,C's are? How else can you evaluate their effectiveness at meeting the competency requirements for the "job description"?

BTW, likely one of the most readable and accessible considerations of this kinds of needs analysis and proficiency analysis is Rober Mager's Six Pack. They are very pragmatic and, at times, also humerus. You can preview contents a bit by looking at the individual book descriptions. I'd highly recommend this set to anyone looking at curricula development and/or proficiency management and/or BOK development.

Comment by Mike Hinkle on October 24, 2009 at 12:30pm

I am glad these statistics are low. Maybe Associations may lower costs even more for therapists. But I still feeel licensure is important to protect the public and mandated by law, to protect the state and the citizens of the state that will have to pay for the lawsuit.

Some schools excel, some need shut down. Hours take hours to complete. KSA's will take hours to complete. Same thing. It can be dressed however you want and whatever terminology can explain it away. Won't change the fact that students need to know and have achieved A,B,C. The only thing with KSA's we don't know how many hours the KSA's will take, because they don't exist yet.

Comment by Keith Eric Grant on October 24, 2009 at 12:14pm

Mike,

The statistics for significant physical harm from massage a quite low, from multiple sources. They also, from discussions with ABMP, show little or no variance with hours of education. Since I present those statistics in the report on California massage education I won't rewrite the details here. Details of particular cases and specific rates can be hard to come by, often being considered as proprietary information. The paper by Studdert et al. (1998, JAMA) referenced in the report just mentioned is an exception.

The issues of psychological harm and malfeasance are not issues of training but of oversight. This implies the need for boards/agencies that have the resources and will to process complaints effectively. This too often is not the case in health care. CLEAR's blog has noted the revamping of the California Nursing Board and a crackdown on other boards. The result seems to be that the nursing board has halved their response time from 34 months to 17 months. This is not so atypical. I've had a quote for a number of years on an investigation of psychological oversight:

The Plain Dealer, located in Cleveland, held a six month investigation revealing that nearly 200 psychologists who "were found to have committed serious ethical violations in the last 18 years nationwide were allowed to continue their practice without ever serving any suspension." The article went on to say, "The nearly 200 psychologists who were not suspended for even a day were found to have engaged in sexual misconduct with patients, convicted of criminal offenses or committed other major ethical violations. The Plain Dealer looked at records from all 50 state licensing boards and created a data base containing the names of 2,218 psychologists who have been disciplined or denied licensure as a result of ethics violations. The study went back to 1971, although 80 percent, or 1,754, of the disciplinary actions were taken after Jan. 1, 1990 and reported that 27 states have revoked five or fewer licenses. West Virginia, Rhode Island, North Dakota and Montana, which license a total of 1,500 psychologists have taken a combined 15 disciplinary actions, but have never revoked a license. New York, the paper said, has about 14,000 psychologists, and has revoked 12 licenses. In Ohio, where there are 3,900 licensed psychologists, the Ohio Board of Psychology has revoked 16 licenses."

As to schools, a school that teaches to the explicit requirements and that graduates students able to meet licensing requirements and pass licensing exams is not "causing problems". They are meeting their responsibilities as defined by the requirements. At the same time, if the requirements are insufficient or incomplete, the same "qualified" graduates may also be incompetent in actual practice. The was the point of Ralph Stephens column that I pointed to earlier. I, btw, agree with his observations, although not necessarily his analysis of the causes.

Comment by Mike Hinkle on October 24, 2009 at 12:02pm

Hi Noel,

1. I was using naked for emphasis. Intrinsic procedural risks,situation amplifications, adverse physical effects, fruad and abuse or explotation are just some of the potential risk from a legilators viewpoint. There is more to protecting the public than just "physical harm".

2. By licensing, I believe thay are taking "remedy" steps that can't be even looked at, without records. And I think doing background checks for licensure, probably will help eliminate, at least some, of the potential folks that might cause "mental harm". Are states not doing their jobs with schools? Good question.

3. Ok. Here's where it gets dicey! Some therapists will go on and get certified in areas that will enable them to work hand in hand with the healthcare profession. The question then becomes, "Acceptance into the healthcare industry" - At what cost?

Comment by Noel Norwick on October 24, 2009 at 11:44am

Mike: I'm curious about your thinking re:

1. Shiatsu is typically performed on clothed clients (not "naked under someones hands), so in your mind, does this obviate the "potential mental harm" and need for licensure of this modality?

2. Given government's well documented proclivity for ever increasing taxes, onerous regulations, fiscal mis-management and providing continuing evidence that the "law of unintended consequences" is alive and well, what leads you to believe the states can effectively protect the public from "mental harm", much less decide what should be included in massage school curriculum's?

3. What benefits do you think massage practitioners will gain by acceptance from the healthcare field?

Comment by Mike Hinkle on October 24, 2009 at 11:19am

I agree, why are the insurance companies keeping this info close to the vest? Is it that massage does "little harm" physically?

But step back for a moment, I think a large larger point to regulation is not to just protect the general public from physical harm but from potential mental harm. Before regulation, there was no control of who or where the "events" were taking place. Many of the public feel that since they are naked under someones hands they should be protected. It is an event in a state and it is the states job to protect it's public, right? How else would the state be able to protect it's citizens and yet give some of it's citizens the right to practice the event? There has to be someone to hold accountable as well, if something should happen. And without records, how?

Next, healthcare. If anyone is going to be part of healthcare, they are going to be licensed. So they are bound by state law. Without licensure, I find it hard to believe we will ever be accepted by the healthcare field.

Trying to do this, I think will be a lot harder that coming up with a number. Does it address your concerns about skill levels, no. But I think schools need more guidelines and rules and their cirriculum should be subject to state approval. If a school does not meet standards then they lose their license just like therapists.

I think this would do away with a lot of schools causing the problems in the industry. States need to shut them down. They set the rules and schools must comply. If they can't pay a qualified teacher, they don't need to be a school. Set your skill levels and give them to the schools. They are the one's teaching. If they can't do it with the present system then shut them down.

If the states could agree to the hours, 50 per cent of the problems would be solved.

P.S. Since you wrote the paper; How dangerous is massage?

Comment by Keith Eric Grant on October 24, 2009 at 11:15am

Bert,

Another item from the Canadian side that is worth the look is the 2006 FOMTRAC report authored by Donelda Gowan-Moody and Amanda Baskwill. Donelda is one of my co-members on the Massage Therapy Foundation's Best Practice Committee. One can't consider any particular document to happen in a vacuum by itself. Part of the challenge is to integrate the views, knowledge, and methodology occurring in the larger international and health care contexts.

Comment by Keith Eric Grant on October 24, 2009 at 10:55am

Mike,

Even if the states could agree on hours as requirements, that still does not adequately define what we expect from graduates, does not define hazards of practice and ensure that protocols to minimize them are taught, and does not ensure that "advanced" students are ready for advanced learning. Also, when hours become the measure rather than the content within the hours, people start equating more hours to higher quality, which is not true without better specification/management of content.

The other side of the problem is that explicit entry standards need to be complete. They don't add to tacit requirements, they replace them. I'd explored this in a piece called Changing from Tacit to Explicit Requirements. As I point out in that piece, a school is fulfilling it's job if it is teaching to the explicit entry requirements. If that is not a sufficient set of criteria, i.e. if we expect something more, then we need to make what we expect part of the requirements.

If massage regulation is intended to prevent harm from incompetence, for example, we need to specify the tasks to be done, identify hazards within those tasks, create training and protocols to mitigate hazards, and monitor the results (i.e. reports of harm) to ensure that our actions are effective. This is basic industrial hazards control. I have yet to see it used in massage therapy regulation. There is, btw, an existing National Health Practitioners Data Bank covering disciplinary and insurance action relating to all health professions. Massage therapy has been included in it since 1999. I'd previously compiled (i.e. not current) the publicly available reports entered for massage therapy. They don't include the mechanism of injury within the public data, but that's what we need to get, examine, and mitigate to increase public protection. I haven't seen or heard of it being done.

Comment by Bert Davich on October 24, 2009 at 10:17am

I realize Keith probably already is aware of this but for those who do not know, I discovered only 3 Canadian provinces regulate Massage therapy; British Columbia, Ontario, and Newfoundland.

What is interesting is that the In the other (non-regulated) Canadian provinces, in each jurisdiction, the Professional Association for Massage Therapists have established standards of practice that are based on those in the three regulated provinces that require membership in one of the member associations that require 2200 hours of school and pass test to join. They advocate the exclusive use of member therapists.

Another Interesting point is the following:
"The professional standards among these jurisdictions is nearly although not completely consistent. Efforts continue between these three jurisdictions to ensure consistency in standards in particular to allow for portability of health professionals between the provinces"

The term "efforts continue" and BC's recent upping the minimum educational requirement to 3000 hours imply that portability isn't so seamless.

I think with the guidance of our learned colleagues we can do better.

Keith, I am referring to you in particular. I hope you will continue to participate and in an even larger way. You should be a part of the BOK committee. We really need your experience and expertise to help guide this undertaking in a way that serves the interest of Massage Therapist's and the Public primarily rather than inconsistent state by state regulation that may favor special interests first and will make portability difficult if not impossible.

Comment by Mike Hinkle on October 24, 2009 at 12:58am

So many maybes caused because states can't agree to whatever the average (mean) number of all their hours is.

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