Massage Therapy Body of Knowledge

Comment

Comment by Mike Hinkle on October 23, 2009 at 8:02pm

I know all about CA's massage exports as Esalen massage, Trager Work, Heller Work, and Deane Juhan's "Job's Body" I have put all of them into the Massage Therapy Hall of Fame.

I still would not look to CA for guidance in licensure. You, yourself give the reason: but such immunity cannot be delegated to an agency not part of the state itself. It would be illegal.

I understand your pride in your state, but it is not the way I see the nation going. Please do not take it personally.

Comment by Keith Eric Grant on October 23, 2009 at 7:47pm

Mike,

One reason I so strongly advocate for being evidence-based practice and for basing training on outcomes is that I believe in measurable standards of competence rather than hours of unspecific training. Ralph Stephens, in one of his columns also complained that students, graduated from relatively long-hour programs and carrying NCBTMB certification were not prepared for his classes. The problem is that the outcomes of training are relatively undefined. You get what you require. It does little good to raise hour requirements if you aren't using the hours you have to teach effectively to outcomes, which is difficult if the needed outcomes haven't been specified. As Yogi Berra has said, “You've got to be very careful if you don't know where you're going, because you might not get there." Similarly, if you don't know what they need to learn, you might not teach it. Additionally you might waste a lot of time teaching something that, at this point, they don't need.

The California certification law, like most U.S. laws is ill-defined in terms of competency management. That is among the reasons I truly would like to see a BOK based on concepts of competency management in the assurance of public safety and benefit.

A title act without specific requirements is known as registration. A title act in which the person must meet certain criteria is called certification. An act that restricts practice to those meeting certain criteria is called licensing. The terminology is from the Council on Licensure, Enforcement, and Regulation (CLEAR) and is standard to those working on issues of regulation. Legislatures play fast and loose with terminology. Licensing is an undelegatable power of the state. A state can authorize creation of a special private organization to handle voluntary certification, however, as has been done in California with CAMTC.One of the issues here is anti-trust. State actions have immunity from anti-trust, but such immunity cannot be delegated to an agency not part of the state itself. A state can do any of registering, certifying, or licensing, but can only delegate the first two (assuming they are voluntary).

Using the CLEAR terminology, neither British Columbia nor Ontario license. They regulate under title acts and would be considered to be certifications. The terminology they use, however, is RMT (r = registered). While BC and Ontario don't license, there is still much that can be learned from how they have set up their health care systems and what they stipulate in competency profiles.

Any private organization can set up it's own voluntary certification, independent of state law. This is essentially how board certification is handled in the medical profession. The state licenses basic medical competence. Board certifications are handled post-licensing by the member boards of the American Boards of Medical Specialties. At least in CA, the only nod that the state gives to such certification is to declare that it is an unfair business practice to claim to be "board certified" unless one has been certified by an ABMS member board (i.e. the state gave them title protection).

Teaching for competency management is a concept independent of licensing or certification. Applying such concepts to manage competency for public safety and benefit is an issue in licensing and/or state-directed certification. Calif's. CAMTC is a private agency, but it is still a beast of the state and under periodic sunset review by the legislature.

You have just been provided with information from a state that doesn't license. Esalen massage. Trager Work. Heller Work. Deane Juhan's "Job's Body". California exports.

Comment by Mike Hinkle on October 23, 2009 at 6:57pm

If our intent is to increase standards (which you have been using for days in this discussion by using Canada as the mode) 100 hours to be able to do massage doesn't hold up. I have heard the call for more education for students for years. Teachers have been complaining to mme at Festivals that therapists are not prepared for their classes. CA, to me. has appeased everyone and it is so confusing it shouldn't even be addressed. For one reason. They don't even license and yet states that do, should look for the answer there. I don't think things are headed towards certification instead of licensure.

Most in the field have told me and I agree that certification is done by private entities that qualify therapists to reach a level that they can legally advertise that they are accomplished to a level at that paticular modality.

I am not being dismissive, I am being frugal with my time. I don't see it wise to ask a state, that doesn't license, for advice on how to license. Sorry if you see it that way. Congratulations, being on the board of directors! Good luck!

Comment by Noel Norwick on October 23, 2009 at 6:47pm

Keith: I'm delighted to learn that you may soon be on the CAMTC board as the IMSAC representative.

Comment by Keith Eric Grant on October 23, 2009 at 5:50pm

California currently (and newly) has a two-tier system (250 and 500). There's more discussion of that, including my own clarifications and comments. It appears that I may soon be the representative from IMSAC on the board of directors for the certification agency created under state law.

What is done under law to protect the public and serve the public benefit and was is done in terms of quality outcomes and educational innovation are two separate issues. Being dismissive doesn't buy you much in my book.

Comment by Carl W. Brown on October 23, 2009 at 5:04pm

Keith, I don’t believe that a doctor going to a spa for a feel good massage is looking for a medical professional. They are looking for someone good at what they do and that includes the kinesthetic aspects of the work. In some ways it is like entering an art gallery. One does not expect an artist to be expert in anatomy to paint people. However, there are artists who do study anatomy.

I believe that there are people who want to compete in the medical world and for thouse I don’t believe that a list of skills that matches what was not independently developed and justified based on actual performance is enough. I also believe that this is a very different set of standards than entry level massage. To gain respect I believe that we are talking about a set of standards for experienced professionals. I also think that because of the audience you have to stick with scientific evidence. If you mix in energy work you lose credibility with thouse who do not believe.

I see no problem with multiple standards.

I don’t compete with the medical profession, instead I give relief to thouse for whom medicine cannot help. I refer my clients to other for medical help as well as good relaxing sessions.

Comment by Mike Hinkle on October 23, 2009 at 5:03pm

We are headed towards KSA's so you can let the hours vs KSA argument go. That said CA still recognizes hours.(?) Next, states will not give up revenue collected from licensing. A National license therefore will not happen.

Two and a half weeks and you are a therapists? No, I won't be looking to CA for any guidance.

Every part of state healthcare systems are licensed. Once licensed, revenue, schooling and all the rest follows. This will not go away based on "possible harm information." It is the same with taxes. Once implemented they increase the amounts, not the opposite.

The education in schools will be increased as you increase KSA's or hours. The tier method being proposed and propagated will basically create ranks (levels). This will create a lot of hardship and separate the industry even more. Now everyone won't be just a massage therapist.

"I am a ( ex. Master Sargent) "A" level therapist and she is only a (private) "D" level therapist. I see problems that aren't necessary if you set a standard and let people improve to their capabilities. Usually, what follows this is time standards to aquire a level or lose your license. I see a mess, but I am not going to fight against these KSA's that seem to be the way we are headed.

Comment by Carl W. Brown on October 23, 2009 at 4:38pm

Mike, the reason the licensing failed in CA is that the majority of the people here did not believe that the “national standard” reflected the minimum requirements needed to enter the profession. I think that speaking of 250, 300, 500 750, 1000, 3000 or 3300 hours does not make sense to me. Instead we need to justify that specific KSAs are needed and establish for each one the problems of practicing if the person fails to meet them. I think this would also remove the factor of individual state credentialing that poses a real problem for national recognition. If the person can prove that they meet the standard regardless of how they learned it and you can correlate to testing to actual performance then I think you have a winner.

We live in a world here in CA where most people start with just 100 hours and cannot understand why the Canadians need 3300 hours to learn the same basics. If your goal is to be able to practice anywhere in the 50 states then it would be best to be able to explain how you independently arrived at the standards.

I feel that the problem is that the people who set up the original standards felt that they were inadequate and needed padding. This is just a feeling but I was hoping that someone in charge could actually provide supportable documentation to justify the standards. I was hoping that this committee who has access to the association who can request that the insurance companies provide them with the same data that they use to underwrite our insurance and use that information to develop a real work model of the potential harm that untrained therapists pose. Then we would have a legally defensible set of standards.

Comment by Keith Eric Grant on October 23, 2009 at 4:16pm

Carl,

I tend to be quite tolerant of what people want to practice (even if it has elements of Larry Niven's concept of mana), as long as things are not implied to be based on an evaluation of "knowledge" -- i.e. having a basis in research and physiology. I have no problem with something characterized as a survey of what's being taught. In fact, that is a quite useful step in the process of then evaluating what we have as objective knowledge. A catalog says nothing about whether something should be taught or whether there's anything objective we can say about necessary skills and specific outcomes.

Now, I also don't think such a beastie will buy much in health care credibility -- it doesn't match the conceptual outline I posted previously, gained partly from what health care is looking at and reflecting on for its own internal consistency and credibility. But, I look at the issue of creating a catalog and a BOK aimed at health system credibility as separable issues. I just want it clear that one isn't the other.

Comment by Mike Hinkle on October 23, 2009 at 4:13pm

States are already cooperating together to do what you outlined, Carl and so much more. Reciprocity across the board though is basically DOA. However, portability is a working option.

• ‹ Previous
• 1
• …
• 26
• 27
• 28
• 29
• 30
• …
• 51
• Next ›
• Page