Massage Therapy Body of Knowledge

Comment

Comment by Carl W. Brown on November 7, 2009 at 12:39pm

Shawn, “A basic program that is complete. Isn’t that the main goal? Figuring out what BASIC means to everyone... What is enough training to get you out there with basic qualification...” The draft has lots of KSAs that are not essential for all people practicing basic Swedish massage. I just posted a draft of what the minimal requirements might be to the strawman discussion. I am hoping that if we have a starting point we can then add or subtract from this to come up with a consensus of what it takes to do basic (non-therapeutic) massage. This would be a starting point from which people could do either relaxation work or therapeutic in its diverse forms. I think that too often schools spread the training thin and miss some of the essentials and produce ill-trained practitioners.

To meet a BOK standard one must have all of the skills because they are all interdependent to achieve the type of person that one is training.

Comment by Keith Eric Grant on November 7, 2009 at 11:34am

Mike, following enactment in Colorado in 1976, 36 states, including California, adopted sunrise/sunset laws. California has stuck with the system of legislative review of need more stringently than many of the other states. Thus negative impact of the attempt in the 1970's was indicative of the likely result since then. It was the growth of massage in the 1990's as well as the growth of corporate massage employers that essentially motivated the legislature to recommend limited regulation based on local regulation being variable and in some places inequitable. California is the state that passed Proposition 13 in 1978 (which limited local taxation and shifted funding of schools among other things from local funding to state funding), as a two-thirds requirement on passing a budget, term-limits to ensure legislative inexperience, and, via initiative, has left only a small portion of the state budget under legislative discretion. The nature and timing of massage regulation in California is as much a product of the system of CA governance itself as it is of any specific industry group or attitudes.

Hopefully, regulation can evolve to specifically address issues of oversight and minimum competence at the state regulatory level and allow industry (employer, referrer, facility use) standards and certifications to self-regulate beyond that. Given emerging tools in competency management and the self-reflections on competence I see in the medical profession, I do have substantial hope for the future. This is likely the area, I suspect, in which you and I shall have to politely disagree and likely work at cross purposes.

Comment by Carl W. Brown on November 7, 2009 at 10:48am

Shawn, you are right on. Massage license we introduced because law enforcement wanted to control prostitution and the AMTA told the public that massage was a dangerous profession without proper training. Both are lies, law enforcement has shown that licensing shields prostitution form search and massage is not a dangerous profession.

To intent behind these law is protectionism. Make it harder to be an MT and maybe we will get respect and keep too many people from entering the profession. Instead we should focus on coast effective education that produces quality practitioners.

Comment by Carl W. Brown on November 7, 2009 at 10:42am

Mike, “The reason is obvious in CA. Because they did not license, they have professions that carve off pieces of their scope of practice and have no state board to protect their profession.” It is obvious that Keith is right that you do not understand the situation in CA. Had we passed a practice act like other states they would have cut into our scope of practice. Because we passed a title act instead we don’t have these restrictions and we protect not only massage therapist but we also protect other forms of bodywork that other states like yours have hurt.

It is also interesting that by saying that if CA were to pass a law like in other state I should learn Swedish just to get licensed shows contempt for the educational requirements because if the only reason to go to school is to get the license the educational standards only are there to serve as barrier to entry. If the law mandates education that does not serve a useful propose then the law is bad.

I still do not understand that if this is the way you feel why have massage licensing at all? Why not just get a PT or chiropractic license? These licenses would see to fill the bill that you are looking for with massage licensing. What is different that massage needs a different license?

Right now I don’t understand your point of view. PT licenses seem to meet all the requirements you are looking for in massage. If you could explain to me why you feel that massage needs separate licensing then maybe I will understand you better.

Comment by Mike Hinkle on November 7, 2009 at 2:25am

Keith, you hit it on the button in your opening paragraph. Because CA didn't set explicit licensure laws (prior to the 1990's) "the issue is still open and left as a fight for another day.

And I would argue there has been no adjustment in terms of actual practice. Licensure would have blocked these other professions from these challenges. The entire framework appears to be quite an adjustment, in itself.

What format is in place to check that those who recieved conditional certification are meeting additional educational requirements? Is that CAMTC?

I get that schools were not reviewed due to DCA. But, I do feel a state board would have had more influence with the Governor and other commissions. Have schools been meeting any standards, even the minimums? Hard to know with no reviews going on. And yet CA wants other states to follow its lead?

I really do wish you the best and hope you don't face a challenge by a force you say is likely the most powerful political groups in California. It probably will force CA therapists to compromise (monetarily) further, to me it looks like that.

Comment by Keith Eric Grant on November 7, 2009 at 1:36am

Mike,

Rather than allow an explicit limitation on scope of practice, the scope of practice was left implicit by removing it from the bill. There was no adjustment in terms of actual practice and the issue is still open and left as a fight for another day.

"Going to Sacramento" has already happened with the January 2005 sunrise hearing. What the legislature and Governor were willing to pass in terms of regulation is what we have with CAMTC. CAMTC is the form of regulation specifically created by the regulatory bill written by the (then) chair of the Joint Legislative Committee on Boards, Commissions, and Consumer Protection. Even apart from the current budget crisis, as the "going to" document notes, the legislature has largely been unwilling to recommend licensing going back well longer than the last decade. Occupational regulation passes through sunrise review in the beginning, and sunset review periodically thereafter. CAMTC is a 501(c)(3) nonprofit specifically authorized by the state (and under state review) to regulate massage therapy via voluntary certification..

There is a grandfathering provision in the bill, but it still has minimums. In some cases, conditional certification will be done with additional education requirements over the next several years.

The postsecondary school issue was more general, affecting all private postsecondary schools in California. Even a licensing board would not have been given the authority to approve schools. The prior school regulation law was an admitted mess -- it was long and in places self-contradictory. The Governor wouldn't sign an extension, insisting that the legislature create a better law. The new law creates a new bureau under the Department of Consumer Affairs, replacing the former bureau which also resided with the DCA..

A legislative challenge to state regulation from the cities or the chiefs of police is never minimal. Those are likely the most powerful political groups in California. A change in the enabling law is a change in the law and they could as easily add a clause to a licensing law enabling additional local regulation of establishments as they could change the law authorizing CAMTC. Hopefully, it does not come down to that.

Comment by Mike Hinkle on November 7, 2009 at 12:59am

I do understand. Budget restraints won't allow CA to license, if CA wanted to. It was Noel, that sited PTs and Chiros trying to take portions of your scope of practice. It was also said, you had to change certain ROM stretches. This, to me, is carving on.

Licensure would have placed restrictions, to stop these other professions and you would have had a state massage board to protect you. With the number of therapists you have, you could have led the nation. And yes, it may not be as bad as in some states. To me having to give any scope is because licensure did not take place, before these other boards grew powerful enough to do this.

I do understand CA politics. Therapists are stuck, because their state government that can't afford a state massage board and is allowing an agency (CAMTC) to certify therapists. A lot of these therapists don't want any regulation and want to practice as they always have. You have AMTA members wanting to increase standards. You have ABMP saying everyone is to be grandfathered in and face no additional education requirements.You have to find a middle ground to keep the practice going and all parties from going at each other in court amd the concessions (agreements) keep happening. The present regulations of allowing some in the north with 75-100 hours to work. And 100 basic knowledge hours with 150 more in another basic modality such as Esalen or Swedish or other combination to reach 250. No school inspections from June 2007 till June 2010, all budgetary situations. These to me would have been different with licensure.

I do understand all these factors and there are probably a lot more than these listed. I understand, therapists holding Carl's idea, as correct, are why CA is at this point. Licensure would have taken care of most of the challenges CA faces and yet he continues to say licensure isn't needed, in CA but anywhere. Even the problems the therapists face from cities and the CA Association of Chiefs of Police would be minimal if they were trying to rebuke state licensure.

Because the effort failed, 20 years ago doesn't mean as much, as the fact now, the state is budget strapped. I feel, if left to CA, it never will be "time to go to Sacramento."

I admire the job, the stakeholders and CAMTC have taken to hold the practice together, so massage can be practiced in CA.

I hope it works for all those concerned, but without licensure, professions are open to any other profession. That is a trade-off for no licensure.

Comment by Keith Eric Grant on November 7, 2009 at 12:30am

As basic as possible would imply that a person is able to provide at least one massage service in a safe and effective manner that customers would buy and have satisfaction with. Once doing that, a person would have economic basis for success and also to extend their learning over time as their business needs and potential customers might indicate. It is a philosophy that has had notable success over an extended period of time in California.

Just to be clear, level of training (and "as basic as possible") is a separate issue from whether or not a regulatory agency is providing oversight against acts of malfeasance.

Comment by Keith Eric Grant on November 6, 2009 at 11:41pm

Blew that first link. Should be here.

Comment by Keith Eric Grant on November 6, 2009 at 11:38pm

Mike says

The reason is obvious in CA. Because they did not license, they have professions that carve off pieces of their scope of practice and have no state board to protect their profession. Now with the state budget crunch in CA, the odds are it will be a long while before, if ever, they do. The Chiros and the PTs have state boards.

Mike, I've already "">responded to the "carve off" consideration.

Again, you don't understand much about CA's politics. In the mid to late 1970's, there was an attempt at licensing. As I recall, Rob Flammia got some of the material held by the state archivist on this. The net result was that the legislature enacted a law giving common law cities the right to license massage. It's hard to judge the overall effect of that, since charter cities essentially have the authority to regulate local affairs under the state constitution unless specifically preempted by state law.

In the mid 1990's a coalition that included what is now billed as AMTA-CA, wrote a document advising against a licensing attempt -- Why This Is Not the Time to Go to Sacramento. The analysis in that document is not spurious. The private regulatory body created under state law, CAMTC, may yet face a legislative attempt by some cities (or the CA Association of Chiefs of Police) to gut its ability to exempt practitioners from local regulation. We are hoping that better understanding of the current law will avoid that, but city power to regulate in CA is jealously guarded and cities are an extremely powerful political force. In any case, one can't easily conclude that there was ever any better time to attempt state regulation than when it was done. The same state senator that essentially wrote the current regulatory bill was also reviewing applications by other professions in the late 1990's with no less critical scrutiny.

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