The ELAP Flap Continues

Earlier this week I received the ELAP (Entry-Level Analysis Project) Description from ABMP. I’ve been blogging about this for several weeks, first because I was upset that it was shrouded in secrecy; then last week because I finally got word of who is serving on this work group. While that information didn’t exactly smooth my ruffled feathers, I was gratified to see that I know some of the people working on it and know that they do the best job they can at whatever tasks they take on. And the document has changed quite a bit from the first proposal I saw, which I had numerous objections to (see previous blogs under this one). That being said, I’m still not thrilled with it.

I feel that there are some big pieces missing here, and that the profession would be better served by pointing resources in a different direction. To begin with, the document makes the point that how regulatory agencies arrived at the 500-hour minimum that has been a benchmark of entry-level education is unknown…that’s true, but it’s also unknown of how states with more hours arrived at those requirements. One thing that’s mentioned is the influence of federal financial aid, which presumably has led some schools  to offer more hours (or states to require them). As is the case with a lot of things, following the money trail often gives insight into real motivation.

Personally, I don’t think financial aid, or the lack of it, should be influencing this project at all. As a former school administrator, I’ve been involved in the financial aid process first-hand in the past. Whenever a recession and massive job layoffs happen, as they have here in my home state for the past three years or so, there’s a phenomenon that occurs. There’s an influx of displaced workers into the community college system, where financial aid is a given, and I’ve been told by students who had never even considered massage as a career that “the job counselor said I could get my schooling paid for if I would study massage.” That’s just not the reason I want to see people coming into the profession.

I feel there are some other tasks that need to be completed before anything like this is undertaken. The ELAP description states only two goals, one of which is to assess how many program hours are needed to attain this KSA (knowledge, skills, and abilities) goal, assuming capable instruction.

That’s a major issue, in my opinion—because you can’t and shouldn’t assume capable instruction. The Alliance for Massage Therapy Education is working on a National Teacher Education Standards Project to define the KSAs needed by teachers, both entry-level and more experienced/advanced. There is also a line-by-line review of the MTBOK going on. To charge headlong into the ELAP before these two initiatives are complete seems like putting the cart before the horse.  In all fairness, I am glad to see our organizations collaborating instead of refusing to play nice, but I would prefer to see them applying their resources to the National Teacher Education Standards project. The ELAP claims to be addressing what it takes to make a therapist able to practice competently. The fact is if the teachers aren’t competent in a 500-hour program, they’re not going to be any more competent in a 750-hour program until they are educated. We need educators who are competent enough to teach competencies, not just stand in front of a classroom for a longer number of hours.

Part of the rationale for this entire undertaking is the perceived  lack of competence of entry-level therapists. While the FSMTB is about to launch a new Job Task Analysis Survey, and the NCBTMB recently did the same, we ought to bear in mind what it is that a JTA shows. They tend to be snapshots of a day in the life of a massage therapist: see the clients, do the laundry, keep up the paperwork. If the perception is that therapists are not doing what they need to do in order to keep the public safe and practice competently, is asking them what they do all day really effective for this purpose? I don’t think it is. As one of the comments on last week’s blog said, “They don’t know what they don’t know.” There will be also be an accompanying survey within the JTA survey, intended to eliminate the “experience bias” present in these types of surveys, but I think that’s a tricky proposition. The return rate on these surveys tend to be very small–and usually answered by the minority of us who actually give a rip about the state of things. JTA surveys tend to be long and somewhat boring and it’s a very small percentage of people who will even fill them out to begin with.

Reportedly, the ELAP project was conceived to help address the problem of portability of massage between the states. One of the statements reads in part “we need to identify the key KSAs required to pass a national licensing exam and provide competent, safe massage in an early massage career.”

Right there is another problem. While the FSMTB would like to see every state exclusively using the MBLEx, it hasn’t yet happened. Since the NCBTMB is increasing the requirements for National Certification, leaving them with only the NESL options for entry-level exams in the states that accept those, the MBLEx will undoubtedly become exclusive in some places, but New York is not going to throw over their exam for the MBLEx, in my opinion. There is no such thing as national licensing, and there is never going to be. National licensing doesn’t exist in any profession I am aware of. If you’re a doctor, you still have to get licensed in each state in which you want to practice. While portability is a pain in the butt for massage therapists, it has never been shown to be harmful to the public or to the profession on the whole. Inconvenient, yes; but harmful, no.

The FSMTB is also working on the Model Practice Act, as mentioned in the ELAP description. While I wouldn’t go so far as to say it’s a waste of time, I don’t expect any influx of the regulated states lining up to change their existing practice acts to whatever the FSMTB comes up with. I’m sure it will be a helpful guideline for the unregulated states if and when they decide to join the fold, but it will be interesting to see how that document ends up harmonizing with the ELAP. Since the MBLEx has been an exam that uses the 500-hour threshold (and in fact, you can take that exam at any point during your education, prior to graduation), if this project somehow demonstrates that more hours are needed, is the FSMTB going to jack up the requirement to sit for the MBLEx? The Model Practice Act project was also undertaken prior to the ELAP project starting up, and while I haven’t seen a draft and don’t know what it includes, my prior knowledge of state practice acts demonstrates that those generally spell out required education and the breakdown of those hours, so presumably the ELAP would affect the Model Practice Act project as well.

Another part of the hoped-for result of this project is to cut down on the number of lawsuits and ethics complaints against entry-level massage therapists. Personally, I believe someone who is going to act unethically is going to do it regardless of how much education they have. When it comes right down to it, the injuries resulting from massage are a tiny fraction of what they are in other health-care related fields. I’m not saying there aren’t any, but on the whole it’s relatively insignificant when compared to the number of practitioners.

Lest anyone think I am against raising the standards of the profession on general principles, that’s not so. I don’t own a school, and I’m already licensed, so it’s not like this is going to inconvenience me personally. In fact, a few years ago when I was on the North Carolina Board of Massage & Bodywork Therapy, we looked at raising the hour requirement here (currently it’s 500 hours). Like any good organizational beaurocracy, the result of that was to appoint a committee to study the situation. The research they conducted was to ascertain whether or not students from schools with higher number of hours had a better pass rate on the exams than students from 500-hour schools. The answer to that was a big fat “no.”

I’m not sure how much money is being spent on this project; the first proposal I saw mentioned between $60-70,000 to be shared as an expense between the organizations. I urge, or rather, challenge, all of these organizations to pour an equal amount of money into the AFMTE Teacher Standards project. Improving the KSAs of entry-level educators—many of whom tend to be last year’s star students, who may be talented at massage but without a whit of experience and training in teaching methodology—will improve the KSAs of the students, the entry-level practitioners. That should be the important first step—the key word there being first. Don’t try to build a house without a good foundation. It’s a waste of time and money, and ultimately, it doesn’t work.

20 Replies to “The ELAP Flap Continues”

  1. Lots to comment on here, but I’ll just comment on this piece:
    [In fact, a few years ago when I was on the North Carolina Board of Massage & Bodywork Therapy, we looked at raising the hour requirement here (currently it’s 500 hours). Like any good organizational beaurocracy, the result of that was to appoint a committee to study the situation. The research they conducted was to ascertain whether or not students from schools with higher number of hours had a better pass rate on the exams than students from 500-hour schools. The answer to that was a big fat “no.”]

    I assume the exam was written for someone with a 500 hour education since that’s what the state requires. Questions cover that knowledge, not more advanced knowledge, so there should be no expectation that someone with a 750 hour education would do better on the exam than someone with a 500 hour education—assuming that the exam itself is valid.

  2. I thought it was strange that was the only thing they looked at, personally.

  3. I also posted a blog with comments on this project and find that I agreed with Laura’s points.

    Sandy Fritz

    sandycfritz.blogspot.com

    I have also been sharing regularly on facebook to keep the information in front of our attention. If this group is going to continue with the project then they should use indendent educational designers, an additional advisory board, conduct the project following valid research design using expert that know how to do that such as Kieth Grant or Ravensara Travillian and Martha Menard and Glen Hymel. The group needs to be very careful to not appear as if the project is self serving and financial aid should have no influence.

  4. Jan are you aware that the project is not considering any form of online learning only brick and morter. I am very concented about this.

  5. Bravo, Laura! It’s high time our major organizations put TEACHER EDUCATION as the Number One priority to address. Nothing else will make an appreciable difference until instructors in the massage therapy field are competent in the theory and methodology of teaching. This includes the domains of both entry-level programs and continuing education.

    The Alliance is the right organization to lead the Teacher Education Standards Project, but it cannot do it alone. It needs the financial and energetic support of the other stakeholder organizations to get the standards implemented. Without successful implementation, the forthcoming Core Competencies for Massage Therapy Teachers document will sit on a shelf, gathering dust.

    Looking at the regulatory aspect, you mentioned that state laws dealing with other professions “…generally spell out required education and the breakdown of those hours.” In the practice acts I’ve seen from the fields of medicine, nursing, chiropractic, physical therapy, acupuncture, etc., the standard clause that addresses educational requirements for licensure goes something like this:

    “The applicant has graduated from a school of _______________ (name of profession), accredited by the ___________________ (name of the accrediting agency for that profession).”

    In this common model, state licensing boards do NOT get into the business of specifying and approving the training curricula for a given profession; that is the province of the (usually single) accrediting agency that sets educational standards for entry into a particular profession. We are light years away from that model, given the fact that fewer than half of massage schools are accredited, and that we have seven different agencies that accredit massage programs.

    All this emphasis on “safety” in massage therapy practice is misguided. We are dealing with a non-invasive occupational field that produces an extremely small number of actual injuries in clients. Let’s focus on EFFECTIVENESS instead. The best opportunity we have to increase the quality of massage therapy services provided to the public is to improve the entry-level training that is provided. Better teaching, delivered in more coherent curricula, is the way forward.

  6. It’s not an either/or situation. Both teacher standards and entry-level competencies can and should be pursued simultaneously and by different groups of people.

    Entry-level competencies are the “what” – what, at a minimum, therapists are expected to know when they enter the profession. This discussion belongs to and affects multiple groups (employers, clients, educators, states, etc) You don’t know one group alone to dictate those competencies.

    Teaching standards are the “how” – how these competencies can be taught; lesson planning, understanding learning styles, using technology in the classroom, etc. This is specialized work. It belongs to educators. This work is strictly within the realm of AFMTE and should not even matter what the core competencies are for AFMTE to work on teaching standards.

    Take the building a house as an analogy: the people deciding on the “what” are the owners who work with architects, designers, builders, etc to come up with the blueprint. The “how” is left to the specialists, the builders, and others. You don’t want the builders telling the owner what house to build, although you want them to be contributors in the process. Similarly, you don’t want the owner telling builders how to build, they are the masters of their trade.

    Continuing with the house analogy, massage therapy is lacking in both the blueprint and no standards of how it should be build. There is no collective, agreed upon perspective on “what” massage therapy is, and there is no process for “how” teaching should be done.

    On the “what” part, there have been way too many unproductive conversations about what should be included in core competencies. The topics of asian modalities, energy based techniques, and even techniques such as craniosacral therapy and other modalities keep coming up as areas of dispute because they may or may not be evidence-based.

    If there is going to be a massage therapy profession it is time that we agree what massage therapy is, and it will take a group of entities to do that. Without knowing “what” we are building, we will never get there. That’s where the value of the ELAP project is. It is a collaborative effort that has the potential to provide the vision, the blueprint. Teaching standards work can be going on at the same time.

  7. Yeah ! Thank you Emmanuel for clearly distinguishing the apples from the oranges in this blog. As one of the ELAP committee members, I’ve been waiting for someone to express this clarity before I made any comments of my own for fear of being shouted down as biased. You’ve said this so well that I will only add a couple of points. And let me state up front that I am responding only as me – a passionate and opinionated massage therapist, educator, and author, and my comments/opinions do not represent those of the ELAP committee as a whole or any other individual in that group.

    First – I really do appreciate and understand the passionate questioning and concerns being expressed over this, and all projects concerning the profession of massage. It is heartening to know that we all care enough to work toward bettering the profession, and do so in many different ways. However, some of the concerns being expressed here are based on what I see as major misconceptions or misunderstanding of the project’s outline. For example, both Laura and Sandy have expressed concern over the idea that financial aid is influencing the committee’s decisions. That is a mis-interpretation – the statement re: FA was intended as an example of one of the random and non-education based rationales currently being used by some schools around the country to justify the # of hrs in their curriculum. They want to maximize the amount of financial aid a student can receive, so curriculum hours go up. So you’re right, that should not be a consideration in establishing standards of education, and that is not something the committee is considering in its evaluation process.

    I also get a sense that several of your concerns may be based on an underlying belief that the intention of ELAP is to increase the number of curriculum hours being required by massage schools and all state regulatory agents. (there are multiple references to whether students and teachers are better or more ethical if they have been kept in school for more hours). Not so – we are attempting to gather information about what “KSAs” a therapists from an program with “X” number of hrs. believes they were adequately trained in, and need in order to be competent as an entry level therapist. After evaluation of that information and comparison with all the other resources already established (like COMTA standards, NCB, etc) we will make our findings and interpretations available to the profession. What the profession does with that information is not in the ELAP committee hands, but in the hands of our elected leaders, the “stakeholder” groups, and passionate professionals like yourselves. I don’t think it worthwhile to jump to conclusions or project fear out to what these groups MIGHT do with this report.

    Laura, I agree that the the AFMTE National Teacher Standards Project is VERY important, and I would love it if more money was made available to support this project. However, the ELAP project is an equally essential but completely different project – as Emmanuel so clearly described – and while I respect that you believe the teacher standards are more important right now, I believe both avenues need to be pursued. Rick Rosen said it this way: “Better teaching delivered in more coherent curricula is the way forward.” Both are important and one cannot stand without the other.

    Respectfully submitted and looking forward to more face-to-face conversations,
    Pat

  8. Following the comments from Emmanuel and Pat:

    I agree that determining the KSA’s for entry-level massage therapy practice, and the KSA’s for teachers of massage therapy are separate, but inter-related processes. Both are needed in our field, and both are essential. It’s a matter of timing and focus.

    The question is more about whether the ELAP is the most appropriate first step for the group of seven organizations that are still in the early stages of learning how to work together to identify the key problems and challenges in the massage therapy field. Was the ELAP a must-do project at this juncture, or was there a rush to just “do something”?

    There are already significant efforts underway that are looking at various aspects of standards in our field: Along with the Alliance’s Teacher Education Standards Project, FSMTB has a Model Practice Act Task Force that is developing a set of guidelines that will shape massage regulation into the future. This will include both educational standards, as well as a common scope of practice definition.

    Last year, Phase 1 of the MTBOK Project produced a detailed set of KSA’s for entry-level practice. This body of work has recently been expanded by AFMTE, through a process of recalibrating the KSA’s according to what is most commonly taught in entry-level massage training programs, and by mapping each of the competencies into educational objectives (per Bloom’s Taxonomy of Learning).

    These efforts need time to bear fruit, and I am concerned that they are being circumvented by the insertion of yet another standard-setting project on the landscape. As our major stakeholder organizations are learning how to work together, there must be willingness to be patient, and to respect the viewpoints of each entity.

  9. My concern with the influence of financial aid is that it was mentioned in the ELAP press release–red flag for me. I did not even consider it until I read the informaton put forth by the ELAP committee. I have no problem with data collection and comparison. It would be excellent to have clarifying and collaborating information to combine with the MTBOK. This is an important point-It all has to be compared and this should be done using valid research design. I have no problem with the ELAP work group members I do however continue to point out that the work must proceed in an unbiased manner and be very aware of the appearance of self serving. I have been down this road many times over the years and know what happens. I believe that excluding online education is a HUGE mistake. I recall conversation about a project like this at about the same time the MTBOK was released and unfortunately discounted by many in the profession before there was even a chance to truely evaluate the document. AFMTE did a line by line evaluation and it is on the web site. How many of you have looked at it? The MTBOK was pretty close ya all– not perfect but close. The line by line is not perfect either but getting closer. I believe that valid date exists with these two documents to begin the next step which involves comparing this data to compentencies and COMTA has a great start on these. I suggest that this data be given to an independent group of educational designers who can develop a compentency based learning outcomes map with necessary detail for learning objectives upon which to build currriculium.

  10. My concern with the influence of financial aid is that it was mentioned in the ELAP press release–red flag for me. I did not even consider it until I read the informaton put forth by the ELAP committee. I have no problem with data collection and comparison. It would be excellent to have clarifying and collaborating information to combine with the MTBOK. This is an important point-It all has to be compared and this should be done using valid research design. I have no problem with the ELAP work group members I do however continue to point out that the work must proceed in an unbiased manner and be very aware of the appearance of self serving. I have been down this road many times over the years and know what happens. I believe that excluding online education is a HUGE mistake. I recall conversation about a project like this at about the same time the MTBOK was released and unfortunately discounted by many in the profession before there was even a chance to truely evaluate the document. AFMTE did a line by line evaluation and it is on the web site. How many of you have looked at it? The MTBOK was pretty close ya all– not perfect but close. The line by line is not perfect either but getting closer. I believe that valid date exists with these two documents to begin the next step which involves comparing this data to compentencies and COMTA has a great start on these. I suggest that this data be given to an independent group of educational designers who can develop a compentency based learning outcomes map with necessary detail for learning objectives upon which to build currriculium.

  11. I agree that teacher standards are all-important, which is why I volunteered to be on the committee in AFMTE working on core competencies. While the document we have finally finished is well-thought and clearly worded, it is still apparently of concern to some that it doesn’t have any teeth/regulatory power (nor should it, as that is not its purpose), and that as a guideline is still vulnerable to (as Laura put it) sitting on a shelf collecting dust.

    Rick’s statement about better teaching in more coherent curricula is on the money, and I am proud of our profession for pulling together to try to create both of these things. But as to whether or not a school can operate even if they don’t reach the agreed-upon standards (or whether a substandard teacher can teach) will still be up to state regulatory agencies, will it not? The fact that some states still don’t even have a regulatory agency is one of my current concerns.

    I may be getting ahead of (or outside of) the discussion, but is that fact likely to ever change? Just wondering, as I have no real experience with State government (other than attending our NCBMBT meetings).
    Sandy M

  12. Sandy,

    The National Teacher Education Standards Project (TESP) has five progressive phases. The Alliance is still in Phase 1 now, which is development of the Core Competencies for Massage Therapy Teachers. Once that document is finalized, Phases 2 and 3 of the process will deal with creation of a model teacher training curriculum and guidelines for how teacher trainers will be developed in the future.

    Phase 4 would involve the establishment of a voluntary teacher certification examination program, and Phase 5 will be the place where the Alliance works with accrediting agencies and state regulatory boards to get teacher education standards incorporated. That last stage of the process does not have to wait until the other four are completed. In fact, I attended the FSMTB Annual Meeting last October in my role as Alliance Executive Director to begin active dialogue with state board representatives about the TESP. (By the way, I no longer hold any official role with the Alliance.)

    The process will have to involve EACH accrediting agency that deals with massage therapy programs, as well as EACH state board that regulates massage schools. As you might imagine, this will be a long-term effort.

    The Core Competencies for Massage Therapy Teachers being developed by the Alliance are not a reflection of the current state of knowledge and skills found in our teaching community. Rather, it is a prescriptive document, designed to shine a light on the way forward to greater instructional quality at both entry-level and continuing education.

  13. Yes Rick this is an excellent description of the theNational Teacher Education Standards Project (TESP). My links above are relative to the ELAP and what the Alliance has done with the MTBOK. My concern is that the work group for the ELAP is completely aware of how much work has been done in the understanding of what are aspects of Entry Level Massage education. I actually think that the MTBOK captured the KSA’s and most are identified in most school curriculiums reflect these KSAs. Most of the textbooks used cover this content. The problem is the delivery not the content. This is why the teacher standards are so important.

  14. This broad ranging dialogue seems both about process and prioritization. I offer comments about each. While I am an officer of ABMP and one of 13 individuals participating in the group of national massage organization leaders, my observations and comments below in response to this discussion thread are personal rather than presented on behalf of either of these entities.

    First, consider process. The leader group is convening and conversing in a respectful, professional manner on substantive matters important to improving the provision of massage therapy in the United States. One measure of progress is that leaders of these organizations appear to be feeling safe to explore new directions and to re-consider established positions. I consider that a healthy development. While some may be frustrated that the leader group is meeting in private, the reality is that a public meeting format would inhibit candor and the testing of new ideas. In a public forum, leaders might well feel pressured simply to enunciate their respective organization’s existing policy positions.

    Another indicator of health is that, even though the seven national organizations have diverse roles and interests, the conversations have been clearly focused on what can be done to improve the quality of massage experiences for all consumers, not on seeking advantage for one’s own organization.

    These attitudes are light years advanced from the character of conversations and the atmosphere in the room during a previous 2003-2004 effort to bring together leaders of national massage organizations. Current relationships reflect higher levels of trust and mutual respect. The conversations also benefit from several new players around the table.

    Shifting to priorities for profession focus, I confess some degree of personal puzzlement about the view expressed by several folks in this conversation thread that the massage profession ought to tackle challenges in some particular order. While true that one would be ill-advised to put on a roof before all the beams and rafters are securely in place, my personal view is that our profession has multiple needs that can usefully be addressed right now – in parallel rather than sequential fashion. Emmanuel Bistas and Pat Archer beautifully articulated this perspective; I can’t improve upon their words.

    In particular I support parallel progress on rigorous thinking about “what” should be the common content of core curriculum (the aim of the ELAP) and the development of tools and strategies to improve the quality of massage instruction. Yes, let’s shape standards for teachers, but I see that as a necessary, but not sufficient, condition. Even while one group is examining what core curriculum should look like and another is describing what abilities teachers should possess, we also might wisely devote time strategizing about how to create organizations whose mission would be to train highly qualified massage therapy instructors or to persuade existing institutions to add such a mission. Along with curriculum and instructor qualification aim points, we need to conceive and construct a massage therapy specific instructor training pipeline.

    AFMTE representatives have already suggested that the leader group consider at its next meeting “agreement in principle that qualified instructors are one of the keys to consistent massage education.” My voiced reaction was that I suspect such agreement could be quickly reached and that the group might want to take an additional step by making “improving instructor qualifications” a priority discussion topic at our next in-person meeting. Such a discussion might usefully embrace both massage specific considerations and best practices in other health professions. Leader conversation discussion topic choices are reached by consensus, but at least a few votes seem in place to advance such a priority.
    Bob

  15. Wow, a lot in this thread. As a new MT, of almost two years, I’d like to give my two cents worth. I went back to school later in life after I raised my children. This profession has much that needs fixed! And yes, everyone in my class except one was on financial aid. There were some good teachers but some really bad ones. When I got out of school I needed to unlearn many things including some what I might call old wives tales that with an internet search I found out was wrong. Scientific research was highly lacking. My pathology teacher was more interested in talking about his drug parties than teaching.
    I have nothing against Chinese stuff, but I have no interest in it, definately not my cup of tea. But, still have to take too much of it.
    Curriculum was, well the school made up their own. It definately was not the greatest. We did have a good cadaver anatomy lab which was so helpful.
    But then someone who is going into the spa industry and someone like me who is getting into medical massage needs two differing curriculums.
    But us out here in the trenches would like any regulations and laws to be an inprovement over what we have now. I am afraid though that most if not all would just be a pain in the butt and make our jobs harder and cost more money. I have no confidence that it will be better. Please make it better not worse.
    As far as online continuing education, it is the greatest. I’m one of the lucky ones, I don’t have to live off my income. I spend a lot of my money educating myself because I have the money to. Most aren’t that lucky. Online, DVD’s and books/home curriculum for furthur education is precious. We desperately need affordable education beyond school. We need so much more education and we don’t need to be rocket scientists, we just need the info and we can continue our education all on our own.

  16. Am I missing something? I am new to following all of this. If these two projects are to go on – shouldn’t they be working together or in collaboration? The teachers need to be able to teach the entry level requirements and the requirements need to be taught by qualified teachers?

  17. I want to say thank you for the discussion. There is a lot to take in and it is very thought provoking.

    As a new massage school owner I am glad I stumbled upon this and look forward to reading more.

    I agree that teacher training is a must. I started teaching right away had a bumpy road when I first started teaching and grateful I made it through and became the teacher I am today, but would’ve appreciated more guidance through that process.

    I am finding it hard to see the clarity on why the projects can’t be done simultaneously. They serve each other and to me as long as we, as professionals, students, and schools are allowed to follow and comment on the process it would be a win/win for the industry.

    Thank for opening up the discussion and I hope it continues to keep going and growing!

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